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Study finds connection between cardiac blood test before surgery and adverse outcomes – EurekAlert

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IMAGE: PJ Devereaux is a professor of medicine at McMaster University and a cardiologist of Hamilton Health Sciences.
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Credit: Hamilton Health Sceinces

HAMILTON, ON (December 23, 2019) – A common cardiac blood test done before surgery can predict who will experience adverse outcomes after most types of surgery, says an international study led by Hamilton researchers.

Globally, of the 200 million adults who undergo major surgery, 18 percent will experience serious cardiac and vascular complications including death within 30 days following their intervention, such as hip and knee replacements, bowel resections and abdominal aortic aneurysm repair.

“Any type of surgery has the potential to cause damage to heart tissue, through blood clot formation, long periods of inflammation, or bleeding,” said study lead, Dr. PJ Deveraux, professor of medicine, cardiologist at Hamilton Health Sciences (HHS) and scientific lead for perioperative research at McMaster University and HHS’ Population Health Research Institute (PHRI).

The VISION study looked at whether levels of a cardiac blood test, NT-proBNP, measured before surgery can predict cardiac and vascular complications. Higher levels of NT-proBNP, which can be caused by various anomalies in the cardiac muscle, such as stress, inflammation or overstretch, can help identify which patients are at greatest risk of cardiac complications after surgery.

The study included 10,402 patients aged 45 years or older having non-cardiac surgery with overnight stay from 16 hospitals in nine countries.

“As a result of these findings, doctors can predict who is at greater risk of heart attacks and other negative vascular events after surgery,” said Dr. Devereaux.

This phase of the VISION study builds upon six years of research studies to understand pre- and post-operative factors that lead to cardiac complications.

“This simple blood test can be done quickly and easily as part of patient’s pre-operative evaluation and can help patients better understand their risk of post-operative complications and make informed decisions about their surgery,” said first author of the publication, Dr. Emmanuelle Duceppe, internist and researcher at the Centre Hospitalier de l’Universite de Montreal (CHUM), PhD candidate in clinical epidemiology at McMaster University, and associate researcher at PHRI. “This blood test is twenty times cheaper than more time-consuming tests such as cardiac stress tests and diagnostic imaging.”

Results of this simple blood test may inform the type of surgery the patient will undergo, such as laparoscopic or open surgery, the type of anesthesia used during surgery and who will require more intense monitoring post-operatively.

Blood test results can also reduce the need for pre-surgical medical consultations for patients that show no risk for cardiac complications.

“Heart injury after non-cardiac surgery is emerging as an important health issue requiring attention. Using CIHR funding, the research group led by PHRI and Dr. Devereaux, has clarified the association between an elevation of a common biomarker and the risk of per-operative morbidity and mortality,” said Dr. Brian H. Rowe, Scientific Director, Institute of Circulatory and Respiratory Health, Canadian Institutes for Health Research.

Study data was published today in Annals of Internal Medicine.

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Photo caption: PJ Devereaux is a professor of medicine at McMaster University and a cardiologist of Hamilton Health Sciences. Photo courtesy of Hamilton Health Sciences.

For more information or to arrange an interview with Dr. Devereaux, please contact:

Veronica McGuire

Media Relations

McMaster University

vmcguir@mcmaster.ca

905-525-9140, ext. 22169

Roxanne Torbiak

Public Relations

Hamilton Health Sciences

torbiakr@HHSC.CA

289-795-8604

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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438 new COVID-19 cases and 2 more deaths in B.C. – Voiceonline.com

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DR. Bonnie Henry, Provincial Health Officer, and Adrian Dix, Minister of Health, on Tuesday announced 438 new cases, including nine epi-linked cases, of COVID-19, for a total of 81,367 cases in British Columbia.

There are 4,679 active cases of COVID-19 in the province, with 8,445 people under active public health monitoring as a result of identified exposure to known cases. A further 75,255 people who tested positive have recovered.

There have been two new COVID-19 related deaths, for a total of 1,365 deaths in the province.

To date, 283,182 doses of COVID-19 vaccine have been administered in B.C., 86,537 of which are second doses. Immunization data is available on the COVID-19 dashboard at: www.bccdc.ca.

Of the active cases, 243 individuals are currently hospitalized with COVID-19, 63 of whom are in intensive care. The remaining people are recovering at home in self-isolation.

There have been 137 new cases of COVID-19 in the Vancouver Coastal Health region, 249 new cases in the Fraser Health region, 19 in the Island Health region, 16 in the Interior Health region, 17 in the Northern Health region and no new cases of people who reside outside of Canada.

There have been 22 new confirmed COVID-19 cases that are variants of concern in the province, for a total of 182 cases. Of the total cases, eight cases are active and the remaining people have recovered. This includes 159 cases of the B.1.1.7 (UK) variant and 23 cases of the B.1.351 (South Africa) variant.

There have been two new health-care facility outbreaks at Chartwell Carrington House (Fraser Health) and at Eagle Ridge Hospital.

Henry and Dix added: “The COVID-19 pandemic has required us to continually review and adapt our approach based on the scientific evidence and real-world data.

“The experience in our communities has clearly shown us that the older you are, the higher your risk.

“More recently, we have also learned that the approved vaccines are highly effective at providing protection with the initial dose. This means we can safely adjust the time between doses.

“Setting second doses at 16 weeks allows us to use our available supply to protect far more people, far sooner.

“The addition of the newly approved AstraZeneca-Serum Institute of India viral vector vaccine also means we can look at accelerating availability of vaccine for essential workers, including for first responders and those who are unable to work from home.

“While this is encouraging news for everyone, we are not yet at that important level of protection that we need to be at to put aside the public health restrictions. We have to have the confidence that we are slowing the spread in a sustained way, which means we need to continue to stay committed to using our layers of protection, to stay small and stay local right now.”

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What we know about spacing out COVID-19 vaccine doses – CBC.ca

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Federal and provincial health officials are poring over emerging data on the advantages and disadvantages of extending the time between shots of two-dose COVID-19 vaccines. Here are some of the factors they’re weighing and why it matters.

Why do provinces want to space out the doses beyond official recommendations?

More vaccines are arriving and the provinces aim to get them into the arms of willing Canadians as quickly as possible.

But demand exceeds supply, so researchers in British Columbia and Quebec are studying what happens when the interval between doses is extended. That way they can use the supply to vaccinate more people with a first shot sooner.

Late last year, Quebec decided to vaccinate more quickly and more widely by allowing a 90-day delay between doses.

But British Columbia went further on Monday, moving to a four-month interval for doses of the mRNA vaccines from Pfizer-BioNTech and Moderna.

Dr. Howard Njoo, Canada’s deputy chief public health officer, pointed to advances since Health Canada approved those vaccines.

A health-care worker prepares to administer a dose of the AstraZeneca-Oxford vaccine, in Santiago, Dominican Republic, in February. (Ricardo Rojas/Reuters)

“What’s happening is, I think, very encouraging,” Njoo said in a briefing on Tuesday.

“We have real-world data, the actual experience of what’s happening with the vaccination, for example in British Columbia and in Quebec, as they’re vaccinating seniors in long-term care facilities. We’re seeing quite a high level of protection.”

Njoo said experts are balancing vaccinating a large number of Canadians to achieve a good level of protection without compromising the effectiveness of the vaccines.

Dr. Sumon Chakrabarti, an infectious diseases physician in Mississauga, Ont., says the top priority is to protect older individuals and those who are at highest risk of severe consequences, hospitalizations and death.

Chakrabarti said the principle of getting as many people covered with one dose is a good one.

“We do know from other vaccines that increase in the interval between two shots doesn’t have any major consequence in decreasing efficacy and in some situations might actually make it better,” he said. “But keeping that in mind, we do have to be careful. I think that we don’t want to stray too far away.”

What’s the basis for the recommended dosing schedule?

Vaccine-makers tested their shots in clinical trials with certain times between doses.

Pfizer-BioNTech’s vaccine is meant to be given as two doses, 21 days apart, while Moderna recommends 28 days. For AstraZeneca-Oxford’s, the interval is eight to 12 weeks.

Health Canada approved the vaccines based on that clinical trial data. Both Pfizer and Moderna acknowledge that, in a pandemic, health authorities will make their own recommendations.

What’s the scientific basis for delaying?

Chakrabarti says there’s evidence, for example, to support delaying the second dose of the Hepatitis A vaccine by six to 36 months, and that’s true for other vaccines, too. But the COVID-19 vaccines haven’t existed long enough to know.

Efficacy for Pfizer-BioNTech’s vaccine was around 95 per cent after both doses and 52 per cent after the first, according to clinical data. For Moderna’s it was about 80 per cent after one dose and 94 per cent following the second.

WATCH | Stop confusing vaccine messaging, expert says:

Open communication about evolving decisions around COVID-19 vaccinations is very important to keep public trust, says Dr. Isaac Bogoch, a member of Ontario’s COVID-19 task force. 8:14

The benefits of a second dose include include longer-lasting protection says Tania Watts, a professor of immunology at the University of Toronto who is studying immune responses to COVID-19 vaccines in Canadians. 

She says everyone should eventually get a second dose. But “as we go to the broader population, yes, I think we will still get the benefit if you delay the second dose,” Watts said. 

Watts noted that when the mRNA vaccines were developed, the four-week interval for the “prime-boost effect” in the clinical trials was done for practical purposes.

“All things being perfect, we could stick to the protocol,” from the clinical trials, Watt said. “But, if you can save a lot more lives by not giving everyone the second dose at three weeks, but giving a lot more people the first, I think this is where the rationale comes, and I think it makes complete sense.”

What’s unknown?

The variants of concern that are more transmissible than the original coronavirus could throw a wrench into the works for some combinations of vaccines.

Watts said neutralizing antibodies that block the coronavirus from attaching and infecting cells dropped to almost nil in lab tests of those who received the Pfizer-BioNTech shot against the B1.352 variant that first appeared in South Africa.

“After two doses, which gives you stronger antibodies, you still had some partial protection,” she said.

Watts says Canada is at a critical juncture, watching to see if the variants will take off among partially vaccinated people.

Epidemiological or population-level studies are also needed to figure out how many antibodies are needed to prevent infection as well as the details of immune system memory.

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B.C. records two more COVID-19 deaths, as vaccination roll-out stays slow – Richmond News

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Two more British Columbians lost their lives while suffering from COVID-19, pushing the province’s death toll from the virus to 1,365, provincial health officer Bonnie Henry said March 2. 

That comparatively low number of new deaths is good news given that the province’s vaccination effort continues to crawl along. 

Despite Henry saying today that she believes it is possible for all eligible British Columbians to be vaccinated by the end of July, only 7,501 vaccine doses were provided in the past day. Those doses went to 4,746 people as a first dose, and 2,755 people as a second dose.

In total, B.C. has administered 283,182 doses of vaccine to 196,650 individuals, with 86,532 people being fully vaccinated with their needed second doses. Given that children are not eligible for vaccines, the province, which has around 5.1 million people, likely has more than four million additional people that it needs to vaccinate.

Mahesh Nagarajan, a professor at the University of British Columbia’s Sauder School of Business, whose focus area is supply chains, told Glacier Media that he can foresee potential glitches in the province’s roll-out of the vaccines.

New cases continue to rack up, with 438 new COVID-19 infections identified in the past 24 hours. Henry said that 254 cases were detected in the past seven days but not previously reported, so the total number of infected people in B.C. since the first case was detected in January 2020, is 81,367.

The province considers more than 92.4%, or 75,255 people out of those infected to be recovered, because those individuals have tested negative twice for the virus. 

Another 22 cases of what are known as “variants of concern,” bring the total of variant cases identified in B.C. to 182.

Many of these cases were confirmed as variants long after they were first confirmed as COVID-19 cases. That is why the active cases of variants of concern fell to eight today, from 10 yesterday, despite 22 new cases identified.

Of the variant cases, 159 have been the B.1.1.7 virus first identified in the U.K., while 23 have been cases of the B.1.351 variant first identified in South Africa. All but the eight active variant cases are people who are considered to have recovered, so no one has died from a COVID-19 variant yet in B.C. Nine of the 182 people infected with variants in B.C. were in hospital at some point. Only one person with a variant virus is currently in hospital, Henry said. 

More than 68% of the variant cases have been discovered in the Fraser Health region, while more than 27% have been detected in the Vancouver Coastal Health region.

People currently battling serious COVID-19 infections include 243 individuals in hospitals, with 63 of those who are in intensive care units. The vast majority of the 4,679 people actively battling COVID-19 illnesses have been told to self-isolate.

Health officials are monitoring 8,445 people for symptoms because those individuals have had known exposure to identified cases – the highest number since January 8.

Here is the breakdown of where the 438 new cases are located:
• 137 in Vancouver Coastal Health (31.2%);
• 249 in Fraser Health (56.8%);
• 19 in Island Health (4.3%);
• 16 in Interior Health (3.7%); and
• 17 in Northern Health (3.9%).

Because the vast majority of residents in seniors’ care homes have had at least one vaccine dose, Henry said that she expects that rules around visits for residents in those homes could soon be loosened.

“We expect the next step, before the end of this month, to be able to increase visits, and have families be together with their loved ones is care homes,” she said. 

One new outbreak at a seniors’ home is at the Chartwell Carrington House retirement residence in Mission.

That brings the total number of outbreaks in those homes to nine, even though Henry said at the press conference that the total was eight.  

None of those current outbreaks at seniors’ homes are in the Vancouver Coastal Health region. 

The five active outbreaks at seniors’ living facilities in Fraser Health are:
• CareLife Fleetwood in Surrey;
• Chartwell Carrington House in Mission;
• Revera Sunwood in Maple Ridge;
• Royal City Manor in New Westminster; and
• Shaughnessy Care Centre in Port Coquitlam.

The outbreak at Glacier View Lodge in Courtenay is the only outbreak in the Island Health region.

The only outbreak in the Northern Health region is at the Acropolis Manor in Prince Rupert.

The two active outbreaks at seniors’ living facilities in Interior Health are now at Brocklehurst Gemstone Care Centre in Kamloops, and The Florentine in Merritt.

One new outbreak at a B.C. hospital is at Eagle Ridge Hospital in Port Moody.

The other seven active COVID-19 outbreaks at B.C. hospitals include:
• Chilliwack General Hospital in Chilliwack;
• Dawson Creek and District Hospital in Dawson Creek;
• Kelowna General Hospital in Kelowna;
• Mission Memorial Hospital in Mission;
• Royal Columbian Hospital in New Westminster;
• Surrey Memorial Hospital in Surrey; and
• Vancouver General Hospital in Vancouver.

gkorstrom@biv.com

@GlenKorstrom

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