Latest / Morning Medical with Dr. Chow / COVID-19 Vaccine Updates, Cardiovascular Health, and UV Radiation Risks

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COVID-19 Vaccine Updates, Cardiovascular Health, and UV Radiation Risks · Morning Medical with Dr. Chow

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  Good morning, everyone!
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  Welcome to another episode of Morning Medical with Dr.
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  Chow.
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  I'm Dr.
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  Chi-Ming Chow, and today we're diving into some of the latest and most pressing health news
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  from around the globe.
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  Let's get started with an important update on COVID-19 vaccines in the United States.
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  As a summer wave of COVID-19 infections continues in the United States, updated
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  vaccines have been approved by U.S.
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  regulators ahead of the fall and winter seasons.
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  The United States Food and Drug Administration, or FDA, has greenlit and granted emergency use
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  authorization for updated COVID-19 vaccines from Pfizer and Moderna.
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  These vaccines target the most recent virus strains circulating.
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  The new messenger RNA vaccines from both pharmaceutical companies specifically target
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  the Omicron KP.2 variant that was dominating the spread of COVID-19 earlier this year.
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  While additional offshoots, particularly KP.3.1.1, are now spreading in both the United
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  States and Canada, these vaccines promise cross-protection due to their close relation to
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  the targeted variant.
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  According to a statement from the FDA, 'the messenger RNA COVID-19 vaccines have been
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  updated with this formula to more closely target currently circulating variants and
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  provide better protection against serious consequences of COVID-19, including
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  hospitalization and death.'
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  The updated shots have been approved for everyone aged six months and older.
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  They met the FDA's rigorous scientific standards for safety, effectiveness, and
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  manufacturing quality.
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  This approval comes as COVID-19 cases have been rising across the United States over the summer
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  months.
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  The latest United States wastewater data from the Centers for Disease Control and Prevention
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  showed a 'very high' level of COVID-19 in the country.
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  Meanwhile, Health Canada told Global News earlier this week that it was still reviewing
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  submissions from Pfizer, Moderna, and Novavax for their updated COVID-19 shots.
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  Nicholas Janveau, a spokesperson for Health Canada, said in an email on Tuesday, 'Health
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  Canada will authorize the vaccines if, following a thorough and independent scientific
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  review of the evidence, we determine that the vaccines meet safety, quality, and efficacy
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  standards.'
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  Starting in the fall of 2024, Canada’s National Advisory Committee on Immunization strongly
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  recommends the most recently updated COVID-19 vaccines for both previously vaccinated and
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  unvaccinated individuals at increased risk of SARS-CoV-2 infection or severe COVID-19
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  illness.
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  These groups include everyone aged 65 or older, long-term care home residents, pregnant people,
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  those with underlying medical conditions, and people from Indigenous communities.
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  Allison McGeer, an infectious disease physician at Sinai Health in Toronto, told Global News in
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  an interview this week that 'COVID is still a concern in Canada,' urging people to get
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  vaccinated.
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  'I think from what we’ve seen, we are expecting there’s going to be a significant amount of
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  COVID in the fall and winter,' McGeer said.
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  'There’s still very clearly a benefit to getting your shot when they’re available in
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  Canada to protect you through the winter.'
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  While counseling about walking did not increase step counts for people with peripheral artery
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  disease, it was still linked to cardiovascular prevention in a post hoc analysis of a small
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  randomized trial.
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  After a few sessions of advice and goal-setting support, both face-to-face and over the phone,
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  a significant reduction in major adverse cardiovascular events was observed over an
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  average of three and a half years' follow-up.
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  This was compared with controls who received the same amount of attention from
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  non-counseling phone calls.
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  Notably, the difference seemed to be explained by improvements in disease-specific quality of
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  life at four and twelve months.
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  After adjusting for quality of life scores, the counseling intervention was no longer
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  significantly associated with a lower risk of major adverse cardiovascular events, as
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  reported by the BIP trialists led by Jonathan Golledge from James Cook University in
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  Townsville, Australia, in JAMA Surgery.
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  'To our knowledge, the BIP trial is the first randomized clinical trial to show that a
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  physical activity counseling intervention, which also improved quality of life, is
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  associated with reduced risk of major adverse cardiovascular events, a finding which needs to
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  be validated in larger trials,' the authors wrote.
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  That's especially true as the trial missed its primary endpoint, finding that counseling in
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  peripheral artery disease did not significantly increase steps walked.
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  It had been thought that improved walking or increased physical activity would be the main
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  way to reduce cardiovascular events in peripheral artery disease.
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  'It is plausible that both impaired walking and reduced quality of life are independent
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  modifiable risk factors for major adverse cardiovascular events in people with peripheral
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  artery disease,' Golledge and coauthors wrote.
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  Major adverse cardiovascular events included myocardial infarction, stroke, and
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  cardiovascular death in the study.
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  Between the intervention and control arms in BIP, a lower risk of major adverse
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  cardiovascular events was significantly predicted by: Intermittent Claudication
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  Questionnaire score and Peripheral Artery Disease Quality of Life domains of symptoms and
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  limitations in physical functioning.
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  'These results align with other studies that found associations between better quality of
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  life and improved clinical outcomes, although there is limited evidence for this in
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  peripheral artery disease,' commented Manasi Tannu and Jennifer Rymer, both of Duke
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  University School of Medicine in Durham, North Carolina.
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  In an accompanying editorial, Tannu and Rymer cited some data that walking is not all that
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  matters in peripheral artery disease, as home-based walking exercise interventions have
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  increased walking distance without much improvement in quality of life.
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  BIP had been designed to test an intervention aimed at helping patients with the challenges
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  of increasing physical activity.
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  The two hundred participants who were randomized all got a pamphlet recommending that
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  they walk for forty minutes at least three times a week.
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  The intervention arm was provided with two weekly face-to-face meetings with trained
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  allied health professionals and two subsequent phone calls at weeks six and twelve.
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  Among the components of the counseling were advice-giving, social support, and
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  encouragement of three forty-minute sessions per week of interval walking at maximum
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  tolerated speed.
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  'The intervention in the BIP trial focused on assisting participants to understand and
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  self-manage the challenges of exercising with ischemic leg pain.
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  It is possible this led to more acceptance and reduced psychological distress, which then led
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  to less perceived physical disability and pain and, thus, improved quality of life and reduced
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  risk of major adverse cardiovascular events,' Golledge and colleagues suggested.
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  Also, 'there was a significant reduction in depression and anxiety in participants
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  allocated to the intervention, which could have contributed to the reduced risk of major
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  adverse cardiovascular events that was identified.'
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  However, attendance for follow-up dropped from eighty-eight percent at four months to only a
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  quarter at six years.
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  Such large loss to follow-up was a major limitation of the study, which had a small
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  sample to begin with.
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  'In conclusion, the present analysis presents a compelling hypothesis that improving quality of
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  life through counseling interventions may reduce major adverse cardiovascular events in
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  patients with symptomatic peripheral artery disease.
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  Future randomized clinical trials may further define the etiology of such interventions in
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  improving major adverse cardiovascular events, with specific measures for psychological
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  distress and self-care behaviors,' according to Tannu and Rymer.
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  In a significant move towards addressing a growing crisis, the Premier of Manitoba is
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  currently in discussions with the Chief Public Health Officer to officially declare intimate
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  partner violence an epidemic.
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  The talks come as advocates in the province report an alarming increase in both the
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  frequency and severity of family violence incidents.
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  The urgency of the situation has been underscored by recent tragic events, including
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  a triple homicide in southwestern Manitoba last week.
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  This has spurred calls from various advocacy groups for the province to adopt a
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  comprehensive approach to prevent such tragedies from recurring.
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  Advocates are urging the government to work 'across the board' to implement preventive
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  measures and provide support for victims.
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  They emphasize the need for a multi-faceted strategy that includes education, mental health
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  services, and stronger legal protections for those affected by intimate partner violence.
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  Declaring intimate partner violence an epidemic would not only raise public awareness but also
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  potentially unlock additional resources and funding to combat the issue.
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  This designation could lead to more robust policy measures and coordinated efforts across
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  various sectors, including healthcare, law enforcement, and social services.
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  The Premier's office has yet to release an official statement on the matter, but insiders
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  suggest that the discussions are progressing positively.
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  The Chief Public Health Officer has reportedly expressed strong support for the declaration,
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  recognizing the urgent need for a coordinated, province-wide response.
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  Public health experts argue that intimate partner violence has far-reaching consequences,
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  impacting not just the immediate victims but also their families and communities.
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  Addressing it as a public health crisis could facilitate a more holistic approach to
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  intervention and prevention, potentially reducing the long-term social and economic
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  costs associated with family violence.
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  The move to declare intimate partner violence an epidemic is being closely watched by other
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  provinces, which may consider similar actions if the initiative proves successful in
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  Manitoba.
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  This could set a precedent for how intimate partner violence is addressed nationwide,
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  highlighting the importance of a unified and proactive approach to this pervasive issue.
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  While the skin risks of ultraviolet radiation get a lot of attention, exposure to ultraviolet
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  rays can also lead to an eye condition called pterygium, which is commonly referred to as
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  'surfer's eye.'
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  Matthew Gorski, an ophthalmologist at Northwell Health in Great Neck, New York, told MedPage
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  Today that he sees multiple patients with pterygium every single day -- and the vast
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  majority are not surfers but have other exposure risk factors.
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  'A pterygium is a very common fleshy growth of the cornea and conjunctiva.
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  Some people call it 'surfer's eye,' although it can certainly happen in patients who are not
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  surfers,' Gorski said, noting that people who are exposed to a lot of ultraviolet radiation
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  are most at risk.
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  This includes people who spend a lot of time outside as well as people who live close to the
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  equator, where ultraviolet rays are stronger.
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  'Growth usually begins on the conjunctiva, and then you get this fibrovascular development --
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  so blood vessels and fibers grow -- and it can grow from the conjunctiva onto the cornea,' he
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  explained.
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  Wearing sunglasses with ultraviolet protection is critical to preventing pterygium formation
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  and growth, Gorski said.
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  Cheap sunglasses with questionable ultraviolet protection proliferate on sites like Temu and
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  Amazon, but Gorski encouraged purchasing eyewear from reputable vendors to ensure
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  maximum ultraviolet protection.
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  He noted that keeping the eyes lubricated can also help, because a dry ocular surface can
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  promote the growth of pterygia.
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  Patients with a pterygium often present to the office with a red inflamed eye and may complain
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  of irritation or a foreign body sensation.
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  If the pterygium has grown significantly, the patient might notice a white spot on the eye.
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  Pterygia can also become raised, which contributes to the scratchy, irritated feeling.
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  Gorski noted that pterygia does not start in the central visual axis, but they can
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  eventually grow to affect the vision.
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  Treating a pterygium starts conservatively with lubrication from artificial tears and topical
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  anti-inflammatory drops.
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  But at a certain point, surgery is the only way to totally get rid of the growth.
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  Researchers are actively exploring ways to shrink pterygia without surgery, like medicated
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  eye drops, but there are no Food and Drug Administration approved drugs to treat the
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  condition.
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  'If [the pterygium] starts to be persistently red, inflamed, and bothersome, or if it starts
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  to grow towards your central cornea where it's starting to affect the vision, that's when we
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  recommend surgical removal,' Gorski said.
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  He described the removal surgery as low-risk; patients are in and out the same day, though
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  full recovery takes a few weeks.
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  'We delicately peel the growth off the surface of the eye, and then there's a variety of
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  different techniques we use to cover the area where the pterygium used to be,' he explained.
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  One method is conjunctival autograft, which uses a piece of conjunctiva tissue from behind
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  the eyelid to patch the hole.
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  This method still leaves a wound on the eye, but in a better protected area.
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  Another method is amniotic tissue graft, which uses donated amniotic membrane tissue from a
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  placenta to act as a sort of bandage while the eye heals.
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  This technique is especially helpful for pterygia too large for autografting, according
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  to the Cleveland Clinic.
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  Pterygia are benign; but as a safeguard, the surgically removed growths are sent to
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  pathology for testing to ensure they're not cancerous.
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  Cancerous growths 'can sometimes mimic a pterygium, so a thorough clinical evaluation is
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  important,' Gorski said.
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  Part of this evaluation is assessing the mobility of the lesion, as well as looking for
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  any irregular pigmentation or irregular blood vessels.
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  Conjunctival lissamine green might be used to stain the ocular surface to look for these
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  signs that may indicate malignancy.
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  In Canada, a nationwide railway shutdown has raised alarms over a potential critical
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  shortage of essential goods, including chlorine, which is vital for ensuring safe
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  drinking water.
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  The Health Minister, Mark Holland, acknowledged the gravity of the situation, stating that the
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  government is closely monitoring the impact on the supply chain.
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  Minister Holland emphasized that it is still too early to determine the full extent of the
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  impact on Canada's drinking water supply.
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  However, he assured that the government is vigilant and will take necessary measures to
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  mitigate any negative effects.
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  'We're always monitoring the situation.
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  So that's extremely important for us to be able to take a look at what's happening, how it
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  might affect the supply chain, how it might affect health,' Holland told Global News in a
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  recent interview.
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  The railway shutdown follows a failure to reach a new agreement between Canadian National
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  Railway, also known as CN, and Canadian Pacific Kansas City, or CPKC, with the Teamsters union.
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  This lockout has brought rail traffic to a standstill on Canada's two largest railways,
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  affecting the transportation of many critical goods, including chlorine.
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  The Chemistry Industry Association of Canada, or CIAC, has urged the federal government to
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  intervene immediately, warning that the work stoppage could soon have serious public safety
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  implications.
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  According to CIAC, 96 percent of Canadians rely on chlorine and chlorine derivatives for safe
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  drinking water.
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  Without timely intervention, municipalities across the country may be forced to issue boil
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  water advisories.
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  Chlorine, which is used to disinfect drinking water, is primarily distributed throughout
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  Canada and the United States via railway.
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  Due to the lockout, shipments of chlorine are expected to become unavailable, which could
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  impact the quality of drinking water within two weeks.
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  Alan Robinson, the commercial vice-president at Chemtrade Logistics Incorporated, pointed out
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  that their company provides chlorine for 40 percent of Western Canada's drinking water and
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  much of the western United States.
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  Robinson highlighted the logistical challenges of transporting chlorine by any means other
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  than rail.
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  'There is no plan B ...
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  to transport this kind of volume you will need 2,000 trucks, roughly.
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  There aren't 2,000 trucks, and there aren't 2,000 drivers,' he told the Canadian Press.
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  Most municipalities only have a few days' worth of treated water in storage tanks, making the
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  situation even more urgent.
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  Even before the lockout, freight railways had already begun turning away an increasing number
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  of goods in anticipation of a potential work stoppage.
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  This preemptive move aimed to minimize disruptions to supply chains and industries,
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  including the chlorine supply chain.
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  The situation remains fluid, and the federal government is under increasing pressure to find
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  a resolution.
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  The potential public health implications underscore the need for a swift and effective
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  response to ensure the continued safety of Canada's drinking water supply.
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  That wraps up today's episode of Morning Medical with Dr.
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  Chow.
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  Thank you for joining me as we navigated through these crucial health updates.
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  Stay tuned for our next episode, and as always, stay healthy and informed.
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  I'm Dr.
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  Chi-Ming Chow, signing off.