#latent tuberculosis

[arthurs-tb-vaccine]

Sure, tuberculosis can cause hallucinations and psychosis to an extent. That's why it's heavily theorised that Joan of Arc's famous visions were due to possible untreated tuberculosis.

But for Arthur's case, I don't think he saw the deer visions because of his tuberculosis. There's definitely some poetry in there if it was, but I think we're allowed to have unexplainable divine interventions sometimes.

Arthur would had to have been on death's door from very early on to experience that level of psychosis, which he wasn't until much later.

The world of rdr2 is realistic and full of painful, historical, truths, but there's also so much whimsy and supernatural mystery if you know where to look. Whatever Arthur saw, no matter how he saw it, was more of a reflection if anything.

[publicdomainbooksdevotee]

Thus, of a total of 31 discharged from the File Hills school, 9 died at the school, of 6 others there is no record of condition on discharge, but all are reported to be dead, 7 others died from within a few months to three years after discharge and 9 are reported as in good health, 7 being farmers or their wives at the File Hills Colony, 1 a student, and 1 at Coté’s reserve.

It suffices for us to know, however, that of a total of 1,537 pupils reported upon nearly 25 per cent are dead, of one school with an absolutely accurate statement, 69 per cent of ex-pupils are dead, and that everywhere the almost invariable cause of death given is tuberculosis.

[relentlesserudition]

Antibiotics for four months. FOUR!!! WHOLE!!! MONTHS!!!

RIP to my internal flora, I guess.

[yaoiconnoisseur]

one of my favorite ways of inflicting psychic damage upon myself is going onto my blog's art tag and checking how long its been since i last posted anything :)

[girljpg]

I haaaate getting my blood drawn like wtf I need that

[strawberry-cow-sorceress]

so there’s tuberculosis in Illinois and this article says that’s it’s “typically spread by a patient coughing” (they don’t use the term airborne) which puts “those in close proximity potentially at risk.”

those in close proximity

to the AIRBORNE bacterium

that someone is actively coughing...

and then the article goes on to say ‘oh it isn’t even a big deal bc it’s treatable with antibiotics like its fine there shouldn’t be any stigma around TUBERCULOSIS’ like ????? i get stigma is a loaded word but idk i would very much like for ppl to still take tuberculosis seriously and to try to avoid catching it whenever possible tyvm !!! especially in the US where most ppl never get the BCG vaccine that’s used widely in other countries like !!!!!!!

[neha24blog]

 Latent Tuberculosis Infection Detection Market Trends Analysis Report By Test Type, Application, End-User, Region And Forecast To 2030 : Grand View Research Inc.

San Francisco, 30 Jan 2023: The Report Latent Tuberculosis Infection Detection Market Size, Share & Trends Analysis Report By Test Type (Tuberculin Skin Test (TST), Interferon-Gamma Released Assay (IGRA)), By Application, By End User, By Region, And Segment Forecasts, 2022 – 2030 The global latent tuberculosis infection detection market size is expected to reach USD 2.2 billion by 2030,…

[schmergo]

Today I learned a fact that kinda blew my mind, and I'm almost astonished I didn't know this before as someone whose chief interests include zoo animals, the U.S. Presidency, true crime, and D.C. history. What an opener, right? How could those topics possibly combine?

Well, buckle up and get ready to hear how negligent National Zoo leadership potentially could have killed a US President or started a local epidemic. Spoiler alert: They didn't. But only because luck was in their favor.

First, the part that I DID already know. In 2004, Lucy Spelman stepped down as the director of the National Zoo after a spate of controversial zoo incidents, including a string of unfortunate (and often preventable) animal deaths, misleading and missing zoo records, and other signs of negligence. The AZA even "tabled" renewing the National Zoo's accreditation for a year until they made some significant improvements. Spelman was also a vet and some of the cases she was accused of bungling happened at her own hands, not just under her supervision. It was a major disgrace for a zoo that was meant to represent the nation's capital.

I was in elementary school during these fraught years and I remember devouring articles about this in the newspaper, riveted with shock and dismay. Some of the deaths were just bad luck, but others were obviously negligent. The most infamous case was two red pandas killed by rat poison shallowly buried in their enclosures as a slapdash solution to the zoo's pest problem. A young zebra died of starvation and hypothermia after Spelman ordered the zebras' feed be cut in half, an orangutan was euthanized due to a recurrence of cancer that didn't exist (she actually had salmonella), a lion died after being administered over twice the usual amount of anesthetic, and more. I remember the names and details of these animals from when I first read these cases 20 years ago. But the one I'm talking about today is that of Nancy the elephant.

Nancy was a 46-year-old African elephant whose health had been steadily declining for several years. She suffered from a bone infection in her foot that seriously affected her mobility and quality of life. She had lost a lot of weight, she was fatigued, she even lay down at times. Nobody could be blamed for deciding to euthanize the obviously ill animal.

But they could be blamed for what was discovered in the necropsy after she was euthanized. While she did indeed have a diseased foot, the bone infection was only "moderate." Why, then, was she so obviously unwell? Her lungs had been destroyed by the effects of untreated tuberculosis. It was the tuberculosis, not the sore foot, that most contributed to her decline in health.

Here’s the scary part: nobody knows how long she'd had it because she hadn't been tested for tuberculosis, a known concern for zoo elephants, in TWO YEARS. All this despite the fact that it's MANDATORY for all zoo elephants to receive a tuberculosis test once per year-- and in fact, it was a National Zoo staff member who pushed for that reform in the first place. And the elephant was on Prednisone for her foot issues, which zoo staff noted in her records made her more vulnerable to illnesses like TB. In fact, none of the zoo's elephants had been tested recently, which meant any of them, including one who was pregnant, may have had tuberculosis, too.

There are documented cases of humans catching tuberculosis from elephants. Now, Nancy the elephant had bovine tuberculosis, which seems to be less contagious to humans and which elephants haven't so far spread to humans... BUT it has spread to humans from black rhinos, a fairly close relative, so it seems likely that elephants COULD spread it. It can also take a while for TB for incubate (and can also be latent without symptoms), especially for elephants, so the elephants OR keepers who were around Nancy were at serious risk for TB.

NOW HERE IS THE PART THAT I DIDN'T KNOW ABOUT UNTIL TODAY:

Spelman actively tried to COVER UP the situation, potentially putting many more people at risk. The elephant house was closed to zoo guests, but they were only told it was for "renovations." (The actual renovations, incidentally, were to improve ventilation so that illness would be less likely to spread.)

A BBC news crew that came to film the elephants was asked to keep a healthy distance from the elephants for their emotional health and the crew's safety-- the explanation given was that the elephants' group dynamics had been thrown off by Nancy's death. Spelman instructed zoo staff not to mention the TB situation to the BBC crew and, if asked why Nancy died, they were to respond that it was for multiple reasons and that the official test results weren't all back yet.

And here's the most shocking part of all, the part that made me GASP out loud. Spelman still personally gave some special VIP behind-the-scenes tours of the elephant house during the months that the elephant house was closed, a time when the remaining elephant inhabitants could potentially still develop active TB.

One VIP who received an elephant house tour was PRESIDENT BILL CLINTON and five family members!!!!

BILL. CLINTON. THE GOSHDARN PRESIDENT.

While zoo staff says that the tour was deliberately distanced and nobody got close to an elephant, there are photos of Bill Clinton's nephew about a foot away from an elephant's trunk. You know, their nose. The part they can spread disease with. So, uh, definitely in the danger zone there.

Hillary Clinton's brother, Tony Rodham, was on the tour and he said that nobody in the party was warned about TB risk or asked if they had any medical conditions that might (a. make them susceptible to communicable disease, or (b. be contagious to the elephants. This is especially egregious because according to zoo guidelines, all behind-the-scenes tour participants MUST be asked these questions-- not just when there's a very real possibility of a TB outbreak at the zoo.

Fortunately, none of the zoo's other elephants OR keepers ever tested positive for tuberculosis. But it was certainly a close call! And imagine what would have happened if a US President caught TB from a close encounter with an elephant thanks to poorly managed zoo staff.

Presidents meet a lot of people. In fact, this zoo visit happened only 2 weeks before the inauguration of President George W. Bush, which Clinton attended. He very well could have started a TB outbreak there. Heck, TWO US Presidents could have been infected!

Now THAT is something I will be thinking about for a long time!

[rottenpumpkin13]

Ok I now need a whole thing of Sephiroth randomly info dumping

*Zack is happily eating a banana*

Sephiroth: Due to the presence of the isotope potassium-40, bananas are radioactive.

*Zack stops chewing*

Sephiroth: Be not afraid. Radiation is everywhere. Terrestrial radiation, cosmic radiation, electromagnetic radiation, and even in our electronic devices.

*Zack panics and starts crying*

-

*During a meeting*

Lazard: I trust that no one had problems accessing their paychecks last week?

Sephiroth: Women earn approximately 23% less for every gil earned by a man for the same work, a consequence of gross systemic inequities in our society.

Lazard:

Sephiroth: You should be ashamed of yourself.

-

*Genesis coughs*

Sephiroth: Despite the advancement of modern medicine, millions of people still lack access to essential healthcare services, which leads to death and disease.

Genesis: Oh, I'm not sick.

Sephiroth: Tuberculosis is an infectious disease caused by bacteria, known as mycobacterium tuberculosis, and often goes unnoticed during its latent stages, leading the individual to believe they are well.

Genesis: What the fuck do I do with this information now?

Sephiroth: Tuberculosis is one of the top 10 causes of global death, with an average of over 3000 deaths—

Genesis, panicked: STOP IT.

-

*Sephiroth walks up to Angeal*

Sephiroth: Foot odor is caused by the high concentration of sweat glands in the feet, which produce sweat not easily evaporated when confined in shoes, creating a moist environment ideal for bacterial growth.

Angeal: ......

*Sephiroth walks away*

Angeal: ......

*Angeal self consciously removes his boot and brings it up to his nose*

Angeal: MY FEET DON'T SMELL, YOU IDIOT!

-

*Cloud is standing around on patrol when Sephiroth walks up to him*

Sephiroth: Though the weight of a cloud can vary depending on its size, altitude and water content, the average cloud weighs around 500,000 kilograms.

Cloud: .......

*Sephiroth briefly picks Cloud up and places him back down*

Sephiroth: I was wrong.

[kannibalistics]

okay but what if Arthur’s tuberculosis had gone latent? what if he had been the one out of every three people with TB that lived through it without treatment?

would he have gone with John? gone back to Mary, now that his life with the gang would never be a hinderance? would he have turned himself in?

would Arthur living have stopped John from getting revenge? would Arthur living have saved John, as Milton never would’ve found Micah’s body? would Arthur living have saved Jack from becoming what none of them wanted him to be?

[sixminutestoriesblog]

Mercy Brown: when superstitions go awry

Tuberculosis is an insidious disease that comes in quietly and sweeps away entire families, rarely content with just one or two before its run its course. This slowly dividing bacteria travels from host to host through aerosol droplets via sneezing, coughing, speaking and other airborne paths. Considering the fact that TB attacks the lungs most often, resulting in, among other things, coughing up bloody phlegm, this means its highly transmissible and yet, luckily, very slow to be caught by the average passer-by. The longer someone spends with the sick person, and the less well ventilated an area is, the more likely the disease is to pass on to the next victim. Most people that came down with TB caught it from sick family members. These days we have a vaccine against it but TB has been around for most of humanities' recorded history, with even Egyptian mummies having been found with physical evidence of it. In Victorian (and later) times the disease was referred to as 'consumption' with little understanding of its source or its cause, an unknown horror that seemed to come from nowhere, prey on an entire family or community and than vanish again just as mysteriously.

In 1883 (or 1884 or 1888 -the dates are all over the place), a woman in Exeter, Rhode Island by the name of Mary Eliza died of 'consumption'. Six months later, her oldest daughter, Mary Olive, joined her in the graveyard. The distraught husband, George, waited, one can only imagine, with terror for the rest of their children to be swept away as well but for the next several years, all was well in the family. Then, in the cold months at the end of 1891, his daughter Mercy Lena came down with consumption.

From our place, safely in the future, we can look at the case and wonder if she was exposed to a new strain that finally found a weak spot the previous one hadn't and laid claim to her. It's entirely possible however that the same bacteria that killed her mother was now killing Mercy as well. Mercy might have contracted what's known as latent TB from her mother, a case where the bacteria lies dormant in the system, the victim a benign carrier who can't infect others until something, usually an event that suppresses the immune system, triggers it into a full blow, active bought. Whatever the case, whether it was a new infection or the haunting family ghost of her mother's older one, Mercy, and her younger brother Edwin, both came down with active TB in 1891. Edwin, a teenager at the time, was sent to Colorado in the hopes it would heal him - but Mercy died in the first month of the new year, going the way of her mother and older sister before her to the grave. She was only 19.

The story should have stopped there.

I wouldn't be writing about this if it had.

Edwin returned from Colorado and his health continued to decline. Soon, if nothing changed, he would follow the majority of his family into the grave. The neighbors had a plan though. They just needed his father's permission.

What they proposed was that an evil entity was draining the life of the Brown family, picking them off one at a time and returning for each new victim. The evil that was killing the family - was a member of the family.

Here's where we get into the superstition part of things. If you read articles online about Mercy Brown you'll find the word 'vampire' thrown around a lot. It was the word used in the newspapers of the time, that caught wind of what the neighbors planned, and its also modern culture, thanks in large part to Bram Stroker's Dracula (there is speculation that his character of Lucy might have had its roots in stories he'd read about Mercy in the newspapers of his time. Dracula, remember, was published in 1897). A dark force, rising from the grave to suck the life out of its victims. Well, yes - and no. Modern vampires, the way we collectively view them now, with fangs and a hunger for blood, creeping around through windows and walking among us on our crowded nighttime streets is a new reskinning. During Mercy's time, and much much further back than that, the 'vampire' associated with disease like TB was much more nebulous. For many cultures, what was rising out of the grave to drain the life from its own family had more resemblance to an angry or hungry ghost, than a walking, talking monster. A distinction that, realistically, has no bearing on the end result but, metaphysically, the story changes. It becomes something personal, to the victim and the neighbors around the family, someone they knew in life, someone they watched die. It's the sorrow and the potential rage and absolutely the confusion of why it happened in the first place, rising like fog from the grave to whisper across the landscape, trying to take what it once had back to the cold of its tomb with it. It's the familiar knock of a friend at the door when the friend isn't there anymore. It's the smile you knew all the nineteen years of its life on the other side of the window on a moonless night. When the neighbors wanted to dig up Eliza, Olive and Mercy, there was the quiet whisper that traced back through a thousand ancestors into the far past of humanity that murmured that love doesn't die when the body does - and that that's terrifying, not comforting.

George, with his son dying, agreed to let the neighbors go digging up his family. Maybe he believed them, some accounts say he didn't, but whatever the case, he let them pull up the bodies of his dead loved ones out of their cold graves in the late winter and lay them out right there for testing. Mary Eliza and Mary Olive were safe. They were too rotted to be the hungry ghost that was trying to take young Edwin with it. Mercy however - Mercy, according to the reporter that was onsite to record all of this, looked far too fresh to be a two month old corpse. Her hair and nails had grown, her body looked unblemished, reports said her body had shifted since it had been laid out and, most damning of all, when her chest was cut open by the local doctor, her organs were found to still have blood in them. It wasn't important that Mercy's body had been in the ground during some of the coldest, and therefor most preserving, months of the year. They certainly didn't know about the buildup of gas in a body that can make it move or the way the skin shrinks and pulls back from nails and hair, making them seem to grow. No. What they saw was that Mercy wasn't content to travel into death alone. She wanted her baby brother to go with her.

So they burned her heart on a stone in the graveyard, put the ashes in a drink and had Edwin chug it down. In a move that dates back to, at least, Achilles desecrating Hector's body in the Iliad, you rob a ghost of its power by mangling the body that ties it to both this world, and its recognizable identity.

It didn't work. Within two months, Edwin was dead as well. The story however, lived on. Perhaps in Stoker's Dracula and certainly in the papers of the day. Mercy was, perhaps, the last body dug up in New England and given the 'vampire' treatment. She wasn't the only one however. There are at least six other recorded, and possibly other unmarked, instances during what came to be known as the New England Vampire Panic that swept the upper US during the 1800s. Mercy, at this point, seems to be the last, coming in on the tail end of the old century and the beginning of the new. A last flicker of the old superstitions dying out in the face of rising science.

[transgenderer]

I bought an argentine gun and it's activated my latent catholicism like tuberculosis. I need a shine to Mary. The hail Mary is awesome. I need a Mary sticker on my gun. Any links to tiny Mary stickers. I need to honor Mary

[covid-safer-hotties]

Also preserved in our archive

By Gavin Giovannoni

Long COVID is defined as a clinical syndrome of persistent symptoms after acute COVID-19 that last longer than 12 weeks. The symptoms associated with long COVID are numerous and include (see NHS website for more information on long COVID):

extreme tiredness (fatigue)

feeling short of breath

problems with your memory and concentration ("brain fog")

heart palpitations

dizziness

joint pain and muscle aches

loss of smell

chest pain or tightness

difficulty sleeping (insomnia)

pins and needles

depression and anxiety

tinnitus, earaches

feeling sick, diarrhoea, stomach aches, loss of appetite

cough, headaches, sore throat, changes to sense of smell or taste

rashes

Many of these symptoms overlap with multiple sclerosis, chronic fatigue syndrome, and post-viral fatigue syndromes, which are common to numerous viruses, including Epstein-Barr virus (EBV). While the exact mechanisms driving long COVID are still unclear, several sources suggest that EBV reactivation could contribute. This is when I became very interested. Could long COVID be the gateway to developing effective antiviral treatments for EBV and MS?

Like long COVID, EBV-associated infectious mononucleosis (IM) is also a post-acute infection syndrome. It features similar symptoms, including fatigue and muscle pain (myalgia), low mood, cog-fog, insomnia and other mental health problems (depression and anxiety). EBV typically enters a latent phase after the initial infection, be it symptomatic (IM) or asymptomatic, but can reactivate under certain conditions, including acute infections, severe illnesses, or immunosuppression. Several studies have shown evidence of EBV reactivation in COVID-19 patients, which includes:

The presence of detectable EBV viraemia during the acute phase of COVID-19 is predictive of persistent symptoms.

An association between increased seroreactivity to EBV early antigen (EA) and viral capsid antigen (VCA) and the development of long COVID.

It is important to stress that the link between EBV and long COVID is currently an association and not necessarily causal. To prove causation, more research will be done, including trials targeting EBV with antivirals as a potential treatment for long COVID. It is important to note that EBV reactivation can occur in various immune dysregulation contexts, not just long COVID, which some would argue that these findings are non-specific. Intermittent reactivation occurs in MS, and it is this intermittent cycling between latent and lytic infection that may be driving MS disease activity.

As a young general medical registrar or trainee, I was always struck by how tired and ill people were with chronic or persistent infections, be it tuberculosis, hepatitis or HIV in the pre-antiretroviral era. I later learnt about sickness behaviour, a complex behavioural syndrome in response to inflammation, be it from infection or another inflammatory stimulus such as that which occurs with autoimmune diseases. What long COVID is, and probably MS, is a form of sickness behaviour, which is why the symptoms of these two diseases overlap so much. If intermittent EBV reactivation drives long COVID and MS, it should respond to EBV antiviral strategies. I am aware that many pwMS have started taking antivirals off-label to manage their MS. It is remarkable how many pwMS have contacted me to tell me how well they are doing on antivirals. This is reassuring and supports our efforts to develop antiviral therapies for MS. Are you taking antivirals? Which ones? Have any of you noted any response?

Please note that I can not sanction the use of off-label antiviral medications to treat MS. Antivirals need to be tested in well-designed, randomised controlled trials. Without class 1 evidence, we will not be able to get antivirals licensed to treat MS, nor will payers pay for these treatments. Prescribing medications off-label comes with many risks to pwMS, the prescriber and the healthcare system the prescriber works in.

For more information on sickness behaviour, I would recommend an earlier MS-Selfie newsletter on this subject: ‘ Do you suffer from cog-fog, fatigue or sickness behaviour?’ (19-Oct-2021).

The review article that triggered me to write this newsletter below discusses the current understanding of long COVID and the persistent symptoms experienced by some individuals following a SARS-CoV-2 infection. You may find this article of interest; it is accessible to download. The authors discuss the various challenges in defining and researching long COVID, including its wide range of symptoms, variability in symptom severity, and potential mechanisms. The review explores multiple possible causes, such as persistent viral reservoirs, dysregulated immune responses, direct viral damage, and vascular endothelium activation. The article also examines the progress of animal models and clinical trials aimed at understanding and treating long COVID, highlighting the need for more extensive human studies to confirm the effectiveness of various therapeutic approaches.

Paper Antar & Cox. Translating insights into therapies for Long Covid. Sci Transl Med. 2024 Nov 13;16(773):eado2106. www.science.org/doi/10.1126/scitranslmed.ado2106?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Long Covid is defined by a wide range of symptoms that persist after the acute phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Commonly reported symptoms include fatigue, weakness, postexertional malaise, and cognitive dysfunction, with many other symptoms reported. Symptom range, duration, and severity are highly variable and partially overlap with symptoms of myalgic encephalomyelitis/chronic fatigue syndrome and other post-acute infectious syndromes, highlighting opportunities to define shared mechanisms of pathogenesis. Potential mechanisms of Long Covid are diverse, including persistence of viral reservoirs, dysregulated immune responses, direct viral damage of tissues targeted by SARS-CoV-2, inflammation driven by reactivation of latent viral infections, vascular endothelium activation or dysfunction, and subsequent thromboinflammation, autoimmunity, metabolic derangements, microglial activation, and microbiota dysbiosis. The heterogeneity of symptoms and baseline characteristics of people with Long Covid, as well as the varying states of immunity and therapies given at the time of acute infection, have made etiologies of Long Covid difficult to determine. Here, we examine progress on preclinical models for Long Covid and review progress being made in clinical trials, highlighting the need for large human studies and further development of models to better understand Long Covid. Such studies will inform clinical trials that will define treatments to benefit those living with this condition.

[redemn]

so i sort of have a timeline in my head of how his tuberculosis infection progresses ,   when it starts to become more noticeable ,   not just on the outside ,   but on the inside as well   ( he notices himself feeling bad sooner than the players begin to suspect something is wrong ) .

chapter 2 :   primary infection .   we all know why and we all know how .   no symptoms ,   he has no idea he's even caught it .

chapter 3 :   latent tuberculosis .   arthur is unaware he is anything more than strong and healthy here .   he has a few intermittent coughs that are few and far between that begin to bother him ,   but he thinks he just came down with something mild ,   and that this cough might linger for a week or two and then fade away again ,   the way most of his colds happen .   after his torture at the hands of colm o'driscoll ,   his immune system is not able to both fight off the tb infection and repair his body .   the infection spreads rapidly during his recovery .

chapter 4 :   active tuberculosis .   a few weeks later ,   he begins to exhibit more serious symptoms .   these feel like more aggressive cold symptoms ,   ranging from losing his appetite for no reason ,   the lingering but mild coughing fits ,   feeling generally achey ,   though not enough to warrant worry on his part .   he slows down on his smoking just because it's starting to pain him .   he becomes contagious at this point ,   and will continue to be contagious for the rest of his life .

chapter 5 :   during guarma ,   his sickness is spreading and worsening .   he doesn't realise this ,   thinking that the reason he feels so shit compared to all the others is because he was in the sea water for so long and washed up on shore by chance .   at this point ,   his coughing fits are getting a little worse and his lungs are beginning to bother him a lot .   by the time they return to lemoyne ,   he has already declined to the point that he can't be very physically active without needing to stop and take a breather .

chapter 6 :   his disease is in full swing now and has spread out from his lungs to other organs .   it does not get to spread very far ,   given he ends up dying before it gets to the point where he can no longer function ,   but he has the moderate symptoms before this :   generally not feeling well ,   difficulty breathing ,   aching everywhere ,   not having much of an appetite ,   weight loss and night sweats .   of course ,   every coughing spell he has brings up a lot of blood ,   and at this point ,   he can't cough at all without some blood coming up .   his sickness is physically obvious at this point .   pale ,   eyes sunken ,   cheeks flushed constantly .

like i said ,   this isn't a solid timeline of when all this happens ,   and they don't progress per chapter .   it's more of an ease thing for all of you .   in my head and off a post i've read of someone detailing their version of the timeline ,   the game takes place between the months of late april and september ,   so i've made this little visual aid for myself and anyone who is interested or wants to know about this for any threads .

[allthecanadianpolitics]

Nearly two years after the government of Nunavut declared a tuberculosis outbreak in Pangnirtung, a community-wide screening clinic will open in the community of 1,500. 

Jointly funded to an amount of up to $4 million by the federal and territorial governments and Nunavut Tunngavik Incorporated (NTI), the clinic will open this month and operate in the hamlet's community hall until Dec. 1.

It was scheduled to open Wednesday but poor weather delayed the arrival of medical personnel. 

The goal is to identify both active and latent cases of the disease and offer treatment to people who are infected, said the acting chief public health officer for the territory, Jasmine Pawa.

Officials also want to ensure that community members have a place to access information and to ask questions about transmission, testing, and treatment, she said. [...]

Continue Reading.

Tagging: @politicsofcanada

[mcatmemoranda]

Rheumatoid Arthritis:

Refer to rheumatologist.

●Nonpharmacologic measures – Nonpharmacologic measures, such as patient education, psychosocial interventions, and physical and occupational therapy, should be used in addition to drug therapy. Other medical interventions that are important in the comprehensive management of RA in all stages of disease include cardiovascular risk reduction and immunizations to decrease the risk of complications of drug therapies.

●Initiation of DMARD therapy soon after RA diagnosis – We suggest that all patients diagnosed with RA be started on disease-modifying antirheumatic drug (DMARD) therapy as soon as possible following diagnosis, rather than using antiinflammatory drugs alone, such as nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids (Grade 2C). Better outcomes are achieved by early compared with delayed intervention with DMARDs.

●Tight control of disease activity – Tight control treatment strategies to "treat to target" are associated with improved radiographic and functional outcomes compared with less aggressive approaches. Such strategies involve reassessment of disease activity on a regularly planned basis with the use of quantitative composite measures and adjustment of treatment regimens to quickly achieve and maintain control of disease activity if targeted treatment goals (remission or low disease activity) have not been achieved. (

●Pretreatment evaluation – Laboratory testing prior to therapy should include a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), aminotransferases, blood urea nitrogen, and creatinine. Patients receiving hydroxychloroquine (HCQ) should have a baseline ophthalmologic examination, and most patients who will receive a biologic agent or Janus kinase (JAK) inhibitor should be tested for latent tuberculosis (TB) infection. Screening for hepatitis B and C should be performed in all patients. Some patients may require antiviral treatment prior to initiating DMARD or immunosuppressive therapy, depending upon their level of risk for hepatitis B virus (HBV) reactivation.

●Adjunctive use of antiinflammatory agents – We use antiinflammatory drugs, including NSAIDs and glucocorticoids, as bridging therapies to rapidly achieve control of inflammation until DMARDs are sufficiently effective. Some patients may benefit from longer-term therapy with low doses of glucocorticoids.

●Drug therapy for flares – RA has natural exacerbations (also known as flares) and reductions of continuing disease activity. The severity of the flare and background drug therapy influence the choice of therapies. Patients who require multiple treatment courses with glucocorticoids for recurrent disease flares and whose medication doses have been increased to the maximally tolerated or acceptable level should be treated as patients with sustained disease activity. Such patients require modifications of their baseline drug therapies.

●Monitoring – The monitoring that we perform on a regular basis includes testing that is specific to evaluation of the safety of the drugs being; periodic assessments of disease activity with composite measures; monitoring for extraarticular manifestations of RA, other disease complications, and joint injury; and functional assessment.

●Other factors affecting target and choice of therapy – Other factors in RA management that may influence the target or choice of therapy include the disabilities or functional limitations important to a given patient, progressive joint injury, comorbidities, and the presence of adverse prognostic factors.

Osteoarthritis

General principles – General principles of osteoarthritis (OA) management include providing continuous care that is tailored to the patient according to individual needs, goals, and values and should be patient-centered. Treatment can be optimized by OA and self-management education, establishing treatment goals, and periodic monitoring.

●Monitoring and assessment – The management of OA should include a holistic assessment which considers the global needs of the patient. Patient preferences for certain types of therapies should also be assessed, as compliance and outcomes can be compromised if the care plan does not meet the patient's preferences and beliefs.

●Overview of management – The goals of OA management are to minimize pain, optimize function, and beneficially modify the process of joint damage. The primary aim of clinicians should include targeting modifiable risk factors. Due to the modest effects of the individual treatment options, a combination of therapeutic approaches is commonly used in practice and should prioritize therapies that are safer.

●Nonpharmacologic therapy – Nonpharmacologic interventions are the mainstay of OA management and should be tried first, followed by or in concert with medications to relieve pain when necessary. Nonpharmacologic therapies including weight management and exercises, braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required.

●Pharmacologic therapy – The main medications used in the pharmacologic management of OA include oral and topical nonsteroidal antiinflammatory drugs (NSAIDs). Other options include topical capsaicin, duloxetine, and intraarticular glucocorticoids. Our general approach to pharmacotherapy is described below.

•In patients with one or a few joints affected, especially knee and/or hand OA, we initiate pharmacotherapy with topical NSAIDs due to their similar efficacy compared with oral NSAIDs and their better safety profile.

•We use oral NSAIDs in patients with inadequate symptom relief with topical NSAIDs, patients with symptomatic OA in multiple joints, and/or patients with hip OA. We use the lowest dose required to control the patient's symptoms on an as-needed basis.

•We use duloxetine for patients with OA in multiple joints and concomitant comorbidities that may contraindicate oral NSAIDs and for patients with knee OA who have not responded satisfactorily to other interventions.

•Topical capsaicin is an option when one or a few joints are involved and other interventions are ineffective or contraindicated; however, its use may be limited by common local side effects.

•We do not routinely use intraarticular glucocorticoid injections due to the short duration of its effects (ie, approximately four weeks).

•We avoid prescribing opioids due to their overall small effects on pain over placebo and potential side effects (eg, nausea, dizziness, drowsiness), especially for long-term use and in the older adult population.

•We do not routinely recommend nutritional supplements such as glucosamine, chondroitin, vitamin D, diacerein, avocado soybean unsaponifiables (ASU), and fish oil due to a lack of clear evidence demonstrating a clinically important benefit from these supplements. Other nutritional supplements of interest that may have small effects on symptoms include curcumin (active ingredient of turmeric) and/or Boswellia serrata, but the data are limited.

●Role of surgery – Surgical treatment is dominated by total joint replacement, which is highly effective in patients with advanced knee and hip OA when conservative therapies have failed to provide adequate pain relief.

●Factors affecting response to therapy – The discordance of radiographic findings to pain supports the notion that the mechanisms of pain are complex and likely multifactorial. The placebo effect is also known to impact response to therapy.

●Prognosis – Although there is great variability among individuals and among different phenotypes of OA, courses of pain and physical functioning have been found to be predominantly stable, without substantial improvement or deterioration of symptoms over time.