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LHSC expands COVID-19 assessment centre to treat cold and flu

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In an effort to ease pressures on local emergency departments, London Health Sciences Centre (LHSC) is expanding service at its Victoria Hospital COVID-19 Assessment Centre to also treat colds and influenza.

Done in collaboration with the Middlesex London Ontario Heath Team, the move is effective immediately and the centre is now called the COVID, Cold and Flu Care Clinic (CCFCC).

Along with treating symptoms related to those illnesses, such as fever, chills, muscle aches, headaches, nasal congestion and sore throat, the CCFCC will also provide assessments, testing and medical guidance.

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The clinic only serves adults at this time, but LHSC says it plans to expand service to children “in the near future.”

As of 1:45 p.m. Friday, the wait time for non-emergent and non-urgent concerns sat at 2.25 hours for University Hospital’s emergency department and 9.25 hours for Victoria Hospital’s emergency department, according to LHSC’s wait time webpage.

Children’s Hospital is also under immense pressure amid the ongoing respiratory illness season that’s been largely driven by COVID-19, influenza and respiratory syncytial virus (RSV).

Dr. Rod Lim, medical director of the pediatric emergency department at Children’s Hospital, says the hospital is “seeing 150 per cent above historic volumes” when it comes to visits to the emergency department.

“I wish I could say that we are starting to see some alleviation of pressures that we’ve been seeing since September, but unfortunately that’s not the case. There are many, many sick children that are being taken care of,” Lim said.

“Our main virus that we’re seeing right now is influenza, that seems to be the predominant virus, which is a shift from the RSV that we were seeing about a month ago. We are still seeing all three viruses of course.”

Lim says that observation is especially important as children tend to transmit influenza to the general community “usually about three weeks later,” meaning the local adult population could experience a spike in the virus right around Christmas time.

“It takes about two weeks for (influenza) vaccination to work, so if people are wanting to know what they can do to protect themselves and their loved ones, it would really be to take advantage of that now,” Lim added.

As for the CCFCC, Lim says he’s unsure if it will create a sizable, direct and immediate impact on Children’s Hospital’s emergency department “just because of the hours of operation and the number of patients that we’re talking about,” but he’s still grateful for the move.

“What it does represent is a mirroring of the huge amount of effort that’s going on in the community, in peripheral hospitals, in typical adult spaces that have adopted and adapted to help with this pediatric health-care crisis,” Lim added.

“Everyone’s trying to pull together to do the best they can under very difficult circumstances.”

The CCFCC is located in Building 24 at Victoria Hospital and it operates seven days a week from 9:20 a.m. to 6:30 p.m.

Appointments must be made in advance to access the adult-only clinic and they can be made through the clinic’s online booking portal or by calling 519-685-8500 ext. 75503.

LHSC says you should consider making an appointment if you lack a primary care provider, if symptoms are worsening and not improving, if you’ve been advised by a health professional and if you are at high risk of severe illness from COVID-19 and qualify for testing and treatment.

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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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