Podcasts about pasc

David Tuller returns to TWiV to discuss RFK Jr. and the trashing of American public health, rituximab and ME/CFS, The Sick Times, the Cochrane Mess, a Norwegian Long Covid trial, effort preference and more. Host: Vincent Racaniello Guest: David Tuller Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server David Tuller writes at virology blog CFS, a long tangled tale (virology blog) The Sick Times Norwegian Long COVID trial (virology blog) Cochrane mess (virology blog) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content on TWiV should not be taken as medical advice.

For this episode, Paul is joined by Alistaire Handyside MBE the chair of the Professional Association of Self Caterers (PASC UK Ltd). He and his team support the self-catering, short-term lets, holiday lets and serviced accommodation sectors in England and Wales. This includes successfully lobbying the government for reforms that enable these industries to thrive and continue to significantly contribute to the UK economy at a local and national level. Alistair's unique position within the industry means that this is a true state of the nation episode for SA entrepreneurs. It provides valuable insights into how recent and upcoming legislative changes will have on serviced accommodation and its profitability. KEY TAKEAWAYS The people who work for PASC all have highly relevant experience of the industry and/or the writing of legislation, the way parliament works and how legislation is likely to be interpreted and enforced. PASC got some amendments made to the Furnished Holiday Lettings (FHL)  abolition legislation. Details can be found on their website, so you can assess the impact on your taxes. Statutory registration is messy, but progressing fast, so is likely to be in effect across all authorities within a couple of years. Longer term contracts that do not give tenancy rights may still be possible, but only under certain circumstances. Alistair outlined the changes surrounding drip pricing and fake reviews. PASC is actively trying to prevent you from having to publicly share your name and contact details for your product. The plan is that by 2028 all private rental and short-term rental properties will need to be EPC C. PASC is galvanising relevant organisations to effectively challenge this. BEST MOMENTS ‘Today's presentation is a State of the Union type address on all things serviced accommodation.' ‘We´ve (PASC) got advocacy experts in the Labour, Conservative and Liberal Democrat parties.' ‘They won't be able to implement a levy without a statutory registration scheme.' ‘We are really trying to make the case against this kind of non-standardisation.' ‘We've managed to get the Energy Council to write a short paper about why the whole proposed EPC metrics don't work for short term rentals.' 'There is, I believe, the beginnings of a market readjustment.' GUEST AND EPISODE RESOURCES https://www.pascuk.co.uk https://www.linkedin.com/in/alistair-handyside-mbe-4170b216 VALUABLE RESOURCES Discovery Day Sign-Up Page -  https://progressivepropertyreferral.com/serviced-accommodation-discovery-day/amb0676 The Serviced Accommodation Property Podcast - https://itunes.apple.com/gb/podcast/the-serviced-accommodation-property-podcast/id1436005279?mt=2 https://propertysoldier.co.uk/ Serviced Accommodation Success by Kevin Poneskis Rich Dad, Poor Dad by Robert T Kiyosaki ABOUT THE HOST Your host Kevin Poneskis enjoys public speaking, travelling, exercising, and keeping fit. He also enjoys working with a charity called STOLL, which provides accommodation and training for homeless veterans. Kevin was in the British Army serving 24 years, mostly in a Commando unit and retired at the rank of Regimental Sergeant Major. He left the Army in 2011 and became a full-time property investor. During most of his Army career, Kevin was investing in property and has been a property investor now for over 27 years.  CONTACT METHOD https://en-gb.facebook.com/propertysoldier kevin@propertysoldier.co.uk

Na semana da Pascóa e da famosa "Caça aos ovos", a Daniela e a Jéssica decidiram fazer uma caça diferente. Ouçam este episódio e descrubram músicas da Pascóa que não conheciam ou músicas por charadas. Design: Vasco Fonseca e Bernardo SantosSonoplastia: Alexandre Boavida

In his weekly clinical update, Dr. Griffin and Vincent Racaniello discuss changes in access to public health information, the Marburg and Ebola outbreaks in Africa, the largest tuberculosis outbreak in the US ever, the politicization of polio vaccine campaigns in Pakistan, effect of high pathogenic influenza in animals and on the economy before Dr. Griffin reviews recent statistics on RSV, influenza and SARS-CoV-2 infections, the WasterwaterScan dashboard, where to find PEMGARDA, provides information for Columbia University Irving Medical Center's long COVID treatment center, where to go for answers to your long COVID questions, trials and devices to relieve some neurological complications of long COVID and the ramifications of long COVID in children, healthcare workers and adults.  Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode No morbidity and mortality in the US this week? (NPR) More support for Marburg outbreak in Tanzania (Reliefweb) Tanzania confirming second Marburg case (CIDRAP) Norovirus mRNA vaccine …..hmmmm? (moderna) What is noronvirus? (modernatx) Largest tuberculosis outbreak ever in the US (Reuters) Ebola outbreak in DRC during US:WHO strain (STAT News) Uganda Ebola outbreak…..1 dead (Reuters) Polio outside endemic zone due to militants? (Washington Post) Mpox vaccination initiation in central Africa (CIDRAP) Preparing rapid response to emerging infectious disease in Africa (PANTHER Health) Mpox therapeutic study MOSA enrollment begins (Africa CDC) Halting of US foreign aid for health programs…..not in the US best interests? (NY Times) No PEPFAR (NY Times) PEPFAR (US Department of State) PEPFAR…..still not America first? Really? (CIDRAP) Resurgence of infections globally may affect US…..what is global health? (NY Times) Milk testing for H5N1….but I thought raw milk was the only healthy milk? (USDA) How do you like your $10.99 dozen of eggs? (NY Times) Farm outbreak of H5N1 (AP News) US- high pathogenicity avian influenza viruses (World Organization for Animal Health) H5N9 high pathogenic flu in duck farm California (CIDRAP) More egg issues (CIDRAP) Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) Weekly surveillance report: cliff notes (CDC FluView) RSV: Waste water scan for 11 pathogens (WastewaterSCan) RSV-Network (CDC Respiratory Syncytial virus Infection) US respiratory virus activity (CDC Respiratory Illnesses) Respiratory syncytial virus vaccine effectiveness among US veterans, September, 2023 to March, 2024 (LANCET Infectious Diseases) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Where to get pemgarda (Pemgarda) EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD) Fusion center near you….if in NY (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Infectious Disease Society guidelines for treatment and management (ID Society) Drug interaction checker (University of Liverpool) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) When your healthcare provider is infected/exposed with SARS-CoV-2 (CDC) Managing healthcare staffing shortages (CDC) Steroids, dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Long COVID Recovery Program with Zara Dureno, BA, MOT The current and future burden of long COVID in the United States (JID) Transcutaneous vagus nerve stimulation improves Long COVID symptoms in a female cohort (Frontiers in Neurology) Transcutaneous vagus nerve stimulation trials:             https://www.mountsinai.org/clinical-trials/tvns-in-long-covid-19             https://www.centerwatch.com/clinical-trials/listings/NCT06585254/tvns-in-long-covid-19  Devices:             https://pulsetto.tech/products/meet-pulsetto?pulsetto_offer_id=57&transaction_id=1024e5a0258b6647e262ba8fec5d62             https://www.dolphinmps.com/product/dolphin-neurostim-professional-single-kit-vagal-stim-kit/ Distinct pro-inflammatory/pro-angiogenetic signatures distinguish children with Long COVID from controls (Pediatric Research) Persistent symptoms and clinical findings in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome in the second year after acute infection(PLoS Medicine) SARS-COV-2 re-infection and incidence of post-acute sequelae of COVID-19 (PASC) among essential workers in New York (LANCET: Regional Health Americas) Impact of COVID-19 Pandemic on the incidence and prevalence of postural orthostatic tachycardia syndrome (EHJ-QCCO European Heart Journal-Quality of Care & Clinical Outcomes) Letters read on TWiV 1188 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Scott Marsland is a Family Nurse Practitioner since 2014, and Registered Nurse since 1997. He co-founded the Leading Edge Clinic with Dr. Pierre Kory, focusing on treating post-acute sequelae of COVID (PASC), vaccine injuries from COVID shots, and providing adjunctive cancer care. Scott has treated over 1300 patients related to COVID and currently manages more than 300 with PASC and vaccine injuries via telemedicine, serving patients across the U.S. and four continents. Cornerstone Forum ‘25 https://www.showpass.com/cornerstone25/ Contribute to the new SNP Studio E-transfer here: shaunnewmanpodcast@gmail.com Get your voice heard: Text Shaun 587-217-8500 Substack:https://open.substack.com/pub/shaunnewmanpodcast Silver Gold Bull Links: Website: https://silvergoldbull.ca/ Email: SNP@silvergoldbull.com Text Grahame: (587) 441-9100

Did you know that specific nutrients can help aid our immune system in preventing and treating the symptoms of cold, flu and Covid 19?  Join Food Sleuth Radio host and Registered Dietitian, Melinda Hemmelgarn for her conversation with Jacob Mey, PhD, RD,  Registered Dietitian and nutrition researcher at the Pennington Biomedical Research Center, as they delve into the best diet and nutrition approaches to support our immune system through the cold and flu season and beyond. For resources from the Pennington Biomedical Research Center see: https://www.pbrc.edu/training-and-education/community-health-resources/Related Websites: The Role of Nutrition in Mitigating the Effects of COVID-19 from Infection through PASC: https://pmc.ncbi.nlm.nih.gov/articles/PMC9961621/#B72-nutrients-15-00866 Dietary Supplements for Immune Function and Infectious Diseases: https://ods.od.nih.gov/factsheets/ImmuneFunction-HealthProfessional/ Too much zinc and copper deficiency: https://thewaitingroom.karger.com/knowledge-transfer/zinc-oversupplementation-and-copper-deficiency/ Emerging Nutrition Approaches to Support the Mind and Muscle for Healthy Aging: file:///C:/Users/Dan/Downloads/rpn.2204022.pdf

Professor David Putrino is a physiotherapist with a PhD in Neuroscience. He is currently the Director of Rehabilitation Innovation for the Mount Sinai Health System, and a Professor in the Department of Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai. Professor Putrino recently opened the Mount Sinai Cohen Center for Recovery from Complex Chronic Illness in New York also known as (CoRE) and serves as CoRE's Family Director and is also a member of PolyBio's Long COVID Research Consortium.Today we talk about the pathophysiology of Long COVID in the context of describing research into targeted treatments for the disease.REFERENCES1 Proal AD, VanElzakkerMB, Aleman S, Bach K, Boribong BP, Buggert M, Cherry S, Chertow DS, Davies HE, Dupont CL, Deeks SG. SARS-CoV-2 reservoir in post-acute sequelae of COVID-19(PASC). Nature Immunology. 2023 Oct;24(10):1616-27.2 Klein J, Wood J,Jaycox JR, Dhodapkar RM, Lu P, Gehlhausen JR, Tabachnikova A, Greene K, Tabacof L, Malik AA, Silva Monteiro V. Distinguishing features of Long COVID identified through immune profiling. Nature. 2023 Nov 2;623(7985):139-48.3 Long COVID low-dose Rapamycin clinical trial4 Lumbrokinase LongCOVID & ME/CFS clinical trial5 Silva J, Takahashi T, Wood J, Lu P, Tabachnikova A, Gehlhausen JR, Greene K,Bhattacharjee B, Monteiro VS, Lucas C, Dhodapkar RM. Sex differences insymptomatology and immune profiles of Long COVID. medRxiv. 2024 Mar 2:2024-02.6 VanElzakker MB, Bues HF, Brusaferri L, Kim M, Saadi D, Ratai EM, Dougherty DD, Loggia ML. Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [11C] PBR28 PET correlates with vascular disease measures. Brain, Behavior, and Immunity.7 Fernández-CastañedaA, Lu P, Geraghty AC, Song E, Lee MH, Wood J, O'Dea MR, Dutton S, Shamardani K, Nwangwu K, Mancusi R. Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation. Cell. 2022 Jul 7;185(14):2452-68.

In his weekly clinical update, Dr. Griffin summarizes influenza and RSV circulation in the US, the benefit of administering oseltamivir early and if influenza vaccination reduces secondary household infections, before reviewing the recent statistics on SARS-CoV-2 infection, the WasterwaterScan dashboard, how 1st or 2nd trimester SARS-CoV-2 infections may shorten newborn telomeres, what are B1 cells, if IgG4 responses are critical for protection elicited by mRNA vaccines, if there is a difference in protection against the development of severe disease between an mRNA or a protein based vaccine, where to find PEMGARDA, if remdesivir reduces readmission of vulnerable patients once hospitalized for COVID-19, information for Columbia University Irving Medical Center's long COVID treatment center, if transcutaneous electrical nerve stimulation ameliorates musculoskeletal pain and fatigue during long COVID, do antihistamines reduce post-acute sequelae of SARS-CoV-2 infection and how long can SARS-CoV-2 antigens be detected in blood. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Influenza weekly surveillance report: cliff notes (CDC FluView) US respiratory virus activity (CDC Respiratory Illnesses) Influenza vaccines protect against secondary infections in households (JAMA Network) Benefit of early oseltamivir therapy for influenza A (CID) RSV-Network (CDC Respiratory Syncytial virus Infection) COVID-19 deaths (CDC) COVID-19 national and regional trends (CDC) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Maternal infection of SARS-CoV-2 during 1st and 2nd trimesters newborn telomere shortening (Journal of Translational Medicine) What is a B1 cell? (Wikipedia) Pre-COVID and post-COVID vaccination on long COVID (Journal of Infection) Delayed Induction of Noninflammatory SARS-CoV-2 Spike-Specific IgG4 Antibodies after  BNT162b2 Vaccination in Children (The Pediatric Infectious Disease Journal) Relative effectiveness of homologous NVX-CoV2373 and BNT162b2 COVID-19 vaccinations in South Korea (Vaccine) Phase III trial results! Comparative efficacy and safety of COVID-19 vaccines (BMC Infectious Diseases) Where to get pemgarda (Pemgarda) EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD) Fusion center near you….if in NY (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Infectious Disease Society guidelines for treatment and management (ID Society) Drug interaction checker (University of Liverpool) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) When your healthcare provider is infected/exposed with SARS-CoV-2 (CDC) Managing healthcare staffing shortages (CDC) Steroids, dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Remdesivir Effectiveness in Reducing the Risk of 30-day Readmission in Vulnerable Patients Hospitalized for COVID-19 (CID) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) Transcutaneous electrical nerve stimulation for fibromyalgia-like syndrome in patients with Long-COVID(Scientific Reports) Mitigating the risks of post-acute sequelae of SARS-CoV-2 infection (PASC) with intranasal chlorpheniramine (BMC Infectious Diseases) Measurement of circulating viral antigens post-SARS-CoV-2 infection (CID) Letters read on TWiV 1172 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Dr Amy Proal, Microbiologist, President and Chief Scientific Officer of Polybio discusses Long COVID in the context of other viral illnesses that lead to Chronic Post Viral Illness. This is part 2 of a 2 part series.REFERENCES1. Polybio2. Proal AD, VanElzakker MB. Long COVID or post-acute sequelae of COVID-19 (PASC): an overview of biological factors that may contribute to persistent symptoms. Frontiers in microbiology. 2021 Jun 23;12:698169.

Dr Amy Proal, Microbiologist, President and Chief Scientific Officer of Polybio discusses Long COVID in the context of other viral illnesses that lead to Chronic Post Viral Illness. This is part 1 of a 2 part series.REFERENCESPolybioProal AD, VanElzakker MB. Long COVID or post-acute sequelae of COVID-19 (PASC): an overview of biological factors that may contribute to persistent symptoms. Frontiers in microbiology. 2021 Jun 23;12:698169.

MON LIVRE !!! www.amazon.fr/Asia-Gourmet-culinaire-gastronomies-asiatiques/dp/2017252867Bon, on va pas se mentir, la différence d'âge en couple, ça fait toujours parler. Alors aujourd'hui, on va creuser ce sujet sans prise de tête mais avec un peu de sérieux quand même (t'inquiète, ça reste chill). Entre le fameux couple mineur/majeur et les écarts de 10, 15, voire 20 ans, qu'est-ce qui est vraiment OK ou carrément chelou ?

Vincent travels to the Karolinska Institute in Stockholm on 31 May 2024 to meet with Dr. Judith Bruchfeld and discuss her research on the etiology and treatment of Long COVID. Hosts: Vincent Racaniello Guest: Judith Bruchfeld Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server Immune system perturbations in Long COVID (J Immunol) Post-COVID immune system perturbations (J Immunol) Systems disregulation in Long COVID (Sci Rep) Clincal standards for diagnosing, treating, and preventing Long COVID (Intl J Tuberc Lung Dis) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content in this podcast should not be construed as medical advice.

For some, COVID-19 may seem like a thing of the past, but for medical professionals, the data regarding post-acute sequalae of COVID infection is only just emerging. Four years ago, the start of the pandemic left doctors puzzled by certain symptoms. Today, we are learning more about the long-term impacts of SARS-CoV-2 in children, often called long COVID or PASC. As the population continues to struggle with persistent and debilitating after-effects and symptoms, we are looking for answers. To provide insight into this important diagnosis, we are joined by Suchitra Rao, MD. She is an infectious disease specialist at Children's Hospital Colorado, as well as the Associate Medical Director of Infection Prevention and Control. She is also an associate professor of Pediatrics within the sections of Infectious Diseases, Epidemiology, and Hospital Medicine at the University of Colorado School of Medicine. Some highlights from this episode include:    The epidemiology of long COVID in kids  The difference between the data in adults and children A discussion of how to diagnose asymptomatic patients  A closer look at Dr. Rao's groundbreaking research   For more information on Children's Colorado, visit: childrenscolorado.org.    

ஒரே முத்தம் கலைஞரின் நாடகம்- தோழர் ஷோபா || PASC America

Welcome back to A Friend for the Long Haul with me, your host, Beth. This week, I am joined by Alysia Dagrosa, a board-certified patient advocate, full-spectrum doula, certified lactation counselor, Endometriosis advocate, and first wave long hauler. In this deeply personal episode, Alysia recounts the early days of the pandemic, contracting COVID-19 in March 2020, and the challenges she faced living with and caring for her family during lockdown. From her father's cabin fever-induced escapades THAT WILL INFURIATE YOU to the severe health complications that followed, Alysia's story is both harrowing and heartfelt. She opens up about the multi-system failures she experienced, her own struggles with long Covid, and the emotional toll of dealing with a family in denial. While Alysia and I were talking, I was so wrapped up in her story that I couldn't quite process what I was hearing. While editing this episode, I felt all the emotions and you'll go from curious to incredulous to feeling deep empathy to being simply wowed by Alysia as a human. In addition, you'll learn SO MUCH about Endometriosis in this episode. If you're struggling with endo, please give this episode a listen. We mostly get into Alysia's endo advocacy work in the second half and she provides so much education here. Content Warning: This episode discusses serious difficult family dynamics, COVID-19 infection, hospital trips, strokes, and food and body issues which may be difficult for some listeners. This episode is longer than usual, so feel free to take breaks as needed. Join us for an honest conversation filled with vulnerability, resilience, and even moments of humor. Plus Alysia's amazing singing at the end! Don't forget to subscribe, rate, and share the podcast with your friends. Your support helps us reach more listeners who can benefit from these stories. Tune in every Monday for new episodes! You can find Alysia on Instagram at: https://www.instagram.com/tantielys/ Find out more about A Friend for the Long Haul here: https://sites.google.com/view/afriendforthelonghaul Or on Instagram at: https://www.instagram.com/afriendforthelonghaul/ Don't miss this show's playlist, which you can find on Spotify: https://open.spotify.com/playlist/3n0GXLFRWqDJyifglNNM4K?si=665f477ed2b647a0 Disclaimer: While this podcast discusses medical topics, none of the content is intended as medical advice. Please consult your medical professional with any questions or concerns you may have. For more information about the PASC care package fundraiser mentioned at the beginning of this episode, check out https://www.instagram.com/chillusions/ Keywords: Long COVID, patient advocacy, pandemic stories, COVID-19 recovery, endometriosis, endo, advocacy, stroke, personal journey, family struggles, COVID-19 impact

In his weekly clinical update, Dr. Griffin delves highly pathogenic H5N1 biology including its circulation in New York City, being able to infect cells within mammary glands and why testing is not supported before reviewing the recent statistics on SARS-CoV-2 infection, how vaccination reduced deaths and hospitalizations associated with COVID-19 and how to take off PPE to reduce virus transmission, discussing the guidelines for spring administration of COVID vaccines boosters, the emergency use application of a pre-exposure prophylactic, a drug interaction database and the global phase 3 trail of a novel antiviral, continues to dispel the myth of viral rebound, when to use steroids and the benefits of convalescent plasma, what do when healthcare workers succumb to SARS-CoV-2 infection, reminisces about when available monoclonal antibody therapies were effective, and discusses muscle training/exercise for treatment of PASC/long COVID and the use of RNase for its treatment. For more information about long COVID-19 listen to TWiV 1088. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Clade 2.3.4.4b of highly pathogenic H5N1 in NYC (J Vi) Avian and human influenza A receptors in bovine mammary glands (bioRxiv) Where livestock infected with HPAI live (USDA) Another dairy worker contracted bird flu (NY Times) Reluctance to test for H5N1 (STAT News) COVID-19 national trend (CDC) COVID-19 deaths (CDC) Estimates of hospitalization and deaths prevaccination era (Emerg Inf Dis) Slightly less than half of COVID-19 patients died prevaccination (CIDRAP) How to undress in the time of COVID-19 (CID) Spring vaccineadvice (CIDRAP) Older adult spring booster available (CDC) Advisory committee for immunization practices slides (CDC) Advisory committee for immunization practices spring 2024 COVID-19 boosters (CDC) EUA for pemgarda (FDA) CDC Quarantine guidelines (CDC) Early phase of SARs-CoV-2 infection (COVID.gov) NIH COVID-19 treatment guidelines (NIH) Infectious Disease Society guidelines for treatment and management (IDSociety) Drug interaction checker (University of Liverpool) Global phase 3 study of ensitrelvir (Shionogi) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (IDSociety) Updated respiratory virus guidances (CDC) What do when your heathcare provider is infected with SARS-CoV-2 (CDC) Managing healthcare staffing shortages (CDC) Remember when monoclonal antibody therapies worked (JID) Steroids, dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Global clinical study of long COVID-19 (International Journal of Infecitous Diseases) Cardiopulmonary exercises testing of children with long COVID-19 (Pediatric Infectious Disease Journal) Phase 2 trial of RSVL-132 for severe fatigue related to PASC (CID) Muscle training may improve diaphragm muscle weakness 2 years after COVID-19 (American Journal of Respiratory Critical Care Health) Long COVID evidence based review TWiV shout out (TWiV 1088) Contribute to our Floating Doctors fundraiser Letters read on TWiV 1116 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

This week we will discuss a topic that is of concern for millions of people: "Long Covid" and our guest this week is Grace Miller.  Grace is 20 years old, and lives in Iowa. Currently attending college, where she is president of the honor society and finishing up her gen eds. She plans on pursuing a degree in Communication Disorders and become a speech pathologist. Some of her hobbies include crocheting, singing, playing the piano, and learning.  Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as Long COVID or Post-COVID Conditions (PCC). Long COVID is broadly defined as signs, symptoms, and conditions that continue or develop after acute COVID-19 infection. This definition of Long COVID was developed by the Department of Health and Human Services (HHS) in collaboration with CDC and other partners. ​People call Long COVID by many names, including Post-COVID Conditions, long-haul COVID, post-acute COVID-19, long-term effects of COVID, and chronic COVID. The term post-acute sequelae of SARS CoV-2 infection (PASC) is also used to refer to a subset of Long COVID. (Credits: CDC)

Post-acute sequelae of Covid-19 (PASC), also called long-Covid, has been the subject of increasing research. PASC describes the ongoing, relapsing, or new symptoms or conditions present 30 or more days after infection, and it has become a major clinical and public health concern. This roundtable discussion focuses on cognitive, cardiovascular, and autoimmune effects of long-Covid. Roundtable experts include naturopathic oncologist and Editor-in-Chief of the Natural Medicine Journal, Tina Kaczor, ND, FABNO; cardiovascular expert and clinician, Daniel Chong, ND; and immunologist and professor Heather Zwickey, PhD. About the Experts Tina Kaczor, ND, FABNO, is editor in-chief of Natural Medicine Journal and the creator of Round Table Cancer Care. Kaczor is a naturopathic physician board certified in naturopathic oncology. She received her naturopathic doctorate from the National University of Natural Medicine and completed her residency at Cancer Treatment Centers of America. She is also the editor of the Textbook of Naturopathic Oncology and cofounder of The Cancer Pod, a podcast for cancer patients, survivors, caregivers, and everyone in between. Daniel Chong, ND, is a licensed naturopathic physician who has been practicing in Portland, OR, since 2000. He earned his naturopathic doctorate from National University of Natural Medicine. Chong's focus is on risk assessment, prevention, and drug-free treatment strategies for cardiovascular disease and diabetes. In addition to his degree in naturopathic medicine, Chong has completed certificate training in cardiometabolic medicine at The Academy of Anti-Aging Medicine, a BaleDoneen Method Preceptorship, and served for 4 years as a clinical consultant for Boston Heart Diagnostics. He currently  maintains a telehealth-based practice. You can learn more about him at cardiowellnessconsults.com. Heather Zwickey, PhD, is a professor of immunology and chair of the Department of Health Sciences at the National University of Natural Medicine in Portland, Oregon. She launched the Helfgott Research Institute, which advances the science of natural medicine. Zwickey founded the school of graduate studies and developed masters programs in research, nutrition, and global health. Zwickey has received the Champion of Naturopathic Medicine Award from the American Association of Naturopathic Physicians. She currently leads a National Institutes of Health–funded clinical research training program focused on integrative medicine research and studies the gut-brain axis in neuroinflammation.

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or long-haul COVID, refers to a condition where individuals experience persistent symptoms or develop new symptoms after recovering from the acute phase of COVID-19. Long COVID can affect individuals who had mild, moderate, or severe initial COVID-19 infections and can persist for weeks or months after the initial illness. The specific symptoms and their duration can vary widely between individuals, but common symptoms of long COVID include fatigue, shortness of breath, cough, joint pain, chest pain, muscle weakness, brain fog, difficulty concentrating, memory problems, sleep issues, depression, anxiety, and other neurological or psychiatric symptoms. It can also affect multiple organs in the body, such as the heart, lungs, kidneys, and brain. How does COVID-19 affect microcirculation? Microcirculation refers to the circulation of blood in the smallest blood vessels, including arterioles, capillaries, and venules. While COVID-19 primarily affects the respiratory system, there is evidence suggesting that it can have systemic effects, including impacts on the cardiovascular system and microcirculation. Here are some potential ways in which COVID-19 may affect microcirculation: Endothelial Dysfunction: COVID-19 has been associated with endothelial dysfunction, which is a condition where the cells lining blood vessels (endothelial cells) do not function properly. Endothelial dysfunction can lead to impaired regulation of blood flow and increased permeability of blood vessels. In severe cases, viral infection and the resulting immune response may damage endothelial cells, contributing to a pro-inflammatory state and a potential disruption of microcirculation. Blood Clotting and Thrombosis: COVID-19 is known to be associated with an increased risk of blood clot formation (thrombosis). The formation of blood clots can potentially affect microcirculation by blocking small blood vessels. The hypercoagulable state observed in some COVID-19 patients may contribute to microvascular thrombosis, leading to impaired blood flow in affected tissues. Inflammatory Response: The body's inflammatory response to the virus can also impact microcirculation. Inflammation can lead to the release of inflammatory mediators, causing vasodilation (widening of blood vessels) and increased permeability, which may affect blood flow in the microcirculation. Hypoxia and Tissue Damage: Severe cases of COVID-19 may lead to respiratory distress and hypoxia (low oxygen levels). Hypoxia can have detrimental effects on tissues and organs, potentially impacting microcirculation. Tissue damage and inflammation in the lungs may trigger a systemic response that affects microvascular function in other organs. Impaired Oxygen Delivery: In severe cases of COVID-19, where acute respiratory distress syndrome (ARDS) develops, oxygen exchange in the lungs becomes compromised. This can lead to inadequate oxygen delivery to tissues and affect microcirculation. What is grapeseed extract? Grapeseed extract is a dietary supplement derived from the seeds of grapes. It is rich in antioxidants, particularly compounds known as oligomeric proanthocyanidin complexes (OPCs). Additionally, grape seed extract contains flavonoids, another class of polyphenols with antioxidant properties. These antioxidants help protect the body against damage from harmful free radicals, which can play a role in various chronic diseases. Grapeseed extract is commonly used for its potential health benefits, including improved cardiovascular health, reduced inflammation, enhanced immune function, and anti-aging effects. How does grapeseed extract improve microcirculation in Long COVID? The proanthocyanidins in grape seed extract help improve blood flow and circulation. By promoting the dilation of blood vessels, the extract supports the cardiovascular system's ...

In this podcast, expert Rasika Karnik, MD, MS, discusses how to manage the health risks posed by COVID-19 infection and long COVID in individuals with metabolic syndrome or obesity.Dr Karnik discusses the interplay between COVID-19 outcomes, obesity/metabolic syndrome, and social determinants of health and delves into detail on how to address and mitigate these social determinants of health in a high-risk population.Presenters:Rasika Karnik, MD, MSAssistant ProfessorDivision of Primary Care, Department of Internal MedicineUniversity of ChicagoChicago, IllinoisContent based on an online CME program supported by independent educational grants from Pfizer.Link to full program: https://bit.ly/46yuChS

In this podcast, experts Donna Ryan, MD, and Renslow Sherer, MD, discuss how to manage the health risks posed by COVID-19 infection and long COVID in individuals with metabolic syndrome or obesity.First, Dr Ryan presents an overview of the relationship between COVID-19 and weight, including the mechanisms of how obesity may drive COVID-19 disease and how COVID-19 may in turn worsen obesity, through both immunologic and social or societal drivers.Dr Ryan also discusses the relationship between obesity and the risk for long COVID.In his segment, Dr Sherer discusses COVID-19 vaccination and antiviral therapy within the context of obesity and metabolic syndrome. Dr Sherer also delves into detail on how obesity-related risk factors or comorbidities may affect treatment decisions and presents strategies on individualizing treatment, including in patients with long COVID.This episode includes results from several reviews and meta-analyses examining the relationship between vaccination, as well as an observational study investigating the impact of nirmatrelvir/ritonavir therapy on long COVID in vaccinated patients.Presenters:Donna Ryan, MDProfessor Emerita Pennington Biomedical Research Center New Orleans, Louisiana Renslow Sherer, MDDirector of the International HIV Training Center Professor of MedicineInfectious Diseases and Global Health Department of Medicine University of Chicago Department of Medicine Chicago, IllinoisContent based on an online CME program supported by independent educational grants from Pfizer.Link to full program:https://bit.ly/46yuChS

TWiV explains how immune profiling was used to identify distinguishing features of Long COVID, and how a co-opted feline endogenous retroviral envelope promotes cell survival by controlling copper transport and homeostasis in cats. Hosts: Vincent Racaniello, Alan Dove, Rich Condit, and Brianne Barker Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server MicrobeTV store at Cafepress Spike shirts at vaccinated.us (promo code Microbetv) Research assistant position in Rosenfeld Lab CBER/FDA (pdf) Features of Long COVID (Nature) ERV envelope mediates feline copper homeostasis (Cell Rep) Letters read on TWiV 1049 Timestamps by Jolene. Thanks! Weekly Picks Brianne – Webb spots a building block of life on Jupiter's moon Europa Rich – Are we really made of ‘star stuff?' Learn about your body's elements Alan – Avian flu has reached the Galàpagos Vincent – Why the US can't have nice things Listener Pick Az – Free solo Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

TWiV explains a study of postacute sequelae of COVID-19 at 2 years, and respiratory droplet transmission of human-isolated avian H3N8 influenza virus between ferrets. Hosts: Vincent Racaniello, Dickson Despommier, Rich Condit, and Brianne Barker Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server MicrobeTV store at Cafepress Research assistant position in Rosenfeld Lab CBER/FDA (pdf) 4:20 Postacute sequelae of COVID-19 at 2 years (Nat Med) Disability-adjusted life years (DALYs) (WHO) Respiratory droplet transmission of H3N8 virus (Cell) Letters read on TWiV 1047 Timestamps by Jolene. Thanks! Weekly Picks Dickson – UN Climate Action and California sues oil companies for exacerbating climate change Brianne – COVID Drugs are a Miracle Cure for Cats Rich – American Prometheus by Kai Bird and Martin J. Sherwin Vincent – Free Carl Zimmer writings Listener Pick Anne – She wrote to a scientist about her fatigue. It inspired a breakthrough. Alan – This Tiny Parasitic Wasp Can Drill Through Plastic Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

This episode of Conversations for Health features Designs for Health, Inc. and Diagnostic Solutions Laboratory, LLC Chief Medical Officer, Dr. David Brady.  With over 30 years of experience as an integrative practitioner and over 25 years in health sciences academia, Dr. Brady is a licensed naturopathic medical physician & clinical nutritionist, and professor and director emeritus of The Nutrition Institute at the University of Bridgeport.   In our conversation, Dr. Brady explores the rise and implications of long haul syndrome, or PASC, including popular correlation hypotheses, associations and patterns and insights from recent studies.  He details the challenges of major gaps in long haul syndrome clinical care, patient stories, and developing nutraceutical and traditional treatment options that have proven effective, as well as his own case-by-case approach to helping patients manage long haul syndrome effectively as answers continue to be uncovered by researchers and medical professionals.    I'm your host Evelyne Lambrecht, thank you for designing a well world with us.    Key Takeaways:   [1:36] Dr. Brady highlights the defining symptoms of long haul syndrome.  [4:25] The prevalence of long haul syndrome in the U.S., according to a Brooking Institute study. [5:18] Changes in our understanding of long haul syndrome from 2020 to the present.  [8:10] Addressing the major gaps in clinical care regarding long haul syndrome.  [10:33] Hypotheses regarding pathogenesis, mechanisms, and other fundamental long haul syndrome questions.  [13:02] The association between long haul syndrome, immunological cytokine patterns and other metabolomic signatures.  [19:24] Dr. Brady shares the resolution patterns and inconsistencies he has seen in panels.  [21:58] Possible correlations between genetic SNPs and the propensity toward developing long haul syndrome.  [24:43] Insights into the potential correlation between mitochondrial dysfunction and long haul syndrome.  [28:28] Findings from Harvard and Yale long haul molecular and metabolic function studies.  [30:49] Dr. Brady's recommendations for addressing the vasculature aspect of long haul syndrome.  [33:06] Information gained from the microbiota patterns in long haulers.  [35:55] Dr. Brady details the journey of his wife from healthy, fit dancer to long hauler.  [40:30] Evidence based drugs and nutraceuticals that are being used to manage long haul syndrome.  [52:26] Dr. Brady's approach to managing long haul symptoms on a case-by-case basis.  [54:51] Nutraceutical recommendations for approaching long haul syndrome and POTS.  [56:35] Dr. Brady shares his top three favorite supplements, his personal health practices, and what he has changed his mind about in recent years.   Episode Resources:   Dr. David Brady   Presentation: (IHS) Long Covid | Exploring the Latest Science and Pathways Forward   Design for Health Resources:   Designs for Health    Presentation: (CASI 22) Bruce Patterson – Diagnosis, Treatment, and Immunopathogenesis of Chronic Inflammation, including COVID-19 Long-haul syndrome   Presentation: (CASI 22) David Brady – Clinical Round | COVID-19 Long Haul Syndrome   Blog: Specialized Pro-resolving Mediators Novel Mechanisms for Supporting a Healthy Inflammatory Response   Blog: Combination of Geranylgeraniol + Ubiquinol to Support Mitochondrial Function   Blog: Fueling Mitochondria for Illness Recovery   Blog: L-Carnitine for Energy Production and Beyond   Blog: Rhamnan Sulfate to Support the Endothelial Glycocalyx   Blog: How Polyphenols Promote a Healthy Gut Microbiome   Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars and our blog.   

In his weekly clinical update, Dr. Griffin discusses the new risk assessment for the H5N1 avian flu viruses, the development of monoclonal antibody-based blocking ELISA for detecting SARS-CoV-2 exposure in animals, repeated antibiotic exposure and risk of hospitalization and death following COVID-19 infection, COVID-19 rebound study: a prospective cohort study to evaluate viral and symptom rebound differences in participants treated with Nirmatrelvir plus Ritonavir versus untreated controls, exaggerated blood pressure elevation in response to orthostatic challenge a post-acute sequelae of SARS-CoV-2 infection (PASC) after hospitalization, long term follow-up of a multicenter cohort of COVID-19 patients with pulmonary embolism, and risk of cardiovascular disease after COVID‐19 diagnosis among adults with and without diabetes. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode New risk assessment for H5N1 avian flu viruses (CDC) Development of monoclonal antibody-based blocking ELISA for detecting SARS-CoV-2 exposure (Virology) Repeated antibiotic exposure and risk of hospitalization and death following COVID-19 infection (eClinicalMedicine) COVID-19 Rebound Study (CID) Exaggerated blood pressure elevation in response to orthostatic challenge (AN) Long term follow-up of a multicenter cohort of COVID-19 patients with pulmonary embolism (TR) Risk of Cardiovascular disease after COVID‐19 diagnosis among adults with and without Diabetes (JAHA) Contribute to our FIMRC fundraiser at PWB Letters read on TWiV 1025 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Long COVID, or PostAcute Sequelae of SARS-CoV-2 Infection (PASC), was identified early in the pandemic. With over 200 symptoms attributed to PASC, join host, Geoff Wall, as he evaluates a seminal paper describing the diagnostic criteria, symptoms, and incidence of Long COVID. The GameChangerThe PASC score can be used to detect Long COVID and help establish patients into care. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint Health ReferenceThaweethai T, Jolley SE, Karlson EW, et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA. Published online May 25, 2023. doi:10.1001/jama.2023.8823https://recovercovid.org/ Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Apply the PASC score to a patient with Long COVID.2. Describe the limitations of the RECOVER study.  0.05 CEU/0.5 HrUAN: 0107-0000-23-236-H01-PInitial release date: 7/3/2023Expiration date: 7/3/2024Additional CPE details can be found here.This podcast episode was financially supported through grant funding from Ananda Professional. Want to learn more about CBD as an expanded pharmacy service? Join the CBD Academy in the CEimpact App by CLICKING HERE.Follow CEimpact on Social Media:LinkedInInstagramDownload the CEimpact App for Free Continuing Education + so much more!

This week's topics include intentional infection of people with COVID-19 and transmission, screening for anxiety, screening for depression, and does PASC differ from sequelae of other infectious disease acute illnesses?

Long COVID is tricky, and it takes a dedicated team of doctors to find the right treatment plan for your specific case! Patients Medical (212-794-8800) combines conventional and alternative treatments to help you recover faster. Visit https://www.patientsmedical.com/treatments/covid-long-haulers.aspx for more information! Patients Medical PC 1148 5th Avenue Suite 1B, New York, New York 10128, United States Website https://www.patientsmedical.com/ Phone +1-212-794-8800 Email patientsmednyc@gmail.com

This month on Episode 48 of Discover CircRes, host Cynthia St. Hilaire highlights three original research articles featured in the April 28th issue of Circulation Research. This Episode also includes a discussion between Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova, who all contributed to manuscripts to the May 12th Compendium on Covid-19 and the Cardiovascular System.     Article highlights:   Heijman, et al. Mechanisms of Enhanced SK-Channel Current in AF   Chen, et al. IL-37 Attenuates Platelet Activation   Enzan, et al. ZBP1 Protects Against Myocardial Inflammation   Compendium on Covid-19 and the Cardiovascular System.   Cindy St. Hilaire: Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's journal, Circulation Research. I'm your host, Dr Cindy St. Hilaire, from the Vascular Medicine Institute at the University of Pittsburgh. Today, I'm going to be highlighting articles from our April 28th and May 12th issues of Circulation Research. I'm also going to have a chat with Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova, who all contributed to articles in the May 12th COVID Compendium. But before we have that interview, let's first talk about some highlights.   The first article I want to present is titled Enhanced Calcium-Dependent SK-Channel Gating and Membrane Trafficking in Human Atrial Fibrillation. This article is coming from the University of Essen by Heijman and Zhou, et al. Atrial fibrillation is one of the most common forms of heart arrhythmia in humans and is characterized by irregular, often rapid heartbeats that can cause palpitations, dizziness and extreme fatigue. Atrial fibrillation can increase a person's risk of heart failure, and though treatments exist such as beta blockers, blood thinners and antiarrhythmia medications, they can have limited efficacy and side effects. A new family of drugs in development are those blocking small-conductance calcium-activated potassium channels called SK channels, which exhibit increased activity in animal models of AF and suppression of which attenuates the arrhythmia. In humans however, the relationship between SK channels and atrial fibrillation is less clear, at least in terms of SK channel mRNA levels. Because mRNA might not reflect actual channel activity, this group looked at just that and they found indeed that channel activity was increased in cardiomyocytes from atrial fibrillation patients compared to those from controls even though the mRNA and protein levels themselves were similar. The altered currents were instead due to changes in SK channel trafficking and membrane targeting. By confirming that SK channels play a role in human atrial fibrillation, this work supports the pursuit of SK channel inhibitors as possible new atrial fibrillation treatments.   The next article I want to present is titled IL-37 Attenuates Platelet Activation and Thrombosis Through IL-1R8 Pathway. This article comes from Fudan University by Chen and Hong, et al. Thrombus formation followed by the rupture of a coronary plaque is a major pathophysiological step in the development of a myocardial infarction. Understanding the endogenous antithrombotic factors at play could provide insights and opportunities for developing treatments. With this in mind, Chen and Hong, et al. investigated the role of interleukin-1 receptor 8, or IL-1R8, which suppresses platelet aggregation in mice, and of IL-37, a newly discovered human interleukin that forms a complex with IL-1R8 and is found at increased levels in the blood of patients with myocardial infarction. Indeed, the amount of IL-37 in myocardial infarction patients negatively correlates with platelet aggregation. They also show that treatment of human platelets in vitro with IL-37 suppresses the cell's aggregation and does so in a concentration-dependent manner. Moreover, injection of the protein into the veins of mice inhibits thrombus development and better preserves heart function even after myocardial infarction. Such effects were not seen in mice lacking IL-1R8. This suggests IL-37's antithrombotic action depends on its interaction with the receptor. Together, the results suggest IL-37 could be developed as a antithrombotic agent for use in MI patients or indeed perhaps other thrombotic conditions.   The last article I want to present before our interview is titled ZBP1 Protects Against Mitochondrial DNA-Induced Myocardial Inflammation in Failing Hearts. This article is coming from Kyushu University and is by Enzan, et al. Myocardial inflammation is a key factor in the pathological progression of heart failure and occurs when damaged mitochondria within the stricken cardiomyocyte release their DNA, triggering an innate inflammatory reaction. In a variety of cells, DNA sensors such as Z-DNA-binding protein 1 or ZBP1 are responsible for such mitochondrial DNA-induced inflammation. In theory then, it's conceivable that therapeutic suppression of ZBP1 might reduce myocardial inflammation in heart failure and preserve function. But as Enzan and colleagues have now discovered to their surprise, mice lacking ZBP1 exhibited worse, not better heart inflammation and more failure after induced myocardial infarction. Indeed, the test animals' hearts had increased infiltration of immune cells, production of inflammatory cytokines and fibrosis together with decreased function compared with the hearts of mice with normal ZBP1 levels. Experiments in rodent cardiomyocytes further confirmed that loss of ZBP1 exacerbated mitochondrial DNA-induced inflammatory cytokine production while overexpression of ZBP1 had the opposite effect. While the reason behind ZBP1's opposing roles in different cells is not yet clear, the finding suggests that boosting ZBP1 activity in the heart might be a strategy for mitigating heart inflammation after infarction.   Cindy St. Hilaire:         The May 12th issue of Circulation Research is our COVID compendium, which consists of a series of 10 reviews on all angles of COVID-19 as it relates to cardiovascular health and disease. Today, three of the authors of the articles in this series are here with me. Dr Mina Chung is a professor of medicine at the Cleveland Clinic. She and Dr Tamanna Singh and their colleagues wrote the article, A Post Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2. Dr DeLisa Fairweather, professor of medicine, immunology and clinical and translational science at the Mayo Clinic, and she and her colleagues penned the article, COVID-19 Myocarditis and Pericarditis. Dr Milka Koupenova is an assistant professor of medicine at the UMass Chan School of Medical and she led the group writing the article, Platelets and SARS-CoV-2 During COVID-19: Immunity, Thrombosis, and Beyond. Thank you all for joining me today.   DeLisa Fairweather:    Thank you so much for having us.   Mina Chung:   Thank you.   Milka Koupenova:       Thank you for having us, Cindy.   Cindy St. Hilaire:         In addition to these three articles, we have another seven that are on all different aspects of COVID. Dr Messinger's group wrote the article, Interaction of COVID-19 With Common Cardiovascular Disorders. Emily Tsai covered cell-specific mechanisms in the heart of COVID-19 patients. Mark Chappell and colleagues wrote about the renin-angiotensin system and sex differences in COVID-19. Michael Bristow covered vaccination-associated myocarditis and myocardial injury. Jow Loacalzo and colleagues covered repurposing drugs for the treatment of COVID-19 and its cardiovascular manifestations. Dr Stephen Holby covered multimodality cardiac imaging in COVID, and Arun Sharma covered microfluidic organ chips in stem cell models in the fight against COVID-19.   Cindy St. Hilaire          As of today, worldwide, there have been over six hundred million individuals infected with the virus and more than six and a half million have died from COVID-19. In the US, we are about a sixth of all of those deaths. Obviously now we're in 2023, the numbers of individuals getting infected and dying are much, much lower. As my husband read to me this morning, one doctor in Boston was quoted saying, "People are still getting wicked sick." In 75% of deaths, people have had underlying conditions and cardiovascular disease is found in about 60% of all those deaths. In the introduction to the compendium, you mentioned that the remarkable COVID-19 rapid response initiative released by the AHA, which again is the parent organization of Circ Research and this podcast, if I were to guess when that rapid response initiative started, I would've guessed well into the pandemic, but it was actually March 26th, 2020. I know in Pittsburgh, our labs have barely shut down. So how soon after we knew of SARS-CoV-2 and COVID, how soon after that did we know that there were cardiovascular complications?   Mina Chung:               I think we saw cardiovascular complications happening pretty early. We saw troponin increases very early. It was really amazing what AHA did in terms of this rapid response grant mechanism. You mentioned that the RFA was announced, first of all, putting it together by March 26th when we were just shutting down in March was pretty incredible to get even the RFA out. Then the grants were supposed to be submitted by April 6th and there were 750 grants that were put together and submitted. They were all reviewed within 10 days from 150 volunteer reviewers. The notices were distributed April 23rd, less than a month out.   Cindy St. Hilaire:         Amazing.   Mina Chung:               So this is an amazing, you're right, paradigm for grant requests and submissions and reviews.   DeLisa Fairweather:    For myocarditis, reports of that occurred almost immediately coming out of China, so it was incredibly rapid.   Cindy St. Hilaire:         Yeah, and that was a perfect lead up to my next question. Was myocarditis, I guess, the first link or the first clue that this was not just going to be a respiratory infection?   DeLisa Fairweather:    I think myocarditis appearing very early, especially it has a history both of being induced by viruses, but being strongly an autoimmune disease, the combination of both of those, I think, started to hint that something different was going to happen, although a lot of people probably didn't realize the significance of that right away.   Cindy St. Hilaire:         What other disease states, I guess I'm thinking viruses, but anything, what causes myocarditis and pericarditis normally and how unique is it that we are seeing this as a sequelae of COVID?   DeLisa Fairweather:    I think it's not surprising that we find it. Viruses around the world are the primary cause of myocarditis, although in South America, it's the parasite Trypanosoma cruzi. Really, many viruses that also we think target mitochondria, including SARS-CoV-2, have an important role in driving myocarditis. Also, we know that SARS-CoV-1 and MERS also reported myocarditis in those previous infections. We knew about it beforehand that they could cause myocarditis.   Cindy St. Hilaire:        Is it presenting differently in a COVID patient than say those South American patients with the... I forget the name of the organism you said, but does it come quickly or get worse quickly or is it all once you get it, it's the same progression?   DeLisa Fairweather:    Yeah. That's a good question. Basically, what we find is that no matter what the viral infection is, that myocarditis really appears for signs and symptoms and how we treat it identically and we see that with COVID-19. So that really isn't any different.   Cindy St. Hilaire:         Another huge observation that we noticed in COVID-19 patients, which was the increased risk of thrombic outcomes in the patients. Dr Koupenova, Milka, you are a world expert in platelets and viruses and so you and your team were leading the writing of that article. My guess is knowing what you know about platelets and viruses, this wasn't so surprising to you, but could you at least tell us the state of the field in terms of what we knew about viruses and platelets before COVID, before Feb 2020?   Milka Koupenova:       Before Feb 2020, we actually knew that influenza gets inside in platelets. It leads to not directly prothrombotic events, but it would lead to release of complement 3 from them. That complement 3 would actually increase the immunothrombosis by pushing neutrophils to release their DNA, forming aggregates. In cases when you have compromised endothelium and people with underlying conditions, you would expect certain thrombotic outcomes. That, we actually published 2019 and then 2020 hit. The difference between influenza and SARS-CoV-2, they're different viruses. They carry their genome in a different RNA strand. I remember thinking perhaps viruses are getting inside in platelets, but perhaps they do not. So we went through surprising discoveries that it seemed like it is another RNA virus. It also got into platelets. It was a bit hard to tweak things surrounding BSL-3 to tell you if the response was the same. It is still not very clear how much SARS or rather what receptor, particularly when it gets inside would induce an immune response. There are some literature showing the MDA5, but not for sure, may be responsible. But what we found is that once it gets in platelets, it just induces this profound activation of programmed cell death pathways and release of extracellular vesicles and all these prothrombotic, procoagulant form of content that can induce damage around, because platelets are everywhere. So that how it started in 2019 and surprisingly progressed to 2021 or 2020 without the plan of really studying this virus.   Cindy St. Hilaire:         How similar and how different is what you observe in platelets infected, obviously in the lab, so I know it's not exactly the same, but how similar and how different is it between the flu? Do you know all the differences yet?   Milka Koupenova:       No offense here, they don't get infected.   Cindy St. Hilaire:         Okay.   Milka Koupenova:       Done the proper research. The virus does not impact platelets, but induces the response.   Cindy St. Hilaire:         Okay.   Milka Koupenova:       That goes back to sensing mechanism. Thank goodness platelets don't get infected because we would be in a particularly bad situation, but they remove the infectious virus from the plasma from what we can see with function.   Cindy St. Hilaire:         Got it. So they're helping the cleanup process and in that cleaning up is where the virus within them activates. That is a really complicated mechanism.    Milka Koupenova:       Oh, they're sensing it in some form to alert the environment. It's hard to say how similar and how different they are unless you study them hint by hint next to each other. All I can tell is that particularly with SARS-C, you definitely see a lot more various kinds of extracellular vesicles coming out of them that you don't see the same way or rather through the same proportion with influenza. But what that means in how platelet activates the immune system with one versus the other, and that goes back to the prothrombotic mechanisms. That is exactly what needs to be studied and that was the call for this COVID compendium is to point out how much we have done as a team. As scientists who put heads together, as Mina said, superfast response, it's an amazing going back and looking at what happened to think of what we achieved. There is so much more, so much more that we do not understand how one contributes to all of these profound responses in the organs themselves, such as myocarditis. We see it's important and that will be the problem that we're dealing from here on trying to figure it out and then long COVID, right?   Cindy St. Hilaire:         Yeah. Related to what you just said about the mechanism, this cleanup by the platelets or the act of cleaning up helps trigger their activation, is that partly why the antiplatelet and anticoagulant therapies failed in patients? Can you speculate on that? I know the jury's still out and there's a lot of work to be done, but is that part of why those therapies weren't beneficial?   Milka Koupenova:       The answer to that in my personally biased opinion is yes. Clearly, the antiplatelet therapies couldn't really control the classical activation of a platelet. So what I think we need to do from here on is to look at things that we don't understand that non-classically contribute to the thrombotic response downstream. If we manage to control the immune response in some way or the inflammation of the infection or how a platelet responds to a virus, then perhaps we can ameliorate a little bit of the downstream prothrombotic effect. So it's a lot more for us to trickle down and to understand in my personal opinion.   DeLisa Fairweather:    There is one thing that was really remarkable to me in hearing your experience, Milka, is that I had developed an autoimmune viral model of myocarditis in mice during my postdoc. So I've been studying that for the last 20 years. What is unique about that model is rather than using an adjuvant, we use a mild viral infection so it doesn't take very much virus at all going to the heart to induce it. I also, more recently, started studying extracellular vesicles really as a therapy, and in doing that, inadvertently found out that actually, the model that I'd created where we passage the virus through the heart to induce this autoimmune model, we were actually injecting extracellular vesicles into the mice and that's what was really driving the disease. This is really brought out. So from early days, I did my postdoc with Dr Noel Rose. If you've heard of him, he came up with the idea of autoimmune disease in the '50s. We had always, in that environment, really believed that viruses were triggering autoimmune disease and yet it took COVID before we could really prove that because no one could identify them. Here we have an example and I think the incidence rates with COVID were so high for myocarditis because for the first time, we had distinguished symptoms of patients going to the doctor right at the beginning of their infection having an actual test to examine the virus, knowing whether it's present or not, whether PCR or antibody test, and then being able to see when myocarditis happened.   Cindy St. Hilaire:         Yeah. I think one thing we can all appreciate now is just some of the basic biology we've learned on the backend of this. Actually, those last comments really led well to the article that your team led, Dr Chung, about what we call long COVID, which I guess I didn't realize has an actual name, post-acute sequelae of SARS-CoV-2 or PASC is the now more formal name for long COVID. But what is it? We hinted at it that there's these bits about autoimmune and things like that. What counts as long COVID?   Mina Chung:   Yeah. Our article was led by Tamanna Singh. She did a fantastic job of putting this together. We've had, and others, theorized that the huge palette of symptoms that you can experience post-COVID, they can affect all these organ systems with brain fog, these atypical chest pains, postural orthostatic tachycardia, a lot of palpitations, atrial fibrillation, many weakness and fatigue. To us, really, you can get GI symptoms. We've been very interested in, is this an autoimmune phenomenon directed against nerves and all those things. It's also very interesting because many of the non-COVID syndromes that existed pre-COVID like POTS and chronic fatigue syndrome and a lot of other syndromes are associated with autoantibodies. So that is a very interesting area to explore. Is there a persistence of viral fragments. Is there autoimmunity? Is it also a component of persistence of the damage from the initial infection? So it's an area that still needs a lot of work and a lot of work is going into it, but this is like a post or inter pandemic of itself, so hopefully we'll get more insights into that.   Cindy St. Hilaire:         Yeah, it's really interesting. I have a friend who has very debilitating long COVID and one of her doctors had said, "If I didn't know any better, I would just describe this as a autoimmune type X." What do we know, I guess, about the current hypothesis of the pathogenesis of PASC? Are there any prevailing theories right now as to why it's occurring? Is the virus still active or is it these domino effects that are leading to multi-organ collapse of some sort?   Mina Chung:   Yeah. In some people, persistent viral particles can be identified for months, but whether or not that's what's triggering it, it's hard to know. We see more autoimmune disease that's been reported and various antibodies being reported. So those are clearly processes to be investigated. The microthrombosis is still up there in terms of potentially playing a role in long COVID.   Milka Koupenova:       Mina, you probably know better because you see patients, but to all I have been exposed to, long COVID does not really have a homogeneous symptom presentation and then a few theories as to what may be going on in these patients. Not everybody has a microthrombosis. Not everybody have a D-dimer elevated, but some people do. Some people have, as you pointed out, these spectacularly profound brain fog. People can't function. It's probably your friend, Cindy, right?   Cindy St. Hilaire:         Yeah.   Milka Koupenova:       So one of the theories that I have been, from a viral perspective, very interested in is that a lot of the symptoms in certain individuals such as fatigue, brain fog, sensitivity to light and skin can very well be explained by a flare-up of Epstein-Barr virus that may be what SARS-CoV-2 somehow is inducing. I don't know, DeLisa, what your experience with long COVID is as a scientist. I hope only. But I would like to hear your perspective too because it's so heterogeneous and it is amazing what happens.   DeLisa Fairweather:    I have a very interesting perspective from a number of different directions. One, as I mentioned before, my long history with Dr Rose and I've written many articles theorizing how viruses could cause autoimmune disease. This has grown and really, I think this has been extremely revealing during COVID for many of those theories. One thing that I write about in the review for this article is that mast cells, from all the research I've done with myocarditis in our model, mast cells are central to what is driving everything. We show they're the first innate immune cell acting as an antigen-presenting cell, completely driving the response in a susceptible pattern. One of the things that's very important in autoimmune disease is both sex and race. I'd say one of the big weaknesses we have in myocarditis pre-COVID and post-COVID has been ignoring what's going on with race. In the United States, myocarditis is 90%, 95% white men that are under 50 years of age and most of the cases are under 40 or some of the ones really associated with sudden cardiac death are under 30. So it's very specific. I've been studying sex and race differences and we see those exact differences in our animal models. In animal models, whether you're susceptible or not depends on how many mast cells you have. Well, I've proposed from the beginning, looking, I've written a lot of different sex difference reviews looking at viruses and autoimmune disease with different autoimmune diseases and hypothesizing and really seeing that mast cells do a lot of the things we're talking about. They have all of the receptors, the whole group of them that have been related to SARS-CoV-2 so they can be activated or stimulated by the virus itself. They act as a antigen-presenting cell. They're critical in the complement pathway as well as macrophages. We see the dominant immune phenotype really being macrophages. Mast cells just are usually not counted anywhere. And of course, these receptors, a lot of them have to do with enzymes and things that are all related to mast cells pathways. Then how they activate the immune response and lead it towards the pathway that leads to chronic autoimmune disease with increased autoantibodies in females, mast cells are very different by sex. This has to do also when we talked in the Review about myocarditis and pericarditis. It's both those appearing. Although clinically, we have really boxed them as separate things, because there is some definite clinical pericarditis phenotypes that are different, myocarditis in animal models is always myopericarditis. It always then, in that outer pericardial areas where mast cells sit, they sit around the vascular area in most concentrated. So when they degranulate, we see inflammation coming in the vessel, but really concentrated with fibrosis there and along the pericardium. So that's very typical of what's going on. When we shift anything that shifts that, it changes whether you have more pericarditis or less pericarditis and the vascular inflammation by altering anything that affects the mast cells. I talk a little bit about in the review, I think there's only been a few recent things looking at it in COVID, but I think mast cells and certain susceptibility to autoimmune diseases that occur more often in women can really predispose.We need to pay more attention to mast cells and what they might indicate for all these pathways.   Milka Koupenova:       I think we should study the platelet mast cell access at this point.   DeLisa Fairweather:    Yes.   Milka Koupenova:       Because as you're talking about these sex differences, which is spectacular, these things to me are so mind-boggling how one, the infection itself would be more prevalent in men, but then long COVID is more prevalent in women. All of these things and why we understand so very little, what we found about a few years ago in the Framingham Heart Study in the platelets from those people is that all toll-like receptors are expressed at the higher level in women and they associate with different things between men and female. For instance, toll-like receptors in women will associate more with a prothrombotic response while in male with pro-inflammatory response. I think they grossly underestimate the amount of our sex differences from cell to cell.   DeLisa Fairweather:    It is, yeah.   Mina Chung:   One other thing that I learned about the sex differences from this compendium is Mark Chappell also notes, you mentioned TLR and TLR7 and ACE2 are X chromosome in an area that he says escapes X-linked inactivation. So it could very well be involved in further.   DeLisa Fairweather: Further, yeah. And ACE2 is expressed more highly in male cells for what's been researched because of the sex difference in COVID, both the COVID infection   Cindy St. Hilaire:         So a variety of organ systems are impacted in patients with PASC, also referred to as long COVID, the lungs, the heart, the pancreas, the GI system, pretty much any system, the brain, nervous system. We've just been talking about the mast cell impact. I was really thinking in my head, well, the one thing that connects all of it is the vasculature. I'm a vascular biologist, so I have certain biases, I'm sure, but how much of the sequelae that we see is a function of vascular phenotypes?       Milka Koupenova:       I do think the vasculature is super important. It's clear that not all endothelial cells, for instance, will pick up the virus and respond to it. That's why you have this patchy breakage when you look at autopsies. Hence, platelets will respond according to what's local. That's why you find these micro thrombotic events at certain places. Why does it happen in each organ? How does the virus get to each organ to respond? Or is it just inflammation, but why is it in specific places? That's what we don't understand. That's where we need to go. Perhaps, as DeLisa points out, perhaps it's a lot more complicated than how we traditionally think of thrombosis. Actually, my personal bias, again 100% sure that it is a lot more complicated than the traditional mechanisms that we have understood, and that's where the immune system comes and autoimmunity perhaps stems from and they probably speak to each other, right? It's not just one thing.   DeLisa Fairweather:    Yeah. I think really, EVs are bringing lots of understanding. A lot of things we used to just think were maybe free-floating and the serum are inside EVs. I think that the immune response is perhaps even more specific than we ever thought and more regulated than we ever understood.   When an EV comes through a cardiomyocyte, whether it's from the mitochondria or through a lysosome, is part of what goes into its outer membrane, something that tells the immune system that that came from the heart, so it knows to go. This will solve a lot of our questions with autoimmune disease if it's very specific like that. It doesn't just have to be the release of free-floating cardiac myosin. We know cardiac myosin is the driver of the autoimmune response in myocarditis, but they're probably  much more fine-tuned.   Cindy St. Hilaire:         Yeah. I just would love to end with hearing from each of you. You each have your own domain of specialty. If I gave you a massive pot of money, what would be the question you would want to tackle? What's the gap you would love to answer?   Milka Koupenova:       We still don't understand specifically what kind of vesicles are coming out, what are their contents in addition to those vesicles. We don't understand. When it comes to platelets, what comes from their granules? We see these breakages of the membrane. Those are non-granule proteins, and non-granule proteins, they serve as dangerous associated molecular pattern signals and can be profoundly inflammatory to the surrounding environment, can be procoagulant. What are those? How are they affecting the surrounding environment? Ultimately, why is there a microthrombi? Why is there not a profound thrombosis everywhere? Thank goodness there isn't, but why isn't? That's what I would do with my money.   DeLisa Fairweather:    I think I would do something very similar. All of our research in our animal model, on the one side, we are looking in this viral myocarditis animal model and finding the EVs that come from that are driving myocarditis. On the other hand, we're using EVs that come from healthy human plasma or fat, and we're seeing a profound downregulation of everything if you give it early and we're trying to see how late you can give it and still get an effect. So looking at those and really understanding the components in the context of COVID and COVID vaccines to understand those components, I really think that's the future of where we're going to find what's causing disease and also how we can find therapies. They may be able to reverse this.   Mina Chung:   Yeah, I'm interested very much in the autoimmunity and the autoantibodies that are    and how they may react with those microthrombi. Perhaps there's autoantibodies within a lot of that material. We're looking at using human and pluripotent stem cell-derived cell models to study the effects of those. That is what I would use our money for.   Cindy St. Hilaire:        Well, Dr Mina Chung, Dr DeLisa Fairweather, Dr Milka Koupenova, thank you all so much for joining me today and talking about not only the articles that you wrote and with your colleagues, but also other articles in this amazing compendium. I do think this is one of the first all-encompassing compendiums or group of articles that focus specifically on COVID and cardiovascular disease. So thank you all so much.   Mina Chung:   Thank you.   DeLisa Fairweather:    Thank you.   Milka Koupenova:       You're welcome.   Cindy St. Hilaire:         That's it for highlights from the April 28th and May 12th issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle @circres and #DiscoverCircRes. Thank you to our guests, Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova. This podcast is produced by Ishara Ratnayaka, edited by Melissa Stoner and supported by the editorial team of Circulation Research. Some of the copy text for the highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire, and this is Discover CircRes, your on-the-go source for the most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, visit ahajournals.org.    

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Current COVID-19 landscapeRapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides: bit.ly/3oHKC09To view the full online program: bit.ly/4201xcO

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Current COVID-19 landscapeRapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides: bit.ly/3oHKC09To view the full online program: bit.ly/4201xcO

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Current COVID-19 landscapeRapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides: bit.ly/3oHKC09To view the full online program: bit.ly/4201xcO

In this episode, Alba Azola, MD, and Monica Verduzco-Gutierrez, MD, discuss diagnosis and management of long COVID, including: Definitions of post COVID conditionsDiagnosis, including symptoms and clinical presentationEpidemiologyRisk factorsPossible treatment optionsClinical guidance statementsPresenters:Alba Azola, MDAssistant ProfessorDepartment of Physical Medicine and RehabilitationJohns HopkinsCo-DirectorJohns Hopkins Post Acute COVID Team ClinicBaltimore, MarylandMonica Verduzco-Gutierrez, MDProfessor and Distinguished ChairDepartment of Rehabilitation MedicineUniversity of Texas Health Science Center at San AntonioDirector, UT Health COVID-19 Recovery ClinicDepartment of Rehab MedicineUT Health San AntonioSan Antonio, TexasLink to full program:https://bit.ly/3Gn4tXOLinks to Consensus Guidance Statements on Assessment and Treatment of Post-Acute Sequelae of COVID-19:Autonomic Dysfunction:https://bit.ly/3GHeUGYCardiovascular Complications:https://bit.ly/3CmupkXCognitive Symptoms:https://bit.ly/3X9tnkwFatigue:https://bit.ly/3ihiLRQRespiratory Sequelae: https://bit.ly/3IrUkMc

Episode 83: Neurostabilization with Amber Walker. Link in Profile and below, or Scan QR code on picture. The worlds of Mast Cell Activation Disorder, Postural Orthostatic Tachycardia Syndrome, and Hypermobility Ehlers Danlos Syndrome have many threads in common and many shared experiences. The common thread in these conditions expands to the fact that the symptoms, causes, and triggers are unpredictable, undefined, and this experience is largely disruptive to the nervous system. Further the nervous system disruption makes the symptoms worsen. How serious should we take neurostabilization in these conditions? To help answer this question, I welcomed on Amber Walker, PT, DPT, CFMP, CNPT. Her unique personal and clinical journey provides a most comprehensive look at this area: We cover many things such as: Where to start when complex health conditions present. How the immune system and environmental triggers effect the Vagus nerve and limbic system Polyvagal theory Nervous system balancing Mast Cells and much more This episode is dedicated to Projectmercy.org an organization committed to education, healthcare, food security, adult skills and infrastructure in Ethiopia. For each of the first 100 listens we will donate $1. You too can donate here BIO- Amber Walker, PT, DPT, CFMP, CNPT is a doctor of physical therapy with advanced training in functional medicine, nutrition and natural healing. She specializes in working with patients who suffer from mast cell activation issues, Chronic Inflammatory Response Syndrome from mold exposure, dysautonomia, hypermobility spectrum disorders, hereditary angioedema, PASC (post-acute sequelae of Covid-19) and other chronic conditions. As the owner of Origin Wellness, she encourages a “root issue” approach to patient care. Amber is the author of “Mast Cells United: A Holistic Approach to Mast Cell Activation Syndrome” (2019) and “The Trifecta Passport: Tools for Mast Cell Activation Syndrome, Postural Orthostatic Tachycardia Syndrome and Ehlers-Danlos Syndrome” (2021). Her 2022 course "Conquering CIRS" focuses on healing from mold exposure. Amber utilizes the Safe & Sound Protocol to help foster healing for autonomic nervous system regulation and is trained in CranioBiotic Technique, a natural method of addressing health stressors and improving immune function. She utilizes a hands-on approach to physical therapy through dry needling, manual therapy and chronic illness-conscious exercise strategies. Career highlights include the role as a public health volunteer in Peru, and Amber continues to be passionate about working toward creative community health solutions. She's also enjoyed the roles of swimming coach, paddleboarding company owner, faculty with two universities in Colorado and is a member of the Ehlers-Danlos Society International Consortium: Allergy & Immunology Working Group. In her spare time, you can find Amber on a surfboard, mountain trail or somewhere in Latin America. Learn more: www.originwellnesscolorado.com https://originwellness.teachable.com/p/conquering-cirs www.mastcellsunited.com --- Support this podcast: https://anchor.fm/adam-rinde/support

On this episode, we're talking to physiatrist expert Dr. Alba Azola about long COVID (or PASC). How common is it, what are the symptoms, and how can we treat it? She tells us all this and more to help you protect yourself and your loved ones.Dr. Alba Azola, MD is a rehabilitation physician and the co-director of the Johns Hopkins Post-Acute COVID-19 Team (PACT), in collaboration with the division of Pulmonary and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, MD. PACT is a multidisciplinary clinic that offers comprehensive outpatient care and rehabilitation services for patients with post-COVID conditions, and it was established in April of 2020. Dr. Azola's expertise includes neurorehabilitation, management of autonomic dysfunction, rehabilitation for swallowing disorders, and post-COVID rehabilitation, and she's one of a small group of physicians in the U.S. who are at the forefront of post-COVID research and treatment.*************************************Connect with us on Facebook, Instagram, Twitter and Pinterest!And we'd love it (and you, forever) if you subscribe to our show and review us in Apple Podcasts ... it helps other people like you find the show!Thanks for listening and chat again soon!

Diagnosing long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is challenging for clinicians. With up to 200 possible symptoms, heterogeneous presentations and no definitive diagnostic test, the diagnosis is a clinical one.In this episode, Dr. Kieran Quinn, a general internist and palliative care physician at Mount Sinai and Bridgepoint Hospitals in Toronto, emphasizes the importance of judicious diagnostic testing in patients with suspected long COVID. Dr. Quinn, who is co-author on three “Five Things to Know…” articles published in CMAJ that cover diagnosing, assessing and treating long COVID, suggests that limited routine blood work and, occasionally, an echocardiogram or pulmonary function test may be sufficient to make the diagnosis without the need for extensive testing and consultations.The episode also features the personal experience of Suzie Goulding, the founder of COVID Long Haulers Canada, a support group for people struggling with long COVID, who shares her journey with the illness and her ongoing recovery process.Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the podcast.You can find Blair and Mojola on Twitter @BlairBigham and @DrmojolaomoleCMAJTwitter (in English): @CMAJ Twitter (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Fernando Carnavali, MD; Rasika Karnik, MS, MD; and Renslow Sherer, MD, discuss long COVID, including:Long COVID prevention strategies, including COVID-19 vaccinationLong COVID treatment approachesStrategies for management of patients with long COVIDPresenters:Fernando Carnavali, MDAssociate Professor of MedicineDivision ChiefGeneral Internal MedicineDepartment of MedicineSite DirectorCOVID Center of Excellence Satellite-Ansonia Mount Sinai Health New York, New YorkRasika Karnik, MS, MDAssistant ProfessorDivision of Primary CareDepartment of Internal MedicineUniversity of ChicagoMedical DirectorPost-COVID Recovery ClinicChicago, IllinoisRenslow Sherer, MDDirectorInternational HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisLink to slides: https://bit.ly/3hXMgIdLink to full program: https://bit.ly/3G271KL

Millions of individuals will have persistent symptoms following an acute COVID-19 infection requiring post COVID-19 rehabilitation. Common symptoms include fatigue, decreased activity tolerance, cognitive dysfunction (brain fog), shortness of breath, and pain. This leads to decreased ability to complete activities of daily living, return to work or school and affects quality of life.There are many terms for post COVID-19 condition including long COVID (proposed by patients in May 2020) and post acute sequelae of COVID-19, also known as PASC. The World Health Organization created a clinical case definition in October 2021.Ongoing research includes assessing risk factors to determine who might develop post COVID- 19 condition. Vaccinations reduce the risk of developing post COVID-19 condition to some degree, and reduces the duration of symptoms. However, even without risk factors, individuals can develop post COVID-19 condition. The primary preventative strategy remains minimizing risk of acquiring the initial infection.In this episode, we discuss up to date evidence for post COVID-19 condition rehabilitation. Guest: Dr. Simon Decary (https://twitter.com/simondecary)Additional Resources:World Health Organization Clinical management of COVID-19: Living guideline (including post COVID rehab)CADTH Post COVID-19 Condition Treatment and Management Rapid Living Scoping Review Scoping review of rehabilitation care models for post COVID-19 conditionhttps://longcovid.physio

Our guest today is Chelsea Weaver, a 31-year-old living in Tennessee. She has a beautiful little girl that is just over 2 years old, a wonderful husband, and they all live on a quiet farm property.  Before coming down with COVID, she was a surgical technologist.   She used to assist in open heart surgery as well as some other specialties but hasn't been able to function in her career for about two years now.  Unfortunately, her COVID symptoms have morphed into Long COVID (specifically POTs or Postural Orthostatic Tachycardia Syndrome.)   While the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has slowed, many people suffer long-lasting symptoms, a condition known as post-acute sequelae of COVID 2019 (COVID-19) (PASC), or long COVID. Even though PASC is not widely described, it is most commonly defined as COVID-19 symptoms that continue longer than 30 days. PASC can manifest as a wide range of symptoms, many exhibiting autonomic characteristics. An autonomic nervous system illness, postural orthostatic tachycardia syndrome (POTS), strongly connected with a prior viral infection, is the most prevalent autonomic diagnosis correlated with PASC. The most prevalent symptoms were brain fog, exhaustion, shortness of breath with exercise, headache, palpitations, body pains, tachycardia, and lightheadedness, consistent with previous research that found many of the same symptoms in individuals with PASC. A COMPASS-31 score of above 20 was found in 67% of PASC patients, indicating autonomic dysfunction with moderate to severe. The COMPASS-31 consists of 31 questions that fall into 6 domains of dysautonomia: orthostatic intolerance (4 items), vasomotor dysfunction (3 items), secretomotor dysfunction (4 items), GI dysfunction (12 items; includes gastroparesis, constipation, and diarrhea), urinary dysfunction (3 items), and pupillomotor dysfunction (5 items). An answer was scored as zero when it was not assigned a point. A raw domain score was obtained by adding together points within each domain. The total score within each domain was weighted as previously described15 and then added together to give a total score ranging from 0 to 100. The maximum weighted scores for each subdomain are as follows: 40 for orthostatic intolerance, 5 for vasomotor dysfunction, 15 for secretomotor dysfunction, 25 for GI dysfunction, 10 for urinary dysfunction, and 5 for pupillomotor dysfunction. CONCLUSIONS: "Our study finds that 67% of individuals with Long COVID are developing dysautonomia. That's an estimated 38 million Americans with Long COVID dysautonomia, and millions more around the world,” says Lauren Stiles, President of Dysautonomia International and Research Assistant Professor of Neurology at Stony Brook University. (CREDITS: https://bit.ly/3VzS7BQ & https://bit.ly/3VPnU1u )

We invited Dr. Monica Gandhi back to share her expertise on the illnesses we are seeing in all of our preschools. Recorded on Nov. 1, 2022, Dr. Gandhi talks about RSV, vaccinations, long Covid in children, and how to protect our children and families in the holiday season. Her extensive knowledge on Covid and public health allows us to look ahead to plan for illnesses this winter. Some articles mentioned by Dr. Gandhi: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00544-8/fulltext https://jamanetwork.com/journals/jama/article-abstract/2796961#:~:text=Postacute%20sequelae%20of%20SARS%2DCoV%2D2%20infection%20(PASC),that%20included%20659%20286%20children.

Dr. Ramchandani discusses  POST COVID-19 Syndrome and what to do to avoid it.  There are many resources including the PASC website - https://pascdashboard.aapmr.orgLinked from this website are many resources that may help find some information about it!  Talk to your doctor if you are suffering from POST COVID-19 Syndrome.  

In this episode, Renslow Sherer, MD, and Trinh P. Vu, PharmD, BCIDP, discuss strategies for managing ambulatory patients with acute or previous COVID-19 infection, including:Rapid antigen tests and PCR testsRisk stratification of patients who have a positive SARS-CoV-2 testAntiviral treatment (nirmatrelvir + ritonavir, remdesivir, and molnupiravir)Monoclonal antibody treatment (bebtelovimab)Long COVIDPresenters:Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisTrinh P. Vu, PharmD, BCIDPClinical Pharmacy Specialist in Infectious DiseasesDepartment of Pharmaceutical ServicesEmory University Hospital MidtownAtlanta, GeorgiaTo download the slides:https://bit.ly/3TkT7sJTo view the full online program:https://bit.ly/3TqnNIX

The syndrome that's appearing after someone is infected with COVID is an emerging global health crisis. Yet, confusion about Long COVID remains. Which symptoms get ruled-in? Which get ruled-out? Can anything be a symptom of Long COVID if it occurs after a COVID infection?On today's program, we talk with researchers studying the illnesses that people who have had COVID are living with, including persistent fatigue, loss of the sense of smell, vascular conditions, and brain fog and other neurological problems. We also talk with a psychologist who began support groups for Long COVID patients who often feel their symptoms are ignored (or not understood) by their doctors and families. And four patients describe their life with Long COVID for us. .James R. Heath, Ph.D.PresidentInstitute for Systems BiologySeattle, Wash.The Heath Lab.Jason D. Goldman, M.D., MPHInfectious Disease SpecialistSwedish Center for Comprehensive CareSeattle, Wash..Drs. Heath and Goldman are co-principal investigators of the PASC study — (Post-acute sequelae of COVID-19) — published in the March 3, 2022 issue of the journal Cell.  It is part of a nationwide initiative to study the aftermath of COVID-19 infection known as RECOVER: Researching COVID to Enhance Recovery..James C. Jackson, Psy.D.Research Associate Professor of MedicinePsychiatry and Behavioral SciencesDirector of Long-Term Outcomes, ICU Recovery CenterVanderbilt UniversityNashville, Tenn..Dr. Jackson welcomes email from clinicians interested in starting Long COVID support groups at their institutions...PATIENT STORIESThis episode begins with the voices of four people who are living with Long COVID in conversations facilitated by producer Scott Acord. We're grateful for them taking the time to talk about their experiences. You can listen to extended cuts of their conversations here:Pam & Lyla Bishop: Bedbound  Alicia Swift: Bone-tired Suzanne Martin: The hardships of having Long COVIDTJ Roseberry: A wanderer is homebound..  

TWiV reviews human monkeypox infections, evidence for human Mimivrus infections, and incidence of long COVID in post-vaccine SARS-CoV-2 infections. Hosts: Vincent Racaniello, Dickson Despommier, Rich Condit, and Brianne Barker Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Monkeypox update (ProMedMail) Multi-country monkeypox outbreak (WHO) Monkeypox new global threat (Science) Monkeypox outbreak 9 US states (MMWR) Mimivirus in human respiratory samples (Sci Rep) Long COVID after post-vaccination infection (Nat Med) Letters read on TWiV 906 Timestamps by Jolene. Thanks! Weekly Picks Dickson – Lake Mead water level very low Brianne – Transplantation of a 3D printed ear made out of human cells Rich – nderstanding Vaccine Safety and the Roles of the FDA and the CDC and The Facts About Vaccine Safety Vincent – My new favorite backpack Listener Pick Greg – Against the Rules Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

Description: In this podcast, we invited Dr. Igho Ofotokun, Professor of Medicine at Emory University School of Medicine and PI for the NIH funded Researching COVID to Enhance Recovery initiative, to talk all thing related to long COVID, including PASC vs long COVID, hypotheses around long COVID causes, vaccination impact on long COVID, future research, and more. Speakers: Igho Ofotokun, MD, MSc Christopher Crnich, MD, PhD (moderator) Interested in becoming a SHEA member? Use the coupon code LearningCE22 to get $20 any membership type. What do you think of our podcasts? Do you have topic or speaker suggestions? Let us know at https://learningce.shea-online.org/content/shea-podcast-feedback

I really appreciate the ability to work with what you have, and in the case of covid, where it can take you by surprise, you may not have what you think you need on hand to help you. In this episode, I share almost 70 different plants and many ways they can be useful for different aspects of covid, both during an active infection and during recovery. As always, please seek medical attention if you need it, and if you would like assistance creating a wellness plan for your needs, send an email to laureltreewellness@gmail.com or visit www.laureltreewellnessllc.com Thank you for listening! If you found this podcast helpful, please leave a review!

Additional resources OHA COVID-19 vaccine website: covidvaccine.oregon.gov OHA Facebook  Safe+Strong website Ask a Black Doctor on The Numberz REACH webpage and REACH Facebook Long COVID and Emerging Variants Q1: I have heard people talking about long-term COVID. What is that? Long-term COVID goes by many names. Some people call it post-COVID syndrome, long COVID or long-haul COVID. It is formally known as PASC, or post-acute sequelae of SARS-CoV-2. It is a post-viral syndrome and refers to conditions that people experience 28 days or more after first being infected with COVID-19.  Post-viral syndromes occur from a range of infections, and long-term COVID can be different types and combinations of health problems for different lengths of time. Symptoms persist in an estimated 10% to 30% of COVID-19 patients and can happen to anyone who has had COVID-19, even if the illness was mild, they had no initial symptoms or they no longer test positive for the virus or antibodies.  Long COVID has potentially affected up to 23 million Americans. The Centers for Disease Control and Prevention and experts around the world are working to learn more about short- and long-term health effects of COVID-19, who gets them, and why.  Q2: How can I prevent having long-term COVID? The best way to prevent post-COVID conditions is to prevent COVID-19 illness. Get vaccinated and boosted. If you are high risk, consider wearing a well-fitted mask – preferably an N95 mask – to help protect yourself and others. Q3: When should I see a doctor about post-COVID symptoms? Long-term COVID doesn't usually come with one symptom—there's often a cluster of symptoms. There are many symptoms and they affect many organ systems. Don't ignore loss of smell, depression, anxiety or insomnia. Any symptom that interferes with your daily life is worth a call to your doctor. If you experience new chest pain, difficulty breathing, bluish lips or any other sign of a life-threatening problem, seek emergency medical care. It is also important to talk to a health care provider because another condition could be masquerading as long COVID. In spring 2021, Oregon Health & Science University launched a Long COVID Program designed to coordinate care and learn about the long-term effects of coronavirus. OHSU's criteria for Long COVID referrals is 28 days from hospital discharge, or three months when not hospitalized. If you have questions or want to learn more, please call the program at 833-647-8222 weekdays, 8 a.m. to 5 p.m.  Q4: Is long COVID considered a disability? As of July 2021, “long COVID” can be considered a disability under the Americans with Disabilities Act (ADA), Section 504, and Section 1557, if it substantially limits one or more major life activities. “Major life activities” include activites such as caring for oneself, eating, sleeping, breathing, concentrating, thinking, interacting with others and working. “Major life activities” also refers to the operation of a major bodily function, such as the immune system, cardiovascular system, neurological system or circulatory system, or the operation of an organ. Q5: How do I know if I have long COVID or not? Because data on COVID-19 and its long term effects only date back to the past two years, experts are still learning what long COVID is and how it affects people. There is no one way to test for long COVID. It is possible to have many of the symptoms of long COVID, but they could be caused by something else.  To be sure, talk to a health care provider. Health care providers may use COVID-19 antibody tests to confirm previous infection, then rule out other conditions. Treatment is based on a patient's specific symptoms and may include therapeutics, such as steroids or anti-inflammatory medication. Trials are underway to test new therapeutics for long COVID patients. According to the CDC, the most common lasting symptoms are fatigue, shortness of breath, cough, joint pain and chest pain. Other issues include cognitive problems, difficulty concentrating, depression, muscle pain, headache, rapid heartbeat and recurrent fever. Additional effects of Long COVID could be loss of appetite and diarrhea, acute kidney injury, blood clots, hair loss and rashes. For some, COVID-19 may cause the immune system to attack its own antibodies. For others, it may disrupt the immune system and reactivate old viruses like Epstein-Barr.  No organ system is spared from long COVID. Q6: My neighbor has long term COVID. How can I help her? A good place to start is to listen with compassion. Taking steps to understand the person's experiences might make them feel less isolated. Directly ask what they need or what you can do to help. There will be times where you may not be able to support a person exactly as they need, and it's OK to acknowledge that. Just be direct in saying what you can and can't do.  School administrators, school counselors and school nurses can work with families and health care professionals to provide learning accommodations for children with post-COVID conditions, particularly those experiencing thinking, concentrating or physical difficulties. Q7: What's the latest information on COVID variants? The emerging variant of interest in the United States is still Omicron. The most important thing to understand is the infectiousness of these variants—they move very quickly, and vaccination and boosting is key to preventing severe disease.  Omicron infection generally causes less severe disease than infection with prior variants. Some people, however, may still have severe disease, need hospitalization and could die from the infection with this variant. The Omicron variant, like other variants, is comprised of a number of lineages and sublineages. The three most common lineages of Omicron are BA.1, BA.1.1 and BA.2. Document accessibility: For individuals with disabilities or individuals who speak a language other than English, OHA can provide information in alternate formats such as translations, large print, or braille. Contact the Health Information Center at 1-971-673-2411, 711 TTY or COVID19.LanguageAccess@dhsoha.state.or.us.

In this episode, Renslow Sherer, MD, discusses what is known to date regarding long COVID, also known as postacute sequelae of COVID-19 infection, including:Possible causes and risk factorsSigns and symptomsClinical managementTreatment options under considerationRole of vaccinationPresenter: Renslow Sherer, MDDirector, International HIV Training CenterProfessor of MedicineSection of Infectious Diseases and Global HealthDepartment of MedicineUniversity of ChicagoChicago, IllinoisReview the downloadable slideset and the full program at: https://bit.ly/3Ix8uZg

On this episode of the AMSSM CRN Spotlight Podcast (T: @TheAMSSM) host Dr. Jeremy Schroeder, DO, is joined by Dr. Monica Verduzco-Gutierrez (T: @MVGutierrezMD), who is serving as the AAPM&R Exchange Lecture Speaker during the 2022 AMSSM Annual Meeting. In this conversation, Dr. Verduzco-Gutierrez discusses her upcoming presentation in Austin, TX, on Post-COVID Syndrome in Athletes and address the following topics: • Defining Post-COVID Syndrome and its many potential impacts • How and why she developed a Post-COVID Recovery Clinic • Her contributions to multi-disciplinary collaborative consensus guidance statements for patients with PASC • How she generally approaches treating patients with Post-COVID Syndrome • The differences in rates and severity in Post-COVID Syndrome in athletes compared with other populations • Her advice for aspiring researchers in sport and exercise science Resources: Models of Care for Postacute COVID-19 Clinics: Experiences and a Practical Framework for Outpatient Physiatry Settings (https://pubmed.ncbi.nlm.nih.gov/34793373/) Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)(https://onlinelibrary.wiley.com/doi/10.1002/pmrj.12744) Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients (https://onlinelibrary.wiley.com/doi/full/10.1002/pmrj.12684)

On this episode of the AMSSM Sports Medcast, host Dr. Jeremy Schroeder, DO, is joined by Dr. Monica Verduzco-Gutierrez, MD (T: @MVGutierrezMD), who is serving as the AAPM&R Exchange Lecture Speaker during the 2022 AMSSM Annual Meeting. In this conversation, Dr. Verduzco-Gutierrez discusses her upcoming presentation in Austin, TX, on Post-COVID Syndrome in Athletes and addresses the following topics: Defining Post-COVID Syndrome and its many potential impacts How and why she developed a Post-COVID Recovery Clinic Her contributions to multi-disciplinary collaborative consensus guidance statements for patients with PASC How she generally approaches treating patients with Post-COVID Syndrome The differences in rates and severity in Post-COVID Syndrome in athletes compared with other populations Her advice for aspiring researchers in sport and exercise science Resources: Models of Care for Postacute COVID-19 Clinics: Experiences and a Practical Framework for Outpatient Physiatry Settings (pubmed.ncbi.nlm.nih.gov/34793373/) Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)(onlinelibrary.wiley.com/doi/10.1002/pmrj.12744) Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients (onlinelibrary.wiley.com/doi/full/10.1…02/pmrj.12684)