Archive2020

#MSCOVID19 – natalizumab extended interval dosing

More questions around managing MS during the COVID-19 pandemic; this time in relation to natalizumab (Tysabri) dosing. The COVID-19 NHS crisis is a double-whammy for pwMS. First, it is redeploying staff away from MS services to work on the frontline. Secondly, the message has gone out to stop pwMS coming to NHS hospitals, or even connecting with other healthcare facilities such as GP practices...

COVID Breakfast… Lymphopenia the Bog roll effect.

Some people with MS drugs have low levels of white blood cells. This is causing some alarm that you can’t fight infection. I am sure we you can appreciate that is Immunology 101. Something can’t fight something if it is not there. If we look at people who get covid 19. Those who get severe problems have low white blood cells in their blood. This has been repeated in a number of...

The Great Debate at the Neurology Academy

The ABN guidelines are suggesting that most high efficacy DMTs are treated the same. The MS Academy hosted a debate on 31 March 2020 to discuss whether ocrelizumab and cladribine should be treated in the same way as alemtuzumab in terms of risk of #COVID19. Alemtuzumab = cladribine = ocrelizumab If you have an hour on your hands the debate between ProfK and ProfB is here. COI: Multiple Apologises...

It’s T time

Its T time. If you want to learn about Th17, which some people imply are important for autoimmunity. I suppose the thing lacking was discussion of why inhibition of IL-17 (Th17 cytokine) and IL12/23 (producers of TH1 cytokines

Transcriptional Regulators of T Helper 17 Cell Differentiation in Health and Autoimmune Diseases. Capone A, Volpe E. Front Immunol. 2020 Mar 12;11:348.

#MSCOVID19. Am I lucky to be on a DMT?

I think the current view is that the COVID19 disease is a disease of two stages. Stage I. Viral removal by the innate immune system notably the monocyte/macrophage and also perhaps CD8 T cells abit later. These cells are working to get rid of the virus, whilst the virus is trying to evade this immune attack. The balance of this determines what may happen next. It seems that for most people the...

Speedy recovery

We hope the MD1 (Mouse Doctor 1) makes a speedy recovery. He is unfortunately in self-isolation with a high fever and dry cough. He and his wife have both contracted COVID-19. Ware Village Speakeasy, Hertfordshire, linked to spread of COVID-19. Public Health England epidemiologists have tracked down a large cluster of COVID-19 cases to an illegal speakeasy in the Hertfordshire village of Ware...

COVID Breakfast-Transmission

Yesterday in there comments there was a discussion about transmission of COVID 19 but droplets. So today on April First here is another other route of potential transmission. Ths is via a; A stool The ACE2 receptor used by SARS-CoV-2 virus to infect the lung also occurs in the intestine. So not only can it come out of your lungs, but out of the other end too (click). SARS-CoV-2 enters...

COVID19 reality bites

Hats off to our Italian colleagues – I can only imagine what each day has brought into your lives. Last weekend, I held the notorious position as the last Consultant Neurologist on-call for Barts Health, one of the largest NHS Trusts England with 1,255 A&E patient attendances per day. Monday onward, every able bodied member of staff has been redeployed to a major incident rota, the...

COVID Keep your distance after some one near your recovers

At the moment you are being told to hiberate for 7-14 days with suspected issues, but this work is just to warm you that people may have virus for a few days after they seem to be recovering, so maintain your social distancing. People shed virus for a variable amount of time. I haven’t got time to do a full post. Obviously this data was from moderately ill people and people with milder...

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