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Large scale experiment. Out of 10, 579 recruits in BMT close proximity barracks style living, using masks, distancing, and other pharmaceutical. methods, only 5 cases, 3 of which were on contact with 1st patient. Science. Well done Joint Base San Antonio and AETC.
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COVID-19 Monitoring and Response Among U.S. Air Force Basic Military Trainees — Texas, March–April 2020 June 2, 2020

Joseph E. Marcus, MD; Dianne N. Frankel, DO; Mary T. Pawlak, MD; Theresa M. Casey, DVM; Rebecca S. Blackwell, MD; Francis V. Tran, MD; Mathew J. Dolan, MD; Heather C. Yun, MD

The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial morbidity and mortality since it was first described in December 2019 (1). Based on epidemiologic data showing spread in congregate settings (2–4), national, state, and local governments instituted significant restrictions on large gatherings to prevent transmission of disease in early March 2020.

This and other nonpharmaceutical interventions (NPIs) have shown initial success in slowing the pandemic across the country (5). This report examines the first 7 weeks (March 1–April 18) of implementation of NPIs in Basic Military Training (BMT) at a U.S. Air Force base.

In a population of 10,579 trainees, COVID-19 incidence was limited to five cases (47 per 100,000 persons), three of which were in persons who were contacts of the first patient. Transmission of symptomatic COVID-19 was successfully limited using strategies of quarantine, social distancing, early screening of trainees, rapid isolation of persons with suspected cases, and monitored reentry into training for trainees with positive test results after resolution of symptoms.

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My pulmonologist has a different sense of humor

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Cool immunology cells guide download. Have to sign up.

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Large meta analysis of over 20,000 inpatients (about 1/3 of total in the UK).

UK researchers analysed data from 20,133 patients with COVID-19 admitted to 208 acute care hospitals in England, Wales, and Scotland between 6 February and 19 April 2020.

This represents around a third of all patients admitted to hospital with COVID-19 in the UK. The average age of patients in the study was 73 years, and more men (12,068; 60%) were admitted to hospital than women (8,065; 40%).

Besides increasing age, and underlying heart, lung, liver and kidney disease–factors already known to cause poor outcomes–the researchers found that obesity and gender were key factors associated with the need for higher levels of care and higher risk of death in hospital.

At the time of publication, just over a quarter (26%) of all COVID-19 patients in hospital had died, 54% were discharged alive, and a third (34%) remained in hospital. Outcomes were poorer for those requiring mechanical ventilation: 37% had died, 17% had been discharged alive, and 46% remained in hospital.

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I love to sing. Sigh​:frowning::triumph::sneezing_face:

You Can Speak (and Sing) COVID-19

Stephen G. Baum, MD reviewing Hamner L et al.

MMWR Morbidity Mortality Weekly Report
2020 May 15

Stadnytskyi V et al.
Proc Natl Acad Sci U S A
2020 May 13

An epidemiologic investigation of choir-related spread and experimental data on the lifetime of respiratory particles produced by speech indicate that minimal exposure to SARS-CoV-2 can cause disease.

Increasing evidence points to transmission of SARS-CoV-2, the coronavirus that causes COVID-19, by asymptomatic or presymptomatic persons. Two studies contribute to the concept that these persons can transmit infection by producing respiratory droplets or aerosols with what would be considered minimal, nontussive respiratory effort.

Hamner and colleagues report the epidemiology of one of the first outbreaks of COVID-19 in the U.S.

This outbreak occurred in Skagit County, Washington, in March 2020 and was eventually traced back to a choir practice involving 61 persons, 1 of whom had COVID-19 symptoms during the 2.5-hour encounter.

In all, investigators identified 53 affected attendees, including 33 confirmed and 20 probable cases, representing a secondary attack rate of 53.3% for confirmed cases and 86.7% overall.

The encounter involved many socializing events and opportunities, including close seating arrangements, and no precautions were taken at this very early event in the history of the epidemic in the U.S.

Two choir practices within a 2-week period were thought to have amplified the number of infected choir members. The authors calculated that the second practice was most likely a superspreader event.

Stadnytskyi and colleagues used laser light scattering to attempt to measure the amount and size of potentially infectious particles generated by loud speech.

Normal speaking produces thousands of fluid droplets with broad size distribution. The rate at which these droplets fall is directly related to their size. This size may decrease rapidly as the droplets dehydrate due to evaporation, yielding a longer lifetime (suspension time) in air.

Using droplet size and number data, and calculations of the chance that a droplet of a specific size will contain at least one SARS-CoV-2 infectious particle, the authors estimate that 1 minute of loud speech generates at least 1000 virion-containing droplet nuclei that will remain airborne for at least 8 minutes.

Smaller-than-average droplets may remain airborne for much longer, and patients with higher airway viral load may produce droplets with a higher viral concentration than were used in these calculations.

COMMENT

Although these studies had vastly different approaches, they both bear out the concept that SARS-CoV-2 is readily transmissible through speech and such praiseworthy practices as choral singing. These findings, in turn, make the practices of social distancing and mask wearing essential, especially as we “open up society.”

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Stephen G. Baum, MD at time of publication

Consultant/Advisory BoardClinical Infectious DiseasesEquitySelect Medical Holdings Corp. (no annual income is derived from this equity holding)Editorial BoardsMedical Letter

CITATION(S):

Hamner L et al. High SARS-CoV-2 attack rate following exposure at a choir practice— Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020 May 15; 69:606. (High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020 | MMWR)

Stadnytskyi V et al. The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission. Proc Natl Acad Sci U S A 2020 May 13; [e-pub]. (https://doi.org/10.1073/pnas.2006874117)

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Valley Fever (Coccidioidomycosis) is a fungal illness that usually affects the lungs. It is spread through spores in the air when the dirt is disturbed.
People can get Valley Fever if they breathe in the dust from the dirt that contains fungal spores. Fungal spores can get into the air when dirt containing the fungus is disturbed by digging, during construction, or under strong winds.
About 60 percent of persons infected are asymptomatic. Most people who have symptoms develop a flu-like illness with cough, fever, chest pain, headache, muscle aches, rash and tiredness that can last a month. Less than one percent of infected persons develop disseminated Valley Fever, which occurs when the infection spreads to other parts of the body.
When Valley Fever is suspected, the doctor can order an antibody blood test or culture. Although many persons with Valley Fever require no treatment, all persons with symptoms should seek medical attention.
Environments that cause dirt/dust inhalation (where Valley Fever is common) increase the risk of getting the illness, however, Valley Fever is not transmitted from one person to another. Statistics show that some populations are more susceptible to Valley Fever infection than others. This includes persons who are immunocompromised, in the third trimester of pregnancy, the elderly and persons of African or Filipino descent.
Kern County has the highest rate of Valley Fever infections in California with rates varying between 75 to 304 cases per 100,000 people, according to 412th MDG.
Other areas of the state are impacted as well. Already in 2017, media reported 30 cases and two deaths from Valley Fever in San Luis Obispo County in 2017.
There is currently no vaccine. Persons should avoid exposure to dusty air in areas where Valley Fever is common. Those exposed to dust during their jobs or outside activities in these areas should consider respiratory protection such as a properly-fitted N95 mask.

1038

Low-dose aspirin significantly lowers cardiovascular disease risk but increases the risk of bleeding, according to a review published in the British Journal of Clinical Pharmacology.

Investigators conducted the review because the overall balance between risks and benefits of taking aspirin has been unclear. The team pooled information from analyses of all relevant observational studies and randomized controlled trials.

Use of low-dose aspirin in people without cardiovascular disease was associated with a 17% lower incidence of cardiovascular events (such as non-fatal heart attacks, non-fatal strokes, or cardiovascular-related deaths). Low-dose aspirin use was also associated with a 47% higher risk of gastrointestinal bleeding and a 34% higher risk of intracranial bleeding.

“These risks and benefits need to be weighted in formal decision analyses to guide aspirin use in primary prevention,” said co-author Lee Smith, MSc, PhD, of Anglia Ruskin University, in the UK.

The authors noted that although many dozens of health effects besides cardiovascular disease and bleeding have been assessed, evidence for these remains weak and therefore should not be a major consideration when deciding whether to use low-dose aspirin.

https://bpspubs.onlinelibrary.wiley.com/journal/13652125

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Are medical errors the third leading cause of death as purported by a variety of quacks? No. But, one death from medical error is too many. Roughly 5,200 deaths a year from AEMT and 108,000 deaths in which an AEMT was contributory are still too many.

https://www.google.com/amp/s/www.sciencealert.com/no-500-people-don-t-die-in-the-us-every-two-days-due-to-medical-error/amp

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If it isn’t peer reviewed, if they don’t provide refereed journal, references, if they sell their own cures.

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When reading about miracle cures or whacko claims, look for a preponderance of empirical data reproduced by independent groups, documentation of methods, discussion of limitations, and refereed review. No reproducible data, it’s most likely bullshit.

Hitchens’ razor is an epistemological razor expressed by writer Christopher Hitchens. It says that the burden of proof regarding the truthfulness of a claim lies with the one who makes the claim; if this burden is not met, then the claim is unfounded, and its opponents need not argue further in order to dismiss it.

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Survival of the Wrongest

“But personal-health journalists have fallen into a trap. Even while following what are considered the guidelines of good science reporting, they still manage to write articles that grossly mislead the public, often in ways that can lead to poor health decisions with catastrophic consequences. Blame a combination of the special nature of health advice, serious challenges in medical research, and the failure of science journalism to scrutinize the research it covers.”

A plethora of good sources. Many written from press releases, many from original sources. Always demand links to the reference and cross check with other recent references.

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A cool but random desktop photo I found while cleaning up.

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Conversations with Giants in Medicine
Bruton’s tyrosine kinase inhibition effectively protects against human IgE-mediated anaphylaxis

Melanie C. Dispenza, … , Piper A. Robida, Bruce S. BochnerPublished June 2, 2020
Citation Information: J Clin Invest. 2020. https://doi.org/10.1172/JCI138448.

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969

New drug can prevent life-threatening anaphylaxis, shows study

For someone with a food or drug allergy, the risk of life-threatening anaphylactic shock lurks around every corner.

A new Northwestern Medicine study shows there might be a pill that can be taken proactively to prevent mild to life-threatening anaphylaxis, no matter the cause.

Anaphylaxis is a severe, potentially life-threatening systemic allergic reaction that can occur within seconds or minutes of exposure to an allergen.

It occurs in about one in 50 Americans, though many believe the rate is higher (closer to one in 20), according to the Asthma and Allergy Foundation of America.
If a person’s blood pressure drops so low during anaphylaxis or their airway closes up enough that they can’t get enough oxygen to their organs, they enter anaphylactic shock.

How do the drugs stop an allergic reaction before it begins?

The drugs used in the study are known as BTK inhibitors. BTK stands for an enzyme called Bruton’s tyrosine kinase, which is found inside cells, including mast cells.

The reason BTK inhibitors work to block allergic reactions is that by inhibiting, or blocking, the BTK enzyme, the mast cells cannot be triggered by allergens and allergic antibody to release histamine and other allergic mediators.

The study used three different BTK inhibitors, which blocked allergic reactions when tested on human mast cells in a test tube.

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A 2017 Annals of Family Medicine study found that among a group of 142 FM physicians, doctors spent on average nearly 6 of their 11-hour days working on EHRs. Record keeping took up 4.5 hours while on the job and 1.4 hours after clinical hours.

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IgE-mediated mast cell activation promotes inflammation and cartilage destruction in osteoarthritis

Qian Wang, Christin M Lepus, […], and William H Robinson

Osteoarthritis is characterized by articular cartilage breakdown, and emerging evidence suggests that dysregulated innate immunity is likely involved. Here, we performed proteomic, transcriptomic, and electron microscopic analyses to demonstrate that mast cells are aberrantly activated in human and murine osteoarthritic joint tissues.

Using genetic models of mast cell deficiency, we demonstrate that lack of mast cells attenuates osteoarthritis in mice. Using genetic and pharmacologic approaches, we show that the IgE/FcεRI/Syk signaling axis is critical for the development of osteoarthritis.

We find that mast cell-derived tryptase induces inflammation, chondrocyte apoptosis, and cartilage breakdown. Our findings demonstrate a central role for IgE-dependent mast cell activation in the pathogenesis of osteoarthritis, suggesting that targeting mast cells could provide therapeutic benefit in human osteoarthritis.

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A cross-sectional study of nausea in functional abdominal pain: relation to mucosal mast cells and psychological functioning

Craig Friesen, Meenal Singh, […], and Jennifer V. Schurman

BMC Gastroenterol. 2020; 20: 144.
Published online 2020 May 11. doi: 10.1186/s12876-020-01291-2
PMCID: PMC7216423
PMID: 32393272

Nausea is common in children and adolescents with pain-associated FGIDs as defined by Rome IV and is not unique to either FD or IBS.

Nausea is associated with increased mucosal mast cell density, non-gastrointestinal somatic symptoms, and psychologic dysfunction. Because of the distressing nature of nausea, and its negative associations with school and social functioning, it represents a treatment target of importance in its own right.

Prospective studies are needed to determine what is driving the association between nausea, mast cells, and psychological dysfunction, specifically to assess whether there is a cause-and-effect relationship.

Future studies should evaluate specific mast cell mediators in relation to nausea and evaluate the efficacy of medications directed at mast cell stabilization or antagonism of specific mast cell mediators in the treatment of nausea.

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Science and Peer Review. "Sorry, you are right in your criticism of our results, we screwed up. Masks are effective. Will do over. Thank you "