tag:blogger.com,1999:blog-28347098854862597752024-03-21T06:18:10.321-07:00Laryngectomee NewsletterLaryngectomee Newsletter provides information for laryngectomee and neck breathers how to cope with the corona (COVID-19) pandemic. It advises how to prevent the infection and deal with depression, social isolation, fibrosis, lymphedema, mucous problems, and voice prosthesis leak. It provides suggestions how to deal with esophageal dilation, hospitalization, and keep fit and eat well. Created by Itzhak Brook MD, Professor of Pediatrics at Georgetown University, a physician and a laryngectomeeDr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-2834709885486259775.post-67656351129629919762022-10-11T08:26:00.001-07:002022-10-11T08:26:12.484-07:00Comparison of anxiety and depressive of head and neck cancer patients before and during the 2019 coronavirus pandemic<p> </p><p class="MsoNormal"><br /></p>
<p class="MsoNormal">Jiani Liu and colleagues from <span style="mso-spacerun: yes;"> </span>Sun Yat-sen University, Zhuhai, China, <span style="mso-spacerun: yes;"> </span><a href="https://pubmed.ncbi.nlm.nih.gov/36217615/" target="_blank">studied the effect of the COVID-19 pandemic </a>on
the anxiety and depressive symptoms of cancer patients before and during the
2019 coronavirus pandemic.<o:p></o:p></p>
<p class="MsoNormal">A total of 526 head and neck cancer patients were included
in the final analysis; 27% of cases experienced anxiety and depression before the
pandemic and 50 % during the COVID-19 pandemic. (P=0.018). <o:p></o:p></p>
<p class="MsoNormal">The present study demonstrates the significant impact of
COVID-19 on the psychological states of cancer patients. This findings indicating
the need for appropriate changes in treatment decisions, enhanced
psychotherapy, and interventions to reduce the incidence of anxiety,
depression, and even suicide during the pandemic.<o:p></o:p></p><p class="MsoNormal"><br /></p>
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8FVZaK3K5wS74Gbm0Ho3W1xCANw180DsGszdOTgWOixu_-m3SCE-hjsZ1U1rlqjt272YV8C2OgFLG00hvh0Q44sdjzsWo3rVevUYfigDNZaC0ChXDtvlC3niz0BV8QOIrWNHXcUMGSoxZS8zZENp4H2CULcK9pKAQ9BAl7NwVcyUyDaU6AVJWsiQ/s297/download.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="170" data-original-width="297" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8FVZaK3K5wS74Gbm0Ho3W1xCANw180DsGszdOTgWOixu_-m3SCE-hjsZ1U1rlqjt272YV8C2OgFLG00hvh0Q44sdjzsWo3rVevUYfigDNZaC0ChXDtvlC3niz0BV8QOIrWNHXcUMGSoxZS8zZENp4H2CULcK9pKAQ9BAl7NwVcyUyDaU6AVJWsiQ/s1600/download.jpg" width="297" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-28857500642772390202021-12-15T09:37:00.007-08:002021-12-15T09:54:42.389-08:00Getting infected with both COVID-19 and influenza viruses<p> <span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: white; font-size: 15.4px;">Co-infection of COVID-19 with other respiratory pathogens which may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge new concern. </span><span style="font-family: inherit;">Eleven prevalence
studies with total of 3,070 patients with COVID-19, and 79 patients with
concurrent COVID-19 and influenza were evaluated by Dadashi et al from Department
of Microbiology, School of Medicine, Alborz University of Medical Sciences,
Karaj, Iran .</span><span style="font-family: Calibri, sans-serif; font-size: 11pt;"> </span><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: white; font-size: 15.4px;">The overlap of COVID-19 and influenza, as two epidemics at the same time can occur in the cold months of the year.</span><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: white; font-size: 15.4px;"> </span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267808/" style="color: #254da9; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15.4px; text-decoration-line: none;" target="_blank">The prevalence of influenza infection was </a><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: white; font-size: 15.4px;">0.8% in patients with confirmed COVID-19. The frequency of influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and 0.4% in the America. </span></p><p class="MsoNormal" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15.4px;"><o:p></o:p></p><p class="MsoNormal" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15.4px;">This information highlights the importance of getting properly vaccinated for both COVID-19 and influenza and practicing safe prevention (wearing masks and maintaining distance) as advised by the local health authorities. Neck breathers including laryngectomee should practice extra vigilance to avoid respiratory infections.</p><p class="MsoNormal" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15.4px;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgwTYngeVc5fJ7SfQrzLd5N1SPgIjpXbWiW5JYK6ttetw0aXSUSLnPUNdcJV11owbkl-3A9U6AA9ZhYjmqjF2xBGJ6X_Y4DJ_QFL-EHOgJyYFzz0oJnI1BTTN5OpUYoHROBiXlgNIs2fNrtQpFbgVlXAZ5XUt_ZkD5SpJbmihCOXhrHE-gT3EnKnIUR=s700" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="700" height="183" src="https://blogger.googleusercontent.com/img/a/AVvXsEgwTYngeVc5fJ7SfQrzLd5N1SPgIjpXbWiW5JYK6ttetw0aXSUSLnPUNdcJV11owbkl-3A9U6AA9ZhYjmqjF2xBGJ6X_Y4DJ_QFL-EHOgJyYFzz0oJnI1BTTN5OpUYoHROBiXlgNIs2fNrtQpFbgVlXAZ5XUt_ZkD5SpJbmihCOXhrHE-gT3EnKnIUR=s320" width="320" /></a></div><br /><p class="MsoNormal" style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15.4px; text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-43958638753672926772021-10-19T09:58:00.003-07:002021-10-19T09:58:53.452-07:00Discordant in Detection of COVID-19 in the Nasopharynx Versus Trachea for Patients With Tracheostomies<p> Patients with tracheostomies have an anatomically altered
connection between their upper and lower airways that could impact SARS-CoV-2
testing. <a href="https://onlinelibrary.wiley.com/doi/10.1002/lary.29617" target="_blank">Smith and colleagues from the University of Michigan</a> retrospectively
compared the detection of SARS-CoV-2 in hospitalized patients with COVID-19 and
tracheostomies.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The authors employed SARS-CoV-2 RNA nucleic acid
amplification test (NAAT) in 45 newly <span style="mso-spacerun: yes;"> </span>tracheotomized
patients in nasopharyngeal (NP) and tracheal (TR) samples taken within a
48-hour period.<o:p></o:p></p>
<p class="MsoNormal">Thirty-two (71.1%) of the 45 patients had entirely
concordant results after tracheostomy. However, 13 (28.9%) patients had at
least one set of discordant results, the majority of which were NP negative and
TR positive. <o:p></o:p></p>
<p class="MsoNormal">The authors concluded that patients with tracheostomies may
have a higher false-negative rate if only one site is assessed for SARS-CoV-2. They
recommend analyzing samples from both the nasopharynx and trachea for these
patients until more prospective data exist.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiBF4HqBocQD0qefKUlpJuriU3TnvITKzP-TjilU8ZdgXFaShuBn9wnMv_ovF3PEaA2hxORNdHX5pDz0tmZFQaABxByBHJZxTC4fYrREAUVtwTQGDraP2WrcRfi-U7ETGuWCqDZJ_PeJlhCmKHbc-7-PsJnDCfW5NmfzjQ1F3CNwV_bAYQ41PkwxwJ2=s600" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="380" data-original-width="600" height="203" src="https://blogger.googleusercontent.com/img/a/AVvXsEiBF4HqBocQD0qefKUlpJuriU3TnvITKzP-TjilU8ZdgXFaShuBn9wnMv_ovF3PEaA2hxORNdHX5pDz0tmZFQaABxByBHJZxTC4fYrREAUVtwTQGDraP2WrcRfi-U7ETGuWCqDZJ_PeJlhCmKHbc-7-PsJnDCfW5NmfzjQ1F3CNwV_bAYQ41PkwxwJ2=s320" width="320" /></a></div><br /><p class="MsoNormal"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-92189167319700833972021-08-12T08:10:00.003-07:002021-08-12T08:16:36.634-07:00 Hospitalization and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic <p> </p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">People with total laryngectomy (PTL) have
an altered anatomy for breathing and speaking. The presence of a neck stoma
poses an additional virus entry point aside from the nose, mouth and
conjunctiva. This could increase the susceptibility to COVID-19 for PTL.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Govender and colleagues from the University
College Hospital in London <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1460-6984.12656 " target="_blank">performed a national audit</a> to provide data on
shielding, hospital admissions and mortality for patients with total
laryngectomy in the UK over the pandemic. Eight of the 24 PTL that were hospitalized
with COVID -19 died within 28 days. Although the overall mortality in PTL over
the first lockdown did not appear to be higher than the “best case” estimates
from previous years one in three PTL who acquired COVID-19 and were admitted to
hospital, died within 28 days of testing positive. These findings are relevant
to the current care and management of PTL over the pandemic.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This study highlights gaps in the
collection of baseline information on hospital admissions, length of stay and
mortality for people with laryngectomy in the UK, restricting comparisons
between the current data and historical data.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The need for further research on whether
neck-breathers should be tested via both nasopharyngeal and tracheal aspirates
is important not just currently, but also in case of any future respiratory
epidemics.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-OLjZV_CFpMc/YRU5zCPSZxI/AAAAAAACp3c/m7t2BabxKIY-A75eL-6jE4NwTEVpPZp9wCLcBGAsYHQ/s331/download.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="152" data-original-width="331" height="147" src="https://1.bp.blogspot.com/-OLjZV_CFpMc/YRU5zCPSZxI/AAAAAAACp3c/m7t2BabxKIY-A75eL-6jE4NwTEVpPZp9wCLcBGAsYHQ/s320/download.jpg" width="320" /></a></div><br /><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-83652533881031650712021-03-23T11:01:00.001-07:002021-03-23T11:01:17.523-07:00 Safety of celebrating the spring holidays with family and Friends for head and neck cancer patients.<p><br /></p>
<p class="MsoNormal">The upcoming spring holidays (Easter, Passover and Ramadan)
creates challenges for those who are looking forward to celebrating them in
person with friends and family. The availability of vaccination against the
virus made it easier to resume the tradition of in person celebration although
the risk of acquiring the infection can be high in some situations.<o:p></o:p></p>
<p class="MsoNormal">Vigilance and mitigating the risk of acquiring COVID-19
infection are especially important for Individuals with cancer including of the
head and neck, who are at greater risk of suffering from a serious and life
threatening COVD -19 infection.<o:p></o:p></p>
<p class="MsoNormal">Celebrating the holidays in close settings can be risky
because of the difficulty of maintain social distance, and adequate
ventilation. Mask wearing is impractical while eating and drinking.<o:p></o:p></p>
<p class="MsoNormal">The Center of Disease Control’s Interim Public Health
Recommendations for Fully Vaccinated provide useful guidelines that can help
plan a safe Seder and avoid risky scenarios that would allow the COVID-19 virus
to spread. <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html">https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html</a>
<o:p></o:p></p>
<p class="MsoNormal">For the purposes of the CDC’s recommendations people are
considered fully vaccinated for COVID-19 more than 2 weeks after they have
received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna),
or<span style="mso-spacerun: yes;"> </span>more than 2 weeks after they have
received a single-dose vaccine (Johnson and Johnson/Janssen ).<o:p></o:p></p>
<p class="MsoNormal">Interpretation of the CDC recommendations to the spring
holidays scenario for fully vaccinated people are:<o:p></o:p></p>
<p class="MsoNormal">•<span style="mso-tab-count: 1;"> </span>It is
permissible for fully vaccinated people to celebrate indoor with other fully
vaccinated people or unvaccinated people from a single household who are at low
risk for severe COVID-19 disease without wearing masks or physical distancing.<o:p></o:p></p>
<p class="MsoNormal">•<span style="mso-tab-count: 1;"> </span>Wearing
masks, practicing physical distancing, and adhering to other prevention
measures is required when celebrating with unvaccinated people who are at
increased risk for severe COVID-19 disease or who have an unvaccinated
household member who is at increased risk for severe COVID-19 disease<o:p></o:p></p>
<p class="MsoNormal">•<span style="mso-tab-count: 1;"> </span>Wearing
masks, maintaining physical distance, and practicing other prevention measures
are required when celebrating with unvaccinated people from multiple households<o:p></o:p></p>
<p class="MsoNormal">•<span style="mso-tab-count: 1;"> </span>Avoiding
medium - and large-sized Seder <o:p></o:p></p>
<p class="MsoNormal">•<span style="mso-tab-count: 1;"> </span>Unvaccinated
individuals from different households should refrain from celebrating in
person.<o:p></o:p></p>
<p class="MsoNormal">Since the COVID-19<span style="mso-spacerun: yes;">
</span>vaccine is not currently available to children, extra caution should be
practiced when they are present. Outdoor gathering with masks or opening the
windows to improve the ventilation, and distancing would be safest. <o:p></o:p></p>
<p class="MsoNormal">Although the available vaccines are helpful in curbing the
spread of COVID-19 their efficacy against the variants of the virus in unknown.
These variants seem to spread more easily and quickly than other variants,
which may lead to more cases of COVID-19. It is there prudent to continue to
maintain vigilance in the upcoming holiday.<o:p></o:p></p>
<p class="MsoNormal" style="text-align: center;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-ZsF16elkqa0/YFos2BsfjBI/AAAAAAACpXo/qE73vSRqsekdWFyGlkmnckizwitIAo3HgCLcBGAsYHQ/s500/pexels-photo-3184183.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="334" data-original-width="500" src="https://1.bp.blogspot.com/-ZsF16elkqa0/YFos2BsfjBI/AAAAAAACpXo/qE73vSRqsekdWFyGlkmnckizwitIAo3HgCLcBGAsYHQ/s320/pexels-photo-3184183.jpeg" width="320" /></a></div><br /><o:p><br /></o:p><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-72387734887777268032021-01-25T09:52:00.001-08:002021-01-25T09:52:52.358-08:00Potential devastating impact of COVID-19 pandemic on the diagnosis and treatment of head and neck cancer <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><a href="https://mailchi.mp/31172eacae72/an-important-press-release-the-forgotten-cancer-in-the-fight-against-covid-19?e=963dcc777c " target="_blank">New data from the United Kingdom </a>reveals
potential devastating impact of COVID-19 pandemic on head and neck cancer
patients. At the peak of the first lock down, there was a 59% drop in urgent
referrals for people with a suspicion of head and neck cancer. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The devastating impact on projected
five-year survival for people with head and neck cancer sees the pre-COVID
projected 5 year survival of 47% will potentially drop to 43% of head and neck
cancer patients.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This could lead to an additional 451
deaths in people with head and neck cancer in the United Kingdom.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The data from DATA-CAN (The Health Data
Research Hub for Cancer) provided a valuable insight into the effects of the
COVID-19 pandemic on all cancer patients and cancer services. The research
found:<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"></p><ul style="text-align: left;"><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">A decline in urgent referrals for cancer
(70% decrease) during the initial lock down</span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">A decline in chemotherapy attendances
(40% decrease) during the initial lock down</span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">For certain cancers, these declines had
only partially recovered.</span></li></ul><p></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The researchers have now looked in detail
at the impact on head and neck cancers and found that, at its worst, there was
a drop of nearly 60% in urgent referrals for a suspicion of head and neck
cancer during the first lockdown. This meant that 6 out 10 people who had
symptoms potentially indicating head and neck cancer were not being referred to
a specialist to investigate further.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Estimates suggest that this could have a
devastating impact on five-year survival for people with head and neck cancer.
Pre-COVID, around 47% of people with head and neck cancer would be projected to
survive for five years or more. This figure could now drop to 43% which could
potentially lead to an additional 451 deaths in people with head and neck
cancer as a result of the pandemic.<o:p></o:p></span></p><p>
<span style="font-family: "Arial",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-bidi; mso-bidi-language: HE; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi;">Watch
a video that presents the data and how to mitigate it.</span></p><p><span style="font-family: Arial, sans-serif;"><span style="font-size: 14.6667px;"><br /></span></span></p><p></p><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/ZfXDznMnMTg" width="320" youtube-src-id="ZfXDznMnMTg"></iframe></div><br /><span style="font-family: Arial, sans-serif; font-size: 14.6667px;"><br /></span></div><br /><p></p><span style="font-family: "Calibri",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-language: HE; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-43893635615671784472021-01-24T13:20:00.002-08:002021-01-25T08:34:48.902-08:00Laryngectomees’ challenges coping with COVID – 19 Pandemic as vaccines are available.<p> </p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Laryngectomees are more susceptible to
some respiratory infections because the air they inhale is not filtered by
passing through their nose. Consequently, they are at an increased risk of
inhaling respiratory pathogens (viruses, bacteria, and fungi) directly into
their lungs. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Laryngectomees are also at high risk for
poor outcomes when contracting COVID-19 because of their propensity to suffer from
collapse of the lower lobs of their lungs (atelectasis). This is due to loss of
upper airway resistance and impaired mucociliary functions, and mucosal
irritation from cold, or dry inspired air. Further comorbidities such as
advanced age, chronic disease (pulmonary, peripheral vascular, cardiac,
cerebrovascular), diabetes, and past smoking, increase this risk. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Therefore, laryngectomees have to be vigilant
and protect themselves from becoming infected with COVID-19. This can be done
by wearing eat and mosuture exchanger (HME) with greater filtering properties (
i.e., Provox Micron TM); using 2 surgical masks (preferably N95), one over the
stoma and the other over the mouth and nose; staying at least 6 feet away from
others; washing hands often with soap and water for at least 20 seconds; and
not touching their stoma, HME, eyes, nose, and mouth with unwashed hands. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Laryngectomees can protect themselves by receiving
vaccination against COVID-19. All COVID-19 vaccines currently available in the
United States have been shown to be highly effective at preventing COVID-19.
Based on clinical trials, experts believe that getting a COVID-19 vaccine may
also help keep one from getting seriously ill even when one get infected with COVID-19.
Becoming vaccinated may also protect people around the vaccinated person,
particularly those at increased risk for severe illness from COVID-19. This
also contributes to the curbing of the national and world pandemic.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Among the benefits of being vaccinated is
the emotional relief of gaining protection from the virus, and the ability of
feel safer in face to face social interactions and when seeking medical and
dental care. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Clinical trials demonstrated that the
known and potential benefits of these vaccine outweigh the their side effects,
and the known and potential harms of becoming infected with COVID-19. The Center
for Disease Control’s (CDC) has reported that severe allergic reactions to
COVID-19 vaccines are very rare and happened at a rate of 11.1 cases per
million vaccinations. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Arial, sans-serif;">Vaccination is not expected to relax the CDC
recommendations for continued use of masks and social distancing. This is
because vaccines are not 100% effective, their protective effect is not maximized
for at least six weeks, and vaccines may keep a person from getting sick but
not from transmitting the virus. Masks and HMEs reduce the spread of any
mutated strain of the coronavirus, while vaccines may not be as effective in
preventing the transmission of newer, more contagious strains.</span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">It is advisable to contact one’s
physicians for guidance about vaccination or if one gets ill with the Corona
virus. There are currently treatments available that can be administered early
in the course of the infection to mitigate the illness and prevent
complications. It would be prudent to following the guidance and instruction issued
by the CDC and the local government health authorities.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;">
</p><p class="MsoNormal" style="line-height: 150%;"><br /></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-f2c7bgAbEeo/YA3jo6uWZwI/AAAAAAACpVM/44YOrfOiSSoB1R7I-gfV11nLj5mfJNnxgCLcBGAsYHQ/s820/SARS-CoV-2-vaccine-820x440.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="440" data-original-width="820" src="https://1.bp.blogspot.com/-f2c7bgAbEeo/YA3jo6uWZwI/AAAAAAACpVM/44YOrfOiSSoB1R7I-gfV11nLj5mfJNnxgCLcBGAsYHQ/s320/SARS-CoV-2-vaccine-820x440.jpg" width="320" /></a></div><br /><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-91960978399846481172021-01-22T07:03:00.000-08:002021-01-22T07:03:03.168-08:00Asymptomatic transmission of COVID-19, with or without vaccination<p> </p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Arial, sans-serif;">One of the problems with this COVID-19 pandemic, from a public health
standpoint, is that asymptomatic or presymptomatic persons can transmit the
virus to others without knowing that they are infected themselves. Estimates of
asymptomatic transmission are 17-20%.</span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Protection procedure include <span style="mso-spacerun: yes;"> </span>isolation (keeping infected persons away from
others); and quarantine ( keeping persons who might have been exposed to the
virus away from others). <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Asymptomatic infections complicate these
protective measures since it is impossible to tell who is infected. Current
practice is essentially to assume that anyone might be infected and capable of
transmission, and therefore masks and social distancing are necessary. Despite
trials showing 95% efficacy of the two mRNA vaccines (compared to 70%, possibly
higher, for the Johnson and Johnson vaccine), vaccination is not expected to
relax the recommendations for continued masks and social distancing. The
reasons are:<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"></p><ul style="text-align: left;"><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Vaccines are not 100% effective;</span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Vaccines protective effect is not maximized
for at least six weeks; </span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Vaccines may keep a person from getting
sick but not from transmitting the virus.</span></li></ul><p></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Masks (if clean and properly worn) reduce
the spread of any mutated strain of the coronavirus, while vaccines may not be
as effective in preventing the transmission of newer, more contagious (but not
more virulent) strains. There have been several mutated strains appearing in
the UK, Brazil, South Africa, California, and other countries and states. As a
rule they do not cause a more severe case of the disease but they may be more
infective than existing strains. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Based on Dr. Glen Reeves article.</span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-uYvZfPHED48/YAro1x_nF8I/AAAAAAACpU0/yX_XtKQYZ_c7CHLIePj9l848ZN3boibYQCLcBGAsYHQ/s660/Document.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="371" data-original-width="660" src="https://1.bp.blogspot.com/-uYvZfPHED48/YAro1x_nF8I/AAAAAAACpU0/yX_XtKQYZ_c7CHLIePj9l848ZN3boibYQCLcBGAsYHQ/s320/Document.jpg" width="320" /></a></div><br /><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-42875590983970948542021-01-22T07:00:00.000-08:002021-01-22T07:00:31.801-08:00COVID-19 vaccines adverse reactions in the USA<p> </p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">The Vaccine Adverse Event Reporting System (VAERS) receives reports on
adverse reactions to vaccines. These reports can be filed by patients, health
care providers, or even family members. As of 17 January 55 Americans have died
soon after receiving an mRNA vaccination. The FDA and CDC investigate all these
reports. Of course, most deaths are due to underlying illnesses; the system
does not require proof that the vaccine caused the event in order to accept the
report. The CDC has reported that severe allergic reactions to COVID-19
vaccines were happening at a rate of 11.1 per million vaccinations; for a rough
comparison flu vaccinations have a rate of 1.3 deaths per million. Norway has
changed its COVID-19 vaccination guide to direct officials not to give
"very frail" people the vaccines.</span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Arial, sans-serif;">based on Dr Glen Reeves article.</span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Arial, sans-serif;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-Le-7DOnAj4w/YAroCR-EYGI/AAAAAAACpUk/XndlzXuaTR44G9I2WpKl6I2HVNsTCe5xACLcBGAsYHQ/s2048/vac%2Bi.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" src="https://1.bp.blogspot.com/-Le-7DOnAj4w/YAroCR-EYGI/AAAAAAACpUk/XndlzXuaTR44G9I2WpKl6I2HVNsTCe5xACLcBGAsYHQ/s320/vac%2Bi.jpeg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"> </div><br /><span style="font-family: Arial, sans-serif;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-8955241193036960142020-12-23T09:06:00.002-08:002020-12-23T09:06:11.563-08:00Cancer Care During the COVID- 19 Pandemic<p> </p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Dr Brook's <a href="https://www.nytimes.com/2020/12/22/opinion/letters/trump-martial-law.html#link-6f2ae34d" target="_blank">Letter to the Editor<span style="mso-spacerun: yes;"> </span>published in the New York Times</a> has an
important message to all cancer survivors:<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The prolonged COVID -19 pandemic has led
to an increase in the number of patients who present with late-stage,
previously undiagnosed cancers, and recurrence of a previously diagnosed
malignancy.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This is probably due to the reluctance of
people to seek medical care because of fear of contracting COVID -19 at medical
facilities; the closing or reduction in clinical services; the requirement to
obtain COVID -19 testing before some medical procedures; and the use of
telemedicine without physical examination instead of an actual office visit.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">It is important that people not defer
their medical care during the pandemic. It is especially important that those
who previously received a cancer diagnosis continue their treatment and
follow-up. Those who experience new or unusual signs and symptoms that may
indicate aggravation of their condition or a new ailment should seek medical
care without delay.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Postponing care or ignoring symptoms may
lead to complications and deterioration, making future care more difficult and
leading to increased morbidity and mortality.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-olGTKgz-jdw/X-N4YEF6z8I/AAAAAAACpS8/zsgnBMvLnM8gT8yQSP13CblFJzyHEC3bQCLcBGAsYHQ/s1024/doctors-cancer-sekeres-jumbo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="631" data-original-width="1024" src="https://1.bp.blogspot.com/-olGTKgz-jdw/X-N4YEF6z8I/AAAAAAACpS8/zsgnBMvLnM8gT8yQSP13CblFJzyHEC3bQCLcBGAsYHQ/s320/doctors-cancer-sekeres-jumbo.jpg" width="320" /></a></div><br /><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-80781831200735548702020-10-29T13:26:00.004-07:002020-10-29T14:07:19.984-07:00Increased risk of serious illnesses including advanced stage cancer due to COVID -19 pandemic<p> </p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The prolonged COVID-19 world wide
pandemic led to an increase in medical problems due to other etiologies. Medical
providers are facing growing number of patients with previously undiagnosed
late stage cancers, and recurrence of a previously diagnosed malignancies.<span style="mso-spacerun: yes;"> </span>This led to an increase in the number of radical
surgeries including laryngectomies and <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30388-0/fulltext">increase in the death rate among patients</a> with many types of cancer. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This is likely due to several factors that
include the reluctance of individuals to seek medical care because of fear of
contracting COVID-19 at medical facilities; the closure or reduction of
clinical services, </span><span style="font-family: inherit;">the suspension of cancer screening, the deferral of
routine diagnostic work, </span>the requirement to obtain COVID-19 testing prior to some
medical procedures, and the utilization of telemedine without physical
examination instead of an actual office visit.</p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">It is therefore important that
individuals do not defer their medical, dental, and mental care during the
COVID-19 pandemic. It is especially important that those who were previously
diagnosed with an ailment including cancer continue their treatment and follow
up. Those who experience new or unusual signs and symptoms that may indicate an
aggravation of their condition or a new ailment should seek medical care
without delay. Postponing care or ignoring symptoms may lead to complications
and deterioration making future care more difficult and may lead to increase
morbity and mortality. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-iwW1EvQKCzo/X5slTvlJrFI/AAAAAAACpM8/c8X1z7Z4nmcpdDRzgh4NcuTaDl17yQLFgCLcBGAsYHQ/s1053/travel_vlog_youtube_thumbnail_2.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1053" src="https://1.bp.blogspot.com/-iwW1EvQKCzo/X5slTvlJrFI/AAAAAAACpM8/c8X1z7Z4nmcpdDRzgh4NcuTaDl17yQLFgCLcBGAsYHQ/s320/travel_vlog_youtube_thumbnail_2.png" width="320" /></a></div><br /><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-46594158606261701282020-09-11T08:42:00.001-07:002020-09-11T08:42:08.504-07:00<p> </p><p class="MsoNormal"><span style="font-family: Arial, sans-serif;">Three studies from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269926/pdf/main.pdf?fbclid=IwAR3fgY4XSi1xyqKntjShI-fsoXfdPRM0jwyxFV_CqrCne4xQhQ-N7Bg_Z7Y" target="_blank">Italy</a> <a href="https://pubmed.ncbi.nlm.nih.gov/32583671/ " target="_blank">and </a><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468680/pdf/S0022215120001310a.pdf?fbclid=IwAR3fgY4XSi1xyqKntjShI-fsoXfdPRM0jwyxFV_CqrCne4xQhQ-N7Bg_Z7Y" target="_blank">Scotland </a>reported seven laryngectomees who </span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">developed COVID -19 infection. Two acquired the infection while in the hospital after undergoing laryngectomy. The infection was serious in three of them and they required intubation and intensive care admission. All the patients survived.</span></p><p class="MsoNormal"><span style="font-family: Arial, sans-serif;">The authors concluded that individuals who have undergone laryngectomy for head and neck squamous cell carcinoma are high risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways.</span></p><p class="MsoNormal"><span style="font-family: Arial, sans-serif;"><br /></span></p><p class="MsoNormal" style="text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-ofFM2yYgaGo/X1uaxOU3WoI/AAAAAAACpGk/10GhEqgIoAUx7BoreKx2LB0I_k8Cf_rGQCLcBGAsYHQ/s259/download.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="194" data-original-width="259" src="https://1.bp.blogspot.com/-ofFM2yYgaGo/X1uaxOU3WoI/AAAAAAACpGk/10GhEqgIoAUx7BoreKx2LB0I_k8Cf_rGQCLcBGAsYHQ/s0/download.png" /></a></div><br /><span style="font-family: Arial, sans-serif;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-19217922677873807712020-08-25T11:32:00.021-07:002020-12-31T12:14:55.139-08:00The "Laryngectomee Guide for COVID-19 Pandemic" is available in English, Spanish, Portuguese, Italian, Turkish, Bosnian, and Japanese.<p><b>The "Laryngectomee Guide for COVID-19 pandemic” is available in English, Spanish, Portuguese, Italian, Turkish, Bosnian, Malaysian, and Japanese</b>.</p><br style="font-family: arial, sans-serif;" /><div class="MsoNormal" style="line-height: 24px;"><div class="MsoNormal" style="line-height: 24px;"><p class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;">The corona (COVID-19) pandemic presents many medical, social and psychological challenges for laryngectomees and their medical providers. The Laryngectomee Guide for COVID -19 provides information for laryngectomee and neck breathers how to cope with the COVID -19 pandemic. It contains information how to prevent the infection and deal with depression, social isolation, fibrosis, lymphedema, mucous problems, and voice prosthesis leak. It provides suggestions how to deal with esophageal dilation, hospitalization, and keep fit and eat well.</span><span face="Arial, sans-serif"><o:p></o:p></span></p><div><br /></div></div></div><div class="MsoNormal" style="line-height: 24px;"><span face="">The Guide in <b>English</b> is available as eBook (free) at </span><span style="font-family: inherit;"><a href="https://bit.ly/2AY41RO">https://bit.ly/2AY41RO</a><span face=""> </span><span face="">, </span></span><span face="">and paperback </span><span face="">at: </span><span style="font-family: inherit;"><a href="https://amzn.to/3i5XncR">https://amzn.to/3i5XncR</a><span face=""> </span></span><span style="font-family: arial;"> </span><span face=""> </span><span>through Amazon.com and</span><span face=""> </span><span><a href="https://bit.ly/3glrlJf">https://bit.ly/3glrlJf</a><span face=""> through Lulu publishing. </span></span></div><div class="MsoNormal" style="line-height: 24px;"><span><span face=""><br /></span></span></div><div class="MsoNormal" style="line-height: 24px;"><span><span style="font-family: inherit;"><span face=""><span face="">The Guide in <b>Spanish</b> is available as eBook (free) at </span></span></span><span style="font-family: arial;"><a href="https://bit.ly/3bFgPeb">https://bit.ly/3bFgPeb</a> and paperback at <a href="https://bit.ly/32djqIW">https://bit.ly/32djqIW</a> </span></span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"> </span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;">The Guide in<b> Portuguese</b> is available as as eBook (free) at </span><span style="font-family: arial;"><a href="https://bit.ly/3eFcYPN">https://bit.ly/3eFcYPN</a><span> and paperback at </span><a href="https://bit.ly/3pklpVJ">https://bit.ly/3pklpVJ</a> </span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;">The Guide<a href="https://www.aptf.org/" target="_blank"> is available</a> from </span><span style="background-color: white; color: #1d2228;"><span style="font-family: inherit;">Associação Portuguesa de Terapeutas da Fala (APTF)</span></span><a href="http://voz.pmpterapia.pt/pt_PT/2020/11/o-guia-do-laringectomizado-para-a-pandemia-de-covid-19/?fbclid=IwAR0K17XkZMn5pn14KPp8YbmTFA8SkljtaAmQwX6bIorlG6jgjfcD7TFKAsg" target="_blank"><span style="background-color: #f8f9fa; color: #202124; white-space: pre-wrap;"><span><span style="font-family: inherit;">(</span></span></span></a><span style="background-color: #f8f9fa; color: #202124; white-space: pre-wrap;"><span><a href="http://voz.pmpterapia.pt/pt_PT/2020/11/o-guia-do-laringectomizado-para-a-pandemia-de-covid-19/?fbclid=IwAR0K17XkZMn5pn14KPp8YbmTFA8SkljtaAmQwX6bIorlG6jgjfcD7TFKAsg" style="font-family: inherit; white-space: normal;" target="_blank"><span style="color: #202124; white-space: pre-wrap;"><span style="font-family: inherit;">Portuguese Speech Therapists Association</span></span></a><span style="font-family: inherit;">)</span></span></span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><br /></span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><span><span face=""><span face="">The Guide in <b>Italian</b> is available as eBook (free) at </span></span></span><span face="Arial, sans-serif" style="line-height: 15.6933px;"><a href="https://bit.ly/2RfdrgE">https://bit.ly/2RfdrgE</a></span> and paperback at </span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><span face="Arial, sans-serif"> </span><a href="https://bit.ly/2DSWq92" style="font-family: Arial, sans-serif;">https://bit.ly/2DSWq92</a></span></div><div class="MsoNormal" style="line-height: 24px;"><br /></div><div class="MsoNormal" style="line-height: 24px;"><span>The Guide in<b> Romanian</b> is available as eBook (free) at </span><span class="MsoHyperlink"><span color="windowtext" face="Arial, sans-serif" style="font-size: 11pt; line-height: 15.6933px;"><a href="https://bit.ly/3nfGSgO" target="_blank">https://bit.ly/3nfGSgO</a></span></span> and paperback at <span class="MsoHyperlink"><span color="windowtext" face="Arial, sans-serif" style="font-size: 11pt; line-height: 15.6933px;"><a href="https://bit.ly/3a7kWAS" target="_blank">https://bit.ly/3a7kWAS</a> </span></span></div><div class="MsoNormal" style="line-height: 24px;"><br /></div><div class="MsoNormal" style="line-height: 24px;"><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><span><span face=""><span face="">The Guide in<b> Bosnian</b> is available as eBook (free) at </span></span></span><span face="Arial, sans-serif" style="line-height: 15.6933px;"><a href="https://bit.ly/2TzfKfG">https://bit.ly/2TzfKfG</a></span> and paperback at <a href="https://bit.ly/3p2Mf4e">https://bit.ly/3p2Mf4e</a> and </span><span style="font-family: inherit;"><span face="Arial, sans-serif"> </span></span><a href="https://publish.sweek.com/books/244071/" style="font-family: Arial, sans-serif;">https://publish.sweek.com/books/244071/</a><span style="font-family: inherit;"> </span></div></div><div class="MsoNormal" style="line-height: 24px;"><br /></div><div class="MsoNormal" style="line-height: 24px;"><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><span><span face=""><span face="">The Guide in<b> Turkish</b> is available as eBook (free) at </span></span></span><span style="line-height: 17.12px;"><a href="https://bit.ly/2RHYIeg">https://bit.ly/2RHYIeg</a></span> and paperback at </span></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><span face="Arial, sans-serif"> </span></span><span face="Arial, sans-serif"><a href="https://bit.ly/3cmgu0k" target="_blank"><span face="Calibri, sans-serif">https://bit.ly/3cmgu0k</span> </a></span></div><div class="MsoNormal" style="line-height: 24px;"><br /></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: inherit;"><span style="background-color: white;">The Guide in </span><b style="background-color: white;">Malaysian</b><span style="background-color: white;"> is included in The Laryngectomee Guide Malaysian Edition. It is available as </span><span style="background-color: white;">Paperback </span><a href="http://bit.ly/3n4fK3m" style="background-color: white; color: #6a6a6a; text-decoration-line: none;">http://bit.ly/3n4fK3m</a><span style="background-color: white;"> </span><span style="background-color: white;">, eBook </span><a href="http://bit.ly/2X29Rcu" style="background-color: white; color: #6a6a6a; text-decoration-line: none;">http://bit.ly/2X29Rcu</a> <span style="background-color: white;"> </span></span></div><div class="MsoNormal" style="line-height: 24px;"><br /></div></div></span></div><div class="MsoNormal" style="line-height: 24px;"><span face="">The Guide in <b>Japanese</b> is available as eBook (free) <a href="https://bit.ly/3j94Don">https://bit.ly/3j94Don </a> , and paperback at:<span style="font-family: arial;"> </span></span><a href="https://bit.ly/3jd85yf"><span style="font-family: inherit;">https://bit.ly/3jd85yf</span></a></div><div class="MsoNormal" style="line-height: 24px;"><span style="font-family: arial;"><span face=""> </span><span face=""> </span><span face=""> </span><span face=""> </span></span></div><div class="MsoNormal" style="line-height: 24px;"><span face="">The eBook is also available from the <a href="https://www.nikkouren.org/%E3%82%B5%E3%83%9D%E3%83%BC%E3%83%88/%E3%82%B5%E3%83%9D%E3%83%BC%E3%83%88%E6%83%85%E5%A0%B1/ ">Japanese Laryngectomee Association.</a></span></div><div class="MsoNormal" style="line-height: 24px;"><span face="" style="font-size: x-small;"><br /></span></div><div class="MsoNormal" style="line-height: 24px;"><span face="" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-x1JNY9R9WAo/Xs6DbUSTrbI/AAAAAAACo3M/pjyZndlw-5YnfwDNhGeBF303IoUcjq2AwCLcBGAsYHQ/s1600/COVID%2BGuide.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1006" height="320" src="https://1.bp.blogspot.com/-x1JNY9R9WAo/Xs6DbUSTrbI/AAAAAAACo3M/pjyZndlw-5YnfwDNhGeBF303IoUcjq2AwCLcBGAsYHQ/s320/COVID%2BGuide.jpg" width="201" /></a></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b>Guide in English</b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b><br /></b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b><br /></b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-5GNZ6o1NG4o/X1kwTAQ6gdI/AAAAAAACpFo/9hTQ7FttK-Y-cbsmbJxXCPCWLbp02-udwCLcBGAsYHQ/s497/frontSPanishCovid.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="497" data-original-width="384" height="320" src="https://1.bp.blogspot.com/-5GNZ6o1NG4o/X1kwTAQ6gdI/AAAAAAACpFo/9hTQ7FttK-Y-cbsmbJxXCPCWLbp02-udwCLcBGAsYHQ/s320/frontSPanishCovid.jpg" /></a></div><b>Guide in Spanish</b><br /><b><br /></b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b><br /></b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-0VHkfksIddk/X6mLcPuyIfI/AAAAAAACpNw/jHUJz4H1ggQnzGkAhj4fFwsqykSq5z3JwCLcBGAsYHQ/s543/cover.LaryGuiCOVId.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="543" data-original-width="384" height="320" src="https://1.bp.blogspot.com/-0VHkfksIddk/X6mLcPuyIfI/AAAAAAACpNw/jHUJz4H1ggQnzGkAhj4fFwsqykSq5z3JwCLcBGAsYHQ/s320/cover.LaryGuiCOVId.jpg" /></a></div><br /><b>Guide in Portuguese</b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b><br /></b></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b><br /></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-dAT8W7dNchU/X1qv8wInrcI/AAAAAAACpGI/XF3knyDI1aA-uPT6iSsviF4_OF3oNZzfACLcBGAsYHQ/s543/FrontPg.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="543" data-original-width="384" height="320" src="https://1.bp.blogspot.com/-dAT8W7dNchU/X1qv8wInrcI/AAAAAAACpGI/XF3knyDI1aA-uPT6iSsviF4_OF3oNZzfACLcBGAsYHQ/s320/FrontPg.jpg" /></a></div><b><div style="text-align: center;"><b>Guide in Italian </b></div></b><div class="MsoNormal" style="line-height: 24px; text-align: center;"><br /></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-CDQig164S2I/X2ZaiED3EiI/AAAAAAACpHk/jEcR3UF3g8wet1Ff4AMJpXZuknZy2t-vwCLcBGAsYHQ/s576/coverTurkishCovid.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="576" data-original-width="384" height="320" src="https://1.bp.blogspot.com/-CDQig164S2I/X2ZaiED3EiI/AAAAAAACpHk/jEcR3UF3g8wet1Ff4AMJpXZuknZy2t-vwCLcBGAsYHQ/s320/coverTurkishCovid.jpg" /></a></div><b><div style="text-align: center;"><b>Guide in Turkish </b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-yP7h_o4QpvE/X9Vw24L-sEI/AAAAAAACpQw/gVjiJW7uUdkmUsg-eq-i4CrfwerTlS2owCLcBGAsYHQ/s543/COVER%2BGuide%2BRomanian%2BCovid.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="543" data-original-width="384" height="320" src="https://1.bp.blogspot.com/-yP7h_o4QpvE/X9Vw24L-sEI/AAAAAAACpQw/gVjiJW7uUdkmUsg-eq-i4CrfwerTlS2owCLcBGAsYHQ/s320/COVER%2BGuide%2BRomanian%2BCovid.jpg" /></a></div><br /><b>Guide in Romanian</b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-DJ6iD3IUMIM/X5nWaaftEJI/AAAAAAACpMk/fttSKcuc9-oLun2YfBTMydKrsHKi9KG0ACLcBGAsYHQ/s2048/coverLaryGuiCOVID.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1448" height="320" src="https://1.bp.blogspot.com/-DJ6iD3IUMIM/X5nWaaftEJI/AAAAAAACpMk/fttSKcuc9-oLun2YfBTMydKrsHKi9KG0ACLcBGAsYHQ/s320/coverLaryGuiCOVID.jpg" /></a></div><br /><b><br /></b></div><div style="text-align: center;"><b>Guide in Bosnian</b></div><div style="text-align: center;"><b><br /></b></div></b><div class="MsoNormal" style="line-height: 24px; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-rVUg_JvReOQ/X0VXP4451UI/AAAAAAACpDM/kYBQh3UxJekD6CLSmeFriPifzARhjo-fgCLcBGAsYHQ/s543/CoronaFrontJapan.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="543" data-original-width="384" src="https://1.bp.blogspot.com/-rVUg_JvReOQ/X0VXP4451UI/AAAAAAACpDM/kYBQh3UxJekD6CLSmeFriPifzARhjo-fgCLcBGAsYHQ/s0/CoronaFrontJapan.jpg" /></a></div><div class="MsoNormal" style="line-height: 24px; text-align: center;"><b>Guide in Japanese</b></div><br /><div class="MsoNormal"><span class="MsoHyperlink">The Head and Neck Alliance offers links for Laryngectomee Guide and Laryngectomee Guide for COVID-19 pandemic.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span class="MsoHyperlink"><a href="https://www.headandneck.org/laryngectomee-guide/?fbclid=IwAR3FPqWb8j8yvrIhoVb4mspoWzT0kLMCV5ZAEGUmkQOpeN3TKyuIj9fHfHQ">Click this link </a>to obtain <i>The Laryngectomee Guide</i> in 20 languages/dialects: English, French, Russian, Italian, Chinese (traditional and simplified), Korean, Indonesian,Turkish, Arabic, Bulgarian, Romanian, Portuguese, Persian (Farsi), Tagalog, Bosnian, and Spanish (Central American, Andine, Spain, and South American version) and <i>Laryngectomee Guide for COVID-19 Pandemic</i>.<o:p></o:p></span></div><div class="MsoNormal"><span class="MsoHyperlink"><br /></span></div><div class="MsoNormal"><span class="MsoHyperlink">All eBooks are Free.</span></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-90172717595822316372020-08-05T12:02:00.001-07:002020-08-24T10:38:54.984-07:00How to avoid and cope with quarantine fatigue<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Months into the COVID-19 pandemic, the
effects of the disease and public safety precautions have been devastating —
mental health and addiction issues have risen, jobs have been lost and,
tragically, tens of thousands have lost their lives. Some have simply become
weary of the monotony and loneliness of staying at home. These lonely and
isolation can be more severe in laryngectomees and head and neck cancer
survivors who have communication difficulties.</span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">All of this has led to what experts are
calling <b>“COVID-19 quarantine fatigue</b>,” a modern-day version of what is
known as “<b>caution fatigue</b>.” This is a phenomenon when one’s body and
mind tire of the persistent sense of danger and the constant stress it is
causing, leading to becoming complacent or unable to make good decisions.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Arial, sans-serif;">With quarantine fatigue, one might grow
weary of — or actively ignore — the precautions that can slow the spread of
COVID-19. The sense of urgency in managing the global health emergency may fade,</span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">leading to impatient or tiredness of
complying with the health and safety guidelines.</span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">One may begin to feel hopeless, as if no
amount of measures can keep one safe from exposure. This can result in decreasing
the home sanitizing and forgetting to wear a face covering when going out. Some
may expand the number of people they spend time with in person or forego all
precautionary measures.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">There is an understandable eagerness to
‘go back to normal.’ Since the virus is invisible, <span style="mso-spacerun: yes;"> </span>it may seem that it does not really exist,
even though there is evidence it is still spreading. There is a genuine desire
to and interact and connect with others and deny or ignore the health risks
associated with the virus. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">It is important to resist quarantine
fatigue and remember that we are all in this together and it takes cooperation
from everyone in the community to decrease the spread of COVID-19. Yielding to
isolation fatigue can cause an increase in COVID-19 cases as well as repeated
lockdowns and further shuttering of businesses and schools. A rise in infection
rates, can overwhelm the health care system, and increased deaths in those who
are vulnerable.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Resisting quarantine fatigue is
especially important in older adults, people who have severe underlying medical
conditions and immunocompromised individuals who are at higher risk for
developing serious complications from COVID-19 illness.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Enclosed are recommendations how to avoid
quarantine fatigue and continue being diligent in the collective efforts to
keep our community healthy and reduce the number of COVID-19 infections:<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"></p><ul style="text-align: left;"><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Staying informed with trusted and
reliable resources, such as the Centers for Disease Control and Prevention
(CDC) website.</span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Avoiding constant exposure to news,
though it may be beneficial to check local news at occasional intervals to
learn pertinent details about COVID-19 in your community.</span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Taking care of oneself — eating a nutritionally
balanced diet, exercising, getting appropriate amounts of sleep, practicing
self-care, and taking care of one’s medical needs.</span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Staying connected with loved ones, friend
and support groups. </span></li><li><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Maintaining precautions to avoid catching
or spreading the disease.</span></li></ul><p></p>
<div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-AZbJ7JQ1pJQ/XysCLxmsp9I/AAAAAAACpAk/EcwpGZiceHImhP1jU53SFUA_QEe6_lZ0QCLcBGAsYHQ/s912/EWo1aDyXsAIWEgM.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="512" data-original-width="912" src="https://1.bp.blogspot.com/-AZbJ7JQ1pJQ/XysCLxmsp9I/AAAAAAACpAk/EcwpGZiceHImhP1jU53SFUA_QEe6_lZ0QCLcBGAsYHQ/s640/EWo1aDyXsAIWEgM.jpg" width="640" /></a></div><div style="text-align: center;"><br /></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-14401562122767652502020-07-31T05:36:00.000-07:002020-07-31T05:36:11.584-07:00Hydroxychloroquine and Coronavirus Disease 2019: A Systematic Review<p class="MsoNormal" style="line-height: 200%;"><span style="font-family: Arial, sans-serif;">Hydroxychloroquine (HCQ) emerged early in
the course of the coronavirus disease 2019 (COVID-19) pandemic as a possible
drug with potential therapeutic and prophylactic benefits. It was quickly
adopted in China, Europe, and the USA. A systematically review of the existing
clinical evidence of HCQ use for the prevention and treatment of COVID-19 was
performed by </span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;">Rakedzon and colleagues from
Rambam health Center, Haifa, Israel</span></p>
<p class="MsoNormal" style="line-height: 200%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The researcher all clinical studies
describing HCQ administration to treat or prevent COVID-19 in PubMed before
June 20, 2020. This included randomized controlled trials (RCTs), non-randomized
comparative cohorts, and case series studies that had all undergone peer
review. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 200%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">A total of 623 studies were screened; 17
studies evaluating HCQ treatment were included. A total of 13 were
observational studies, and 4 were RCTs. In terms of effect on mortality rates,
observational studies provided conflicting results. As a whole, RCTs, including
one large British RCT that has not yet been published, showed no significant
effect of HCQ on mortality rates, clinical cure, and virologic response. The
use of HCQ as a post-exposure prophylactic agent was found to be ineffective in
one RCT. The authors concluded that there is no evidence supporting HCQ for
prophylaxis or treatment of COVID-19. Many observational trials were
methodologically flawed. Scientific efforts have been disappointingly
fragmented, and well-conducted trials have only recently been completed, more
than 7 months and 600,000 deaths into the pandemic.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 200%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-yTCFkwmpe3g/XyQQF1SVBcI/AAAAAAACo-w/_OAg1S_3CCkC_Jek57u3YmpyKg_qnQkGgCLcBGAsYHQ/s1028/060320_ts_hydroxy_feat-1028x579.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="579" data-original-width="1028" src="https://1.bp.blogspot.com/-yTCFkwmpe3g/XyQQF1SVBcI/AAAAAAACo-w/_OAg1S_3CCkC_Jek57u3YmpyKg_qnQkGgCLcBGAsYHQ/s640/060320_ts_hydroxy_feat-1028x579.jpg" width="640" /></a></div><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p><p class="MsoNormal" style="line-height: 200%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><br />Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-90490842727704526672020-06-28T08:03:00.001-07:002020-06-28T08:03:10.141-07:00List of Open Clinical Trials for Patients with COVID-19 in the USA VA and Department of Defense facilities.<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">There is an urgent need to find effective
treatment or a vaccine for COVID-19. Worldwide there are over 1,800 trials addressing
COVID-19-related health care. There are 10 trials developed by the US
Department of Veterans Affairs (VA), US Department of Defense, and the
National Institute of Allergy and Infectious Diseases have provided important
data on effective treatment options. The clinical trials listed below are all
open as of May 31, 2020. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Adaptive COVID-19 Treatment Trial (ACTT)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This study is an adaptive, randomized,
double-blind, placebo-controlled trial to evaluate the safety and efficacy of
novel therapeutic agents in hospitalized adults diagnosed with COVID-19. The
study will compare different investigational therapeutic agents to a control
arm. ID: NCT04280705<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Study to Evaluate the Safety and
Antiviral Activity of Remdesivir (GS-5734) in Participants with Severe
Coronavirus Disease (COVID-19)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The primary objective of this study is to
evaluate the efficacy of 2 remdesivir (RDV) regimens with respect to clinical
status assessed by a 7-point ordinal scale on Day 11 (NCT04292730) or Day 14
(NCT04292899).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Expanded Access Remdesivir (RDV; GS-5734)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The treatment of communicable Novel
Coronavirus of 2019 with Remdesivir (RDV; GS-5734) also known as severe acute
respiratory syndrome coronavirus 2.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">A Study to Evaluate the Safety and Efficacy
of Tocilizumab in Patients With Severe COVID-19 Pneumonia (COVACTA)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This study will evaluate the efficacy,
safety, pharmacodynamics, and pharmacokinetics of tocilizumab <span style="mso-spacerun: yes;"> </span>compared with a matching placebo in combination
with standard of care in hospitalized patients with severe COVID-19 pneumonia.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Administration of Intravenous Vitamin C
in Novel Coronavirus Infection (COVID-19) and Decreased Oxygenation (AVoCaDO)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The study evaluates if Vit C is safe and
tolerable in COVID-19 subjects given early or late in the disease course and may
reduce the risk of respiratory failure requiring mechanical ventilation and
development of ARDS along with reductions in supplemental oxygen demand and
inflammatory markers.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Treatment Of CORONAVIRUS DISEASE 2019
(COVID-19) With Anti-Sars-CoV-2 Convalescent Plasma (ASCoV2CP)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This is an expanded access open-label,
single-arm, multi-site protocol to provide convalescent plasma as a treatment
for patients diagnosed with severe, or life-threatening COVID-19.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">A Study to Evaluate the Safety and
Efficacy of MSTT1041A (Astegolimab) or UTTR1147A in Patients With Severe
COVID-19 Pneumonia (COVASTIL)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This is a Phase II, randomized,
double-blind, placebo-controlled, multicenter study to assess the efficacy and
safety of MSTT1041A (astegolimab) or UTTR1147A in combination with standard of
care (SOC) compared with matching placebo in combination with SOC in patients
hospitalized with severe coronavirus disease 2019 pneumonia.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Adaptive COVID-19 Treatment Trial 2
(ACTT-II)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">ACTT-II will evaluate the combination of
baricitinib and remdesivir compared to remdesivir alone. Subjects will be
assessed daily while hospitalized. If the subjects are discharged from the
hospital, they will have 3 home visits. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><a href="https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/issues/articles/0620fed_pp_clin_trials.pdf">Click to get more information </a><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
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<a href="https://1.bp.blogspot.com/-QQvPJB0EoMg/XvixIu61OAI/AAAAAAACo6w/EILSM8mEEys2x5x5SVwIDzKDFxvfeIWAACLcBGAsYHQ/s1600/clinical%2Btrials.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="263" data-original-width="400" height="210" src="https://1.bp.blogspot.com/-QQvPJB0EoMg/XvixIu61OAI/AAAAAAACo6w/EILSM8mEEys2x5x5SVwIDzKDFxvfeIWAACLcBGAsYHQ/s320/clinical%2Btrials.png" width="320" /></a></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-85991822000846884602020-06-14T12:57:00.002-07:002020-06-14T13:10:57.912-07:00Dr. Brook's interview about becoming a laryngectomee, and coping with COVID-19 <div dir="ltr" style="text-align: left;" trbidi="on">
<br />
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Dr. Itzhak Brook is a physician and
laryngectomee. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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<span style="font-family: "arial" , sans-serif;">In the interview </span><span style="font-family: "arial" , "helvetica" , sans-serif;">made <span style="background-color: white; color: #1c1e21;">for the International Association of Laryngectomees 69th Annual Meeting - Voice Institute 60th meeting on June 13, 2020,</span> </span><span style="font-family: "arial" , sans-serif;">he describes how he
dealt with throat cancer, and became a laryngectomee. He also discusses how
laryngectomees can protect themselves from COVID-19 virus and deal with the
challenges of caring for their airways during this period.</span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-63549963812622821732020-06-14T12:57:00.001-07:002020-06-14T12:57:46.477-07:00<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal" style="line-height: 24px;">
<span style="font-family: Arial, sans-serif;">Dr. Itzhak Brook is a physician and laryngectomee.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 24px;">
<span style="font-family: Arial, sans-serif;"><br /></span></div>
<span style="font-family: Arial, sans-serif;">In the interview </span><span style="font-family: Arial, Helvetica, sans-serif;">made <span style="background-color: white; color: #1c1e21;">for the International Association of Laryngectomees 69th Annual Meeting - Voice Institute 60th meeting on June 13, 2020,</span> </span><span style="font-family: Arial, sans-serif;">he describes how he dealt with throat cancer, and became a laryngectomee. He also discusses how laryngectomees can protect themselves from COVID-19 virus and deal with the challenges of caring for their airways during this period.</span><br />
<span style="font-family: Arial, sans-serif;"><br /></span>
<span style="font-family: Arial, sans-serif;"><br /></span>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-84391335941288442102020-06-08T11:06:00.002-07:002020-06-08T11:06:54.862-07:00Treatments for COVID-19 What helps, what doesn't, and what's in the pipeline for COVID-19<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Most who become ill with COVID-19 will be
able to recover at home. No specific treatments for COVID-19 exist right now.
But some of the same things you do to feel better if you have the flu — getting
enough rest, staying well hydrated, and taking medications to relieve fever and
aches and pains — also help with COVID-19. <o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Scientists are working hard to develop
effective treatments. Therapies that are under investigation include drugs that
have been used to treat malaria and autoimmune diseases; antiviral drugs that
were developed for other viruses, and antibodies from people who have recovered
from COVID-19.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Enclosed is an update about the current
treatments and potential ones for COVID-19 <a href="https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19">prepared by Harvard Medical School. </a><o:p></o:p></span></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-61275305742368903122020-06-05T12:03:00.002-07:002020-06-09T13:15:56.000-07:00Signs and symptoms of COVID-19 infection<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">COVID-19 affects different people in
different ways. Infected people have had a wide range of symptoms reported –
from mild symptoms to severe illness.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Symptoms may appear 2-14 days after
exposure to the virus. The CDC recommends that people with these symptoms may
have COVID-19:<o:p></o:p></span></div>
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<li><span style="line-height: 107%;"><span style="font: 7pt "Times New Roman";"> </span><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></span></span><!--[endif]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span dir="LTR"></span><span style="line-height: 107%;">Fever or chills<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Cough<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Shortness of breath or difficulty breathing<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Fatigue<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Muscle or body aches<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Headache<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">New loss of taste or smell<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Sore throat<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Congestion or runny nose<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Nausea or vomiting</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span><span dir="LTR" style="text-indent: -0.25in;"></span><span style="line-height: 107%; text-indent: -0.25in;">Diarrhea</span></span></li>
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<span style="line-height: 107%;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Look for emergency warning signs for
COVID-19. If someone is showing any of these signs, seek emergency medical care
immediately<o:p></o:p></span></span></div>
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<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Trouble breathing<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Persistent pain or pressure in the chest<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">New confusion<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Inability to wake or stay awake<o:p></o:p></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 107%;"><span style="mso-list: Ignore;"><span style="font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span dir="LTR"></span><span style="line-height: 107%;">Bluish lips or face<o:p></o:p></span></span></li>
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<span style="line-height: 107%;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Call your medical provider for any
other symptoms that are severe or concerning to you.<o:p></o:p></span></span><br />
<span style="line-height: 107%;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span>
<span style="line-height: 107%;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">It is helpful to have a plan in place in
case one becomes sick. Identifying a caregiver and staying in touch with
family, friends, neighbors, and healthcare professionals during the pandemic
through email or phone, especially if some lives alone is important. If one is aware
of an exposure or are experiencing symptoms such as a sore throat, dry cough,
fever, and/or shortness of breath, seek medical help as soon as possible. Trying
to contact one’s care team over the phone before coming into a medical center
can facilitate their care.<o:p></o:p></span></div>
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<a href="https://1.bp.blogspot.com/-e-L1i7XON8k/XtqVqPw8U4I/AAAAAAACo4k/TMoTRhgi9agy0JT2Nz0T5F4z0GU86FcfwCLcBGAsYHQ/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="153" data-original-width="328" height="149" src="https://1.bp.blogspot.com/-e-L1i7XON8k/XtqVqPw8U4I/AAAAAAACo4k/TMoTRhgi9agy0JT2Nz0T5F4z0GU86FcfwCLcBGAsYHQ/s320/images.jpg" width="320" /></a></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-76858734417685025062020-06-01T10:10:00.000-07:002020-06-01T10:10:12.958-07:00COVID-19 May Be a Blood Vessel Disease. Learn more about this<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial, sans-serif;">Many of the infection’s bizarre symptoms
have one thing in common. This article is by <o:p></o:p></span><span style="font-family: Arial, sans-serif; font-size: 11pt;"><a href="https://elemental.medium.com/coronavirus-may-be-a-blood-vessel-disease-which-explains-everything-2c4032481ab2">Dana G Smith. </a></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 11pt;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Months into the pandemic, there is now a
growing body of evidence to support the theory that the novel corona virus can
infect blood vessels, which could explain not only the high prevalence of blood
clots, strokes, and heart attacks, but also provide an answer for the diverse
set of head-to-toe symptoms that have emerged. <o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">In a paper published in April in the
scientific journal The Lancet,<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255293/pdf/main.pdf"> Mehra and a team</a> of scientists discovered that
the SARS-CoV-2 virus can infect the endothelial cells that line the inside of
blood vessels. Endothelial cells protect the cardiovascular system, and they
release proteins that influence everything from blood clotting to the immune
response. In the paper, the scientists showed damage to endothelial cells in
the lungs, heart, kidneys, liver, and intestines in people with COVID-19. <o:p></o:p></span></div>
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<span style="line-height: 107%;"><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://elemental.medium.com/coronavirus-may-be-a-blood-vessel-disease-which-explains-everything-2c4032481ab2">Click to read the whole article. </a></span></span></div>
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<a href="https://1.bp.blogspot.com/-ofmcoqzWXmQ/XtU1XjqznCI/AAAAAAACo3o/a-AJNyfqEd08BpYsYI-sC1g26UUtHL6VgCLcBGAsYHQ/s1600/1_J0sbPDMUn3fUlbZl-qyuvg.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="933" data-original-width="1400" height="213" src="https://1.bp.blogspot.com/-ofmcoqzWXmQ/XtU1XjqznCI/AAAAAAACo3o/a-AJNyfqEd08BpYsYI-sC1g26UUtHL6VgCLcBGAsYHQ/s320/1_J0sbPDMUn3fUlbZl-qyuvg.jpeg" width="320" /></a></div>
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<span style="line-height: 107%;">COVID-19 virus and blood cells</span></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-54085505453132740742020-05-28T09:27:00.000-07:002020-05-28T09:33:36.479-07:00DIAGNOSTIC TESTS FOR CORONA VIRUS INFECTION<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The pandemic of coronavirus disease 2019
(COVID-19) continues to affect much of the world. Knowledge of diagnostic tests
for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still
evolving, and a clear understanding of the nature of the tests and
interpretation of their findings is important. <span style="font-family: Arial, Helvetica, sans-serif;">An <a href="https://jamanetwork.com/journals/jama/fullarticle/2765837">article by Sethuraman et al. </a></span><span style="font-family: Arial, sans-serif;">describes how to interpret 2 types of diagnostic tests commonly in use for SARS-CoV-2 infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time.</span>describes how to
interpret 2 types of diagnostic tests commonly in use for SARS-CoV-2
infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and
IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over
time. </span></div>
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<a href="https://1.bp.blogspot.com/-P_-8uwoO1d4/Xs_mIC4cgKI/AAAAAAACo3Y/d4zVGM7QPG4vqbuNWRWsbnQ_or1M23kegCPcBGAYYCw/s1600/https___s3-ap-northeast-1.amazonaws.com_psh-ex-ftnikkei-3937bb4_images_4_7_8_8_24718874-2-eng-GB_Cropped-1580421113RTS300FZ.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="179" src="https://1.bp.blogspot.com/-P_-8uwoO1d4/Xs_mIC4cgKI/AAAAAAACo3Y/d4zVGM7QPG4vqbuNWRWsbnQ_or1M23kegCPcBGAYYCw/s320/https___s3-ap-northeast-1.amazonaws.com_psh-ex-ftnikkei-3937bb4_images_4_7_8_8_24718874-2-eng-GB_Cropped-1580421113RTS300FZ.jpg" width="320" /></a></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-57793859190379332222020-05-27T08:15:00.000-07:002020-05-27T08:34:52.490-07:00Publication of the "Laryngectomee Guide for COVID-19 Pandemic"<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: "arial" , sans-serif;">The "Laryngectomee Guide for COVID-19 pandemic” is available.</span><br />
<br style="font-family: arial, sans-serif;" />
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<span style="font-family: "arial" , sans-serif;">It provides information about preventing infection, dealing with voice prosthesis leak, social isolation, psychological issues, and hospitalization.</span></div>
<br />
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<span style="font-family: "arial" , sans-serif;">It is available as eBook (free) </span><a href="https://bit.ly/2AY41RO" style="font-family: Arial, sans-serif;">https://bit.ly/2AY41RO</a><span style="font-family: "arial" , sans-serif;"> </span><span style="font-family: "arial" , sans-serif;">, and paperback </span><span style="font-family: "arial" , sans-serif;">at: </span><a href="https://bit.ly/3glrlJf" style="font-family: Arial, sans-serif;">https://bit.ly/3glrlJf</a><span style="font-family: "arial" , sans-serif;"> </span></div>
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<a href="https://1.bp.blogspot.com/-x1JNY9R9WAo/Xs6DbUSTrbI/AAAAAAACo3M/pjyZndlw-5YnfwDNhGeBF303IoUcjq2AwCLcBGAsYHQ/s1600/COVID%2BGuide.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1006" height="320" src="https://1.bp.blogspot.com/-x1JNY9R9WAo/Xs6DbUSTrbI/AAAAAAACo3M/pjyZndlw-5YnfwDNhGeBF303IoUcjq2AwCLcBGAsYHQ/s320/COVID%2BGuide.jpg" width="201" /></a><br />
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<br />
<br />
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<span class="MsoHyperlink"><span style="font-family: "arial" , sans-serif; text-decoration: none;">The Head and Neck Alliance offers links for
Laryngectomees Guide and Laryngectomee Guide for COVID-19 pandemic.<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="MsoHyperlink"><span style="font-family: "arial" , sans-serif; text-decoration: none;"><a href="https://www.headandneck.org/laryngectomee-guide/?fbclid=IwAR3FPqWb8j8yvrIhoVb4mspoWzT0kLMCV5ZAEGUmkQOpeN3TKyuIj9fHfHQ">Click this link </a>to obtain <i>The Laryngectomee Guide</i> in 19
languages/dialects: English, French, Russian, Italian, Chinese (traditional and
simplified), Korean, Turkish, Arabic, Bulgarian, Romanian, Portuguese, Persian
(Farsi), Tagalog, Bosnian, and Spanish (Central American, Andine, Spain, and
South American version) and <i>Laryngectomee Guide for COVID-19 Pandemic</i>.<o:p></o:p></span></span></div>
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<span class="MsoHyperlink"><span style="font-family: "arial" , sans-serif; text-decoration: none;"><br /></span></span></div>
<div class="MsoNormal" style="text-align: left;">
<span class="MsoHyperlink"><span style="font-family: "arial" , sans-serif; text-decoration: none;">All eBooks are Free. <o:p></o:p></span></span></div>
<br /></div>
</div>
Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-81606287775297636462020-05-16T15:31:00.000-07:002020-05-19T09:15:08.894-07:00Dr. Brook's video: Copping with the COVID -19 as a laryngectomee<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen="" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/rPu6FoyV1d0/0.jpg" frameborder="0" height="266" src="https://www.youtube.com/embed/rPu6FoyV1d0?feature=player_embedded" width="320"></iframe></div>
<br />
<div style="text-align: center;">
<b>Click to watch the 16 minutes video about how laryngectomees can protect themselves from getting infected with COVID-19, feal with voice prosthesis leakage, and cope with medical , social and psychological issuses during the pandemic. </b></div>
</div>
Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-2834709885486259775.post-85377406273747692192020-05-08T13:29:00.002-07:002020-05-21T06:39:54.538-07:00 in Spanish: Laringectomía y Total y el nuevo virus corona: Sugerencias para la protección.<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="line-height: 24px;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span>
<br />
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Laringectomía y Total y el nuevo virus
corona: Sugerencias para la protección.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">30 de marzo de 2020. Dr. Itzhak Brook.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Sugerencias sobre cómo los pacientes con
cáncer de cabeza y cuello (incluidos los que respiran el cuello) pueden
protegerse de la nueva infección por coronavirus (COVID -19).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Los pacientes con cáncer de cabeza y
cuello (CCC) y los respiradores de cuello (incluidos las laringectomías) pueden
tener un mayor riesgo de sufrir una infección grave por COVID-19. El riesgo de
enfermedad grave es especialmente alto en aquellos que actualmente reciben o
han recibido recientemente quimioterapia o terapia inmunosupresora.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Es prudente que los pacientes con CCC y
los respiradores de cuello sigan las instrucciones del gobierno y las
autoridades de salud locales y eviten la exposición al virus siguiendo las
indicaciones de aislamiento estrictamente.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Los respiradores de cuello son
susceptibles a las infecciones del tracto respiratorio inferior porque el virus
puede ingresar a su tracto respiratorio directamente a través del estoma del
cuello. Los virus respiratorios también pueden acceder al cuerpo a través de la
boca, la nariz y la conjuntiva. Por lo tanto, es imperativo que tales
individuos ejerzan un cuidado especial para evitar infectarse.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">COVID-19 puede causar una infección grave
en personas con vías respiratorias comprometidas. Las vías respiratorias de los
laringectomas pueden verse comprometidas porque su tráquea y bronquios a menudo
están secos e irritados crónicamente, y su capacidad pulmonar puede verse
reducida debido al colapso parcial de sus lóbulos inferiores (atelectasia).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Las medidas que pueden reducir el riesgo
de infección incluyen:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Limpieza frecuente de manos:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Lavarse las manos con frecuencia con
jabón y agua caliente durante al menos 20 segundos, especialmente después de
estar en un lugar público, o después de limpiarse el estoma del cuello, sonarse
la nariz, toser o estornudar.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Si no hay agua y jabón disponibles, use
un desinfectante para manos que contenga al menos 60% de alcohol.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Evitar tocarse los ojos, la nariz, la
boca y el estoma con las manos sin lavar.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Evitar el contacto cercano:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Evitar el contacto cercano con personas
enfermas.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Poner distancia entre uno mismo y otras
personas. Esto es especialmente importante para las personas que corren un
mayor riesgo de enfermarse gravemente.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Tomar medidas para proteger a los demás:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Quedarse en casa cuando está enfermo,
excepto para recibir atención médica.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Cubrirse cuando tosa y estornude<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Cubrirse la boca, la nariz o el estoma
con un pañuelo al toser o estornudar o al usar el interior del codo.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Tirar pañuelos usados a la basura.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Lavarse las manos inmediatamente (ver
arriba)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Usar una mascarilla cuando está enfermo<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Limpieza y desinfección:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Limpieza y desinfección de superficies
frecuentemente tocadas.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Evite tocar superficies que no estén
limpias.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Lávese las manos inmediatamente después
de tocar una superficie que no estaba limpia.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Los laringectomizados pueden protegerse
tomando estos pasos adicionales:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Usar un intercambiador de calor y
humedad (HME) 24/7 si pueden. Un HME proporciona humidificación del aire inhalado
y cierto nivel de filtración (mecánica) dependiendo del tamaño de la partícula
en relación con el tamaño de poro del material HME y la tapa sólida evita el
contacto directo entre el dedo y el estoma (es decir, Provox XtraMoist y Provox
XtraFlow de Atos Medical). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Las HME con alta eficiencia de filtración
funcionarían mejor para reducir el riesgo de inhalar el virus (es decir, Provox
Micron de Atos Medical). Provox Micron es un HME que tiene un filtro
electrostático integrado que proporciona una eficiencia de filtración de>
99% para bacterias y virus y su cubierta evita el contacto directo de los dedos
con el estoma. El filtro electrostático proporciona filtración
independientemente de la dirección del flujo de aire, por lo que usarlo también
protege a otras personas de infectarse cuando el laringectoma está infectado.
(ver foto 1)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Usar un HME de manos libres, que no
requiere tocarse al hablar, en quienes usan el habla traqueoesofágica con una
prótesis de voz. Aquellos que usan un HME regular deben lavarse las manos antes
de tocar su HME.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Usar una mascarilla (preferiblemente
N95) sobre el estoma (ver fotos 2-4). Se puede modificar una máscara facial con
cuatro cuerdas para que se ajuste sobre el estoma. Una de las cadenas se puede
extender con una cadena adicional; y el par inferior de cuerdas se puede atar
detrás de la espalda.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">• Usar mascarilla sobre la nariz y la
boca, y anteojos protectores. Esto puede evitar que el virus ingrese al cuerpo
a través de estos sitios.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Si se usa correctamente, una máscara
facial puede ayudar a bloquear las gotas de partículas grandes, salpicaduras,
aerosoles o salpicaduras que pueden contener gérmenes (virus y bacterias). Las
mascarillas también pueden ayudar a reducir la exposición de las secreciones
respiratorias del usuario a otras personas.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Los pacientes con CCC (incluidos los
laringectomas) deben consultar a sus médicos acerca de los pasos adicionales a
seguir.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Para protegerse. Las personas deben
comunicarse con sus médicos ante cualquier signo de infección respiratoria.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Finalmente, aunque todas estas medidas
pueden ser útiles para proteger a los pacientes con CCC y los respiradores de
cuello Infección por COVID-19, no son necesariamente infalibles y ciertamente
no se garantiza que eviten la adquisición una infección.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Itzhak Brook MD<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Departamento de Enfermedades Infecciosas<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Profesor de Pediatría y Medicina.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Facultad de medicina de la Universidad de
Georgetown<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Washington DC<o:p></o:p></span></div>
<span style="line-height: 24px;"><span style="font-family: "arial" , "helvetica" , sans-serif;">
</span></span><br />
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "arial" , sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Estados Unidos<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
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<span style="line-height: 24px;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Suggestions in Spanish: <a href="https://drive.google.com/file/d/1FSwknY1X0eV77edP0lHuf6jtLXkpKllQ/view?usp=sharing">Laringectomía y Total y el nuevo virus corona:</a> Sugerencias para la protección.</span></span><br />
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<a href="https://1.bp.blogspot.com/-AVG0zmn76gc/XrrMwV_9NuI/AAAAAAACoBQ/QUGwBHYhZasOHulnUrUC_aniUh1rSMVuACLcBGAsYHQ/s1600/Micron.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://1.bp.blogspot.com/-AVG0zmn76gc/XrrMwV_9NuI/AAAAAAACoBQ/QUGwBHYhZasOHulnUrUC_aniUh1rSMVuACLcBGAsYHQ/s320/Micron.JPG" width="320" /></a></div>
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<b>Foto 1 </b></div>
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<a href="https://1.bp.blogspot.com/-bhzSrJVPvrM/XrrMWqjmVOI/AAAAAAACoBE/Wx1jVnC0d3QvA_0tnpT2_z97Y82Ei7MiACEwYBhgLKs0DAL1OcqxlJsZ9BgKR1Dg4GnDMyXa3AX5RGB5W2r5bJHlX-gpf3EC7Ttp3s48zLc7B2aFfLgMsAgZAIdyQqqbwsR2JFEsk-Hs4P_EFXI595LBz2P_A2bz2jx2RqCM5456Yevjy2fYOs2oAjJ7p48o9gp2ftiShEPZ6WnmywXnd9G92JfBiltsdIQPxMmwTW4wML7Hc8beOXzNaKGdQ8jnvnXBYsqDGn79VH5kwmOXFcbWghYafnvcZWBbQqcl-HrWqq1shzMJLW28wkp6jEWd6YVj4RHY-K1k-H9n73Pxxp8BoojYqW6NU0uS4fFp9IxdhYt0xM2TfC-T45lU053vvv45ubKjyZUikHjuZ-yqFFnyBxaKmREpZaik0157BMLETrx4rP7pSDGuSxSx-gMAml5VaVMu7HJHVSKa5zn6tzOQOfgmjIj63ViEsL1UX-KS_gkcmMN26vXrZM7DW88grt_9E6XCY3SGNQG7vR_0BMZp28eJuhRdvWq6Hb6_LAwK4vZfLZrcMh5lW4kJaeCGFG0mU-1BOP9zLJm77w_lgkENnzyWqE1ypKdZf1AZ8ZPSHfKx9M1wsDdEs2Z4-RX4MmzHEKGmP1ku2X2SMY6AwwZ7r9QU/s1600/IMG_7383.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" height="320" src="https://1.bp.blogspot.com/-bhzSrJVPvrM/XrrMWqjmVOI/AAAAAAACoBE/Wx1jVnC0d3QvA_0tnpT2_z97Y82Ei7MiACEwYBhgLKs0DAL1OcqxlJsZ9BgKR1Dg4GnDMyXa3AX5RGB5W2r5bJHlX-gpf3EC7Ttp3s48zLc7B2aFfLgMsAgZAIdyQqqbwsR2JFEsk-Hs4P_EFXI595LBz2P_A2bz2jx2RqCM5456Yevjy2fYOs2oAjJ7p48o9gp2ftiShEPZ6WnmywXnd9G92JfBiltsdIQPxMmwTW4wML7Hc8beOXzNaKGdQ8jnvnXBYsqDGn79VH5kwmOXFcbWghYafnvcZWBbQqcl-HrWqq1shzMJLW28wkp6jEWd6YVj4RHY-K1k-H9n73Pxxp8BoojYqW6NU0uS4fFp9IxdhYt0xM2TfC-T45lU053vvv45ubKjyZUikHjuZ-yqFFnyBxaKmREpZaik0157BMLETrx4rP7pSDGuSxSx-gMAml5VaVMu7HJHVSKa5zn6tzOQOfgmjIj63ViEsL1UX-KS_gkcmMN26vXrZM7DW88grt_9E6XCY3SGNQG7vR_0BMZp28eJuhRdvWq6Hb6_LAwK4vZfLZrcMh5lW4kJaeCGFG0mU-1BOP9zLJm77w_lgkENnzyWqE1ypKdZf1AZ8ZPSHfKx9M1wsDdEs2Z4-RX4MmzHEKGmP1ku2X2SMY6AwwZ7r9QU/s320/IMG_7383.JPG" width="240" /></a></div>
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<b>Foto 2</b></div>
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<a href="https://1.bp.blogspot.com/-3XoDzVFx-us/XrrMbNzjmrI/AAAAAAACoBM/oOQR5rHztuc8C8WD-Z2t2baL6wV1FgbMwCEwYBhgLKs0DAL1Ocqw8nr_WN7JpkJP9VxZGiN0sTtTOrsYf9QTFCJH0JO-ShOShwsw11obq3XAdaUg51E4rm_sWWscsJOLp70o2j9GXwqwZhBTKCb3X8tr9NSo4ZVau4Qix266_tvybeVIYi6GJBbRmBRtKWBJVu0k4VeMgL4T09LUgzKNSY53c8pNJbkD-AJ1UJE6yj3Gp63YgzU7RxQpJ3aFXO-FaD3JlNYiaVGTYmbmjd-RURX53Fj2VCZKIvjwjMlBgv3yVYdq6w3iA8u8yDPAUP_XkW6vva8wARBoFh3JnmIKEBAmEpqTwvMBALJLcGe0UtnVVAHfFlNhCzStfinZpPdCguIIp0dcH5w9GN2FXyujSsG9LPpBcwCsynGUYaawWnZ1wV2gug9_ZbCFlzQK5YwrFP6wb-uAJB4domatmuPjFO4S-_JnRyH9qt7gnkUQ1KYiISASgbnYeiYwrCMZbo2SqbQMl1XMLUNzoz6R2JJ6Z4X_RnqoCa25RG4DKLclDdyZX_MX6V0H_4ggAZMdMcpZk62Mad1cawC9gd7ajsLCPAm8zXycp-4_MeIJQb_aXzUhcrO2MexnxtJBrekq7O653rg3RWOGEq9ONjMsrfzQw2J7r9QU/s1600/IMG_7385.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="910" data-original-width="1212" height="240" src="https://1.bp.blogspot.com/-3XoDzVFx-us/XrrMbNzjmrI/AAAAAAACoBM/oOQR5rHztuc8C8WD-Z2t2baL6wV1FgbMwCEwYBhgLKs0DAL1Ocqw8nr_WN7JpkJP9VxZGiN0sTtTOrsYf9QTFCJH0JO-ShOShwsw11obq3XAdaUg51E4rm_sWWscsJOLp70o2j9GXwqwZhBTKCb3X8tr9NSo4ZVau4Qix266_tvybeVIYi6GJBbRmBRtKWBJVu0k4VeMgL4T09LUgzKNSY53c8pNJbkD-AJ1UJE6yj3Gp63YgzU7RxQpJ3aFXO-FaD3JlNYiaVGTYmbmjd-RURX53Fj2VCZKIvjwjMlBgv3yVYdq6w3iA8u8yDPAUP_XkW6vva8wARBoFh3JnmIKEBAmEpqTwvMBALJLcGe0UtnVVAHfFlNhCzStfinZpPdCguIIp0dcH5w9GN2FXyujSsG9LPpBcwCsynGUYaawWnZ1wV2gug9_ZbCFlzQK5YwrFP6wb-uAJB4domatmuPjFO4S-_JnRyH9qt7gnkUQ1KYiISASgbnYeiYwrCMZbo2SqbQMl1XMLUNzoz6R2JJ6Z4X_RnqoCa25RG4DKLclDdyZX_MX6V0H_4ggAZMdMcpZk62Mad1cawC9gd7ajsLCPAm8zXycp-4_MeIJQb_aXzUhcrO2MexnxtJBrekq7O653rg3RWOGEq9ONjMsrfzQw2J7r9QU/s320/IMG_7385.jpg" width="320" /></a></div>
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<b>Foto 3</b></div>
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<a href="https://1.bp.blogspot.com/-mrPLN5V_RJ8/XrrMbS2MLzI/AAAAAAACoBI/FpMHdApff-gJNMzl1FrR3s8i7_Oi6GBoACEwYBhgLKs0DAL1OcqwMNiWr3zLG3jfiWV_GrDE0Vq0SlRWpd4MD9J1fOlrY2G-59sSjvw68DgwiGMIcV7ZVEFm_CgIy64VaGwmWFx7rjbPBb-pZkAADljci2lI9zlWM75pZRm5o6c6T_UrMgv8MEdlwftVIC9Z6ElIpJ2rm-jdurzgXbqCenH6W0MuBWWNKJvSejVLPzIpi6fOUGQM5muVaFey4SYALSpGLn50I4slyQJeQcJVIEDvpA7keUhQRl7PGx_pDcf4LZfszXfMAgeAgAh2fE1UL2ygvlaSP7Z4GaMt7hUwxyldIqvLeL2W70kCkfxn3jTVo9D2SvH3R4V4wOYVSi9mo5DYUPKt6YVI6fPEE75Kgn2Q3pNKmDzQ2LRZn5Rccg03kWTwErYmkTTbOorOSvKaRbksI086A6qhYUw3AVjMnIWUnrqlVO2QC3RaZ_XE9q5O8xQ8uHBnDfEniB7F9Fv5rnGoV7scPwma9mN4SBxznhAQq7tMYkDPeUNoLCmjKSBukkDIdKTJxZYjzdjckwPBlQthnzjoxZz2O6A8JJMkq9PxD56RjlnOjFgXEqoWQQ4U7-a1I5NJGHHcYJGS-0Y626duh3EMxnht6XkcQqa8w7p7r9QU/s1600/IMG_7390.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="1112" height="320" src="https://1.bp.blogspot.com/-mrPLN5V_RJ8/XrrMbS2MLzI/AAAAAAACoBI/FpMHdApff-gJNMzl1FrR3s8i7_Oi6GBoACEwYBhgLKs0DAL1OcqwMNiWr3zLG3jfiWV_GrDE0Vq0SlRWpd4MD9J1fOlrY2G-59sSjvw68DgwiGMIcV7ZVEFm_CgIy64VaGwmWFx7rjbPBb-pZkAADljci2lI9zlWM75pZRm5o6c6T_UrMgv8MEdlwftVIC9Z6ElIpJ2rm-jdurzgXbqCenH6W0MuBWWNKJvSejVLPzIpi6fOUGQM5muVaFey4SYALSpGLn50I4slyQJeQcJVIEDvpA7keUhQRl7PGx_pDcf4LZfszXfMAgeAgAh2fE1UL2ygvlaSP7Z4GaMt7hUwxyldIqvLeL2W70kCkfxn3jTVo9D2SvH3R4V4wOYVSi9mo5DYUPKt6YVI6fPEE75Kgn2Q3pNKmDzQ2LRZn5Rccg03kWTwErYmkTTbOorOSvKaRbksI086A6qhYUw3AVjMnIWUnrqlVO2QC3RaZ_XE9q5O8xQ8uHBnDfEniB7F9Fv5rnGoV7scPwma9mN4SBxznhAQq7tMYkDPeUNoLCmjKSBukkDIdKTJxZYjzdjckwPBlQthnzjoxZz2O6A8JJMkq9PxD56RjlnOjFgXEqoWQQ4U7-a1I5NJGHHcYJGS-0Y626duh3EMxnht6XkcQqa8w7p7r9QU/s320/IMG_7390.jpg" width="278" /></a></div>
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<b>Foto 4</b></div>
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Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0