Imperial College London begins dosing in Covid-19 vaccine study
A clinical team at Imperial College London has administered a Covid-19 vaccine candidate to the first healthy participant in their clinical trial.
A small dose of the vaccine was given to the volunteer at a West London facility.
The development and clinical trials of this Covid-19 vaccine candidate are supported by more than £41m funding from the UK Government and an additional £5m in philanthropic donations.
Based on a new self-amplifying RNA (saRNA) technology, the vaccine was found to be safe and generated promising evidence of an effective immune response in pre-clinical safety tests and animal studies.
Imperial College London Infectious Disease department professor Robin Shattock said: “The first participant marks an important step for our saRNA vaccine platform, which has never before been trialled in humans.
“We now eagerly await rapid recruitment to the trial so that we can assess both the safety of the vaccine and its ability to produce neutralising antibodies, which would indicate an effective response against Covid-19.”
The volunteer who received the first dose will be given a second booster dose within four weeks. Multiple other participants are set to receive a first dose over the coming days.Participants will be monitored for safety and generation of antibodies against SARS-CoV-2.
Initially, 15 healthy volunteers in the trial will be given a low dose of Imperial vaccine, followed by increasingly higher doses for subsequent participants in order to evaluate safety and determine the optimal dosage.
Over the coming weeks, 300 healthy volunteers are set to receive two vaccine doses. If positive safety and immune response data is obtained, larger trials will be planned for later this year.
COVID-19 (Wuhan Coronavirus, 2019-nCoV) : Symptoms & Signs
SARS-CoV-2 (2019 novel coronavirus, 2019-nCoV, Wuhan coronavirus) is a new virus that researchers first identified in Wuhan province, China, in late 2019. Infection with SARS-CoV-2causes an illness called COVID-19. The virus has rapidly spread from China to other countries, including the U.S.
Symptoms of COVID-19 vary in severity. These can include flu-like symptoms suchas
- fever,
- cough,
- shaking chills,
- loss of sense of smell (anosmia) or taste (ageusia),
- headache,
- muscle pain,
- difficulty breathing, and
- shortnessof breath.
- On occasion, people may also have signs and symptoms that include diarrhea, a sorethroat, a stuffy or runny nose, and body aches and pains.
- In some people, the symptoms progressed to organ failure and death.
Cause of COVID-19
The cause of the illness is a novel coronavirus called SARS-CoV-2. Other viruses of this type have been responsible for outbreaks of pneumonia and related illnesses such as MiddleEast respiratory syndrome (MERS)and severe acute respiratory syndrome (SARS).
- Body Aches and Pains
- Cough
- Diarrhea
- Difficulty Breathing
- Fever
- Headache
- Loss ofSense of Smell (Anosmia)
- Loss of Sense of Taste (Ageusia)
- Muscle Pain
- Runny Nose
- Shaking Chills
- Shortness of Breath
- Sore Throat
- Stuffy Nose
Meter Dose Inhaler Use Method with the Spacer-Pulmonary Disorders Series 2020
A metered-dose inhaler is a small, hand-held device filled with medicine. It helps deliver a certain amount of medicine through your mouth and into your lungs. It is commonly used to treat breathing difficulties related to asthma, chronic obstructive pulmonary disease (COPD), and other respiratory problems.
Each inhaler consists of a small canister of medicine connected to a mouthpiece. The canister is pressurized. As you press down on the inhaler, it releases a mist of medicine. You breathe that mist into your lungs. It’s important to use your inhaler correctly. Otherwise, your airways will not receive the right amount of medicine. Read and follow all instructions that come with your inhaler
.
Here are the steps to correctly use your inhaler:
- · Remove the cap and hold the inhaler upright.
- · If your doctor recommends, use a spacer (a hollow, plastic chamber) to filter the medicine between the inhaler and your mouth. The chamber protects your throat from irritation from the medicine. Note: Check your insurance plan as some may not cover spacers.
- · Stand or sit up straight.
- · Shake the inhaler.
- · Tilt your head back slightly and breathe out all the way.
- · Put the inhaler in your mouth.
- · Press down on the inhaler quickly to release the medicine as you start to breathe in slowly.
- · Breathe in slowly for 3 to 5 seconds.
- · Hold your breath for 10 seconds to allow medicine to go deeply into your lungs.
- · Breathe out slowly.
- · Repeat puffs as directed by your doctor. Wait 1 minute before taking the second puff.
- · Some inhalers (steroid) also recommend rinsing your mouth out with water and gargling with water (spit out the water) after use.
- · These instructions are for a metered-dose inhaler only. Inhaled dry-powder inhalers are used differently. To use a dry powder inhaler, close your mouth tightly around the mouthpiece and breathe in quickly.
- · Talk to your doctor if you have any questions about how to take your inhaler.
It’s important to keep track of how much medicine you’ve used so you can replace your inhaler before you run out of medicine. Many inhalers include a “counter” on the back that keeps track of how much medicine is left in the device. If your inhaler does not, you can use the following method to figure out when you’ll need to get a refill:
With a new inhaler, the canister will usually have the number of puffs available printed on the label. Divide the number of puffs in the canister by the number of puffs you take each day. The number you get will be the number of days the canister should last. For example, if you take 4 puffs each day from a 200-puff canister, you will need to have a new canister every 50 days.
Using a calendar, count forward that many days to see when your medicine will run out. Choose a day 2 days before this date to have your prescription refilled so you won’t run out of medicine.
With a permanent marker, write the refill date on the canister and on your calendar.
If you use your inhaler for rescue medicine (when you are struggling the most to breathe), ask your doctor if he or she will write a prescription for 2 inhalers. Rescue inhalers aren’t used regularly, so it will be difficult to plan a refill date. Get your prescription filled when the first inhaler is empty. This way, you’ll always have enough rescue medicine on hand.
Asthma-Understanding the Disease-Management and Standard Treatment Guidelines
What is Asthma?
Asthma is a common disease, affecting approximately 8–10% of the population. It is slightly more common in male children (younger than 14 years) and in female adults. There is a genetic predisposition to asthma. Prevalence, hospitalizations, and fatal asthma have all increased in the United States over the past 20 years. Each year, approximately 10 million office visits, 1.8 million emergency department visits, and more than 3500 deaths in the United States are attributed to asthma. Hospitalization rates have been highest among blacks and children, and death rates are consistently highest among blacks aged 15–24 years.
Causes of Asthma
Asthma is a chronic disorder of the airways characterized by variable airway
obstruction, airway hyperresponsiveness, and airway inflammation. No single
histopathologic feature is pathognomonic but common findings include
1.airway inflammatory cell infiltration with eosinophils, neutrophils, and lymphocytes (especially T cells); goblet cell hyperplasia, sometimes plugging of small airways with mucus.
2.collagen deposition beneath the basement membrane; hypertrophy of bronchial smooth muscle; airway edema; mast cell activation; and denudation of airway epithelium.
3.Interleukin-5 is important in promoting eosinophilic inflammation.
4.The strongest identifiable predisposing factor for the development of asthma is atopy, but obesity is increasingly recognized as a risk factor.
Pathogenesis
1.Nonspecific precipitants of asthma include exercise, upper respiratory tract
infections, rhinosinusitis, postnasal drip, aspiration, gastroesophageal reflux, changes in the weather, and stress. Exposure to products of combustion (eg, from tobacco, crack cocaine, methamphetamines, and other agents) increases asthma symptoms and the need for medications and reduces lung function.
2.Air pollution (increased air levels of respirable particles, ozone, SO2, and NO2) precipitate asthma symptoms and increase emergency department visits and hospitalizations.
3.Selected individuals may experience asthma symptoms after exposure to aspirin (aspirin-exacerbated respiratory disease), nonsteroidal anti-inflammatory drugs, or tartrazine dyes.
4.Occupational asthma is triggered by various agents in the workplace and may occur weeks to years after initial exposure and sensitization.
5.Women may experience catamenial asthma at predictable times during
the menstrual cycle.
6.Exercise-induced bronchoconstriction begins during exercise or
within 3 minutes after its end, peaks within 10–15 minutes, and then resolves by 60 minutes. This phenomenon is thought to be a consequence of the airways’ attempt to warm and humidify an increased volume of expired air during exercise.
7.“Cardiac asthma” is wheezing precipitated by decompensated heart failure. Cough-variant asthma has cough instead of wheezing as the predominant symptom of bronchial hyperreactivity.
Symptoms and Signs
Asthma is characterized by episodic wheezing, difficulty in breathing, chest tightness, and cough.
Excess sputum production is common.
The frequency of asthma symptoms is highly variable.
Some patients have infrequent, brief attacks of asthma while others may suffer nearly continuous symptoms.
Asthma symptoms may occur spontaneously or be precipitated or exacerbated by many different triggers as discussed above.
Asthma symptoms are frequently worse at night; circadian variations in bronchomotor tone and bronchial reactivity reach their nadir between 3 AM and 4 AM, increasing symptoms of bronchoconstriction.
Hunched shoulders and use of accessory muscles of respiration suggest an increased work of breathing.
Laboratory Findings (Diagnosis)
Arterial blood gas measurementsmay be normal during a mild asthma exacerbation, but respiratory alkalosis and an increase in the alveolar-arterial oxygen difference (A–a–DO2) are common. During severe exacerbations, hypoxemia develops and the PaCO2 returns to normal. The combination of an increased PaCO2 and respiratory acidosis may indicate impending respiratory failure and the need for mechanical ventilation.
Pulmonary Function Testing
The evaluation for asthma should therefore include spirometry (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC) before and after the administration of a short-acting bronchodilator. These measurements help determine the presence and extent of airflow obstruction and whether it is immediately reversible. Airflow obstruction is indicated by a reduced FEV1/FVC ratio. Significant reversibility of airflow obstruction is defined by an increase of 12% or more and 200 mL in FEV1 or FVC after inhaling a short-acting bronchodilator. Exercise challenge testing may be useful in patients with symptoms of exercise induced bronchospasm.
Peak expiratory flow (PEF)
These meters are handheld devices designed as personal monitoring tools. PEF monitoring can establish peak flow variability, quantify asthma severity, and provide both patient and clinician with objective measurements on which to base treatment decisions. An absolute eosinophil count can identify patients eligible for anti–interleukin-5 therapy to manage eosinophilic airway disease.
Differential Diagnosis
Patients who have atypical symptoms or poor response to therapy may have a condition that mimics asthma. These disorders typically fall into one of five categories:
Systemic vasculitides
Cardiac disorders
Psychiatric disorders
Upper airway disordersthat mimic asthma include vocal fold paralysis, vocal fold dysfunction syndrome, foreign body aspiration, laryngotracheal masses, tracheal narrowing, tracheobronchomalacia, and airway edema (eg, angioedema or inhalation injury).
Lower airway disordersinclude nonasthmatic chronic obstructive pulmonary disease (COPD) (chronic bronchitis or emphysema), bronchiectasis, allergic bronchopulmonary mycosis, cystic fibrosis, eosinophilic pneumonia, hypersensitivity pneumonitis, sarcoidosis, and bronchiolitis obliterans.
Systemic vasculitideswith pulmonary involvement may have an asthmatic component, such as eosinophilic granulomatosis with polyangiitis.
Cardiac disordersinclude heart failure and pulmonary hypertension. Psychiatric causes include conversion disorders (“functional” asthma), emotional laryngeal wheezing, vocal fold dysfunction, or episodic laryngeal dyskinesis. Rarely, Münchausen syndrome or malingering may
explain a patient’s complaints.
Report of the National Asthma Education and Prevention
Program (NAEPP), in conjunction with the Global Initiative for Asthma, a collaboration between the National Institutes of Health/National Heart, Lung, and Blood Institute and the World Health Organization, provides guidelines for diagnosis and management of asthma. This report identifies four components of chronic asthma diagnosis and management:
(1) assessing and monitoring asthma severity and
asthma control
(2) patient education designed to foster a partnership for care
(3) control of environmental factors and comorbid conditions that affect asthma
(4) pharmacologic therapy for asthma.
Clinical Diagnosis
1.Episodic or chronic symptoms of wheezing, dyspnea, or cough.
2.Symptoms frequently worse at night or in the early morning.
3.Prolonged expiration and diffuse wheezes on physical examination.
4.Limitation of airflow on pulmonary function testing or positive bronchoprovocation challenge.
5.Reversibility of airflow obstruction, either spontaneously or following
bronchodilator therapy.
Pharmacologic Agents
Asthma medications can be divided into two categories:
(1) quick relief (reliever) medications that act principally by direct relaxation of bronchial smooth muscle, thereby promoting prompt reversal of acute airflow obstruction to relieve accompanying
symptom
(2) long-term control (controller) medications that act primarily to
attenuate airway inflammation and that are taken daily independent of symptoms to achieve and maintain control of persistent asthma. Anti-inflammatory agents, long-acting bronchodilators, and leukotriene modifiers comprise the important long-term control medications. Most asthma medications are administered by inhalation or orally. Inhalation of an appropriate agent results in a more rapid onset of pulmonary effects as well as fewer systemic effects compared with oral administration of the same dose. Proper inhaler technique and the use of an inhalation chamber (a “spacer”) with metered-dose inhalers
(MDIs) decrease oropharyngeal deposition and improve drug delivery to the lung. Nebulizertherapy is reserved for patients who are acutely ill and those who cannot use inhalers because of difficulties with coordination, understanding, or cooperation.
Gilead’s Investigational Antiviral Remdesivir Receives U.S. Food and Drug Administration Emergency Use Authorization for the Treatment of COVID-19
Food & Drug Administration,United States of America on May 1,2020 authorised the emergency use of investigational & under trial drug named as Remdesivir for treatment of hospitalized patients with COVID-19.
Authorization Enables Broader Use of Remdesivir to Treat Hospitalized Patients with Severe COVID-19 Disease.Based on Patients’ Severity of Disease, Authorization Allows 5-day and 10-day Treatment Durations.
History of REMDESIVIR
Remdesivir is a broad-spectrum antiviral medication developed by the biopharmaceutical company Gilead Sciences. Earlier studies found antiviral activity against several RNA viruses including SARS coronavirus and Middle East respiratory syndrome-related coronavirus, but it is not currently approved for any indication.Remdesivir was originally developed to treat Ebola virus disease and Marburg virus disease but was ineffective for these viral infections.
As of 2020, remdesivir is under investigation as a specific treatment for COVID-19, and has been authorised by the US Food and Drug Administration (FDA) for emergency treatment for those hospitalized with severe disease.It may have an effect on the time it takes to recover from the disease.
Drug Details(pharmacology)
Remdesivir is an investigational antiviral compound undergoing clinical trials in a number of countries as a potential treatment for COVID-19. Remdesivir is a nucleoside ribonucleic acid (RNA) polymerase inhibitor.It is a direct acting antiviral drug that inhibits viral RNA synthesis. It is an investigational drug and is not currently approved for any indication.It has activity in cell culture and animal models against SARS-CoV, MERS-CoV, and SARS-CoV-2.
Targeted patients
· The remdesivir covered by this authorization will be used only to treat adults and children with suspected or laboratory confirmed COVID-19 and severe disease defined as SpO2 ≤ 94% on room air, requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).
· Remdesivir is administered in an in-patient hospital setting via intravenous (IV) infusion by a healthcare provider.
Product Description
Remdesivir is a nucleoside ribonucleic acid (RNA) polymerase inhibitor.
Remdesivir for injection, 100 mg, is a sterile, preservative-free lyophilized solid that is to be reconstituted with 19mL of sterile water for injection and diluted into 0.9% saline prior to intravenous (IV) administration.
Following reconstitution, each single-dose, clear glass vial contains a 5 mg/mL remdesivir concentrated solution with sufficient volume to allow withdrawal of 20 mL. Remdesivir Injection, 5 mg/mL, is a sterile, preservative- free, clear, solution that is to diluted into 0.9% saline prior to intravenous (IV) administration.
The authorized remdesivir vial label and/or the carton labeling is clearly marked for “emergency use authorization” or for “investigational use.”
Storage of Drug
Remdesivir for injection, 100 mg, vials should be stored below 30 °C until time of use.
Remdesivir injection, 5 mg/mL vials should be stored at refrigerated temperatures (2 °C to 8 °C) until time of use.
Following dilution with 0.9% saline, the solution can be stored for up to 4 hours at room temperature (20 °C to 25 °C) or 24 hours at refrigerated temperatures (2 °C to 8 °C).
Disorders of Airways-Pulmonary Disorders Management and Guides Series
Disorders of Airways-Pulmonary Disorders Management and Guides
Disorders of Upper Airways
1.Acute obstruction of the upper airway
It can be immediately life-threatening and must be relieved promptly to avoid asphyxia.
Causes & Diagnosis
Acute upper airway obstruction causes include trauma to the larynx or pharynx, foreign body aspiration, laryngospasm, laryngeal oedema from thermal injury or angioedema, infections (acute epiglottitis, Ludwig angina, pharyngeal or retropharyngeal abscess), and acute allergic laryngitis.
2.Chronic obstruction of the upper airway
It may be caused by carcinoma of the pharynx or larynx, laryngeal or subglottic stenosis, laryngeal granulomas or webs, or bilateral vocal fold paralysis. Laryngeal or subglottic stenosis may become evident weeks or months after trans laryngeal endotracheal intubation. Inspiratory stridor, intercostal retractions on inspiration, a palpable inspiratory thrill over the larynx, and wheezing localized to the neck or trachea on auscultation are characteristic findings.
Diagnosis
Flow-volume loops may show characteristic flow limitations. Soft-tissue radiographs of the neck may show supraglottic or infraglottic narrowing. CT and MRI scans can reveal exact sites of obstruction. Flexible endoscopy may be diagnostic, but caution is necessary to avoid exacerbating upper airway edema and precipitating critical airway narrowing.
Vocal fold dysfunction syndrome
It is characterized by paradoxical vocal fold adduction, resulting in both acute and chronic upper airway obstruction.
Causes & Diagnosis
It can cause dyspnoea and wheezing that may be distinguished from asthma or exercise-induced asthma by the lack of response to bronchodilator therapy, normal spirometry immediately after an attack, spirometry evidence of upper airway obstruction, a negative bronchial provocation test, or direct visualization of adduction of the vocal folds on both inspiration and expiration. The condition appears to be psychogenic in nature.
Treatment
It consists of speech therapy, which uses breathing, voice, and neck relaxation exercises to abort the symptoms
Disorders of Lower Airways
1.Tracheal obstruction
Causes
It may be intrathoracic (below the suprasternal notch) or extrathoracic.Fixed tracheal obstruction may be caused by acquired or congenital tracheal stenosis, primary or secondary tracheal neoplasms, extrinsic compression (tumors of the lung, thymus, or thyroid; lymphadenopathy; congenital vascular rings; aneurysms; etc), foreign body aspiration, tracheal granulomas and papillomas, and tracheal trauma.Tracheomalacia, foreign body aspiration, and retained secretions may cause variable tracheal obstruction.
2.Acquired tracheal stenosis
Causes
It is usually secondary to tracheotomy or endotracheal intubation. Dyspnoea, cough, and inability to clear pulmonary secretions occur weeks to months after tracheal decannulation or extubating.
Diagnosis
Physical findings may be absent until tracheal diameter is reduced 50% or more, when wheezing, a palpable tracheal thrill, and harsh breath sounds may be detected. The diagnosis is usually confirmed by plain films or CT of the trachea. Complications include recurring pulmonary infection and life-threatening respiratory failure.
Management
It is directed toward ensuring adequate ventilation and oxygenation and avoiding manipulative procedures that may increase enema of the tracheal mucosa. Surgical reconstruction, endotracheal stent placement, or laser photo resection may be required.
3.Bronchial obstruction
Causes
It may be caused by retained pulmonary secretions, aspiration, foreign bodies, bronchomalacia, bronchogenic carcinoma, compression by extrinsic masses, and tumours metastatic to the airway.
Diagnosis & Management
Clinical and radiographic findings vary depending on the location of the obstruction and the degree of airway narrowing. Symptoms include dyspnoea, cough, wheezing, and, if infection is present, fever and chills. A history of recurrent pneumonia in the same lobe or segment or slow resolution (more than 3 months) of pneumonia on successive radiographs suggests the possibility of bronchial obstruction and the need for bronchoscopy. Radiographic findings include atelectasis (local parenchymal collapse), post obstructive infiltrates, and air trapping caused by unidirectional expiratory obstruction. CT scanning may demonstrate the nature and exact location of obstruction of the central bronchi. Bronchoscopy is the definitive diagnostic study, particularly if tumour or foreign body aspiration is suspected. The finding of bronchial breath sounds on physical examination or an air bronchogram on chest radiograph in an area of atelectasis rules out complete airway obstruction. Bronchoscopy is unlikely to be of therapeutic benefit in this situation.
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