health

Coronavirus Antibodies Used in Two New Ways

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | May 8th, 2020

Dear Doctor: I heard on the news about a coronavirus medicine made with blood from people who were sick and got better. But my husband says it’s actually a blood test to see if someone ever had the virus. Who’s right?

Dear Reader: You and your husband are both correct. Two different uses for antibodies have recently been greenlit by the U.S. Food and Drug Administration.

You’re referring to an experimental treatment that was approved on March 24 for very limited use. Your husband is talking about a quick and simple blood test approved by the FDA on April 2. The test, which is already in use in other parts of the world, reveals whether or not someone has been infected with the novel coronavirus. The treatment and the test each rely on antibodies, which are blood proteins that the immune system produces during and after its fight against a foreign invader, such as a virus or bacterium.

Let’s start with the therapy you’re asking about. It’s based on the idea that, when introduced to antibodies used to fight a specific pathogen, a sick person’s immune system will produce those very antibodies. This type of treatment has been in use since the 1890s for diseases such as polio, SARS, Ebola and the H1N1 flu. The idea of using it to treat COVID-19 arises from a very small pilot study -- just six men and four women -- recently conducted in three hospitals in China.

Each of the patients, who were gravely ill with COVID-19, received a single dose of antibodies gathered from the blood of patients who had recovered from the illness. According to the published research, the treatment resulted in improved oxygen levels and a shorter duration of symptoms in all 10 patients. Most improved within one to three days after receiving the antibodies. The patients also cleared the virus from their bodies more quickly than those who did not receive the treatment. This sounds promising, but it’s important to note that the FDA approval limits treatment to patients who are so ill that they have no other options, and to clinical trials.

The antibody test that your husband is referring to is much closer to a wide release. It uses a pinprick of blood and delivers results in about 15 minutes. Unlike the diagnostic test for COVID-19, which identifies genetic material from the virus itself, this test looks for the antibodies that will be present only if the body has already encountered and fought off the virus. This is valuable information on two fronts. First, widespread use of the antibody test will give scientists a clearer picture of the spread and reach of coronavirus infection in the U.S. Just as important, the test hints at a potential path forward after the height of the epidemic has passed. People who have been exposed to the virus may have some degree of immunity, which would allow them to safely rejoin normal daily life. The challenge here is that, at this time, how much immunity is granted by prior infection, and how long that immunity may last, is not yet known.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

COVID-19
health

Different Kinds of Heart Murmurs Require Different Treatments

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | May 6th, 2020

Dear Doctor: My 7-year-old niece has been diagnosed with a heart murmur, and my brother says she won’t be receiving any kind of treatment. What is a heart murmur? Will it interfere with the activities she loves, like soccer and softball?

Dear Reader: When someone has a heart murmur, it means an extra and unusual sound has been detected while their heart beats.

During the normal cycle of a heartbeat, blood is propelled through the chambers of the heart via muscle contractions, and its flow is directed by a series of valves that open and close in a specific sequence and pattern. The normal two-part sound of a heartbeat, which is often described as lub-DUB, is made by the heart valves as they close. When someone has a heart murmur, their heartbeat makes a whooshing or swishing sound. This is caused by turbulent blood either within or near the heart. We know that all of this can sound alarming, but a heart murmur isn’t necessarily dangerous and doesn’t automatically require treatment. A heart murmur may be congenital, which means you are born with it, or it can develop later in life.

The condition is divided into two categories -- innocent or abnormal. Innocent heart murmurs, sometimes also referred to as functional or normal murmurs, don’t pose a danger to the individual and generally don’t require treatment. An innocent heart murmur is a common finding in children and infants. In the majority of cases, no structural abnormalities to either the heart or the vessels that serve it are present. In fact, researchers estimate that fewer than 1% of childhood heart murmurs are associated with congenital heart disease.

An abnormal heart murmur can be caused by structural problems that interfere with optimal cardiac function. These can include valve abnormalities or septal defects, which are holes in the heart. Infections, such as rheumatic fever, can lead to a heart murmur. So can endocarditis, which is an infection of the heart’s inner lining.

In some people, an abnormal heart murmur is accompanied by symptoms such as shortness of breath, a bluish tinge to the skin or lips, chest pain, rapid breathing, a chronic cough or light-headedness. Abnormal heart murmurs require treatment, which can range from medications to manage the condition, to surgery to repair the structural causes.

The fact that your niece has seen a doctor and won’t receive treatment suggests she has an innocent murmur. However, her doctor will continue to monitor the murmur throughout her childhood. If problems arise, she will be referred to a pediatric cardiologist, who may use an X-ray, electrocardiogram or echocardiogram to learn more about her heart and the murmur.

For the majority of children living with an innocent heart murmur, life goes on as normal. They can run, ride bikes, jump rope, go swimming and play sports. If she begins to exhibit any of the symptoms we mentioned earlier, then she will need to be reevaluated. But the good news is that in many cases, innocent heart murmurs resolve by themselves by adulthood.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Physical Health
health

Every Home Needs a Personalized First-Aid Kit

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | May 4th, 2020

Dear Doctor: Now that it’s harder see a doctor or go to the emergency room, I want to beef up our first-aid kit. What should we have on hand?

Dear Reader: We’re big fans of maintaining a well-stocked first-aid kit and agree that having the right supplies on hand is particularly important right now. We’ll go a step further and suggest that you keep an edited version of the home kit in each car.

Your first step is to identify your family’s specific needs. If someone has a food allergy or a respiratory condition, such as asthma, you’ll want to stock extras of the medications you use to manage those conditions. Be sure to clearly mark each medication with its expiration date.

When it comes to general items, think in terms of the types of medical situations that require prompt attention. These include skin injuries, such as cuts, scrapes, burns, rashes and splinters; mishaps such as pulled muscles or strained ligaments; infections such as a sore throat or a cold; and common allergic reactions such as poison oak, poison ivy and insect stings. Buy the products you’re familiar with and that you’ve had success with in the past.

We also think it’s wise to invest in a good first-aid handbook, which will guide you through the diagnosis and treatment of the mishaps that can occur at home. Leaf through it before stowing it with your gear. Knowing in advance how to approach a burn, cut or sprain will lessen everyone’s stress during an emergency, and it will improve the quality of the first-aid care you’re rendering. Make learning the ropes a family enterprise so everyone can help each other.

First-aid supplies for a family of four should include:

-- 25 adhesive bandages of assorted sizes

-- Antibiotic ointment and antiseptic wipes

-- Aspirin

-- An instant cold compress

-- 2 absorbent compress dressings

-- 1 adhesive cloth tape

-- Nonlatex gloves to be worn when dealing with blood or bodily fluids

-- Hydrocortisone ointment

-- A pair of scissors and a set of tweezers

-- A 3-inch and a 4-inch roller bandage

-- 10 sterile gauze pads (3-by-3 inches and 4-by-4 inches)

-- An oral thermometer that is not glass and does not contain mercury -- and if your thermometer uses batteries, be sure to stock extras

Additional items you may consider include antacid tablets, antidiarrhea meds, a bee-sting kit, a small mirror and blunt-tip scissors. Store everything in a waterproof container that’s easy to open and easy to carry. Something with separate compartments is best so you can easily see and reach the items you need. Use one of the compartments for the family-specific items we talked about earlier. Bathrooms tend to be damp environments, so store your supplies somewhere else, such as a linen closet or kitchen pantry.

Finally, be sure to set up and maintain a first-aid kit checklist. You’ll use this to replenish supplies as you use them, and to keep track of all medications with expiration dates. This is also a good spot to include all of the emergency phone numbers you rely on.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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