• Making healthy lifestyle choices goes a long way towards preventing cancer

• Our focus should be on getting enough exercise and eating correctly

• It is also best to avoid alcohol altogether

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The latest cancer prevention guidelines may change your typical backyard barbecue: Gone are the hot dogs and booze. In are veggie kebabs and maybe a swim or some badminton.

The American Cancer Society’s new cancer prevention recommendations suggest, among other things, adding more physical activity to your days. About 20 minutes a day is the minimum, but 40 minutes or more daily is even better.

The new guidelines also add emphasis on avoiding unhealthy foods, including red and processed meats, refined grains and alcohol.

“The new recommendations really increase emphasis on a few key areas [including healthy weight and diet, physical activity, and avoiding or limiting alcohol],” said Dr Laura Makaroff, senior vice president of prevention and early detection for the American Cancer Society (ACS).

Healthy choices a challenge

These factors accounted for up to 18% of cancer cases and 16% of cancer deaths in the United States, according to the new report.

Along with recommendations for individual lifestyle practices, the ACS also included guidance for communities to take action.

“In addition to recommendations for individual choices, ACS recognises that making healthy choices can be challenging for many people. We need to reduce barriers to living well and achieving a healthy lifestyle, and that will require working collaboratively at all levels to develop and implement policies to ensure access to healthy foods and opportunities for exercise,” Makaroff said.

Registered dietician Pat Talio, the clinical nutrition outpatient programme coordinator at Northern Westchester Hospital in Mount Kisco, New York, agreed.

“This has to be a community and a societal effort. Given Covid and the amount of money that’s been spent on that, it will be especially important to keep focusing on healthy lifestyle,” Talio said. “It won’t help overall health if communities reduce funding in schools by cutting out gym teachers and sports programmes.”

The biggest changes to the guidelines included:

• Physical activity. In line with US government recommendations, the ACS guidelines say Americans should get between 150 and 300 minutes of moderate physical activity each week. If you up your activity level to vigorous activity, the ACS advises 75 to 150 minutes a week.
• Alcohol. The ACS says your best bet is to skip alcohol altogether. If you chose to drink, limit your alcohol consumption to one drink a day for women or two a day for men.
• Diet. The guidelines recommend not eating, or limiting, foods such as red or processed meats, sugar-sweetened beverages, refined grains and other highly processed foods. The ACS encourages a diet full of a variety of healthy foods, particularly 2.5 to 3 cups of vegetables and 1.5 to 2 cups of fruit each day. The ACS also recommends incorporating legumes and whole grains in your diet.

Along with these changes, the ACS also reconfirmed the importance of maintaining a healthy body weight. Nearly 11% of cancers in women and 5% in men have been linked to being overweight or obese. Only cigarette smoking accounts for a higher percentage of cancer, the guidelines said. Some cancers linked to excess weight include:

• Breast
• Ovary
• Kidney
• Oesophagus
• Colon
• Liver
• Gallbladder
• Pancreas

“There is no magic pill for preventing cancer,” Talio said. “People say that even though they’re not eating all their vegetables, they are taking a supplement. But that’s not the same. You have to eat well to get the right nutrients. Have a variety of vegetables and fruits – in all different colours. Concentrate on the vegetables.”

The new ACS guidelines are consistent with other government and major health organisation recommendations for preventing heart disease and diabetes.

The new guidelines were published on 9 June in CA: A Cancer Journal for Clinicians.

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A triple whammy of three antiviral drugs shows promise in fighting mild to moderate Covid-19, a new, small study suggests.

Two weeks of interferon beta-1b, lopinavir-ritonavir and ribavirin – along with standard care – was tested in 127 adult patients in six Hong Kong hospitals.

The triple antiviral treatment was started within seven days of the patients showing Covid-19 symptoms and was found to be safe and to shorten the duration of viral shedding compared to lopinavir-ritonavir alone (average seven days vs. 12 days).

The phase two study in the 8 May issue of The Lancet journal didn’t include patients with severe illness, and the researchers emphasised that larger phase three studies in critically ill patients are needed to determine if the triple therapy can provide clinically significant benefits.

Safe and well-tolerated

“Our trial demonstrates that early treatment of mild to moderate Covid-19 with a triple combination of antiviral drugs may rapidly suppress the amount of virus in a patient’s body, relieve symptoms, and reduce the risk to health-care workers by reducing the duration and quantity of viral shedding [when the virus is detectable and potentially transmissible],” said study leader Dr Kwok-Yung Yuen, from the University of Hong Kong.

“Furthermore, the treatment combination appeared safe and well-tolerated by patients,” he added in a journal news release.

“Despite these encouraging findings, we must confirm in larger phase three trials that interferon beta-1b alone or in combination with other drugs is effective in patients with more severe illness,” Yuen said.

Another expert agreed that the antiviral combo needs further testing.

“Since some of these agents have proven antiviral properties it makes sense to test them,” said Dr Matthew Heinz, a hospitalist at Tucson Medical Center who also assisted in the American response to the Ebola crisis during the Obama administration.

A step forward

“Lopinavir-ritonavir is an anti-retroviral medication used to treat HIV, and ribavirin is used to treat hepatitis C. Interferon beta-1b occurs naturally in humans when responding to viral infections such as influenza and is commonly used to treat multiple sclerosis,” he said.

But “this study excluded severely and critically ill patients,” Heinz added. “So we have no idea if the sickest Covid-19 patients would benefit from the combination therapy.”

Still, the author of an accompanying commentary said the trial is a step forward in the search for a Covid-19 treatment.

“Most published studies so far have been retrospective or observational. Therefore, this prospective, randomised controlled design adds notable value to the growing evidence on treatments, eliminating a number of limitations inherent to retrospective studies,” said Dr Sarah Shalhoub, from Western University in Canada.

“This study presents a step towards finding a much-needed therapy for SARS-CoV-2. However, as the authors acknowledge, future studies to examine the efficacy of interferon beta-1b alone or in combination with other drugs to treat severe or critically ill patients with confirmed Covid-19 compared with placebo are warranted,” she wrote.

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• In a breakthrough trial, dexamethasone appears to be a Covid-19 miracle 
• This common corticosteroid is widely used to treat inflammatory conditions
• The details of the trial still need to be released before we can know exactly which patients are likely to benefit

In a trial, the steroid dexamethason was found to have saved the lives of a third of the most serious Covid-19 cases, according to results hailed on Tuesday as a “major breakthrough” in the fight against the disease, News24 reported on 16 June 2020.

Researchers led by a team from the University of Oxford administered the widely available drug to more than 2 000 severely ill Covid-19 patients, mostly on ventilators. Deaths of those patients were reduced by 35%.

But what is this widely available, affordable steroid that made the headlines?

For what is dexamethasone usually prescribed?

Dexamethasone is a corticosteroid, which is similar to a natural hormone we all produce in our adrenal glands. When your body doesn’t make enough of this hormone, it needs to be replaced.

Dexamethasone is usually prescribed to relieve inflammation such as swelling, redness and pain in the body. Doctors prescribe this medication for certain forms of arthritis and severe allergic reactions that can lead to swelling, as well as asthma.

Why did scientists experiment with this as a Covid-19 treatment?

Since early in the Covid-19 outbreak, Health24 has been reporting on scientific testing of various existing medications as a treatment for Covid-19. As the SARS-CoV-2 virus is new, there is not yet any specific antiviral vaccine to treat Covid-19.

Scientists, including those collaborating in the World Health Organization Solidarity Trial, looked at various types of medications, including hydroxychloroquine, usually prescribed for lupus, and remdesivir, an antiviral used in the treatment of HIV.

 A project called the RECOVERY trial was launched in March 2020 to test the efficacy of dexamethasone. At first, the WHO and other countries cautioned against the use of steroids to treat viral respiratory infections such as Covid-19, according to Peter Hornby, an infectious-disease specialist at the University of Oxford and chief investigator on the trial.

Data of steroid use in SARS and MERS, also caused by coronaviruses, were inconclusive. But as dexamethasone is such a readily available drug and showed promising results from previous studies during outbreaks, Hornby felt that it needed to go through a clinical trial.

A steroid drug suppresses the immune system, which can help those Covid-19 patients whose lungs are severely affected by an overreactive response from their immune systems. The WHO was sceptical, as patients still need a functional immune system to fight SARS-CoV-2 and the Covid-19 infection.

What are possible side effects from normal use?

As with any other medication, dexamethasone may cause some side effects. Side effects that were most commonly reported in the past include:

• Upset stomach and vomiting
• Headache
• Dizziness
• Restlessness
• Anxiety or depression
• Increased hair growth
• Insomnia
• Irregular menstrual cycle
• Bruising

What about corticosteroids and diabetes?

Unfortunately, the use of corticosteroids to treat inflammation can lead to higher than normal blood glucose levels and insulin resistance, and if they are used long-term, may lead to type 2 diabetes.

 As those with diabetes are more at risk for severe Covid-19 complications, the use of dexamethasone might be a concern, but typically, the effect on blood glucose only counts if corticosteroids are administered for a long period of time.

A study published in the British Journal of Anaesthesia found that 10mg of dexamethasone was enough to raise the blood glucose levels of non-diabetic and type 2 diabetic patients undergoing abdominal surgery. The outcome was that hyperglycaemia may occur in those with poorly controlled diabetes and severe obesity – two profiles especially at risk for severe Covid-19.

However, blood glucose levels should return back to normal as soon as one has finished the course of this medication, but people with pre-existing risk factors for type 2 diabetes, may be diagnosed with diabetes after use. This is especially the case when taking dexamethasone or any other corticosteroid orally.

It is said that non-oral methods of administering, such as injections, might have a lesser effect on the glucose level and might be better for those prone to type 2 diabetes or those who already have it.

But the exact effect of dexamethasone in patients with Covid-19 and diabetes as an underlying condition is not yet known. 

If I have mild Covid-19, will the drug help me?

According to Nahid Bhadelia, a physician at the Boston Medical Centre, the initial results from this trial looked remarkable for those who were already severely ill from Covid-19.

“I can see ICU physicians being more likely to provide steroids in the critically ill who are mechanically ventilated and who are not improving from other interventions based on these results,” she stated. But she also added that she was disappointed that the RECOVERY trial team did not release more information on exactly what subset of Covid-19 patients would benefit from dexamethasone.

Therefore, it’s vital to understand that we still need more details about the efficacy of dexamethasone before we know who can receive this treatment safely. It is not meant for mild cases of Covid-19 and one should not be taking a corticosteroid such as dexamethasone without clear instructions from a doctor.

Is dexamethasone the Covid-19 solution?

Martin Landray, an epidemiologist at the University of Oxford and another chief investigator of the trial remains optimistic about the breakthrough of dexamethasone as a Covid-19 treatment. He stated that its affordability and it being a medical staple is a particular benefit in countries with limited access to healthcare.

Information about the trial was made available in a press statement released on 16 June 2020, but the findings of the trial are not yet available. The researchers said that they are aiming to publish the results as soon as possible and share their findings with regulators worldwide. But many are already optimistic.

The National Health Service from the United Kingdom announced that standard clinical guidelines for Covid-19 patients will allow for dexamethasone.

And in South Africa, Dr Zweli Mkhize, Minister of Health, announced in a statement on the SA Coronavirus website that the Ministerial Advisory Committee on Covid-19 has issued an advisory pertaining to the clinical applications of dexamethasone and that they were “extremely excited about this important breakthrough”.

Landray understands that other experts want to see more details first before getting too excited. But in a situation where so many people were dying, he stated that it was important to get the basic message out right away.

“There is this tension between having the final details and the final decimal points nailed down, and having what is actually a clear-cut and practical message in the public domain,” he said.

“The decimal points might change a bit when we tidy things up, but we’ve got to a point where the message will not change,” Landray stated.

READ | The lowdown on Covid-19 treatments

READ | Covid-19: What’s next for hydroxychloroquine?

READ | Remdesivir will not be enough to curb Covid-19, study finds

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Marelize Wilke

• Many male students who like playing video games have unhealthy lifestyles

• They tend to eat junk food and don’t get enough exercise

• This kind of lifestyle can lead to weight gain and chronic disease

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Video games often stand in the way of exercise and healthy eating among male college students, a new study shows.

“It’s important to understand that video games are a risk factor for poor lifestyle habits that may contribute to poor health,” said researcher Dustin Moore, a graduate student at the University of New Hampshire.

“We know that habits developed in adolescence and early adulthood can stick with people for the rest of their lives, so if we can encourage video game users to eat healthier and exercise more, we could help them live healthier without completely giving up video games,” he noted.

For the study, Moore and his team collected data on 1 000 male students aged 18 to 24 at the University of New Hampshire.

Participants reported how much time they spent playing video games and what they ate. Physical activity was recorded with a pedometer.

Chronic disease later in life

More than 40% of the men played video games for least five hours a week, the findings showed. Those who played video games ate more saturated fat and sodium than non-players, suggesting they are eating more salty snacks.

Players also ate fewer fruits and vegetables and were less physically active than non-players, the researchers found.

Although no differences were seen in weight between players and non-players, poor eating and exercise habits might lead to excess weight gain and chronic disease later in life, the investigators noted.

The findings were scheduled for presentation at the virtual meeting of the American Society for Nutrition (ASN). Such research is considered preliminary until published in a peer-reviewed journal.

“The video game industry is continuing to grow at a fast pace and more people are playing than ever,” Moore said in an ASN news release.

“If the findings of our study are indicative of general population, increases in video game usage could translate to increases in overweight/obesity and chronic disease in the general population, which is already a big issue,” he added.

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• A lung transplant was the only way to save the life of a Hispanic woman after recovering from Covid-19
• She had suffered irreversible lung damage after her infection
• She could only get on the waiting list for a transplant after she tested negative for the virus

A young Covid-19 survivor received a double-lung transplant to save her life in what’s believed to be the first such surgery in the United States, Northwestern Medicine doctors report.

Following her infection, the Hispanic woman in her 20s suffered irreversible lung damage and had to be put on a life-support machine that does the work of the heart and lungs.

“A lung transplant was her only chance for survival,” said Dr Ankit Bharat, surgical director of Northwestern Medicine’s lung transplant programme.

“We are one of the first health systems to successfully perform a lung transplant on a patient recovering from Covid-19. We want other transplant centres to know that while the transplant procedure in these patients is quite technically challenging, it can be done safely, and it offers the terminally ill Covid-19 patient another option for survival,” Bharat said in a Northwestern news release.

Before the patient could be put on the transplant wait-list, she had to test negative for Covid-19.

Still much to learn about Covid-19

“For many days, she was the sickest person in the Covid ICU – and possibly the entire hospital,” said Dr Beth Malsin, a pulmonary and critical care specialist at Northwestern Memorial Hospital in Chicago.

“There were so many times, day and night, our team had to react quickly to help her oxygenation and support her other organs to make sure they were healthy enough to support a transplant if and when the opportunity came,” Malsin said. “One of the most exciting times was when the first coronavirus test came back negative and we had the first sign she may have cleared the virus to become eligible for a life-saving transplant.”

The transplant was performed 48 hours after the patient was listed for a double-lung transplant.

Dr Rade Tomic is medical director of Northwestern’s lung transplant programme. He said, “How did a healthy woman in her 20s get to this point? There’s still so much we have yet to learn about Covid-19. Why are some cases worse than others? The multidisciplinary research team at Northwestern Medicine is trying to find out.”

Tomic added, “While this young woman still has a long and potentially risky road to recovery, given how sick she was with multiorgan dysfunction for weeks preceding the transplant, we hope she will make a full recovery.”

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• Covid-19 may cause neurological symptoms, including headache and dizziness
• This can cause serious damage to the central nervous system
• Research urges patients and physicians not to ignore these symptoms

Almost half of hospitalised patients with Covid-19 have presented with neurological symptoms, including headache, dizziness, decreased alertness, difficulty concentrating, disorders of smell and taste, seizures, strokes, weakness and muscle pain. This is according to a new review – based on current literature on Covid-19 cases – that was published in Annals of Neurology by researchers from Northwestern University this month.

“Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (Covid-19) also involves multiple  other organs including the central and peripheral nervous system,” the researchers wrote.

Neurological symptoms may occur before fever

The review specifically looks at various neurological conditions that may occur in Covid-19 patients, and offers advice for physicians on how to diagnose these patients.

The number of neurological manifestations of SARS-CoV-2, the virus that causes Covid-19, the disease, is rapidly increasing, the authors wrote, and say that it’s important for both the general public and physicians to be aware of this – particularly because these symptoms may show before the more common symptoms listed by the World Health Organization (WHO) likely to be experienced first, such as fever and a dry cough.

Disease may affect multiple organs

According to the researchers, Covid-19 may affect the entire nervous system, including the brain, nerves, spinal cord and the muscles, and added that the brain may also suffer from a lack of oxygen or clotting disorders which may then lead to stroke.

“Although we are only starting to grasp the complexity of  SARS-CoV-2 biology, it is already apparent that Covid-19 causes a global threat to the entire nervous system…

“As we hope for a vaccine or a cure, neurologists will play an important role in diagnosing, investigating and treating the many neurologic manifestations of Covid-19,” the authors said.

Previous studies lend support

A study published earlier this year looked at 214 cases of severe Covid-19 patients who were treated in Wuhan during the early phase of the global pandemic, Health24 reported. Like the more recent study above, the researchers of this study indicated that sometimes neurological symptoms appeared in the relative absence of the typical, more common symptoms of Covid-19.

It has only emerged in the past few months that the virus can infiltrate the brain and central nervous system (CNS), causing a loss of sense of smell and taste, meaning that it may somehow affect the nerve pathways of the infected individual. Another recent study revealed that almost 100% of hospitalised Covid-19 patients presented with smell “dysfunction”.

Earlier this month, Health24 also reported on a study that looked at 725 hospitalised Covid-19 patients, 108 of whom had brain imaging done, and were found to have two specific neurological symptoms – stroke, and “altered mental state”.

Researchers in all these studies have stressed the need for further research into Covid-19 and its impact on the CNS, and that these symptoms be taken seriously so that there may be better and quicker interventions for patients in future.

Zakiyah Ebrahim

• In times of uncertainty, paranoia is more prevalent
• According to a new study, this is especially the case during the Covid-19 pandemic
• While paranoia is usually a symptom of mental illness, it becomes more common during certain events

Have you been feeling trapped in a spiral of irrational, negative thoughts during the current Covid-19 pandemic? Is the uncertainty of events causing you to think of the worst possible scenarios?

You are certainly not the only one. According to a new study by researchers at Yale University, which was published in the journal eLife, there is a link between unprecedented global events, uncertainty and paranoia.

What is paranoia?

Paranoia can be described as a mental condition characterised by delusions of persecution, unwarranted jealousy or exaggerated self-importance, especially in an organised system.

While most people tend to experience these exaggerated, irrational thoughts from time to time, chronic paranoia is often a debilitating, extremely unpleasant symptom of illnesses such as bipolar disorder, schizophrenia and paranoid personality disorder.

When you experience paranoia, you may think that “someone or something is out to get you”, you may feel misunderstood, you may feel a mistrust, especially in organised systems such as the government, you may feel isolated and your relationships might even fall apart because of this.

Paranoia and a pandemic – what the researchers say

You may have experienced many jarring, frustrating, even irrational thoughts during the uncertainty of the Covid-19 pandemic, but according to the latest study from Yale University, these are situational and not necessarily linked to a chronic mental illness.

The reason for increasing paranoia is because we don’t feel in control of our current situation and there is no longer as much of a sense of certainty.

“When our world changes unexpectedly, we want to blame that volatility on somebody, to make sense of it, and perhaps neutralise it,” stated Yale’s Philip Corlett, associate professor of psychiatry and senior author of the study in a press release. “Historically, in times of upheaval, such as the great fire of ancient Rome in 64 C.E. or the 9/11 terrorist attacks, paranoia and conspiratorial thinking increased.”

This rings true during the Covid-19 situation, as many people believe in various conspiracy theories regarding the pandemic.

Where does the paranoia stem from?

According to the research, the prevailing theory is that paranoia stems from an inability to accurately assess social threat. But according to authors Corlett and Erin Reed from Yale, it is hypothesised that paranoia is rooted in a more basic mechanism that is triggered by uncertainty, even when there is no actual social threat.

“We think of the brain as a prediction machine; unexpected change, whether social or not, may constitute a type of threat. It limits the brain’s ability to make predictions,” Reed said. “Paranoia may be a response to uncertainty in general, and social interactions can be particularly complex and difficult to predict.”

The researchers conducted a series of experiments among subjects with various levels of paranoia. One of the experiments involved a card game, where the best choices of success were changed secretly. People with low levels of paranoia didn’t immediately assume that the best choice changed, but those with paranoia expected this immediately and changed their choices even after they won.

As the levels of uncertainty changed suddenly, even those participants with low-level paranoia started acting paranoid.

Why paranoia can be dangerous during a pandemic

Dr Elliot B. Martin, a psychiatrist from Newton Massachusetts, explained in Psychiatric Times that he had several sudden cases of psychosis in their emergency rooms, which he has started to refer to as “corona psychosis”.

According to him, the psychological effects of the virus have been overwhelming, both for his regular patients and healthcare providers. “Healthcare workers, especially those used to a degree of predictability, seem to be susceptible to the stress of uncertainty and loss of control engendered by the Covid-19 pandemic,” he wrote.

Not only can this temporary paranoia take a toll on one’s mental and physical health, but irrational thoughts can lead to irresponsible actions. When someone, for instance, believes that the current pandemic is “not real”, there is a bigger chance of them spreading damaging misinformation and exposing themselves to possible infections.

How to cope

This new situation hasn’t been easy for many, whether it meant a sudden loss of income, a halt in plans, sudden isolation from friends and family, or the fear of getting sick. But there are small ways to take care of your mental health:

• Don’t always focus on what’s on your mind, but focus on the evidence in front of you, suggests Dr Michael Sinclair, a consultant psychologist.
• Control the things you can. If you are scared of getting infected, repeat to yourself that you can protect yourself by washing your hands, keeping your distance and wearing a mask.
•  Set aside time to do something “offline” such as exercise, reading a book or meditating, especially when you are still working from home.
• Focus on eating a healthy diet and getting enough sleep.
• Stay in contact with friends and family through digital methods.
• Avoid speculation and focus only on facts and official information.
• If you feel out of control, don’t hesitate to ask for professional help from a psychiatrist or counsellor.

If you’re feeling anxious or depressed and feel like you need help, you can reach SADAG on their 24-hour helpline: 0800 456 789.

For a suicide emergency, dial 0800 567 567. 

READ | Mental health effects of Covid-19 pandemic, lockdown – and concern over suicide risk

READ | Avoiding fear, anxiety while you self-quarantine

READ | Opinion: the mental health effects of Covid-19 are as important to address as the physical effects

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Marelize Wilke

Unpaid carers looking after their parents and relatives are turning to food banks, say researchers.

Two leading doctors said regular testing is needed to give patients confidence as the NHS reopens.