Author: Centrum Pharmacy

On October 13th, 2023, the Ministry of Health issued a guidance document.  The Ministry have updated the EO Notice to include information regarding the newly approved Pfizer and Moderna XXB.1.5 vaccines.

Effective October 13th, 2023, the Ministry is recommending that: 

All individuals eligible to receive a COVID-19 vaccine this fall should be offered the Moderna or Pfizer COVID-19 XBB formulations. 

Individuals who have previously been vaccinated, meaning they have completed their primary vaccination series and are now eligible for a booster dose, may be offered the Moderna or Pfizer XBB vaccine if it has been at least 6 months since their last COVID-19 vaccine dose or since their last COVID-19 infection. A minimum interval of 3 months since the patient’s last COVID-19 vaccine dose or COVID-19 infection may also be considered based on the judgment of pharmacy professionals and specific patient factors. 

The XBB formulation is the preferred product for individuals who have not been previously vaccinated against COVID-19.

The new XBB formulations will be made available to the general public beginning on October 30th, 2023.

Thyroid hormone medications, thyroxine and L-thyroxine, rank among the most frequently prescribed drugs. However, not every elevated thyroid-stimulating hormone (TSH) value requires immediate therapy. TSH values can fluctuate and should be interpreted cautiously. Here’s a concise breakdown:

1. Check Again:

A slightly elevated TSH value may not warrant treatment. Reassess TSH levels 2-6 months later, especially if the patient shows no symptoms. 50%-60% of cases see TSH values normalize without treatment.

2. Reasons for Elevated TSH:

TSH levels fluctuate with the time of day and year, sleep patterns, and age. Sex and obesity can also influence TSH values. Biotin supplements, commonly used for hair and nail health, can affect TSH measurements.

3. Avoid Hasty Prescriptions:

Not every high TSH value signifies hypothyroidism. Patients with thyroid nodules due to iodine deficiency may be overprescribed thyroid hormones. Iodine supplementation, not thyroid hormones alone, is recommended for iodine-deficient individuals.

4. When to Consider Treatment:

Treatment is warranted in young patients with TSH values > 10 mU/L. Young symptomatic patients with TSH values between 4 and < 10 mU/L may require treatment. Treatment is necessary after thyroid surgery, radioactive iodine therapy, or in cases of a diffuse enlarged or severely nodular thyroid gland. Pregnant women with elevated TSH values should also be treated.

Standard TSH determination may not be sensible; instead, clinicians should investigate patients with symptoms and conduct comprehensive thyroid function assessments. Autoimmune-related hypothyroidism (Hashimoto thyroiditis) is a common cause of high TSH levels. In summary, not all elevated TSH values require immediate action, and careful evaluation is key to determining the appropriate course of treatment.

A recent study has shed light on the connection between exercise and cancer prevention, specifically in individuals with Lynch syndrome, a genetic condition associated with a heightened risk of early-onset cancer. Researchers at the University of Texas MD Anderson Cancer Center discovered that engaging in intense exercise for just forty-five minutes, three times a week, can significantly reduce the risk of cancer in these patients.

The study’s findings revealed that this level of exercise had a profound impact on the immune system’s ability to combat cancer cells. All twenty-one participants in the study had Lynch syndrome and were divided into two groups: one received a 12-month exercise program, while the other did not. Researchers closely monitored their cardio and respiratory fitness levels and tracked immune cells, including natural killer cells and CD8+ T cells, in both their blood and colon tissues.

These immune cells play a crucial role in targeting foreign entities, such as cancer cells, and the exercise group exhibited heightened activity in these cells. Additionally, individuals in the exercise group experienced a decrease in the levels of the inflammatory marker prostaglandin E2 (PGE2), which was closely associated with the increased activity of immune cells. Both of these changes suggest a more robust immune response. Scientists believe these changes are linked to an enhanced “immune surveillance” system in the body, which helps detect and eliminate cells that could otherwise become cancerous.

Scientific evidence has long supported the idea that regular exercise can contribute to cancer prevention. A comprehensive systematic review conducted in 2019, comprising over 45 studies and several million people, provided strong evidence that exercise can reduce the risk of various cancers, including bladder, breast, colorectal, and gastric cancers, by as much as 20%.

According to the American Cancer Society, lifestyle factors, such as physical inactivity, excessive body weight, alcohol consumption, and poor nutrition, contribute to over 15% of cancer-related deaths in the United States (excluding tobacco-related cancers). To mitigate cancer risk, the society recommends 150 to 300 minutes of moderate-intensity exercise per week. Remarkably, the study participants experienced a significant immune response with just 135 minutes of high intensity exercise each week.

Unfortunately, we do get less flexible as we get older. Clinicians even have a test called ‘Sit to Stand’ (measuring the ability to stand up from a chair), widely used to examine physical function and screen older people at risk of falls and frailty.

There are lots of reasons why standing up gets harder as we age. It’s thought that our tendons get tighter around joints and the cartilage between our joints deteriorates. There is also a general deterioration in ligaments and a reduction in fluid within the joint (synovial fluid) along with tightening of muscles surrounding the joint.

Our muscle mass also reduces as we get older, especially muscles such as the quadriceps (around the front of your thighs), which are needed to help us stand up from a chair.

But the good news is that these changes may be slowed down. Regular physical activity is thought to slow down the deterioration in our flexibility, along with the other benefits it has for bone density, cardiovascular health and our mental health.

Studies have shown that people who are physically active can achieve a greater range of motion than sedentary individuals, even in older age. It is recommended that older adults should do activities that improve strength, balance and flexibility at least twice a week, as well at least 150 minutes of moderate-intensity activity a week (or 75 minutes of vigorous-intensity activity if you’re already active).

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The reason statins can make your muscles sore or weak was unclear—until scientists accidentally stumbled upon an answer.

Statins, one of the most extensively studied drugs on the planet, taken by tens of millions of Americans alone, have long had a perplexing side effect. Many patients—some 5 percent in clinical trials, and up to 30 percent in observational studies—experience sore and achy muscles, especially in the upper arms and legs. A much smaller proportion, less than 1 percent, develop muscle weakness or myopathy severe enough that they find it hard to climb stairs, get up from a sofa, get up from the toilet.

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