What to know about breast cancer

Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer.

Advances in screening and treatment for breast cancer have improved survival rates dramatically since 1989. According to the American Cancer Society (ACS), there are more than 3.1 million breast cancer survivors in the United States. The chance of any woman dying from breast cancer is around 1 in 38 (2.6%).

Awareness of the symptoms and the need for screening are important ways of reducing the risk. In rare instances, breast cancer can also affect men, but this article will focus on breast cancer in women. 

Symptoms

The first symptoms of breast cancer usually appear as an area of thickened tissue in the breast or a lump in the breast or an armpit.

Other symptoms include:

  • pain in the armpits or breast that does not change with the monthly cycle
  • pitting or redness of the skin of the breast, similar to the surface of an orange
  • a rash around or on one of the nipples
  • discharge from a nipple, possibly containing blood
  • a sunken or inverted nipple
  • a change in the size or shape of the breast
  • peeling, flaking, or scaling of the skin on the breast or nipple

Most breast lumps are not cancerous. However, women should visit a doctor for an examination if they notice a lump on the breast.

Stages

A doctor stages cancer according to the size of the tumor and whether it has spread to lymph nodes or other parts of the body.

There are different ways of staging breast cancer. One way is from stage 0–4, with subdivided categories at each numbered stage. Descriptions of the four main stages are listed below, though the specific substage of a cancer may also depend on other specific characteristics of the tumor, such as HER2 receptor status.

  • Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within the ducts and have not invaded surrounding tissues.
  • Stage 1: At this stage, the tumor measures up to 2 centimeters (cm) across. It has not affected any lymph nodes, or there are small groups of cancer cells in the lymph nodes.
  • Stage 2: The tumor is 2 cm across, and it has started to spread to nearby nodes, or is 2–5 cm across and has not spread to the lymph nodes.
  • Stage 3: The tumor is up to 5 cm across, and it has spread to several lymph nodes or the tumor is larger than 5 cm and has spread to a few lymph nodes.
  • Stage 4: The cancer has spread to distant organs, most often the bones, liver, brain, or lungs.

Causes

After puberty, a woman’s breast consists of fat, connective tissue, and thousands of lobules. These are tiny glands that produce milk for breastfeeding. Tiny tubes, or ducts, carry the milk toward the nipple.

Cancer causes the cells to multiply uncontrollably. They do not die at the usual point in their life cycle. This excessive cell growth causes cancer because the tumor uses nutrients and energy and deprives the cells around it.

Breast cancer usually starts in the inner lining of milk ducts or the lobules that supply them with milk. From there, it can spread to other parts of the body.

Risk factors

The exact cause of breast cancer remains unclear, but some risk factors make it more likely. It is possible to prevent some of these risk factors.

1. Age

The risk of breast cancer increases with age. At 20 years, the chance of developing breast cancer in the next decade is 0.06%. By the age of 70 years, this figure goes up to 3.84%.

2. Genetics

Women who carry certain mutations in the BRCA1 and BRCA2 genes have a higher chance of developing breast cancer, ovarian cancer, or both. People inherit these genes from their parents.

Mutations in the TP53 gene also have links to increased breast cancer risk.

If a close relative has or has had breast cancer, a person’s chance of developing breast cancer increases.

Current guidelines recommend that people in the following groups seek genetic testing:

  • those with a family history of breast, ovarian, fallopian tube, or peritoneal cancer
  • those in whose ancestry there is a history of breast cancer related to BRCA1 or BRCA2 gene mutations, for example, people with Ashkenazi Jewish ancestry

3. A history of breast cancer or breast lumps

Women who have previously had breast cancer are more likely to have it again than those who have no history of the disease.

Having some types of noncancerous breast lump increases the chance of developing cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.

Individuals with a history of breast, ovarian, fallopian tube, or peritoneal cancer should ask their doctors about genetic testing.

4. Dense breast tissue

Women with more dense breasts are more likely to receive a diagnosis of breast cancer.

5. Estrogen exposure and breastfeeding

Extended exposure to estrogen appears to increase the risk of breast cancer.

This could be due to a person starting their periods earlier or entering menopause at a later than average age. Between these times, estrogen levels are higher.

Breastfeeding, especially for over 1 year, appears to reduce the chance of developing breast cancer. This is possibly due to the drop in estrogen exposure that follows pregnancy and breastfeeding.

6. Body weight

Women who become overweight or develop obesity after menopause may also have a higher chance of developing breast cancer, possibly due to increased estrogen levels. High sugar intake may also be a factor.

7. Alcohol consumption

A higher rate of regular alcohol consumption appears to play a role in breast cancer development.

According to the National Cancer Institute (NCI), studies have consistently found that women who consume alcohol have a higher risk of breast cancer than those who do not. Those who drink moderate to heavy levels of alcohol have a higher risk than light drinkers.

8. Radiation exposure

Undergoing radiation treatment for a different cancer may increase the risk of developing breast cancer later in life.

9. Hormone treatments

According to the NCI, studies have shown that oral contraceptives may slightly increase the risk of breast cancer

According to the ACS, studies have found that hormone replacement therapy (HRT), specifically estrogen-progesterone therapy (EPT), is related to an increased risk of breast cancer.

Cosmetic implants and breast cancer survival

A 2013 review found that women with cosmetic breast implants who received a diagnosis of breast cancer also had a higher risk of dying from the disease.

This could be due to the implants masking cancer during screening or because the implants bring about changes in breast tissue.

However, a 2015 review published in Aesthetic Surgery Journal found that having cosmetic breast implant surgery did not increase the risk of breast cancer.

Scientists need to carry out more research to confirm the link.

Types

There are several different types of breast cancer, including:

  • Ductal carcinoma: This begins in the milk duct and is the most common type.
  • Lobular carcinoma: This starts in the lobules.

Invasive breast cancer occurs when the cancer cells break out from inside the lobules or ducts and invade nearby tissue. This increases the chance of cancer spreading to other parts of the body.

Noninvasive breast cancer develops when the cancer remains inside its place of origin and has not yet spread. However, these cells can sometimes progress to invasive breast cancer.

Diagnosis

A doctor often diagnoses breast cancer as the result of routine screening or when a woman approaches her doctor after detecting symptoms.

Several diagnostic tests and procedures help to confirm a diagnosis.

Breast exam

The doctor will check the breasts for lumps and other symptoms.

During the examination, the person may need to sit or stand with their arms in different positions, such as above their head or by their sides.

Imaging tests

Several tests can help detect breast cancer.

Mammogram: This is a type of X-ray that doctors commonly use during an initial breast cancer screening. It produces images that can help a doctor detect any lumps or abnormalities.

A doctor will usually follow any suspicious results with further testing. However, mammography sometimes shows a suspicious area that turns out not to be cancer.

Ultrasound: This scan uses sound waves to help a doctor differentiate between a solid mass and a fluid-filled cyst.

MRI: Magnetic Resonance Imaging (MRI) combines different images of the breast to help a doctor identify cancer or other abnormalities. A doctor may recommend an MRI as a follow-up to a mammogram or ultrasound. Doctors sometimes use them as a screening tool for those at higher risk of breast cancer.

Biopsy

In a biopsy, the doctor extracts a sample of tissue and sends it for laboratory analysis.

This shows whether the cells are cancerous. If they are, a biopsy indicates which type of cancer has developed, including whether or not the cancer is hormone sensitive.

Diagnosis also involves staging the cancer to establish:

  • the size of a tumor
  • how far it has spread
  • whether it is invasive or noninvasive

Staging provides a picture of a person’s chances of recovery and their ideal course of treatment.

Treatment

Treatment will depend on several factors, including:

  • the type and stage of the cancer
  • the person’s sensitivity to hormones
  • the age, overall health, and preferences of the individual

The main treatment options include:

radiation therapy

  • surgery
  • biological therapy, or targeted drug therapy
  • hormone therapy
  • chemotherapy

Factors affecting the type of treatment a person has will include the stage of the cancer, other medical conditions, and their individual preference.

Surgery

If surgery is necessary, the type will depend on both the diagnosis and individual preference. Types of surgery include:

Lumpectomy: This involves removing the tumor and a small amount of healthy tissue around it.

A lumpectomy can help prevent the spread of the cancer. This may be an option if the tumor is small and easy to separate from its surrounding tissue.

Mastectomy: A simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. In some types, a surgeon will also remove the lymph nodes and muscle in the chest wall.

Sentinel node biopsy: If breast cancer reaches the sentinel lymph nodes, which are the first nodes to which a cancer can spread, it can spread into other parts of the body through the lymphatic system. If the doctor does not find cancer in the sentinel nodes, then it is usually not necessary to remove the remaining nodes.

Axillary lymph node dissection: If a doctor finds cancer cells in the sentinel nodes, they may recommend removing several lymph nodes in the armpit. This can prevent the cancer from spreading.

Reconstruction: Following mastectomy, a surgeon can reconstruct the breast to look more natural. This can help a person cope with the psychological effects of breast removal.

The surgeon can reconstruct the breast at the same time as performing a mastectomy or at a later date. They may use a breast implant or tissue from another part of the body.

Radiation therapy

A person may undergo radiation therapy around a month after surgery. Radiation involves targeting the tumor with controlled doses of radiation that kill any remaining cancer cells.

Chemotherapy

A doctor may prescribe cytotoxic chemotherapy drugs to kill cancer cells if there is a high risk of recurrence or spread. When a person has chemotherapy after surgery, doctors call it adjuvant chemotherapy.

Sometimes, a doctor may choose to administer chemotherapy before surgery to shrink the tumor and make its removal easier. Doctors call this neoadjuvant chemotherapy.

Hormone blocking therapy

Doctors use hormone blocking therapy to prevent hormone sensitive breast cancers from returning after treatment. Hormone therapy may be used to treat estrogen receptor (ER)-positive and progesterone receptor (PR)-positive cancers.

They usually administer hormone blocking therapy after surgery but might sometimes use it beforehand to shrink the tumor.

Hormone blocking therapy may be the only option for people who are not suitable candidates for surgery, chemotherapy, or radiotherapy.

Doctors may recommend a person has hormone therapy for 5–10 years after surgery. However, the treatment will not affect cancers that are not sensitive to hormones.

Examples of hormone blocking therapy medications may include:

  • tamoxifen
  • aromatase inhibitors
  • ovarian ablation or suppression
  • Goserelin, which is a luteinizing hormone-releasing agonist drug that suppresses the ovaries

Hormone treatment may affect fertility.

Biological treatment

Targeted drugs can destroy specific types of breast cancer. Examples include:

  • trastuzumab (Herceptin)
  • lapatinib (Tykerb)
  • bevacizumab (Avastin)

Treatments for breast and other cancers can have severe adverse effects. When deciding on a treatment, people should discuss the potential risks with a doctor and look at ways to minimize the side effects.

Outlook

A person’s outlook with breast cancer depends on the staging. Early detection and treatment usually lead to a positive outlook.

According to the ACS, a person who receives treatment for stage 0 or stage 1 breast cancer has a 99% chance of surviving for at least 5 years after being diagnosed, when compared to women who do not have cancer.

If breast cancer reaches stage 4, the chance of surviving another 5 years reduces to around 27%.

Regular checks and screening can help detect symptoms early. Women should discuss their options with a doctor.

Regular screening

There are several different guidelines for how often women should have breast cancer screening.

The American College of Physicians (ACP) recommend that women aged 40–49 years with an average risk of breast cancer should discuss the benefits and risks of regular screenings with a doctor.

Between 50 and 74 years of age, women who have an average risk should undertake screenings every 2 years. Beyond 75 years of age, doctors only recommend screenings for women with a life expectancy of 10 or more years.

The ACS suggest that women of average risk can choose to have yearly scans from the age of 40 years onward. Those who have not should start annual screening at 45 years of age. They may decide to switch to screenings every other year when they reach 55 years of age.

The American College of Radiologists recommend screenings every year, starting from 40 years of age.

Despite the different recommendations, most experts agree that women should talk to their doctors about breast cancer screening from 40 years of age onward.

Prevention

There is no way to prevent breast cancer. However, certain lifestyle decisions can significantly reduce the risk of breast cancer as well as other types.

These include:

  • avoiding excessive alcohol consumption
  • following a healthful diet containing plenty of fresh fruit and vegetables
  • getting enough exercise
  • maintaining a healthy body mass index (BMI)

Women should consider their options for breastfeeding and the use of HRT following menopause, as these can also increase the risk.

Preventive surgery is also an option for women at high risk of breast cancer.

What to know about sleep deprivation

Many people do not get enough quality sleep, and this can affect their health, well-being, and ability to do everyday activities.

The right amount of sleep can vary from person to person, but the Centers for Disease Control and Prevention (CDC) recommend that adults get at least 7 hours each night. They also estimate that 1 in 3 adults do not get enough sleep.

Occasional interruptions to sleep can be a nuisance, while an ongoing lack of quality sleep can affect a person’s performance at work or school, their ability to function day to day, their quality of life, and their health.

This article looks at the effects of sleep deprivation and how to treat and prevent it.

How much sleep do people need?

The CDC recommend the following amounts of sleep in every 24-hour period:

AgeHours of sleep
4–12 months12–16, including naps
1–2 years11–14, including naps
3–5 years10–13, including naps
6–12 years9–12
13–18 years8–10
18–60 years7 or more

It is important to consider quality, as well as quantity, of sleep. If a person has low-quality sleep, they feel tired the next day, regardless of how many hours they have slept.

Low-quality sleep may involve:

  • waking often during the night
  • breathing difficulties, such as sleep apnea
  • an environment that is too hot, cold, or noisy
  • an uncomfortable bed

Symptoms of sleep deprivation

A person who is getting too little quality sleep may experience a range of symptoms, including:

  • fatigue
  • irritability
  • mood changes
  • difficulty focusing and remembering
  • a reduced sex drive

Effects on the body

Sleep deprivation can affect various aspects of health, including:

  • The immune system: Sleep deprivation may cause a person to be more prone to infections, which may take longer to resolve, and respiratory diseases.
  • Weight: Sleep can affect the hormones that control feelings of hunger and fullness. It can also trigger the release of insulin. Changes to sleep can cause increased fat storage, changes in body weight, and a higher risk of type 2 diabetes.
  • The cardiovascular system: Sleep helps the heart vessels heal and rebuild and affects processes that maintain blood pressure, sugar levels, and inflammation control. Too little sleep may increase the risk of cardiovascular disease.
  • Hormone levels: Insufficient sleep can affect hormone production, including the production of growth hormones and testosterone. It also causes the body to release additional stress hormones, such as norepinephrine and cortisol.
  • The brain: Sleep deprivation affects the prefrontal cortex, which handles reasoning, and the amygdala, which deals with emotion. A lack of sleep may also make it harder for a person to form new memories, which can affect learning.
  • Fertility: Poor sleep may affect the production of hormones that boost fertility.

Increased risk of accidents

A lack of sleep can limit the ability to:

  • pay attention
  • react quickly
  • make decisions

A person who gets too little sleep may have a higher risk of drowsy driving, which can lead to accidents. In one survey, 1 in 25 adults in the U.S. said that they had fallen asleep at the wheel within the last month. 

People should not drive or use machinery if they feel drowsy.

Long-term effects and complications

In the long term, having too little sleep may increase the risk of:

  • hypertension
  • diabetes or insulin resistance
  • sleep apnea
  • obesity
  • heart attack
  • stroke
  • depression and anxiety
  • psychosis

Causes

There are many reasons why a person may not get enough sleep. Examples include:

  • shift work
  • meeting deadlines
  • a sleeping environment that is noisy or not the right temperature
  • using electronic devices close to bedtime or keeping them in the bedroom
  • medical problems, such as depression, sleep apnea, or chronic pain
  • caring for another person during the night

Health issues that commonly disrupt sleep include:

  • chronic fatigue syndrome
  • chronic pain
  • substance misuse
  • depression
  • anxiety
  • bipolar disorder
  • schizophrenia
  • obesity
  • sleep apnea
  • bruxism, or grinding the teeth
  • narcolepsy

Anxiety disorder

Everyone feels anxious from time to time, but people with anxiety disorders experience frequent and severe worry that disrupts their normal life.

What is anxiety?

Feeling anxiety before a specific event, such as a test, is normal.

Usually, anxiety is temporary. But someone with an anxiety disorder experiences regular, severe worry. The anxiety may be debilitating and prevent them from doing their normal activities.

Anxiety disorders are common. According to the National Institute of Mental Health, approximately 19.1% of adults in the United States have an anxiety disorder.

Types of anxiety disorder

Agoraphobia

Agoraphobia is the fear of space where it is difficult to escape or receive help if something goes wrong.People with this type of phobia tend to avoid specific places or situations. For example, they might avoid crowds or public transport. Some people may become housebound in severe cases.

Generalized anxiety disorder

Generalized anxiety disorder (GAD) involves constant worrying over everyday things. The anxiety might have no clear cause or trigger. This chronic condition can cause trouble sleeping, irritability, and muscle tension.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) causes distressing, intrusive thoughts that a person may manage by carrying out repetitive behaviors that provide temporary relief.

Examples include compulsively washing the hands in fear of contamination. If a person does not perform the compulsion, they may feel more anxious as a result.

Phobias

Agoraphobia is one type of phobia, or fear. However, many other phobias exist. Some are common and relatively mild, such as a fear of spiders, or arachnophobia. Others may be more disruptive to a person’s life.

Panic disorder

Those with panic disorder are prone to panic attacks. These panic attacks cause physical symptoms similar to a heart attack.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) can develop after a person experiences trauma. For example, someone may develop PTSD after an accident, assault, or a natural disaster.In some people, symptoms are temporary. But others will experience PTSD over long periods.

Selective mutism

People who have this rare disorder avoid speaking, despite having the ability to do so. Those with selective mutism are typically very shy. They fear social judgment and embarrassment.

Separation anxiety

Separation anxiety is common in children, but adults also experience it. People with this type of anxiety disorder have an intense fear of separation from the people who are close to them in their lives.

Social anxiety disorder

People with this anxiety disorder have an intense fear of social interactions. They typically fear social humiliation and worry about judgment from others.

What is an anxiety attack?

An anxiety or panic attack involves a sudden burst of intense anxiety that produces physical symptoms. The symptoms might include difficulty breathing, chest pain, and dizziness.

Some people use the terms anxiety attack and panic attack interchangeably. Panic attacks can last as long as anywhere from 5–30 minutes.

Having a panic attack is frightening, and people who experience them are usually fearful of triggering another. Some people go to great lengths to avoid certain situations that might produce another episode.

Symptoms of a panic attack

Symptoms of a panic attack are not life threatening despite their intensity. They include:

  • sweating
  • shaking
  • trembling
  • dizziness
  • panting and shortness of breath
  • nausea
  • heart palpitations
  • increased heart rate
  • depersonalization
  • hot and cold flushes

Some people experience these kinds of symptoms with their regular anxiety. What makes a panic attack different is how intense and sudden the physical sensations are.

Causes of anxiety

The causes of anxiety are complex. Some potential causes of an anxiety disorder might include:

  • Environment: A person’s life experiences, upbringing, and home environment have a significant impact on whether someone develops anxiety. A 2014 study suggests that some parenting styles increase the risk of anxiety disorders.
  • Genetics: People with a family history of anxiety disorders are more likely to develop one.
  • Health conditions: Some health problems might cause anxiety symptoms, such as thyroid or heart conditions.

Females are also more likely than males to develop an anxiety disorder.

Treatments

There are effective treatment options for anxiety disorders. The type of treatment will vary depending on the anxiety disorder.

Some anxiety treatments include:

Psychotherapy

Talk therapies, such as cognitive behavioral therapy (CBT), are a standard treatment for anxiety disorders. CBT teaches individuals with anxiety to approach their anxious feelings and thoughts differently. CBT can also involve exposure therapy for treating phobias, which means a person gradually and intentionally exposing themselves to their fear.

Medications

In some cases, medications, such as antidepressants and anti-anxiety medication, may help reduce the symptoms of an anxiety disorder. These are helpful for people who have severe symptoms.

A doctor may prescribe beta-blockers to someone with panic disorder. Beta-blockers can help with the physical symptoms of anxiety, such as rapid heartbeat and shaking.

Management

Some self-care strategies can help a person manage anxiety in their daily life. People with severe anxiety should not use these methods to replace help from a mental health professional.

Support groups

Support groups can provide people with anxiety a place to talk about their experiences with others who understand their condition. Additionally, being involved in spiritual groups that focus on compassion and forgiveness may help some people with anxiety.

Relaxation techniques

Activities that calm the nervous system can help ease anxiety, such as:

  • spending time in nature
  • meditation and mindfulness
  • activities a person finds fun

Lifestyle changes

Substances such as caffeine and some nutritional deficiencies can make anxiety worse. Additionally, getting enough exercise and eating a nutrient-rich diet can help to reduce it.

A person with an anxiety disorder may feel some benefits from:

  • reducing caffeine intake
  • focusing on eating whole foods, such as fruits, vegetables, and fish
  • getting regular exercise

Summary

Anxiety is a normal reaction to stress and change, but anxiety disorders are highly disruptive conditions. There are many types of anxiety disorder, including PTSD, OCD, GAD, and phobias.

Treatment for an anxiety disorder might include a combination of therapy and medication. People should seek help for anxiety that regularly affects their normal life.

smoking and vaping could increase the severity of COVID-19 due to blood vessel damage and a higher risk of stroke.

A recent report from a neurological hospital in the United Kingdom identifies cases of delirium, brain inflammation, nerve damage, and stroke in COVID-19 patients.

Reports of stroke in COVID-19 are particularly prevalent. Some reports estimate that 30% of critically ill COVID-19 patients experience blood clots. And if they occur in the brain, they may trigger a stroke.

Researchers from Texas Tech University Health Sciences Center previously found that smoking and vaping increases the risk of viral infection. They have now published a review on how these activities might affect the risk of neurological dysfunction in COVID-19, particularly from damage to blood vessels in the brain.

They found that both smoking and vaping could increase the risk of stroke in COVID-19 due to damage to the blood-brain barrier and a higher risk of blood clots.

Smoking causes well-known damage to the lungs and respiratory system. Previous research has shown that it also makes a person more vulnerable to influenza.

Smoking can also affect the vascular system in the brain, prompting the researchers to review the evidence on how this activity might influence the neurological symptoms of people who contract COVID-19.

They first looked at the evidence on SARS-CoV-2 and neurological disorders, including stroke. They found one study which showed that 36.4% of COVID-19 patients had neurological symptoms. Another paper found five cases of sudden stroke in COVID-19 patients aged 30–40 years due to abnormal blood clotting in their large arteries.

But how does this relate to smoking? The researchers explain that when the body is deprived of oxygen, which occurs with smoking, the amount of clotting factors in the blood increase.

In combination with COVID-19, which also increases blood-clotting proteins, the risk of stroke rises.

COVID-19 seems to have this ability to increase the risk for blood coagulation, as does smoke. This may ultimately translate in higher risk for stroke.”

Although there is less evidence around vaping, the authors found studies that show vape aerosol components can harm blood vessels in the brain.

Vaping also appears to affect the blood-brain barrier, the defensive structure which protects the brain from toxins and pathogens in the blood.

The researchers also found specific evidence that long-term vaping may increase the risk of stroke.

Vaping may also make a person more vulnerable to COVID-19 by increasing the number of ACE2 receptors expressed in the body, which are used by the novel coronavirus to infect cells. Smoking can also increase expression of the ACE2 receptor, and damages the blood-brain barrier.

Love hormone’ oxytocin could be used to treat cognitive disorders like Alzheimer’s

Alzheimer’s disease progressively degrades a person’s memory and cognitive abilities, often resulting in dementia. Amid efforts to find novel treatments for this disease, a recent breakthrough study by scientists from Japan shows that oxytocin―the hormone that we commonly know to induce feelings of love and well-being―can also effectively reverse some of the damage caused by amyloid plaques in the learning and memory center of the brain in an animal model of Alzheimer’s.

Alzheimer’s disease is a progressive disorder in which the nerve cells (neurons) in a person’s brain and the connections among them degenerate slowly, causing severe memory loss, intellectual deficiencies, and deterioration in motor skills and communication. One of the main causes of Alzheimer’s is the accumulation of a protein called amyloid β (Aβ) in clusters around neurons in the brain, which hampers their activity and triggers their degeneration. Studies in animal models have found that increasing the aggregation of Aβ in the hippocampus―the brain’s main learning and memory center―causes a decline in the signal transmission potential of the neurons therein. This degeneration affects a specific trait of the neurons, called “synaptic plasticity,” which is the ability of synapses (the site of signal exchange between neurons) to adapt to an increase or decrease in signaling activity over time. Synaptic plasticity is crucial to the development of learning and cognitive functions in the hippocampus. Thus, Aβ and its role in causing cognitive memory and deficits have been the focus of most research aimed at finding treatments for Alzheimer’s.

Now, advancing this research effort, a team of scientists from Japan, has looked at oxytocin, a hormone conventionally known for its role in the female reproductive system and in inducing the feelings of love and well-being. “Oxytocin was recently found to be involved in regulating learning and memory performance, but so far, no previous study deals with the effect of oxytocin on Aβ-induced cognitive impairment. Realizing this.

Oxytocin is known to facilitate certain cellular chemical activities that are important in strengthening neuronal signaling potential and formation of memories, such as influx of calcium ions. Previous studies have suspected that Aβ suppresses some of these chemical activities. When the scientists artificially blocked these chemical activities, they found that addition of oxytocin addition to the hippocampal slices did not reverse the damage to synaptic plasticity caused by Aβ. Additionally, they found that oxytocin itself does not have any effect on synaptic plasticity in the hippocampus, but it is somehow able to reverse the ill―effects of Aβ.

Text Alzheimers Disease appearing behind ripped brown paper in human brain drawing.

Pregnant during the COVID-19 crisis

The COVID-19 pandemic has changed the healthcare landscape for many patient populations — including pregnant women.

To mark Mental Health Awareness Month this May, we’re bringing you research-backed information to help support the mental well-being of you and your loved ones during this difficult time.

Altered hospital policies, concerns about contracting the SARS-CoV-2 virus, and changes to doctors’ office hours have all affected pregnancy.

Information regarding pregnancy and COVID-19 is continually evolving. This article will cover the currently available information relating to pregnancy during the pandemic.

Pregnancy can be an exciting time, but also one of uncertainty. The COVID-19 pandemic understandably adds further stress and may cause anxiety in some people.

During pregnancy, signs and symptoms of high stress include:

  • changes in appetite
  • frequent feelings of fear and worry about the pregnancy and delivery
  • poor quality sleep
  • problems concentrating

Pregnant women may wish to try the following stress-relieving practices and tips:

  • Refrain from looking at physical media or watching the news around the clock. Instead, limit the news to key times of the day, such as the morning or before dinner, leaving the evenings free for unwinding and promoting sleep.
  • Ask a doctor or midwife about online antenatal classes, which are excellent places to meet and talk to other pregnant women.
  • Try meditating, deep breathing, or gentle stretching.
  • Take care of key relationships by connecting with friends and family over the phone or through video conferences.
  • Get enough sleep by going to bed at a consistent time and limiting screen time beforehand.
  • Maintain a healthful diet and engage in regular exercise. Eating well and staying active can help the body stay healthy in times of mental ill health.
  • Take up a new hobby or rediscover an old one, such as playing an instrument, learning a language, or reading. People may also enjoy making blankets, clothes, or handmade toys for the coming baby, or decorating a nursery.
  • Make use of online support groups and forums for pregnant women and new parents.
  • Consider online counseling. Therapy can be helpful for anyone experiencing anxiety, depression, or stress.
  • Ask for extra help — this may mean that a partner takes a greater share of caring for the children, if applicable, or that a neighbor does the grocery shopping and drops the bags outside the door.

If a woman is experiencing significant mental distress, it is vital to speak to a doctor, midwife, or counselor.

Depression during pregnancy is common but treatable. Even if they are physical distancing, pregnant women do not have to face depression or other mental health concerns alone.

Physical distancing while pregnant

Avoiding contact with others, especially large groups of people, can reduce the transmission of the coronavirus.

Many areas have enacted shelter-at-home or safer-at-home policies that discourage people from going outside except for essential travel, such as going to the grocery store or pharmacy or making other necessary visits.

It is essential to keep attending prenatal appointments, but be aware that some of these appointments may occur over the phone.

Modern technology enables doctors’ offices to change the way in which they help people, including pregnant women.

The American College of Obstetricians and Gynecologists recommend that pregnant women talk with a doctor to determine how often they should go for in-person visits.

Our doctors offer online video call visits called telemedicine. They may recommend spacing out ultrasound appointments or other in-person visits to reduce a woman’s risk for transmission.

If possible, having a partner or delivery service secure key items can help reduce a pregnant woman’s exposure to the public.

People should always wash their hands when returning from the grocery store or a walk outside.

COVID-19 effects during pregnancy

As COVID-19 is a new and developing health crisis, experts have not yet identified its effects on pregnancy. They remain unsure whether pregnant women are more at risk of getting COVID-19 or experiencing more severe symptoms and whether they might pass the virus to the baby.

According to the World Health Organization (WHO), no evidence currently exists to suggest that pregnant women are at higher risk of experiencing severe COVID-19 symptoms than the general population.

A small study of nine pregnant women in their third trimester with COVID-19 and pneumonia symptoms in Wuhan, China, found that one baby tested positive for the virus 36 hours after birth.

However, tests of the woman’s placenta and umbilical cord were negative, which could mean that the newborn contracted the virus after birth, rather than in the womb. This sample size was very small, which makes drawing conclusions difficult.

Another study of 38 pregnant women testing positive for COVID-19 in China did not find that their symptoms were more severe than those affecting the general population.

The study did not report any maternal deaths or the transmission of COVID-19 to any babies.

When to self-isolate

If a pregnant woman has symptoms that resemble those of COVID-19, such as coughing, fever, or shortness of breath, she should call a doctor.

The doctor can make recommendations about whether or not COVID-19 testing is necessary.

If the woman’s symptoms are mild, a doctor will likely recommend that she self-isolate at home.

Home treatment includes taking acetaminophen for fever relief, resting, and drinking plenty of water.

A high fever or difficulty breathing are signs that urgent care is necessary. Try to call the hospital before arriving at the emergency room so that they can take any necessary precautions.

Do you have to give birth alone in the hospital?

Some hospitals in the United States have prohibited visitors for the foreseeable future — including during childbirth — to protect healthcare staff and other patients from the virus. The number of support people who may enter the delivery room can vary from hospital to hospital, however.

Questions to ask a doctor

The pandemic has resulted in many pregnant women experiencing changes to their birth plan, which can cause stress and uncertainty.

Having all the necessary information may help them feel in control and reduce anxiety.

Questions to ask a doctor include:

  • How may your office hours or accessibility change?
  • Are there online alternatives to antenatal classes where I can meet and talk to other pregnant women?
  • How can I ensure that I am safe when visiting my doctor’s office or going to the hospital?
  • How can I expect COVID-19 concerns at the hospital to affect my delivery?
  • Will there be changes in terms of the medications that I may receive or the number of people present in the delivery room?

A woman can also ask her doctor about any area-specific or condition-specific changes.

Summary

Pregnant women may feel additional stress, anxiety, or depression during the COVID-19 pandemic. But even if they are self-isolating, they do not have to face these problems alone.

It is best for pregnant women to focus on the elements that they can control, including self-care and physical distancing.

Keeping in regular contact with a doctor or midwife can also help alleviate worries about health and the birth.

Covid-19 patients recovering quickly after getting experimental drug remdesivir

COVID-19 patients on the antiviral remdesivir recovered about 30 percent faster than those on a placebo, the results of a major clinical trial showed Wednesday, as a top US scientist hailed the drug’s “clear-cut” benefit.

The patients taking part in a clinical trial of the drug have all had severe respiratory symptoms and fever, but were able to leave the hospital after less than a week of treatment, STAT quoted the doctor leading the trial as saying.

“The best news is that most of our patients have already been discharged, which is great.

“Partial data from an ongoing clinical trial is by definition incomplete and should never be used to draw conclusions about the safety or efficacy of a potential treatment that is under investigation.

There is no approved therapy for the Covid-19, which can cause severe pneumonia and acute respiratory distress syndrome in some patients. But the National Institutes of Health is organizing trials of several drugs and other treatments, among them remdesivir.

The drug, made by Gilead Sciences, was tested against Ebola with little success, but multiple studies in animals showed the drug could both prevent and treat coronaviruses related to Covid-19, including SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

Back in February, the World Health Organization said remdesivir showed potential against Covid-19.

Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn’t have to be 10 days.

However, the trial does not include what’s known as a control group, so it will be difficult to say whether the drug is truly helping patients recover better. With a control arm, some patients do not receive the drug being tested so that doctors can determine whether it’s the drug that is really affecting their condition.

Trials of the drug are ongoing at dozens of other clinical centers, as well. Gilead is sponsoring tests of the drug in 2,400 patients with severe Covid-19 symptoms in 152 trial sites around the world. It’s also testing the drug in 1,600 patients with moderate symptoms at 169 hospitals and clinics around the world.

Gilead said it expected results from the trial by the end of the month.

“We understand the urgent need for a COVID-19 treatment and the resulting interest in data on our investigational antiviral drug remdesivir,” the company said in a statement. But it said a few stories about patients are just that.

“The totality of the data need to be analyzed in order to draw any conclusions from the trial. Anecdotal reports, while encouraging, do not provide the statistical power necessary to determine the safety and efficacy profile of remdesivir as a treatment for Covid-19.

Who is at higher risk of CoronaVirus?

Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:

  • Older adults
  • People who have serious chronic medical conditions like:
    • Heart disease
    • Diabetes
    • Lung disease

Get ready for COVID-19 now

Take actions to reduce your risk of getting sick

If you are at higher risk for serious illness from COVID-19 because of your age or because you have a serious long-term health problem, it is extra important for you to take actions to reduce your risk of getting sick with the disease.

  • Stock up on supplies.
  • Take everyday precautions to keep space between yourself and others.
  • When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
  • Avoid crowds as much as possible.
  • Avoid cruise travel and non-essential air travel.
  • During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.

Have supplies on hand

  • Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.
  • If you cannot get extra medications, consider using mail-order for medications.
  • Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
  • Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.

Preparing for COVID-19: Priorities for the US


Three physicians from Johns Hopkins University, in Baltimore, MD, have joined efforts to write an article outlining key action points that the United States healthcare community should take in response to COVID-19.

Drs. Amesh A. Adalja, Eric Toner, and Thomas V. Inglesby wrote the paper, titled “Priorities for the U.S. Health Community Responding to COVID-19.”

The doctors are all from the Johns Hopkins Center for Health Security, as well as the university’s Department of Environmental Health and Engineering.

Appearing in the journal JAMA, the article draws from experiences with similar epidemics — such as the 2009 influenza pandemic, the SARS epidemic in 2003, and the avian influenza A epidemic in 2005 — to outline key measures that the U.S. government and healthcare sector should take to deal with the new coronavirus.

Hospitals, clinics, and other facilities

First, write the authors, healthcare institutions should update preparedness plans that had been developed for the previous epidemics.

“Broadly speaking, those plans addressed the protection of healthcare workers, how to deal with staffing shortages, surges in patient numbers, triage issues, and management of scarce resources,” write Dr. Adalja and colleagues.

Second, hospitals and clinics, which have “critical roles” in the response to COVID-19, must establish clear “protocols for triaging and isolating patients suspected of having infection in emergency departments and urgent care centers.”

Importantly, write the authors, “Similar procedures need to be established in outpatient clinics, dialysis centers, and other medical facilities — especially nursing homes, assisted living centers, and long-term care facilities with particularly vulnerable populations.”

This is to prevent COVID-19 from disrupting regular treatments in medical care units, which would “compound the direct morbidity and mortality of the disease.”

Healthcare workers and ICU units

Protecting healthcare workers is another key priority in the COVID-19 response. This will require the use of personal protective equipment, updated hospital administrative policies, and special training of hospital staff, the authors note.

A considerable number of patients are likely to be severely ill, so hospitals must pay specific attention to preparing their intensive care units (ICUs), Dr. Adalja and colleagues write, explaining: 

“This planning includes evaluation of ICU bed capacity, the ability to augment ICU-level bed space with alternative care sites such as step-down units and postanesthesia care units, mechanical ventilator stock and supply chains, and the logistics of isolating and cohorting patients.” 

“Many hospitals operate at or near capacity already, and even an above-average flu season can cause operational disruption,” the authors point out.

Finally, the team emphasizes that — even though too little is currently known about COVID-19, and healthcare professionals will have to adapt their clinical approaches as more information becomes available — sticking to existing guidelines for pneumonia, sepsis, and acute respiratory distress syndrome (ARDS) is the best course of action.

“This may include the use of investigational antiviral or monoclonal antibody therapy,” the authors note.

More diagnostic tests needed ‘rapidly’

Furthermore, they write, clinicians must “rapidly” extend their diagnostic testing.

“To better understand the burden of COVID-19, medical and public health experts need to expand testing to all patients who have unexplained ARDS or severe pneumonia and ultimately to patients who have mild symptoms consistent with COVID-19.”

The researchers explain that the Centers for Disease Control and Prevention (CDC) — which initially performed all diagnostic tests — and public health labs do not have the capacity to perform testing on the scale that is necessary right now.

“To reach a high level testing capacity will require the major clinical diagnostic companies to develop and manufacture testing kits at large scale. Diagnostic companies may simply be able to add SARS-CoV-2 to existing nucleic acid–based respiratory viral panels or create standalone tests. Ideally, such diagnostic tests would be rapid,” the article cautions.

Also, serological assays, blood tests for specific antibodies, are necessary to help determine an accurate case fatality rate and for monitoring purposes, the authors point out.

Public health and social distancing

“From the outset, SARS-CoV-2 posed a near-impossible challenge for containment,” the team writes.

This is because the virus transmits very effectively; the authors note that the virus was “surreptitiously spreading for at least 6 weeks” and that it has “an epidemic doubling time of about 1 week.”

“As more and more countries report cases, including those with no link to the disease epicenter, it is clear that there are many more unrecognized cases in the world and that community transmission is happening in many countries.”

– Dr. Amesh A. Adalja et al.

Public health measures such as providing rapid diagnoses and isolating people with the virus are the most important actions that can slow the spread of SARS-CoV-2.

Tracking the contacts of people with the virus and placing them in quarantine may also be effective at this early stage of the epidemic.

“However, beyond a certain threshold, it will no longer be feasible to track all contacts.” At this point, actions classified as “social distancing” may be necessary. These include “cancellation of large gatherings, telecommuting to work when feasible, and school closures.”

However, such measures would come at a cost that must be accounted for. For instance, school closures would mean that “Many children who depend on school meals will not receive them, and many single parents will be out of the workforce.”

Finally, in addition to communicating health measures that everyone should take to reduce the spread of the infection, “It will also be important to communicate […] that persons who test positive for this virus but who do not need hospital care should stay at home while they are ill and not go to hospitals.”

“Hospitals may have serious challenges in handling the number of people who do need acute care, so it will be important for those who are infected but otherwise well to not contribute to hospital demands.” Dr. Adalja and colleagues conclude:

“Preparation will take time, so healthcare and public health systems need to move quickly forward in their efforts to be ready to confront this disease around the country.”

For information on how to prevent the spread of coronavirus, this CDC page provides advice.

Coroavirus outbreak

The emergence and rapid increase in cases of coronavirus disease 2019 (COVID-19), a respiratory illness caused by a novel coronavirus, pose complex challenges to the global public health, research and medical communities, write federal scientists from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and from the Centers for Disease Control and Prevention (CDC). 

In response to the outbreak, the United States and other countries instituted temporary travel restrictions, which may have slowed the spread of COVID-19 somewhat, the authors note. However, given the apparent efficiency of virus transmission, everyone should be prepared for COVID-19 to gain a foothold throughout the world, including in the United States, they add. If the disease begins to spread in U.S. communities, containment may no longer be a realistic goal and response efforts likely will need to transition to various mitigation strategies, which could include isolating ill people at home, closing schools and encouraging telework, the officials write.

“The COVID-19 outbreak is a stark reminder of the ongoing challenge of emerging and re-emerging infectious pathogens and the need for constant surveillance, prompt diagnosis and robust research to understand the basic biology of new organisms and our susceptibilities to them, as well as to develop effective countermeasures,” the authors conclude.

Here’s what you can do:

Avoid close contact with people who are sick.

Avoid touching your eyes, nose, and mouth.

Stay home when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Keep your hands clean, and keep your distance from sick people

Unless you are already infected, face masks won’t help you

Stock up on home supplies, medicine and resources

Prepare your family, and communicate your plan

With your children, keep calm and carry on — and get the flu shot

About to go on vacation? Consider your destination and how you feel about risk