Doctors and nurses battle virus skeptics

MISSION, Kan. (AP) — Treating the sick and dying isn’t even the toughest part for nurse Amelia Montgomery as the coronavirus surges in her corner of red America.

It’s dealing with patients and relatives who don’t believe the virus is real, refuse to wear masks and demand treatments like hydroxychloroquine, which President Donald Trump has championed even though experts say it is not effective against the scourge that has killed over 210,000 in the U.S.

Montgomery finds herself, like so many other doctors and nurses, in a world where the politics of the crisis are complicating treatment efforts, with some people even resisting getting tested.


It’s unclear how Trump’s bout with the virus will affect the situation, but some doctors aren’t optimistic. After a few days of treatment at a military hospital, the president tweeted Monday, “Don’t be afraid of Covid. Don’t let it dominate your life. … I feel better than I did 20 years ago!”

After one tough shift in the coronavirus unit at Cox South Hospital in Springfield, Missouri, Montgomery went onto Facebook to vent her frustrations about caring for patients who didn’t socially distance because they didn’t believe the virus was real. The hospital later shared her post on its website.

She complained that some people demand the anti-malaria drug hydroxychloroquine and think the only patients who get really sick have underlying health problems.

“The majority of people don’t understand and can’t picture what we are seeing. That has been frustrating for all of us,” Montgomery said in an interview, adding: “It wears.”

Combating virus skeptics is a battle across the country.

In Georgia, at Augusta University Medical Center, visitors have tried to get around the mask requirement by wearing face coverings made of fishnet and other material with visible holes, something the hospital has dubbed “malicious compliance.” People also have shown up with video cameras in an attempt to collect proof the virus is a hoax, said Dr. Phillip Coule, the health system’s chief medical officer, who contracted the virus in July and has seen two staff members die.

“Just imagine that while you are caring for your own staff that are dying from this disease, and while you are trying to keep yourself safe, and you are trying to keep your family safe, and you are trying to deal with a disease that such little is known about, and then to have somebody tell you that it is all a hoax after you have been dealing with that all day,” he said. “Imagine the emotional distress that that causes.”

He said most skeptics — including some who have argued with him on Facebook — are converted to believers when they get sick themselves. And he is starting to hear fewer people dismiss the virus entirely since the president was diagnosed.

“It is unfortunate that the president has contracted the disease, but it is difficult for groups who support the president to be out there saying it doesn’t exist,” he said.

But he also said

Novak Djokovic enters French Open semi-finals but faces fitness battle

Video: Serena pulls out of French Open with Achilles injury (Reuters)

Serena pulls out of French Open with Achilles injury

UP NEXT

UP NEXT

Novak Djokovic is still in the French Open – but only after a drawn-out struggle in four sets on Wednesday night against Pablo Carreño Busta, the Spaniard who cashed in at the US Open when the world No 1 was disqualified for striking a line official with a spare ball. It was not a joyous reunion.



Novak Djokovic is swinging a racket at a ball: Photograph: Clive Brunskill/Getty Images


© Provided by The Guardian
Photograph: Clive Brunskill/Getty Images

A month after their shared New York drama, Carreño Busta had notions of winning on his own merits after taking the first set of the second quarter-final on day 11, but Djokovic ignored nagging pain in his upper left arm and his neck as he cobbled together a 4-6, 6-2, 6-3, 6-4 win in 3hr 10min under the lights on Court Philippe Chatrier. He has two days to recover before playing Stefanos Tsitsipas on Friday, and he will need every waking hour of them.



Novak Djokovic is swinging a racket at a ball: Novak Djokovic plays a forehand during his French Open quarter-final victory against Pablo Carreño Busta of Spain.


© Photograph: Clive Brunskill/Getty Images
Novak Djokovic plays a forehand during his French Open quarter-final victory against Pablo Carreño Busta of Spain.

Related: Rafael Nadal weathers cold and Jannik Sinner to reach French Open semi-final

If the 2016 champion is to win the title again he has to beat injury, an in-form Tsitsipas and, probably, the 12-time champion, Rafael Nadal, who plays Diego Schwartzman in the other semi-final. It is the sort of mountain Djokovic loves climbing, but the question remains: is he fit and strong enough to reach the summit?

Djokovic was cleared to play in Rome, where he beat Schwartzman in the final, and in Paris after testing positive for coronavirus on his Balkans exhibition tour earlier in the summer – but he looked a physical mess in the first set. Sweating and anxious, he grimaced, tugged at his arm and bandaged neck and tried to bang life into his upper legs with his racket as his opponent waited for his chances.

The tournament physio massaged Djokovic’s arm during the break and the player told him: “It feels better now.” Yet he did not look remotely comfortable, even when he got his serve working and levelled at a set apiece. The trainer returned between the third and fourth games, and it seemed to lift Djokovic’s spirits. Just when he looked as if he was slipping into a confused state again, he bounced back to level at a set apiece.

Related: Petra Kvitova sets up French Open semi-final meeting with Sofia Kenin

He broke early in the third, overcame a blip when Carreño Busta broke back for 2-3, then hit hard again to go a set up. But he looked far from commanding. Carreño Busta dug his heels into the Roland Garros clay in the fourth, and Djokovic had to fight for every point. Carreño Busta chose a woeful option to hand him the break for 3-4, Djokovic saved break point to hold through deuce

Identical twin sisters battle duplicate breast cancer diagnoses

Meagan McCallum and Courtney Werner were diagnosed just months apart.

While the mammogram came back clear, an ultrasound showed an abnormality, forcing McCallum to undergo a biopsy.

PHOTO: Twin sisters Meagan McCallam and Courtney Werner shared a duplicate breast cancer diagnosis at the age of 42.

Twin sisters Meagan McCallam and Courtney Werner shared a duplicate breast cancer diagnosis at the age of 42.

Twin sisters Meagan McCallam and Courtney Werner shared a duplicate breast cancer diagnosis at the age of 42.

The biopsy showed McCallum had invasive ductal carcinoma, the most common type of breast cancer, found in 80% of diagnoses, according to BreastCancer.org, a “nonprofit organization dedicated to providing information and community to those touched by this disease,” according to its website.

McCallum’s twin sister was the first to get the news from McCallum’s husband.

“I cried, right in the middle of work, cried,” Werner, also of New Jersey, told “Good Morning America.” “And then even when Meagan told me, [I] cried again, because it was even more real.”

McCallum underwent a lumpectomy to remove the cancer. When she visited her sister in February, she showed Werner her surgery scars.

PHOTO: Twin sisters Meagan McCallam and Courtney Werner shared a duplicate breast cancer diagnosis at the age of 42.

Twin sisters Meagan McCallam and Courtney Werner shared a duplicate breast cancer diagnosis at the age of 42.

Twin sisters Meagan McCallam and Courtney Werner shared a duplicate breast cancer diagnosis at the age of 42.

“When I showed her where the scars were, she went pale as a ghost, she went so white,” said McCallum. “And I didn’t know at the time that she found her own lump, and the reason she went white was because her lump was in the exact same spot.”

Werner also underwent a mammogram that did not show any abnormalities. Her diagnosis of invasive ductal carcinoma, was found through an ultrasound and in the exact same spot as McCallum’s cancer.

Werner, who was diagnosed in April, chose the same course of treatment as her sister. Both women are now doing well, and pleading for women to get tested for breast cancer.

“Early detection will save your life,” said McCallum. “It absolutely will.”

“Don’t be afraid to go,” added Werner.

As doctors continue their search for a cure for breast cancer, they are looking to twins like McCallum and Werner for answers.

Because identical twins are the result of a single egg that splits, they share the same DNA, which researchers are using to help answer questions about genetics and breast cancer.

One 2016 study found that if one identical twin develops breast cancer, there is a 28% chance the other twin will also

Victims of disgraced Harley Street dentist call for ‘outrageous’ legal loophole to be closed as they launch battle for compensation

Victims of a disgraced Harley Street dentist who was kicked out of the profession for a catalogue of botched procedures have launched a legal bid for compensation.

Fraser Pearce, 51, was left with a pierced sinus from faulty dental work by Dr Shahram Sahba, while Helen Pitt, 55, had £10,000 of veneers fitted in a negligent attempt to fix a receding gum line.

Dr Sahba, who ran the Lister House Dental Clinic in London’s famous medical district, was struck off last year after his professional regulator found him guilty of more than 400 charges of misconduct, negligence, and dishonesty.


A first attempt by his patients to sue for damages was blocked, as the disgraced dentist had left England and his insurers had no obligation to pay out when their client was not co-operating.

Fraser Pearce 

Mr Pearce and Ms Pitt, represented by law firm Devonshires, are now using the Consumer Credit Act to bring fresh legal action, to get money back via the credit card transactions used to pay for the botched procedures.

William Collins, a specialist medical negligence lawyer from Devonshires, called situation “outrageous” and called for the government to close the legal loophole.

Mr Pearce, a business consultant from Sandwich, Kent, needed an operation to try to repair his sinus after work by Dr Sabha, and also discovered the dentist had applied a crown to a perfectly health tooth.

“I felt physically violated”, he said. “I was really angry as I felt like he had breached the relationship between a doctor and his patient.”

Helen Pitt (Submitted)

Ms Pitt, who was treated by Dr Sahba for six years, may need to have her veneers replaced every ten years. She said: “I was so angry as I would never have had them fitted if I’d known that was the case.”

She added: “Dentists are in a position to do serious damage to their patients, so how can it be that dentists are allowed to have insurance that is discretionary and does not protect patients?”

Dr Sahba, who ran his practice just off Harley Street between 2009 and 2015, did not return from Sweden for a General Dental Council disciplinary hearing last year, when he struck off the professional register.

As well as botched procedures, he was found to have charged patients for work they did not receive and also lied about his qualifications.

Source Article

Why Trump’s battle isn’t over

Good evening. I’m Soumya Karlamangla, and it’s Monday, Oct. 5. Here’s what’s happening with the coronavirus in California and beyond.

After a chaotic weekend of conflicting information about President Trump’s battle with COVID-19, the First Patient headed home from Walter Reed National Military Medical Center on Monday evening.

His departure came just three days after he was hospitalized for COVID-19. During that time, he received supplemental oxygen, remdesevir and dexamethasone, medicines typically reserved for the sickest of patients. That Trump was given these treatments so soon after his positive test result was announced raised questions about when the president actually fell sick, when he was first diagnosed, and how serious his symptoms were. Those questions remain unanswered.

Trump and some of his staff maintain that his symptoms are mild. On Sunday, he staged a motorcade drive-by to wave at his supporters lined up outside Walter Reed. On Monday, the president tweeted a message that downplayed the severity of the disease.

“Don’t be afraid of Covid. Don’t let it dominate your life,” he wrote on Twitter. “I feel better than I did 20 years ago!”

Meanwhile, the number of Trump associates testing positive continues to grow. White House press secretary Kayleigh McEnany and aide Nick Luna tested positive for the virus, as did Riverside Pastor Greg Laurie, who attended the Sept. 26 Rose Garden event where Trump announced his nomination of Judge Amy Coney Barrett to the Supreme Court.

Even more could fall sick in the week ahead, as it typically takes between five and seven days to test positive after exposure. Trump traveled to multiple states in the week before the announcement of his diagnosis. Now health officials in New Jersey are trying to contact 200 people who may have been exposed to the virus at a Trump campaign event.

As for Trump’s prognosis, experts say he remains contagious and should isolate himself in the White House for 10 days to avoid infecting others. His physician, Dr. Sean Conley, told reporters that the president has “met or exceeded all standard hospital discharge criteria,” even as he cautioned that Trump could face a relapse and is not “entirely out of the woods yet.”

“If we can get through [next] Monday … then we will all take that deep sigh of relief,” he said.

By the numbers

California cases and deaths as of 4:00 p.m. PDT Monday:

 <span class="copyright">(Los Angeles Times Graphics)</span>
(Los Angeles Times Graphics)

Track the latest numbers and how they break down in California with our graphics.

See the current status of California’s reopening, county by county, with our tracker.

A map of California showing what tiers counties have been assigned based on their local levels of coronavirus risk.
A map of California showing what tiers counties have been assigned based on their local levels of coronavirus risk.
The tiers to which California counties are assigned based on coronavirus risk level. These determine what can reopen.
The tiers to which California counties are assigned based on coronavirus risk level. These determine what can reopen.

Across California

Months of lying in a hospital bed stripped away not only 50 pounds from Dr. Jay Buenaflor, but sometimes the will to live. The Imperial

Precision medicine uses multiomic details to battle kidney disease

September 10, 2020

6 min read


Source/Disclosures



Disclosures:
Bansal, Eadon, Jones-Smith, Kiryluk, and Sharma report no relevant financial disclosures.

We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]

The value of precision medicine has been shown with the identification of the genetic causes of tumors that differ among patients. Applied to nephrology, precision medicine can offer an earlier look at the potential risk for kidney disease.

“Precision medicine is a personalized approach to disease management of the patient … The goal is to have the right dose, delivered at the right time, for the right patient,” according to Shweta Bansal, MD, an associate professor of nephrology at the University of Texas-San Antonio School of Medicine. “It is not about one approach that fits all patients. It must be tailored.”

The treatment regimen is the last step in precision medicine, Bansal said. The work begins with the detection of the origins of disease through genomics.

“[NIH director] Francis Collins said it most straightforward. Precision medicine is the application of prevention and treatment strategies that take individual variability into account,” Michael Eadon, MD, assistant professor of medicine in the divisions of nephrology and clinical pharmacology at Indiana University School of Medicine, told Nephrology News & Issues. “There has always been an overarching connotation that genomic information, either from your genome or downstream applications like gene expression, would be integrated into evidence-based medicine.”

Kumar Sharma, MD, chief of nephrology and professor of medicine at the University of Texas-San Antonio, said research at the Center for Renal Precision Medicine will reveal the likelihood of chronic kidney disease early in high-risk individuals.

Source: Center for Renal Precision Medicine.

Genomic testing

Two examples of the application of genomics to detect the risk of end-stage kidney disease is research on the efficacy of the drug tolvaptan for patients with autosomal-dominant polycystic kidney disease (ADPKD) and the identification of risk variants in the apolipoprotein L1 (APOL1) gene that can lead to kidney disease.

In a study in Clinical Journal of the American Society of Nephrology, David J. Friedman, MD, and colleagues wrote that many types of severe kidney disease are higher in Black patients than in other patient groups. That disparity is attributed to genetic variants in the apoL1 (APOL1) gene found only in individuals with recent African ancestry, the authors wrote. “These variants greatly increase rates of hypertension-associated ESKD, [focal segmental glomerulosclerosis] FSGS, HIV-associated nephropathy, and other forms of nondiabetic kidney disease.”

Friedman and colleagues said the discovery of the APOL1 risk variants has led to discussions about incorporating genetic testing in the screening process for living kidney donors. Those with the APOL1 genomic makeup could pass

Trump reports feeling better, but here’s why the next few days are ‘the real test’ in his COVID-19 battle

President Donald Trump’s battle with COVID-19 will come to a critical turning point in the next few days as the disease tests his immune system.



Donald Trump wearing a suit and tie: President Donald Trump is pictured speaking during the first presidential debate in Cleveland, Ohio.


© Julio Cortez, AP
President Donald Trump is pictured speaking during the first presidential debate in Cleveland, Ohio.

On Saturday, Trump and his doctors acknowledged the importance of the coming days as the illness enters what White House physician Dr. Sean Conley called “phase 2.”

In a video statement released Saturday evening from Walter Reed National Military Medical Center, Trump echoed the concern: “I’m starting to feel good. You don’t know over the next period of a few days, I guess that’s the real test, so we’ll be seeing what happens over those next couple of days.”

Start the day smarter. Get all the news you need in your inbox each morning.

The course of COVID-19 can be highly variable, but the next three to five days are likely to be crucial, physicians who have treated hundreds of coronavirus patients told USA TODAY.

Several days after symptoms of COVID-19 appear, the body’s immune system must make an important switch to fight the virus with precision — or possibly face life-threatening consequences.

COVID-19 patients can “look pretty good for a few days, then they go south,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

That rapid deterioration can occur when the body’s immune system, unable to successfully target the virus, causes widespread collateral damage as it “brings in the troops,” Schaffner said.

A typical timeframe for patents’ decline is about five to 10 days after the person starts getting sick, said Dr. J. Randall Curtis, a professor of pulmonary and critical care at the University of Washington school of medicine in Seattle. 

Conley on Saturday said Trump is in his third day of fighting the virus.

During the early part of a patient’s COVID-19 illness, the body uses an “agnostic” immune response, said Dr. Greg Poland, director and founder of Mayo Clinic Vaccine Research Group. It doesn’t know what it’s fighting, but realizes something potentially dangerous is occurring. That’s called the innate immune system.

Key to a successful recovery is an immune response that targets the coronavirus itself. That’s called the adaptive immune system. 

To avoid serious illness, a patient’s innate and adaptive immune systems must stay in balance, and the virus itself must not cause serious complications along the way.

Age is a risk factor. Older patients tend to be less successful in activating the adaptive response, according to Melissa Nolan, an infectious disease expert and professor at the University of South Carolina.

Trump turned 74 in June, putting him at 90-times higher risk of death than someone in their 20s, according to data from the U.S. Centers for Disease Control and Prevention.

But the course of COVID-19 can be highly variable. The president’s VIP medical treatment and access to cutting-edge therapies make the trajectory of the illness even tougher to predict.

Patients tend to see short-term fluctuations in their symptoms

UK PM Johnson’s Battle With COVID-19 May Be a Warning for Trump | World News

By Guy Faulconbridge, Elizabeth Piper and Michael Holden

LONDON (Reuters) – When Boris Johnson caught COVID-19 in March, the overweight British prime minister tried to work through the illness “in denial” – but ended up wearing an oxygen mask in an intensive care unit and was ultimately out of action for almost a month.

He later said he had fought for his life as the state prepared for the unthinkable: the possible death in office of a prime minister.

Johnson’s experience of trying to stay in charge while struggling with the disease may offer clues about the potential dangers ahead for U.S. President Donald Trump, now that he has tested positive.

After being accused of initially failing to appreciate the gravity of coronavirus crisis for Britain, Johnson, then 55, felt mild symptoms on March 26 while answering questions in the House of Commons chamber.

A few hours later, he received a positive test result, and the next day he made a video statement in which he said he was self-isolating, but would continue to work and lead Britain’s coronavirus response.

But during the next nine days, as he worked in isolation in an apartment above his official Downing Street residence and office, his condition deteriorated, with persistent symptoms including a high temperature.

Later, he said he had been in denial and continued to work despite feeling groggy and “pretty rough”, until doctors told him firmly to go to hospital.

Being a national leader has offered little protection against the new coronavirus.

Brazil’s President Jair Bolsonaro spent weeks in quarantine after testing positive in July 7, and said he had taken antibiotics for an infection that left him feeling weak.

Honduran President Juan Orlando Hernandez needed hospital treatment, and former Italian prime minister Silvio Berlusconi developed double pneumonia and spent 10 days in hospital, being treated with the antiviral drug Remdesivir.

The 84-year-old was allowed home on Sept. 14 saying he had survived “the most dangerous challenge” of his life, and has made no public appearances since.

Johnson’s sudden deterioration after continuing to work may hold a warning for the 74-year-old Trump, now in full campaigning mode for the U.S. presidential election on Nov. 3.

Johnson was admitted to St Thomas’ Hospital in the evening of April 5. The next day he was moved to intensive care, where he received oxygen support but was not put on a ventilator.

“The bad moment came when it was 50-50 whether they were going to have to put a tube down my windpipe,” Johnson said later.

“The doctors had all sorts of arrangements for what to do if things went badly wrong … The bloody indicators kept going in the wrong direction.”

He later said he owed those doctors his life.

While Johnson was ill, his duties were assumed by Foreign Secretary Dominic Raab.

“They had a strategy to deal with a ‘death of Stalin’-type scenario,” Johnson later said. “It was a tough old moment, I won’t deny it.”

Johnson left hospital on April