What you need to know
- Functional neurological disorder (FND) is associated with considerable distress and disability. The symptoms are not faked
- Diagnose FND positively on the basis of typical clinical features. It is not a diagnosis of exclusion
- FND can be diagnosed and treated in presence of comorbid, pathophysiologically defined disease
- Psychological stressors are important risk factors but are neither necessary nor sufficient for the diagnosis
Functional disorders are conditions whose origin arises primarily from a disorder of nervous system functioning rather than clearly identifiable pathophysiological disease—such as irritable bowel syndrome, fibromyalgia, and functional neurological disorder (FND)—they are the second commonest reason for new neurology consultations.1 FND is common in emergency settings,2 stroke,3 and rehabilitation services.4 It causes considerable physical disability and distress, and often places an economic burden both on patients and health services.5 Many clinicians have had little formal clinical education on the assessment and management of these disorders, and patients are often not offered potentially effective treatments.
A reactivation of the chickenpox virus in the body, causing a painful rash. Anyone who’s had chickenpox may develop shingles. It isn’t known what reactivates the virus.Shingles causes a painful rash that may appear as a stripe of blisters on the trunk of the body. Pain can persist even after the rash is gone (this is called postherpetic neuralgia).Treatments include pain relief and antiviral medications such as acyclovir or valacyclovir. A chickenpox vaccine in childhood or a shingles vaccine as an adult can minimize the risk of developing shingles.
Chloroquine was shown in 2004 to be active in vitro against SARS coronavirus but is of unproven efficacy and safety in patients infected with SARS-CoV-2. The drug’s potential benefits and risks for COVID-19 patients, without and with azithromycin, is discussed by Dr. David Juurlink, head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto.
From Wall Street Journal article:
Our experience suggests that hydroxychloroquine, with or without a Z-Pak, should be a first-line treatment. Unfortunately, there is already a shortage of hydroxychloroquine. The federal government should immediately contract with generic manufacturers to ramp up production. Any stockpiles should be released.
As a matter of clinical practice, hydroxychloroquine should be given early to patients who test positive, and perhaps if Covid-19 is presumed—in the case of ill household contacts, for instance. It may be especially useful to treat mild cases and young patients, which would significantly decrease viral transmission and, as they say, “flatten the curve.”
From an MIT Technology Review article (March 11, 2020):
Here are six differences between coronavirus and the flu:
- Coronavirus appears to spread more slowly than the flu. This is probably the biggest difference between the two. The flu has a shorter incubation period (the time it takes for an infected person to show symptoms) and a shorter serial interval (or the time between successive cases). Coronavirus’s serial interval is around five to six days, while flu’s gap between cases is more like three days, the WHO says. So flu still spreads more quickly.
- Shedding: Viral shedding is what happens when a virus has infected a host, has reproduced, and is now being released into the environment. It is what makes a patient infectious. Some people start shedding the coronavirus within two days of contracting it, and before they show symptoms, although this probably isn’t the main way it is spreading, the WHO says.
- Secondary infections. As if contracting coronavirus wasn’t bad enough, it leads to about two more secondary infections on average. The flu can sometimes cause a secondary infection, usually pneumonia, but it’s rare for a flu patient to get two infections after the flu. The WHO warned that context is key (someone who contracts coronavirus might already have been fighting another condition, for example).
- Don’t blame snotty kids—adults are passing coronavirus around. While kids are the primary culprits for flu transmission, this coronavirus seems to be passed between adults. That also means adults are getting hit hardest—especially those who are older and have underlying medical conditions. Experts are baffled as to why kids seem protected from the worst effects of the coronavirus, according to the Washington Post. Some say they might already have some immunity from other versions of the coronavirus that appear in the common cold; another theory is that kids’ immune systems are always on high alert and might simply be faster than adults’ in battling Covid-19.
- Coronavirus is far deadlier than the flu. Thus far, the mortality rate for coronavirus (the number of reported cases divided by the number of deaths) is around 3% to 4%, although it’s likely to be lower because many cases have not yet been reported. The flu’s rate is 0.1%.
- There is no cure or vaccine for the coronavirus. Not yet, anyway, although work is under way. There is, however, a flu vaccine—and everyone should get it, not least because being vaccinated could help lessen the load on overstretched medical services in the coming weeks.
From a Harvard Gazette online article (March 10, 2020):
There’s a symptom review, there’s a travel review, and there’s an exposure review. And if the answer to any of those questions is yes, then you’re asked to not come in. And so far people have been compliant and have left. So that is a good thing.
If you have a cough and a fever, if you’ve got respiratory symptoms and you’re short of breath, if you’ve traveled to a place of concern or if you may have been exposed to someone who did — especially if you’re symptomatic — then I would definitely ask, “Do I really need to visit my grandma today? Can I wait and can I Skype her? Can I do FaceTime?”
I know that’s hard for some of our older adults who aren’t technologically savvy, but maybe now is the time to get them hooked up. It really would be heartbreaking if, in wanting to do something positive for someone’s emotional or mental health, you ended up infecting them.
Harvard-affiliated Hebrew SeniorLife offers a continuum of care for 3,000 elderly people daily, with a range of services including residential assisted living, short-term rehabilitation, outpatient services, and long-term care for those with chronic illness. In a Q&A interview aimed at understanding the challenges involved, Harvard Medical School Assistant Professor Helen Chen, Hebrew SeniorLife’s chief medical officer, discussed steps the facility has taken to combat the virus and the outlook going forward.
The emergent corona virus (SARS-CoV-2) outbreak in China is fast changing, just this week reported cases of the disease covid-19 jumped as new data became available. In this video Wendy Burns, and Peter Openshaw from Imperial College London explain what we know about the basic structure of the virus, it’s mode of transmission, the symptoms and pathogenesis of the diease, what we currently know about treatment, and how the virus may adapt in the future.
To read more about corona virus, all The BMJ’s resources are being made freely available at https://www.bmj.com/coronavirus