Rheumatoid arthritis patients at heightened risk for life-threatening blood clot
VANCOUVER, BC, Jan. 13, 2021 /CNW/ - A new Arthritis Research Canada study reveals rheumatoid arthritis patients have an increased risk of cardiovascular disease after diagnosis compared to the general population.
Researchers specifically looked at the risk of venous thromboembolism (VTE) – a blood clot that starts in a vein and can travel to the lungs (pulmonary embolism or PE) and deep vein thrombosis (DVT) – a blood clot in the leg veins.
"These are serious cardiovascular events associated with increased mortality," said Dr. Antonio Aviña-Zubieta, a rheumatologist and senior scientist of rheumatology at Arthritis Research Canada.
Venous thromboembolism (which includes pulmonary embolism and deep vein thrombosis), represents a relatively common cardiovascular event that is associated with increased mortality and affects more than one in 1000 persons each year in the Western population.
The study found that VTE risk was the highest during the first year after RA diagnosis, then progressively declined but remained statistically significant even five years after diagnosis.
"These findings have important implications for clinical care, both immediately after a rheumatoid arthritis diagnosis and in long-term treatment as treating inflammation decreases the risk," Aviña-Zubieta said. "Clinicians should be aware that RA causes patients to have a higher risk not only of heart attacks and strokes, but also VTE, particularly in the period soon after diagnosis."
Rheumatoid arthritis is the most common form of autoimmune arthritis. It is a serious disease that occurs when the immune system mistakenly attacks healthy cells in the body. Inflammation caused by RA can damage joints and many other parts of the body. Approximately 374,000 Canadians over the age of 16 live with rheumatoid arthritis.
To read the full research paper, please click here.
ABOUT ARTHRITIS RESEARCH CANADA:
Arthritis Research Canada is the largest clinical arthritis research institution in North America. Our mission is to transform the lives of people living with arthritis through research and engagement. Arthritis Research Canada's scientific director, Dr. Diane Lacaille is leading a team of over 100 researchers, trainees and staff whose world recognized research is creating a future where people living with arthritis are empowered to triumph over pain and disability. Arthritis Research Canada is conducting research across Canada in British Columbia, Alberta and Quebec and is affiliated with five major universities: University of British Columbia, Simon Fraser University, University of Calgary, Université Laval, and McGill University. Arthritis Research Canada is leading research aimed at arthritis prevention, early diagnosis, new and better treatment, and improved quality of life.
Salvation: It Should Not Be Complicated or Confusing
Dallas, TX, January 11, 2021— “What do I have to do to be saved?” is the Christian faith’s most important question and one that Lucas Kitchen started asking as a young boy. It should have been an easy question to answer, though no one in the piney woods seemed to agree what that simple answer should be. Despite growing up in the buckle of the Bible belt, confusion about the Christian faith plagued every step of Lucas’ journey.
In Naked Grace: A Quest For Clarity In A World Of Confusion, Lucas Kitchen uses wit, humor and visual storytelling to invite you to join his life-long quest for answers. This multi-decade pursuit took Lucas to some laugh-out-loud places. When the stakes were as high as they could be, the simple answer finally came.
The true-life story in Naked Grace explores the confusion that many Christians quietly experience on a weekly basis. As this book demonstrates: just because they are quiet doesn’t mean they get it. This self-deprecating tale will resonate with anyone who has wrestled with unanswered questions and is dying to know the truth.
One Verse Podcast host Jeremy Myers wrote, “If you have questions about eternal life, the message of the gospel, what it means to follow Jesus as a disciple, or how grace helps us defeat sin in our lives, read his book. I guarantee his story will resemble parts of your own and will help you ask questions and find answers about the Gospel.”
Lucas Kitchen is an Amazon bestselling author with over 20 books written. His writing has been seen and heard by millions, through viral videos, radio and books. Lucas' books have covered genres such as sci-fi, urban fantasy, memoir, biography, children's literature, Christian theology and more. In addition to his writing career, Lucas is a filmmaker, pastor and international speaker. He can also be heard weekdays on the syndicated radio show Grace in Focus. He holds a bachelor's degree in interdisciplinary studies in Bible, psychology and history/political science from Letourneau University. He has a Master of Theology from Liberty University. He lives in East Texas with his family.
Naked Grace: A Quest For Clarity In A World Of Confusion Publisher: Free Grace International ISBN-10: 1661761119 ISBN-13: 978-1661761110 Available from Amazon.com
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Make ‘Go on a Diet’ Resolutions Obsolete with the Whole Person Integrative Eating Program
San Francisco, CA, January 11, 2021 — What if you never again need to make a New Year’s resolution to lose weight or “go on a diet” because your most-of-the-time way of eating empowers you to eat and weigh less? Original, pioneering research by holistic nutrition researcher Deborah Kesten, M.P.H., and behavioral scientist Larry Scherwitz, Ph.D.—authors of the award-winning Whole Person Integrative Eating: A Breakthrough Dietary Lifestyle to Treat the Root Causes of Overeating, Overweight, and Obesity—reveals that replacing the complex reasons you overeat— called“overeating styles”—with the scientifically sound Whole Person Integrative Eating (WPIE) dietary lifestyle (meaning, WPIE is a way of life; it’s not a traditional diet) may make weight-loss resolutions obsolete.
“Now is the time to ‘reset’ and rethink what and how we eat; to replace traditional dieting with a scientifically sound way of eating that lessens overeating and that leads naturally to weight loss, health and healing,” says Kesten.
Kesten and Scherwitz share a simple yet powerful premise: Identify the reasons you overeat (your overeating styles) and gain weight—with the illuminating self-assessment quiz—then overcome overeating and lose weight by replacing your overeating styles with the antidotes: the elements of the Whole Person Integrative Eating program.
By shedding light on the root causes of overeating, Kesten and Scherwitz present a program that empowers readers with a personalized plan, and in turn new hope and new choices to help them reduce overeating, lose weight and keep it off.
WPIE is not a diet that a person goes on … then off. It is a scientifically sound, dietary lifestyle designed to be practiced for a lifetime.
"If people follow the revolutionary program outlined in this game-changing, insightful book, it may be the most helpful step they can take toward losing weight and keeping it off," says bestselling author Kenneth Pelletier, M.D., Ph.D., clinical professor of medicine at University of California School of Medicine, San Francisco.
The authors’ paradigm-shifting message is that food influences not only the physical dimensions of health, but also our emotional, spiritual and social well-being. Their dietary lifestyle can build bridges between the millions who struggle with overeating and weight issues and the medical community. And it can inspire us all to re-envision our relationships with food, eating and weight, so that each time we eat, we are nourished … for life.
Deborah Kesten, M.P.H.,is an international nutrition researcher, award-winning author and health journalist, with a specialty in preventing and reversing obesity and heart disease. She is also an experienced, expert speaker and presenter—from TV and podcast interviews to large conferences and small-group workshops.
Kesten served as Nutritionist on Dean Ornish, M.D.’s first clinical trial for reversing heart disease through lifestyle changes, the results of which were published in the Journal of the American Medical Association. She was Director of Nutrition at cardiovascular clinics in Europe and on the Board of Directors of the American Heart Association, San Francisco.
Kesten has published more than 400 nutrition and health articles. Her first book, Feeding the Body, Nourishing the Soul, received the first-place gold award in the Spirituality category from the Independent Publisher Book Awards. Whole Person Integrative Eating has been honored with the No.1 gold, best-book award in the Health category by Book Excellence Awards and is a No. 1 Amazon best seller. Kesten is a VIP Contributor at Arianna Huffington’s Thrive Global, and is married to behavioral scientist and co-author of Whole Person Integrative Eating, Larry Scherwitz, Ph.D.
Powerful True Story Inspires Others to Seek Adventure, Turn Each Day into a Gift
Fort Wayne, IN, January 11, 2021 — Brittany Moser’s short life was not defined by how she died, but rather, by how she lived each day to the fullest and the profound impact she had on those around her. Brittany died from a rare condition, Addison’s disease, in 2017 at the age of 32. She had been a happy-go-lucky flight attendant, soaring high above reality, when her diagnosis suddenly brought her down to earth.
Rather than buckle under the weight of fear, she chose to be fearless and embarked upon the adventure of a lifetime with her best friend — her father. Free and Fearless: The Amazing Impact of One Precious Lifeis Brittany’s unforgettable story as told by her father, Philip Moser.
“This book is not about the grief of losing a child, but about making the most out of what we are given and living our lives positively and not out of fear,” Moser writes. “Brittany inspired me, an ordinary farm boy, to explore life, to climb mountains and to write a book.”
Free and Fearless is an honest, poignant account of Brittany’s legacy and the ripple effect that her outlook on life had on everyone who knew her. Philip hopes that by hearing her story, readers will be inspired by Brittany’s contagious spirit and unwavering desire for new adventures and experiences — even in the shadow of an incurable illness.
Among Brittany’s valuable life lessons that Philip shares with readers are:
1. How precious life is and how we can affect the people around us; 2. How an open mind and a positive attitude can inspire us to do things we never thought possible; 3. How to move out of our comfort zones and into a challenging existence that can turn each day into an exciting gift to be explored; 4. How to not let fear control us, and to use our abilities to seek unique, positive and inspiring adventures; 5. To embrace change as a natural part of life; 6. And finally, that we won’t be remembered by our things or our savings accounts, but by how we made other people feel.
“I want to share the same inspiration that I received for 32 years,” Philip added. “In the end, love truly does conquer all, and Brittany wanted us to know that.”
Author Philip Moser grew up on a farm in Angola, Indiana. After high school, he began working in different aspects of the grocery business, a career that continues to this day. He and his wife, Marilyn Wells, raised two incredible daughters, Camille and Brittany.
Los Angeles, CA, January 11, 2021 — Is there a science to survival, or are some people simply born with elastic emotional exoskeletons that bounce back readily following even the most traumatic of experiences?
To uncover the answer, world-renown expert on disasters and trauma Dr. Randall Bell undertook unprecedented research, juxtaposing outcomes of scientific studies with stories of real people who have not just survived, but have used their trauma as their fuel to thrive to uncover common denominators. He shares his remarkable insights in his new book, Post-Traumatic Thriving: The Art, Science, & Stories of Resilience.
Dr. Bell sits down with survivors of the Holocaust; murder-victim’s families; crime victims; suicide survivors; and those who’ve experienced homelessness, disasters, addictions, depression, death, divorce, disabilities, defeats and disease to explore the rare mindset of the post-traumatic thriver.
He shares with readers stories of remarkable resilience, including the following:
• A deaf man with a glass eye invented the electric guitar and became a household name, remarkably wealthy and most importantly, happy.
• A convicted murderer took responsibility for the damage he caused, graduated with honors from college, became a minister and turned around the hearts of the most hardened criminals.
• A girl born with cerebral palsy landed the world’s first starring role on national television and spoke at the White House three times.
• A woman hid in a basement for years and lost her entire family in the Holocaust. She eventually found true love and paints stunning artwork.
• The sister of a murder victim helped millions of women in toxic domestic relationships.
• A woman’s car crash resulted in an addiction to prescription drugs, a divorce, a loss of her children and a cot in a homeless shelter. She has rebuilt it all back and more.
• A man set to go to the Olympics had his hopes dashed by Jimmy Carter and went on to build a worldwide business empire.
Ultimately, Dr. Bell documents the science of happiness, as well as the individual styles and common thread that all post-traumatic thrivers have to emerge with a fulfilling life. When trauma hits, your most significant decision will be to dive, survive or thrive. If you choose to thrive, this book is for you.
As an economist, Dr. Randall Bell has consulted on more disasters on earth than anyone in history and is widely considered the world’s top authority in the field of post-traumatic thriving. His clients include the Federal Government, State Governments, International Tribunals, major corporations and homeowners. Dr. Bell believes that “the problem is not the problem — the problem is how we react to the problem.”
Often called the “Master of Disaster,” Dr. Bell is squarely focused on authentic recovery and resilience. His research has been profiled on major television shows and featured in numerous magazines and the international media. More information can be found at www.posttraumaticthriving.com.
Post-Traumatic Thriving: The Art, Science, & Stories of Resilience
Award-Winning Parma! Vegan Parmesan Offers Cheese Lovers A Delectably Nutritious Range of Dairy-Free, Protein-Rich Condiments Ideal For Main Dishes, Salads, Pizza & More!
Parma! Debuts Bold New Website As Company Continues Major Expansion
MEDFORD, OREGON, DECEMBER 25, 2020 - With just the right condiment, a plain salad becomes a festival of flavors, a plate of vegetables transforms into a delectable stroll through a country garden, and an ordinary bowl of pasta becomes a savory work of art. And perhaps no condiment covers as many different foods and as many different cultures as classic Italian Parmesan cheese.
Unfortunately, for vegans or anyone following a dairy-free and/or calorie-conscious diet, parmesan cheese has always been not only off limits but one of the most difficult of life’s little indulgences to forego. If only someone, somewhere, could create a non-dairy parmesan cheese alternative so authentically delectable that even the most discerning cheese lovers would never miss its conventional counterpart ever again!
Well, luckily for countless millions of us, someone has. Welcome to the next revolution within the booming vegan cheese category – Parma!
Created in Oregon just over 15 years ago by Sister River Foods’ founder Shannon Schnibbe (Tofurky founder Seth Tibbott is an ongoing Advisor), Parma! was established in response to a rapidly-growing need within the vegetarian marketplace for a breakthrough allergen-free parmesan alternative.
Comprised of four deliciously distinct varieties – including Better Than Bacon Parma! –voted Favorite Bacon-Flavored Product in 2017 by VegNews magazine – Parma! is a plant-based umami superfood line of convenient and affordable products that are Paleo and Keto-friendly, a complete protein, dairy-free, soy-free, gluten-free, non-GMO and Certified Kosher.
In addition, all four raw nut and seed-based Parma! flavors contain whole raw ingredients, are low in sodium, heart-healthy, packed with essential B vitamins and trace minerals, replete with beneficial animo acids and an excellent source of healthy oils.
A World Of Flavor
Available in health stores nationwide as well as on the brand new www.eatparma.com site, Amazon, VitaCost and other online retailers, Parma! is ideal for environmentally conscious consumers, vegans, vegetarians, flexitarians and all health conscious eaters. Unlike some other vegan cheese alternatives, Parma! has also proven highly appealing to mainstream cheese aficionados who are ready to eschew traditional cheese so long as a healthier option boasting authentic flavor, aroma and texture is available.
Sold in 3.5 and 7-ounce bottles, Parma! can be savored on pasta, lightly steamed vegetables, pizza, salads, potatoes, avocado toast, popcorn and countless other hor d'oeuvres, main dishes and desserts. For suggested recipes, please visit https://eatparma.com/cat egory/recipes/.
Parma! varieties include:
Original Parma! – Featuring an irresistiblycheesey umami flavor. Ingredients: Nutritional Yeast, Organic SunflowerSeeds, Walnuts, Himalayan Crystal Salt, Organic Hemp Seeds.
Better Than Bacon Parma! – Voted Favorite Bacon FlavoredProduct by VegNews and featuring a smokey cheesey umami bacon flavor. Ingredients: Nutritional Yeast, Organic Sunflower Seeds, Walnuts, Ground Paprika, Organic Dried Onion, Natural Flavor, Organic Brown Sugar, Himalayan Crystal Salt, Smoked Salt, Organic Hemp Seeds.
Chipotle Cayenne Parma! – Blessed with a smokey umami flavor akin to the most popular barbeque potato chips, with a slight cayenne kick at the end. Ingredients: Nutritional Yeast, Organic SunflowerSeeds, Walnuts, Organic Ground Chipotle Pepper, Himalayan Crystal Salt, Organic Hemp Seeds, Organic Onion Powder, Organic Ground Cayenne Pepper.
Garlicky Green Parma! – Distinguished by acheesey umami Italian herb flavour complemented by nutritiously delicious kelp, pumpkin and sesame seeds. Ingredients: Nutritional Yeast, Organic SunflowerSeeds, Walnuts, Organic Pumpkin Seeds, OrganicDried Garlic, Himalayan Crystal Salt, Organic Hemp Seeds, Organic Sesame Seeds, Organic Kelp Powder, Organic Dried Basil, Organic Dried Oregano.
For parmesan lovers in Europe (in other words – just about everyone!), Parma! also offers a specially branded line called Shake! Original featuring a mouth-wateringly cheesey umami flavor and such ingredients as nutritional yeast, raw organic sunflower seeds, raw walnuts, raw organic pumpkin seeds, raw organic hemp seeds, and Himalayan crystal salt.
Parma! is expected to introduce a bold new line of products to the U.S. marketplace later this year.
Only The Beginning
Founded in 2004, Parma! has steadily grown to its current status as a leader in the dairy-free cheese alternative arena and a key player in the multi-billion-dollar global vegan food category.
Looking back on the origins of the Parma! brand, Sister River Foods’ co-founder and CEO Shannon Schnibbe recalls that it all started as the result of her severe allergies and effort to find foods that might give her relief. Introduced to raw foods, she was soon inspired to begin making what is now Parma! for herself, friends and family. After moving to Oregon and becoming pregnant with her first baby, she decided to combine her passion for healthy eating with her corporate experience and turn her hobby into an actual business. The vegan parmesan revolution had begun!
Today, Shannon takes special pride not only in the rave reviews, industry honors, new distribution channels and increased sales Parma! has enjoyed in recent years, but in her brand’s ability to provide a more nutritious yet equally delicious alternative for those who have been missing out on one of life’s true culinary pleasures – parmesan cheese.
According to Tofurky founder Seth Tibbott, "Like Tofurky, Parma is an authentic, trailblazing brand with deep roots that took hold when the plant-based world was very young. I love that it is a family owned business run by kind, passionate people producing a wholesome vegan food with exceptional flavor."
Adds Shannon, “Parma! gives you that cheesey flavor without all the dairy baggage. It provides an excellent food source of high-quality vitamins and minerals, including B vitamins, omega 3’s and trace minerals, along with the natural goodness of hemp, and it tastes great! We’re deeply grateful for the exceptionally warm reception our brand has received from consumers and industry leaders since our very first days on the market and look forward to continuing to shake up the dairy-free industry for many, many years to come.”
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Expert Speaker and Brain Health Doctor Addresses Worsening Pandemic-Related Mental Challenges
Chattanooga, TN, January 6, 2021 ― Forced social isolation and shuttered businesses have led to an alarming rise in anxiety, depression, suicide and other mental health challenges. As we search for a clear path toward physical and mental recovery, one world-renowned doctor is uniquely poised to address the very serious subject of brain health from both scientific and spiritual perspectives — a much needed and welcomed approach during these extremely distressing times.
Timothy R. Jennings, M.D., is a board-certified psychiatrist, master psychopharmacologist, lecturer and renowned international speaker. He is also the founder of Come and Reason Ministries and uses his understanding of the Bible and how it relates to our modern world to inform his approach to brain health and overall wellbeing.
Dr. Jennings expertly weaves spirituality with brain science to address fear, depression, anxiety and relationship issues. He recently explored at length the damaging effects of social isolation (https://comeandreason.com/index.php/en/blogs-main/903-social-isolation-during-covid-19) and its profound impact on physical and mental health, particularly for those already suffering from chronic conditions.
He is a much sought-after speaker who regularly addresses non-medical professionals on the subjects of Spirituality in Medicine, Depression and its Spiritual and Physical Connections, and Alzheimer’s Dementia. He also speaks to medical professionals on the topics of Psychotherapy in Clinical Practice, Major Depression in the Primary Care Setting, and the Neurobiology of Depression — among many others.
Dr. Jennings operates a private practice in Chattanooga and has successfully treated thousands of patients. He is a Distinguished Fellow of the American Psychiatric Association and Life-Fellow of the Southern Psychiatric Association.
He is also a prolific author whose books include The God-Shaped Brain: How Changing Your View of God Transforms Your Life; Could It Be This Simple? A Biblical Model for Healing the Mind; The Aging Brain: Proven Steps to Prevent Dementia and Sharpen Your Mind; and The God-Shaped Heart: How Correctly Understanding God’s Love Transforms Us.
To hear his presentations and to learn more about Dr. Timothy R. Jennings and his approach to brain and body health, please visit: www.comeandreason.com.
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SEIU Healthcare Calling on Province to Immediately Remove All Barriers to Vaccination for Frontline Staff
Union calling for urgent government action to pave the way for speedier vaccination rollout including transparency, communications, and emergency paid sick leave for healthcare workers
RICHMOND HILL, ON, Jan. 11, 2021 /CNW/ - SEIU Healthcare, a union that represents over 60,000 frontline healthcare workers in Ontario, is calling on the provincial government to take immediate action to speed up vaccination of essential frontline workers across the entire healthcare system.
The current vaccine roll-out in Ontario is failing due to a lack of transparency, poor communication to frontline providers and insufficient supports for those seeking vaccinations. Our members serving on the frontline continue to report that financial and logistical barriers are preventing them from getting vaccinated.
"Many healthcare workers still don't know when they are due to be vaccinated, where vaccination will take place, and which vaccine will be offered. Healthcare workers are concerned that they will have to take unpaid time off work to get vaccinated at a time when they're struggling to pay their bills," said Sharleen Stewart, president of SEIU Healthcare. "Precariously employed healthcare workers need to know that if they experience side effects from the vaccine, they'll receive ample paid sick leave to recover at home. Combined, these issues are creating significant barriers to vaccination that must be addressed immediately."
That's why we're calling on the Ontario government to immediately implement the following steps to ensure that frontline workers, and those they serve, are protected by vaccination:
Release a detailed vaccine roll-out schedule that lets essential frontline workers know in advance when and where they can access the various COVID-19 vaccines;
Distribute clear multi-lingual communications to inform frontline workers about the vaccination process;
Provide targeted financial assistance that supports those who request time to consult with their physician about the vaccine, as well as financial assistance for those who require time off work to travel to and from a vaccination site;
Ensure ample paid sick leave for those workers who experience side effects from either dose of the vaccination which prevent them from working.
"Frontline workers have given everything to their communities through this battle with COVID-19. Many have gotten sick. Some have lost their lives. We owe it to these workers – and the people they care for every day – to ensure that vaccines are available and that the barriers that could imperil the vaccination effort are eliminated. Government must act now," added Stewart.
On December 24th, SEIU Healthcare, together with other unions in the healthcare sector and the Ontario Hospital Association (OHA), sent a request to the provincial government to fund paid sick leave related to the vaccination for all staff in our hospitals. We received no reply.
On December 29th, SEIU Healthcare, together with AdvantAge Ontario and the OLTCA, sent a similar request to the provincial government to fund paid sick leave related to the vaccination for all staff in the nursing home sector. Again, we received no reply.
SEIU Healthcare represents more than 60,000 healthcare and community service workers across Ontario. The union's members work in hospitals, homecare, nursing and retirement homes, and community services throughout the province. www.seiuhealthcare.ca
SOURCE SEIU Healthcare
Post-Traumatic Thriving
Los Angeles, CA, January 11, 2021 — Is there a science to survival, or are some people simply born with elastic emotional exoskeletons that bounce back readily following even the most traumatic of experiences?
To uncover the answer, world-renown expert on disasters and trauma Dr. Randall Bell undertook unprecedented research, juxtaposing outcomes of scientific studies with stories of real people who have not just survived, but have used their trauma as their fuel to thrive to uncover common denominators. He shares his remarkable insights in his new book, Post-Traumatic Thriving: The Art, Science, & Stories of Resilience.
Dr. Bell sits down with survivors of the Holocaust; murder-victim’s families; crime victims; suicide survivors; and those who’ve experienced homelessness, disasters, addictions, depression, death, divorce, disabilities, defeats and disease to explore the rare mindset of the post-traumatic thriver.
He shares with readers stories of remarkable resilience, including the following:
• A deaf man with a glass eye invented the electric guitar and became a household name, remarkably wealthy and most importantly, happy.
• A convicted murderer took responsibility for the damage he caused, graduated with honors from college, became a minister and turned around the hearts of the most hardened criminals.
• A girl born with cerebral palsy landed the world’s first starring role on national television and spoke at the White House three times.
• A woman hid in a basement for years and lost her entire family in the Holocaust. She eventually found true love and paints stunning artwork.
• The sister of a murder victim helped millions of women in toxic domestic relationships.
• A woman’s car crash resulted in an addiction to prescription drugs, a divorce, a loss of her children and a cot in a homeless shelter. She has rebuilt it all back and more.
• A man set to go to the Olympics had his hopes dashed by Jimmy Carter and went on to build a worldwide business empire.
Ultimately, Dr. Bell documents the science of happiness, as well as the individual styles and common thread that all post-traumatic thrivers have to emerge with a fulfilling life. When trauma hits, your most significant decision will be to dive, survive or thrive. If you choose to thrive, this book is for you.
As an economist, Dr. Randall Bell has consulted on more disasters on earth than anyone in history and is widely considered the world’s top authority in the field of post-traumatic thriving. His clients include the Federal Government, State Governments, International Tribunals, major corporations and homeowners. Dr. Bell believes that “the problem is not the problem — the problem is how we react to the problem.”
Often called the “Master of Disaster,” Dr. Bell is squarely focused on authentic recovery and resilience. His research has been profiled on major television shows and featured in numerous magazines and the international media. More information can be found at www.posttraumaticthriving.com.
Post-Traumatic Thriving: The Art, Science, & Stories of Resilience
Emerging reports of hearing loss during the COVID-19 pandemic and the importance of accessibility to audiological services
Andre Marcoux, PhD, MBA, Michele Dostaler, AuD, Julie-Catherine Ste-Marie, AuD WS Audiology Canada Inc.
Abstract: Covid-19 symptoms range from respiratory distress and fever to completely asymptomatic cases. Several viral infections are known to affect the auditory system and recent case studies propose that SARS-CoV-2 is no exception. Emerging reports indicate the manifestation of both sudden sensorineural hearing loss as well as milder levels of damage during a SARS-CoV-2 infection. Inflammation, ischemia, and thrombosis have, amongst others, been identified as possible causes. Despite the current directives for home isolation and closure of certain services, accessibility to early audiological evaluation and monitoring upon suspicion or detection of sensorineural hearing loss remain essential.
BURLINGTON, ON, Jan. 12, 2021 /CNW/ - A review of emerging case reports and studies suggests that injuries to structures in and around the peripheral and central auditory systems may occur following the infection of SARS-CoV-2; the virus which causes the response more commonly known as COVID-19. Of interest, is the occurrence of hearing loss and other related deficits in both asymptomatic patients and those exhibiting symptoms related to COVID-19. While these reports and studies do not establish causality, various attributions of cause have been proposed and will be highlighted in this article.
The most apparent observations of hearing loss are from confirmed cases of infection of SARS-CoV-2 along with the timely onset of sudden sensorineural hearing loss (SSHL). In March 2020, Sriwijitalai and Wiwanitkit were early in reporting the occurrent of unresolved SSHL in a patient with COVID-19 related respiratory care and recovery. Similarly, Degen, Lenarz and Willenborg (2020) reported the case of a 60-year old man with reported deafness and loud white noise tinnitus bilaterally. Audiologic testing confirmed anacusis on right side and profound sensorineural loss on left side. MRI results for this patient were indicative of an inflammatory process in the right cochlea and meningeal contrast enhancement was detected at the base of the right temporal bone. Cochlear implantation was conducted preventatively on the right side in anticipation of ossification. The left ear was treated with intratympanic injections of triamcinolone without any noted results. This patient also received azithromycin and furosemide during hospitalization, both of which have documented ototoxic effects, but could not have caused the pathological results observed with MRI, or the asymmetrical audiologic findings. The authors highlight the association between Covid-19 acute respiratory distress syndrome and encephalopathy, with more than half of all cases showing meningeal contrast enhancement which subsequently can cause sensorineural hearing loss. Koumpa, Forde and Manjaly (2020), also reported a case of SSHL with accompanying tinnitus without abnormal MRI findings. The 45-year old COVID-19 patient was intubated for 30 days to treat bilateral pulmonary emboli and no ototoxic medications were administered. Bedside testing suggested 65-85 dB descending hearing loss with thresholds at 2, 3, 4, and 6kHz being most affected. A 7-day course of oral prednisone followed by intratympanic steroid injection were administered. Partial improvements of thresholds were subsequently observed. Similarly, Lamounier et al. (2020) reported on a case of predominantly unilateral loss with accompanying disabling tinnitus showing some partial low-frequency improvement following the administration of combined oral and intratympanic corticosteroid therapy. As contemplated, delayed therapy has a limited potential of hearing threshold recovery, such as was observed in an unresolved case of unilateral profound high-frequency SSHL with accompanying tinnitus (Lang, Hintze & Conlon, 2020). Their 30-year old patient did not show any improvement following a course of oral prednisone which was commenced seven weeks after the positive result of SARS-CoV-2 infection and three weeks post onset of hearing loss. The authors highlight the importance of a low index of suspicion of SSHL in hopes of providing a time-sensitive recovery with use of corticosteroid therapy.
Interestingly, cases where SSHL is the only condition related to infection of SARS-CoV-2 have also been noted. Rhman and Wahid (2020) reported a 52-year old male patient with a positive SARS-CoV-2 swab who was otherwise asymptomatic but was subsequently referred for sudden sensorineural hearing loss on the left side preceded by a gradually increasing tinnitus. Hearing thresholds revealed a severe sensorineural hearing loss for the left ear. No intracranial abnormalities could be detected with MRI and no other attributable causes for the sudden hearing loss could be identified. Intratympanic injection of methylprednisolone provided a partial recovery of hearing. Suspecting an emergence of SSHL following the SARS-Cov-2 outbreak, and the known viral etiology of SSHL, Kilic et al (2020) performed a polymerase chain reaction (PCR) test on adults who presented to an ENT clinic with the sole complaint of SSHL. One of the five patients was found to be positive for SARS-CoV-2, and otherwise did not exhibit any symptoms of Covid-19.
A widely cited mechanism to explain the manifestation of SSHL revolves around the same receptor to which SARS-CoV-2 binds to enter the body; the angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 is known to enter the body by binding to ACE2 receptors of the alveolar epithelial cells and endothelial cells of the lungs and from there bind to other areas of the body where ACE2 receptors are found. (Cure & Cumhur Cure, 2020). While it is not known if these receptors are expressed in the human cochlea and whether or not they would permit a direct entry of SARS-CoV-2, they have been found in the mucosal epithelium of the Eustachian Tube and middle ear spaces as well as the cochlea of mice (Uranaka et al., 2020). An ensuing release of inflammatory cytokines would then likely result in oxidative damage of hearing structures. Other possible hypotheses to explain the pathophysiology of SSHL have been proposed, namely, but not limited to, a SARS-CoV-2-induced deoxygenation of erythrocytes leading to the hypoxia of hearing structures, or conversely a thrombosis caused by a change in vascular microstructure leading to ischemic lesions (Cure & Cumhur Cure, 2020).
The direct verification of these proposed etiologies, or others to follow, may shed light on the possible prevalence of SARS-CoV-2-related hearing loss. However, a broader hearing assessment strategy of both symptomatic and asymptomatic cases may also have significant merit. As support of this argument, using transient evoked otoacoustic emissions (TEOAE) which are sensitive to changes of cochlear function, Mustafa (2020), was able to observe differences in cochlear function between asymptomatic individuals, aged 20-50 years, with confirmed infection from SARS-CoV-2 and a control group with normal hearing. Significantly lower TEOAE amplitudes were also accompanied by significantly poorer hearing thresholds at 4, 6, and 8kHz despite no hearing impairment being noted during case history. These results are indicative that SARS-CoV-2 may also cause milder forms of hearing loss than the more apparent cases of SSHL noted above. While the study makes no mention of severity of loss or whether or not there was an asymmetric nature to their results, there is nevertheless indication that milder forms of hearing dysfunction may be measured in individuals infected with SARS-CoV-2. It may also be inferred from these results that hearing dysfunction may be a specific indicator (symptom) of infection for individuals who are otherwise asymptomatic for COVID-19.
As we commence to obtain reports which indicate the potential effects of SARS-CoV-2 on the auditory system, we acknowledge the need for systematic studies on the matter to help establish prevalence as well as other epidemiological data. Also, as part of a broader remedial scope, future studies should also evaluate if milder occurrences of hearing or auditory processing deficits are also prevalent for both symptomatic and asymptomatic cases. In this context, access to audiology services is of substantial value to allow for the adequate surveillance of hearing loss, most notably in cases of suspected SSHL where timely assessments and treatment are often of utmost importance to allow for any recovery of hearing function.
References:
Cure, E., Cumhur Cure, M. Comment on "Hearing loss and Covid-19: A note". American Journal of Otolaryngology. 2020 July-August; 41(4): 102513. Published online 2020 Apr 30. doi: 10.1016/j. amjoto.2020.102513
Degen C., Lenarz T., Willenborg K. (2020). Acute profound sensorineural hearing loss after COVID-19 pneumonia. Mayo Clinic Proceedings. 95:1801–3. doi: 10.1016/j.mayocp.2020.05.034
Kilic, O., Kalcioglu, M. T., Cag, Y., et al. (2020). Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss. International Journal of Infectious Disorders, 97 :208–11. doi: 10.1016/j. ijid.2020.06.023
Koumpa, F. S., Forde, C.T., Manjaly, J.G. (2020) Sudden irreversible hearing loss post COVID-19. BMJ Case Reports, 13:e238419. doi: 10.1136/bcr-2020-238419
Lamounier, P., Gonçalves, V. F., Ramos, H. V. L., Gobbo, D. A., Teixeira, R. P., dos Reis, P. C., Bahmad Jr., F., & Costa, C. C. (2020). A 67-year-old woman with sudden hearing loss associated with SARS- CoV-2 infection. American Journal of Case Reports, 21: 1–6.
Lang, B., Hintze, J., Conlon, B. (2020). Coronavirus disease 2019 and sudden sensorineural hearing loss. The Journal of Laryngology & Otology, 1-3. Advance online publication. doi:10.1017/ S0022215120002145
Mustafa, M.W.M. (2020). Audiological profile of asymptomatic Covid-19 PCR-positive cases. American Journal of Otolaryngology, 41:102483. doi:10.1016/j.amjoto.2020.102483
Rhman S.A., Wahid A.A. COVID-19 and sudden sensorineural hearing loss: a case report. Otolaryngology Case Reports, 16:100198. doi: 10.1016/j.xocr.2020.100198
Sriwijitalai W., Wiwanitkit V. (2020). Hearing loss and COVID-19: a note. American Journal of Otolaryngology, 41:102473. doi: 10.1016/j.amjoto.2020.102473
Uranaka T., Kashio A., Ueha R., Sato, T., Bing, H., Ying, G., Kinoshita, M. (2020). Expression of ACE2, TMPRSS2, and furin in mouse ear tissue, and the implications for SARS-CoV-2 infection. Laryngoscope, 00:1-5.
SOURCE WS Audiology
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