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Atrial Fibrillation and COVID-19

Great Sphinx of Giza on the west bank of the Nile in Egypt. (Dr. Noorali Bharwani)
Great Sphinx of Giza on the west bank of the Nile in Egypt. (Dr. Noorali Bharwani)

COVID-19 affects different people in different ways. Most infected people (80 per cent) will develop mild to moderate illness and recover in a week or so without hospitalization. In some cases, it can take up to 14 days to recover.

About 20 per cent will have serious symptoms requiring hospitalization. These patients quite often have uncontrolled comorbidities like atrial fibrillation, heart failure, diabetes and obesity. The serious symptoms are:

  1. difficulty breathing
  2. chest pain
  3. loss of speech or movement

If you have these symptoms, call 911 right away.

The lifetime risk of atrial fibrillation in North America is as high as one in four. Under non-COVID-19 circumstances, the risk of complications for uncontrolled atrial fibrillation can be serious.

Untreated atrial fibrillation puts you at a higher risk for stroke and heart failure.

The risk of stroke depends on several other risk factors including the presence of heart failure, having high blood pressure or diabetes, being over 40 years of age, or having had a previous stroke or a mini-stroke (TIA).

If you have atrial fibrillation then you need to change your lifestyle. A recent article in the Canadian Medical Association Journal (CMAJ November 16, 2020) says, “Weight loss, achieved and sustained through diet and exercise, is associated with fewer atrial fibrillation recurrence.”

Second thing you should remember is recreational exercise confers protective benefits in atrial fibrillation. A useful goal is to progressively increase your exercise to 200 min/week (about 30 min/da) at moderate intensity.

Many public health experts have come to believe, a reasonably effective vaccine will help us reach some degree of herd immunity, and treatments and therapies will continue to reduce suffering, but the virus will likely continue to circulate.

I came across another article titled, “Addressing Atrial Fibrillation in the World of COVID-19” (Diagnostic and Interventional Cardiology (DAIC) – January 27, 2021).

It says, “And for those who are vulnerable, it (COVID-19) will likely continue to be a grave danger… So, while it can be soothing to think of a world without COVID, we have to prepare and act now as though it will never go away. And this is especially important for those with or at-risk of atrial fibrillation (AFib).” These individuals are at far greater risk of a catastrophic COVID outcome.

Prevention is better than cure.

Avoid getting into trouble by washing your hands frequently. Wear a mask in public. Even when you are wearing a mask, maintain plenty of space from other people. And avoid gatherings.

Have your blood pressure and blood sugar checked regularly.

Hypertension is not just a cause of AFib for many people — it is also linked to increased risk of mortality in patients with COVID, and may be the most prevalent comorbidity in patients hospitalized for the disease.

The second-most prevalent COVID comorbidity is diabetes, which is found in 24 per cent of people hospitalized with COVID and in 32 per cent of those that ultimately required treatment in an ICU. Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed.

Be safe. Follow the guidelines for a healthy living. Hopefully, we will get vaccinated soon and live a new kind of normal healthy life.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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How good is sunscreen in the prevention of skin cancer?

Nodular malignant melanoma in a 92 year-old male. (Dr. Noorali Bharwani)
Nodular malignant melanoma in a 92 year-old male. (Dr. Noorali Bharwani)

In Canada, more than 80,000 cases of skin cancer are diagnosed every year.

We are officially into spring now and summer is round the corner. The sun is shining most of the days and people are walking and running sometimes without adequate clothing. Hopefully, they have sunscreen generously layered over their body. As we know, sunscreen is recommended for prevention of skin cancer but questions about its harms have been raised.

This subject is covered in a review article (The efficacy and safety of sunscreen use for the prevention of skin cancer) published in the Canadian Medical Association Journal (CMAJ Dec 14, 2020). The review is quite detailed. I will try and summarise it.

Because exposure to ultraviolet radiation is estimated to be associated with 80 to 90 per cent of skin cancers, the use of sunscreen — which blocks ultraviolet radiation — is promoted as an important means of preventing skin cancers, as well as sunburn and skin aging.

There are five key points to remember about the use of sunscreen:

  1. Sunscreen use reduces the risk of basal cell, squamous cell and melanoma skin cancers.
  2. Commercial sunscreens protect against the skin-damaging effects of ultraviolet radiation through either chemical or physical ingredients.
  3. The Canadian Dermatology Association recommends the use of an adequate dose of a broad-spectrum sunscreen with a sun protection factor of at least 30 for most children and adults.
  4. Emerging evidence suggests that some chemical sunscreen ingredients are systemically absorbed, but the clinical importance of this remains unclear; further research is required to establish whether this results in harm.
  5. Ultraviolet filters found within chemical sunscreens may be harmful to the environment.

Both the Canadian Dermatology Association and the American Academy of Dermatology recommend the use of sunscreen for the prevention of skin cancer. Then why worry?

What we know:

Since the development of the first commercial sunscreen in 1928, three questions have been raised: are they safe, are they effective, and more recently, the impact of sunscreens on the environment.

The CMAJ article summarizes evidence related to the effectiveness and harms of sunscreen to help physicians counsel their patients.

Sunscreens contain chemical compounds that act to block ultraviolet radiation. There is no doubt the highest-quality evidence available suggests that sunscreens do prevent skin cancer.

People of all skin colours and older than six months should use sunscreen with SPF (Sun Protection Factor) of 30 or higher. The mainstays of sun safety in infants include sun avoidance and protective clothing.

Apply sunscreen generously. Most people tend to underapply. If you are going in water or your activity involves lot of sweating then wait 15 – 30 minutes after applying the sunscreen. And use water-resistance sunscreen.

Recent experimental studies have shown that sunscreen remains on the skin at the desired SPF for as long as eight hours after a single application.

What are the concerns about using sunscreen?

Some recent studies have reported that chemical sunscreen ingredients are detectable in various water sources and may persist despite waste-water treatment processing. An additional recent concern is the detection of sunscreen filters in the tissues of various fish species, raising the possibility of bioaccumulation and biomagnification.

Low-quality evidence has shown that some chemical sunscreen ingredients are systemically absorbed and may be contributing to environmental damage; people who are concerned may consider using physical sunscreens as an alternative. Research on the safety and efficacy of established sunscreens and novel agents is ongoing.

Conclusion:

Currently, there are no good scientific reasons not to use sunscreen. Also remember, besides the use of sunscreen, one should follow other rules about sun protection for avoiding ultraviolet radiation, including the use of wide-brimmed hats, eye protection (e.g., “wrap-around” sunglasses with ultraviolet radiation protection) and seeking shade when the ultraviolet index is above 3 (usually 11 am to 3 pm, April to September).

Take care, be safe, use sun protection and get your COVID-19 vaccine to protect yourself, your family and people around you.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Stress and Rise in Obesity will Worsen Outcomes from COVID-19

Silvertip Golf Course in Canmore, Alberta. (Dr. Noorali Bharwani)
Silvertip Golf Course in Canmore, Alberta. (Dr. Noorali Bharwani)

It is one year since the COVID-19 pandemic hit the Canadians. Our government had no choice but to shut down all kinds of activities and impose physical restrictions.

These restrictions have saved many lives. Nobody can deny that. But there have been many down sides to these restrictions. We can mention a few: anxiety, loneliness, depression, lack of physical activities and weight gain.

I have FIVE questions for you:
1. Have you put on weight in the last one year?
2. Are you eating a healthy diet?
3. Are you mentally and physically active?
4. How are you coping with stress?
5. Are you getting enough sleep?

Obesity is a common, serious, and costly chronic disease.

Having obesity puts people at risk for many other serious chronic diseases and increases the risk of severe illness from COVID-19. Everyone has a role to play in turning the tide against obesity.

I wasn’t surprised to read Vietnam is the least obese country with 2.1 per cent of the population classified as obese. Among the developed countries, the United States is the most obese (36.2 per cent).

If you are obese then the risk of hospitalization due to COVID-19 infection increases. Obesity decreases lung capacity and reserve and can make ventilation more difficult. Obesity also increases your risk of dying from COVID-19. Studies have demonstrated that obesity may be linked to lower vaccine responses for numerous diseases (influenza, Hepatitis B, and tetanus).

What can we do about obesity? Obesity is a complex disease with many contributing factors. Simple answer would be – eat healthy, eat less and exercise more. This requires lot of patience and perseverance. Other option would be to seek professional help so that you can stick to a rigid protocol.

Eating a healthy diet has many advantages. Plenty of fruits and vegetables, lean protein, and whole grains as well as the appropriate number of calories is important. This keeps your weight under control and improves your immune system. As everyone knows a healthy diet is also good for your heart and diabetes.

Besides eating a healthy diet, physical activity is one of the best things people can do to improve their health. It is vital for healthy aging and can reduce the burden of chronic diseases and prevent early death. Only half of adults get the physical activity they need to help reduce and prevent chronic diseases. More needs to be done.

Regular physical activity helps you feel better, sleep better, and reduce anxiety.

Insufficient sleep has been linked to depression, as well as chronic diseases that may increase the risk of severe illness from COVID-19. COVID-19 has made life stressful for millions of people. That will certainly affect your sleep pattern, eating habit and your relationship with friends and family. If that is the case then you should seek professional help.

Take care, eat healthy, lose weight, be physically active, sleep well and get immunized. If stress and depression is affecting your health you must get help from a professional. Sooner you do that, better for you and your family. Everybody wants to be happy and healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Understanding COVID-19 Vaccination Program

Phoenix, Arizona (Dr. Noorali Bharwani)
Phoenix, Arizona (Dr. Noorali Bharwani)

Finally, COVID-19 vaccines have arrived in Alberta. The lineup has begun and the process will take a few months to complete. This is happening in phases so people most at risk get it first. We just have to be patient and wait our turn.

COVID-19 vaccines are safe, effective and save lives. The vaccine helps prevent you from getting infected and protects you from getting severely sick if you do get it.

There are at least seven different vaccines. The first mass vaccination programme started in some countries in early December 2020 and as of February 15, 2021, 175.3 million vaccine doses have been administered.

Canada has approved three vaccines: Moderna COVID-19 vaccine (efficacy rate 94 per cent – need two doses), Pfizer-BioNTech COVID-19 vaccine (efficacy rate 95 per cent – need two doses) and recently approved AstraZeneca-Oxford University COVID-19 vaccine (efficacy rate of 62 per cent – need two doses).

While AstraZeneca vaccine is less effective than the Pfizer-BioNTech and Moderna vaccines at preventing infection, the shot is 100 per cent effective in preventing the severe outcomes of COVID-19 — including serious illness, hospitalizations and death.

This is better than not having a vaccine. Same principle applies to flu vaccines. They are never 100 per cent effective. Flu vaccines, which differ each year depending on the flu strain in circulation, are typically 54 to 64 per cent effective, yet they are widely used to offer some level of protection to more people.

Other advantage of AstraZeneca vaccine is, unlike the other two vaccines which require freezing facilities, AstraZeneca does not require the same cold storage equipment necessary for the other two. The product can be stored and transported at normal refrigerated temperatures of 2 to 8 C for at least six months. This vaccine also can be easily administered in traditional health care settings, like a doctor’s office or pharmacy.

Government of Canada is expecting more supplies of vaccines and by Canada Day several million people will be vaccinated. That is the plan. The plan is to prevent serious illness, reduce hospitalizations and reduce the number of deaths.

What about the second shot of the vaccine? It will be after four to 12 weeks. Most likely 12 weeks. I don’t think the final decision is out yet but early evidence suggest it’s best to wait the full 12 weeks to deploy the second shot.

How long does the immunity last? It’s too early to know. Research is ongoing to answer this question. You should continue to use face mask and avoid close contact and practice good hygiene.

COVID-19 vaccine and other vaccines: Spacing recommendations from the National Advisory Committee on Immunization (NACI) has published the following recommendations:

  • COVID-19 vaccines should not be given simultaneously with any other vaccines.
  • Wait for a period of at least 28 days between the administration of the complete two-dose schedule of COVID-19 vaccine and the administration of another vaccine (except in the case where another vaccine is required for post-exposure prophylaxis). This includes refraining from administering other vaccines between the first and second dose of COVID-19 vaccine.
  • Wait for a period of at least 14 days after the administration of another vaccine before administering a COVID-19 vaccine.

Take care and be safe.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!