Minor stroke needs quick medical attention, too

Agencies
July 4, 2018

Jul 4: Minor strokes and “mini-strokes,” or transient ischemic attacks (TIAs), need early medical attention, just like major strokes, but a public education campaign in the UK had little success convincing the public to act fast after these events.

“Although the campaign worked well for behavior after more major stroke, patients were still slow to act on, or ignored completely, the symptoms of minor events,” said Dr. Peter M. Rothwell from John Radcliffe Hospital, University of Oxford.

“It was almost as though the messages from the campaign about major stroke had falsely reassured them that the more minor event that they had experienced was probably nothing to worry about,” said Rothwell, senior author of a study on the campaign´s impact.

“If you have a minor ‘warning’ event, the risk of a more major stroke over the next week is about 10 percent if you are not treated,” he said in an email. “However, that risk is reduced by 80 percent if simple medical treatments are started urgently.”

If you have sudden, temporary neurological symptoms that you haven’t had before, he advises, “Don’t delay. . . get checked.”

Also, he said, “The most important immediate thing that you can do yourself if you have a ‘TIA’ is to take an aspirin (same as is advised after a suspected heart attack). Take an aspirin and seek medical attention.”

Rothwell’s team looked at the impact of the Face, Arm, Speech, Time (FAST) public education campaign on the likelihood that patients would seek medical attention within three hours of their symptoms.

The campaign warned, “When stroke strikes, act FAST. Face: has it fallen on one side? Arms: can they raise them? Speech: is it slurred? Time: if you notice any of these signs, it’s time to call (for an ambulance).”

Facial weakness, arm symptoms and speech disturbance were less common among people with minor stroke or TIA than among those with major stroke, and only about 35 percent of patients with TIAs who didn’t seek medical attention had any of these signs.

Before the campaign, about 68 percent of people with major stroke obtained medical attention within three hours; after the FAST campaign this increased to 81 percent, according to the report in JAMA Neurology.

In contrast, only about 40 percent of patients with TIA and minor stroke obtained medical attention within three hours both before and after the FAST campaign.

Surprisingly, fewer patients correctly attributed their symptoms to TIA or minor stroke after the FAST campaign (28 percent) than before it (37 percent), and 5 percent of patients did not even report their symptoms until the next routine appointment with their doctor.

“Campaigns rightly stress the need to seek emergency medical attention if you have signs of a major stroke,” Rothwell said. “The symptoms of TIA and minor stroke are very similar - but just less severe and more transient (often lasting only minutes). Current campaigns would really only need to add that message at the end of the TV advertisement or poster – ‘and don’t ignore symptoms that might be a small ‘warning stroke’ either - that is an emergency, too.’”

“For any of the stroke symptoms, major, minor, or transitory, time remains of the essence,” said Dr. Victor Loh from National University Health System, Singapore, who recently detailed the outpatient management of TIA, but was not involved in the study.

“Perhaps after the primary message of needing to head to hospital within the time window for patients with major stroke, the secondary message needs to be emphasized: that even if symptoms are mild or transitory, early review and intervention can drastically reduce the risk of a major stroke,” he said by email.

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International New York Times
July 7,2020

The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests.

This risk is highest in crowded indoor spaces with poor ventilation, and may help explain superspreading events reported in meatpacking plants, churches and restaurants.

It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech.

Follow latest updates on the Covid-19 pandemic here

Aerosols are released even when a person without symptoms exhales, talks or sings, according to Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.

What is clear, they said, is that people should consider minimizing time indoors with people outside their families. Schools, nursing homes and businesses should consider adding powerful new air filters and ultraviolet lights that can kill airborne viruses.

What does it mean for a virus to be airborne?

For a virus to be airborne means that it can be carried through the air in a viable form. For most pathogens, this is a yes-no scenario. HIV, too delicate to survive outside the body, is not airborne. Measles is airborne, and dangerously so: It can survive in the air for up to two hours.

For the coronavirus, the definition has been more complicated. Experts agree that the virus does not travel long distances or remain viable outdoors. But evidence suggests it can traverse the length of a room and, in one set of experimental conditions, remain viable for perhaps three hours.

How are aerosols different from droplets?

Aerosols are droplets, droplets are aerosols — they do not differ except in size. Scientists sometimes refer to droplets fewer than 5 microns in diameter as aerosols. (By comparison, a red blood cell is about 5 microns in diameter; a human hair is about 50 microns wide.)

From the start of the pandemic, the WHO and other public health organizations have focused on the virus’s ability to spread through large droplets that are expelled when a symptomatic person coughs or sneezes.

These droplets are heavy, relatively speaking, and fall quickly to the floor or onto a surface that others might touch. This is why public health agencies have recommended maintaining a distance of at least 6 feet from others, and frequent hand washing.

But some experts have said for months that infected people also are releasing aerosols when they cough and sneeze. More important, they expel aerosols even when they breathe, talk or sing, especially with some exertion.

Scientists know now that people can spread the virus even in the absence of symptoms — without coughing or sneezing — and aerosols might explain that phenomenon.

Because aerosols are smaller, they contain much less virus than droplets do. But because they are lighter, they can linger in the air for hours, especially in the absence of fresh air. In a crowded indoor space, a single infected person can release enough aerosolized virus over time to infect many people, perhaps seeding a superspreader event.

For droplets to be responsible for that kind of spread, a single person would have to be within a few feet of all the other people, or to have contaminated an object that everyone else touched. All that seems unlikely to many experts: “I have to do too many mental gymnastics to explain those other routes of transmission compared to aerosol transmission, which is much simpler,” Marr said.

Can I stop worrying about physical distancing and washing my hands?

Physical distancing is still very important. The closer you are to an infected person, the more aerosols and droplets you may be exposed to. Washing your hands often is still a good idea.

What’s new is that those two things may not be enough. “We should be placing as much emphasis on masks and ventilation as we do with hand washing,” Marr said. “As far as we can tell, this is equally important, if not more important.”

Should I begin wearing a hospital-grade mask indoors? And how long is too long to stay indoors?

Health care workers may all need to wear N95 masks, which filter out most aerosols. At the moment, they are advised to do so only when engaged in certain medical procedures that are thought to produce aerosols.

For the rest of us, cloth face masks will still greatly reduce risk, as long as most people wear them. At home, when you’re with your own family or with roommates you know to be careful, masks are still not necessary. But it is a good idea to wear them in other indoor spaces, experts said.

As for how long is safe, that is frustratingly tough to answer. A lot depends on whether the room is too crowded to allow for a safe distance from others and whether there is fresh air circulating through the room.

What does airborne transmission mean for reopening schools and colleges?

This is a matter of intense debate. Many schools are poorly ventilated and are too poorly funded to invest in new filtration systems. “There is a huge vulnerability to infection transmission via aerosols in schools,” said Don Milton, an aerosol expert at the University of Maryland.

Most children younger than 12 seem to have only mild symptoms, if any, so elementary schools may get by. “So far, we don’t have evidence that elementary schools will be a problem, but the upper grades, I think, would be more likely to be a problem,” Milton said.

College dorms and classrooms are also cause for concern.

Milton said the government should think of long-term solutions for these problems. Having public schools closed “clogs up the whole economy, and it’s a major vulnerability,” he said.

“Until we understand how this is part of our national defense, and fund it appropriately, we’re going to remain extremely vulnerable to these kinds of biological threats.”

What are some things I can do to minimize the risks?

Do as much as you can outdoors. Despite the many photos of people at beaches, even a somewhat crowded beach, especially on a breezy day, is likely to be safer than a pub or an indoor restaurant with recycled air.

But even outdoors, wear a mask if you are likely to be close to others for an extended period.

When indoors, one simple thing people can do is to “open their windows and doors whenever possible,” Marr said. You can also upgrade the filters in your home air-conditioning systems, or adjust the settings to use more outdoor air rather than recirculated air.

Public buildings and businesses may want to invest in air purifiers and ultraviolet lights that can kill the virus. Despite their reputation, elevators may not be a big risk, Milton said, compared with public bathrooms or offices with stagnant air where you may spend a long time.

If none of those things are possible, try to minimize the time you spend in an indoor space, especially without a mask. The longer you spend inside, the greater the dose of virus you might inhale.

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Agencies
February 6,2020

Researchers have found the rates of lung cancer are higher in young women than men.

The study, published in the journal Pediatrics, examined lung cancer rates in young adults in 40 countries across five continents and uncovered a trend of higher lung cancer rates in women compared with men in recent years.

The emerging trend was widespread, affecting countries across varied geographic locations and income levels.

The changes appeared to be driven by a rising rate of adenocarcinoma lung cancer among women, said the study researchers from University of Calgary in Canada.

Lung cancer rates have been higher among men than women because men started smoking in large numbers earlier and smoked at higher rates; however, recent studies have reported converging lung cancer incidence rates between sexes.

Among men, age specific lung cancer incidence rates generally decreased in all countries, while in women the rates varied across countries with the trends in most countries stable or declining, albeit at a slower pace compared to those in men.

For the findings, lung and bronchial cancer cases between 30-64 age group from 1993-2012 were extracted from cancer incidence in five continents.

The study found the higher emerging rates of lung cancer in young women compared to young men.

According to the researchers, future studies are needed to identify reasons for the elevated incidence of lung cancer among young women.

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