ABSTRACT
The recent ongoing COVID-19 pandemic caused by the SARS-CoV-2 virus saw many hospitalizations and deaths among elderly patients. It has been reported that the most common underlying conditions in these patients were obesity and diabetes. While both type 1 and type 2 diabetes pose a higher risk of severe or fatal COVID-19 infections, patients with type 2 diabetes required ICU treatment at a greater frequency than those with type 1 diabetes. However, whether diabetes affects susceptibility for COVID-19 has yet to be explored. This chapter focuses on both type 1 and type 2 diabetes, with the main goal of understanding this chronic condition during the pandemic, based on currently available case studies. © 2023 Elsevier Inc. All rights reserved.
ABSTRACT
Adult vaccination rates are low in the United States, despite clear benefits for reducing morbidity and mortality. Vaccine science is evolving rapidly, and family physicians must maintain familiarity with the most recent guidelines. The recommended adult immunization schedule is updated annually by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. All eligible patients should receive SARS-CoV-2 vaccines according to the current guidelines. Adults without contraindications should also receive an annual influenza vaccine. Hepatitis A vaccine is recommended for adults with specific risk factors. All pregnant patients, adults younger than 60 years, and those 60 years and older who have risk factors should receive a hepatitis B vaccine. A 15- or 20-valent pneumococcal conjugate vaccine is recommended for all patients who are 65 years and older. Patients who receive 15-valent pneumococcal conjugate vaccine should receive a dose of 23-valent pneumococcal polysaccharide vaccine one year later. Adults 19 to 64 years of age should receive a pneumococcal vaccination if they have medical risk factors. A single dose of measles, mumps, and rubella vaccine is recommended for adults without presumptive immunity, and additional doses are recommended for patients with HIV and postdelivery for pregnant patients who are not immune to rubella. A tetanus and diphtheria toxoids booster is recommended every 10 years. For pregnant patients and those in close contact with young infants, a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine should be administered. The human papillomavirus vaccine is recommended for all people through 26 years of age. Herpes zoster vaccine is indicated for all adults 50 years and older.Copyright © 2022 American Academy of Family Physicians.
ABSTRACT
Aim: UK endoscopy services faced challenges prior to SARS-CoV- 2. During the first months of the pandemic, activity fell by 92%. Consequently, in June 2020, NHS England recommended Faecal immunochemical testing (FIT) for all symptomatic patients to rationalise endoscopy. This study sought to evaluate the real-world safety and effectiveness of this approach. Method(s): Patients referred with suspected colorectal cancer (CRC) on the two-week wait (2ww) pathway were asked to complete a FIT. Samples were analysed using the OC-Sensor. While a FIT > 100 mug Hb/g was used to prioritise investigation, all patients were subsequently investigated. FIT results were correlated with diagnostic studies. Result(s): Between January to December 2020, 48% of referred patients had a FIT. 26% was above the threshold of 10 mug Hb/g in and 8.6% above 100mug Hb/g. 347 patients also had a positive FIT but were not referred. The sensitivity, specificity, NPV, PPV, and likelihood ratio at a threshold of 10mug Hb/g were 78.6%(95%CI0.69-0.86%), 36.8%(95%CI0.34-0.39%), 7.1%(95%CI0.057-0.088%), 96.5% (95%CI 0.95-0.98%) and 1.24 respectively. At 100mug Hb/g, this was 37.8%(95%CI0.29-0.48%), 80.2%(95%CI0.78-0.82%), 10.5%(95%CI0.077-0.14%), 95.4%(95%CI0.94-0.96%) and 1.9 respectively. Conclusion(s): FIT shows promise in trials, but our data raises concerns about real-world performance. Only 48% of patients completed FIT before referral, and we are exploring why 347 FIT-positive patients were not referred. While results are broadly congruent with reported literature that suggested 10% of CRC are FIT negative, this is greater in our cohort at 25%. This raises concerns about the safety of discharging patients based on FIT alone. Modifying the FIT threshold may be required and improving safety-netting where FIT is known to be ineffective, such as patients with iron deficiency anaemia.
ABSTRACT
Adult vaccination rates are low in the United States, despite clear benefits for reducing morbidity and mortality. Vaccine science is evolving rapidly, and family physicians must maintain familiarity with the most recent guidelines. The recommended adult immunization schedule is updated annually by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. All eligible patients should receive SARS-CoV-2 vaccines according to the current guidelines. Adults without contraindications should also receive an annual influenza vaccine. Hepatitis A vaccine is recommended for adults with specific risk factors. All pregnant patients, adults younger than 60 years, and those 60 years and older who have risk factors should receive a hepatitis B vaccine. A 15- or 20-valent pneumococcal conjugate vaccine is recommended for all patients who are 65 years and older. Patients who receive 15-valent pneumococcal conjugate vaccine should receive a dose of 23-valent pneumococcal polysaccharide vaccine one year later. Adults 19 to 64 years of age should receive a pneumococcal vaccination if they have medical risk factors. A single dose of measles, mumps, and rubella vaccine is recommended for adults without presumptive immunity, and additional doses are recommended for patients with HIV and postdelivery for pregnant patients who are not immune to rubella. A tetanus and diphtheria toxoids booster is recommended every 10 years. For pregnant patients and those in close contact with young infants, a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine should be administered. The human papillomavirus vaccine is recommended for all people through 26 years of age. Herpes zoster vaccine is indicated for all adults 50 years and older. .
ABSTRACT
The period of conception, pregnancy and the first 1000 days of life are crucial for a person's lifelong health. The recent rises in obesity before conception, through pregnancy and during childhood are increasing the risk of a non-communicable disease epidemic in the near future. Preventive measures targeted at the community level and implemented by local authorities may be the most effective way of creating healthy environments that improve lifelong health.