admin COVID-19 17

New Antigen test for Covid-19

This test has just become available in Spain and has several advantages

  1. Rapid: It is as fast as the rapid antibody test, and faster than the PCR test. The results are ready from about 20 minutes of taking the sample.
  2. Early detection: it can detect Covid-19 as early as 2 day after contact with an infected person, or as soon as symptoms appear until 5 days after symptoms start.
  3. Cheaper than the PCR test. It costs 50 (55€ on weekends/out of hours) euros.
  4. Accurate: Sensitivity is 80-94% and Specificity is >97%  (this satisfies the requirements for intenational travel certification).
  5. It is taken by a nose or throat swab.

Disadvantages

  1. The result becomes negative as the infection clears (after 5 days from the start of symptoms). This may be useful to indicate that a patient is no longer infectious, but it cannot indicate a previous infection (antibody tests are better for this). 

So, which test to have?

      1. To detect a previous infection the ELISA antibody test is the most accurate. A cheaper, faster, but less reliable alternative is the rapid antibody test.
      2. When a PCR test is required for travel or employment, or when cost and rapidity is not an issue the PCR is recommended. At present this is the most accurate method for diagnosing a current active infection
      3. When cost and speed are important the Antigen test is recommended. For example a child may be sent home from school, or an employee sent home from work with possible Covid-19 symptoms, or you have had contact with somebody who tested positive. This test can give a positive or negative result within minutes, allowing that person to either isolate or get back to school/work quickly.

Book a test

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admin COVID-19 7

How to interpret your Covid 19 antibody results

For Rapid antibody tests and ELISA tests the interpretation is the same.

The ELISA test is considered more reliable and also gives a quantitative figure of the amount of antibody (as opposed to a simple positive/negative result with the Rapid test).

There are 4 possible results:

  1. IgM negative, IgG negative.
    1. There is no evidence of current infection or previous infection.
    2. Remember that it takes a minimum of 4 days from the start of symptoms, or 7 days from exposure to the virus before the antibodies show up positive. This means that the antibody test cannot detect an infection in the initial stages.
    3. If there is a suspicion of recent infection in spite of this result a PCR or Antigen test can be done, or repeat the antibody test after a few days.
  1. IgM positive, IgG negative:
    1. This suggests infection in the early stages of the disease.
    2. The patient is infectious
    3. If the result does not coincide with the clinical picture (for example, if there are no symptoms) it could be a false positive. The result can be confirmed with a PCR test or, if the test was a Rapid antibody test, by doing an ELISA test, which is more reliable and uses a different method.
  1. IgM positive, IgG positive:
    1. This suggests infection in the intermediate stage of the disease.
    2. The patient is considered no longer infectious.
  1. IgM negative, IgG positive
    1. There is recovery from the disease and the patient is not infectious
    2. There may be some immunity to Covid-19, although it is not known yet to what extent and how long that immunity may last. Precautions should still be taken.

Book a test

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admin COVID-19 45

Covid-19 testing: which, when and why?

There are now 4 types of Covid-19 tests available at Atlantic Clinic: 

  1. PCR  ultra-fast
  2. Antigen test
  3. Rapid antibody tests for IgM and IgG
  4. ELISA antibody tests for IgM and IgG 

Confused?  Here’s what they mean:

 

1. PCR (polymerase chain reaction): 85€ 

This detects the presence of genetic material from the coronavirus.

How?  Swabs (like a long cotton bud) collect mucous from the back of the throat and nose.

Time for result: from 4 hours

When? The test shows positive early in the disease (within a day or so after symptoms begin).

Why? 

  1. To diagnose the illness in the early stages of the infection, or;
  2. For travel when a negative result is a requirement.

Limitations: 

a. After recovery the PCR may no longer be detectable so it is not so useful to diagnose a previous infection.

b. The PCR may persist for some time even after recovery because of residual genetic material leading to confusion over whether a patient is still contagious.

c. The test may be falsely negative if the sample is not taken correctly, or if the virus is not present in that part of the body (it may be only in the lungs, for example).

Book a test

 

2. Antigen test: 45€

45€ on weekends/out of hours

This detects the presence of the virus in an active infection.

How? A swab collects mucous from the back of the nose.

Time: about 20 minutes.

When? The test shows positive as soon as symptoms start or at least 2 days after contact until 5 days after the symptoms start.

Why?

  1. To diagnose the illness in the early stages of the infection or;
  2. For travel when a negative Antigen test is required

Limitations

The result becomes negative as the infection clears (after about 5 days from the start of symptoms). This may be useful to indicate that a patient is no longer infectious, but it cannot indicate a previous infection (antibody tests are better for this).

Book a test

 

 

 

 3. Rapid antibody tests: 60€ 

This detects the presence of antibodies (the body’s defense against the virus) which are produced in response to the infection.

How? The sample is either a drop of blood from a finger prick or a blood sample taken from the vein. 

Time for the result: At Atlantic Clinic the result is ready the same day.

When? Antibodies take at least 7 days from infection or 4 days from the start of symptoms to show up. The IgM antibodies are seen first as the disease progresses. After recovery, the IgM disappears and IgG persists.

Why? 

  1. It is the quickest and cheapest test.
  2. It is most useful for those who have had no symptoms, or symptoms some time ago, (a minimum of 4 days) and would like to know if:
  •  You have had the disease in the past and have recovered, or;
  • You are currently infected and what stage of infectivity or recovery you are in.

Limitations

Not useful for diagnosis in the early stages of the disease (PCR is better). The test only gives a positive/negative result. Generally the ELISA test is preferred (see below).

Book a test

 

 

 

3. ELISA antibody test (enzyme-linked immunosorbent assay) 95€.

This also detects antibodies but uses more sophisticated techniques and needs skilled technicians. It is more accurate than the rapid test.

How?  A blood sample is taken from the vein. 

Time for result: At Atlantic Clinic the result are ready the same day.

When? As with the rapid test, the antibodies take at least 7 days from infection or 4 days from the start of symptoms to show up. 

Why? It is a more reliable test that the rapid antibody test. It gives a figure showing the amount of IgM and IgG (rather than a simple positive/negative result) which can indicate the degree of immunity. It can used to confirm a rapid antibody test result that is in doubt.

Limitations

  1. It is more expensive than the rapid antibody test and takes longer to get the results.
  2. Not useful for diagnosis in the early stages of the disease (PCR is better).

Book a test

 

 

How accurate are they?

The manufacturers quoted accuracy rates for the methods used at Atlantic Clinic are:

PCR:

Specificity and sensitivity 99.999%

Antigen test:

Specificity 100%, sensitivity: 85%, (this satisfies the requirements for international travel certification)

Rapid antibody test:

– IgM specificity 96% and sensitivity 85%

– IgG specificity 98% and sensitivity 93%

ELISA: 

– IgM specificity 97.5% and Sensitivity 82%

– IgG specificity 97.3% and sensitivity 91.2%

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admin COVID-19 8

How accurate is the Covid-19 rapid antibody test?

The antibody testing at Atlantic Clinic is currently using the Acro Biotech kit.

The American supplier quotes an accuracy rate for the 2 types of antibodies: 

IgM: 92.9% IgG: 98.6%*

However, there are some uncertainties at the moment:

  1. These figures are based on current information. New data is coming in all the time and may refine them.
  1. The usefulness of the test depends to a certain extent on the proportion of people within a given population that has the virus, which is at present unknown. No one knows how many people may have been infected but show no symptoms.
  1. Antibodies take at least 7 days after infection (or after 4 days of symptoms) to show up on the test, so it is not useful in the very early stages of an infection. In these circumstances, where active Covid-19 is suspected, the PCR test is better, which in Spain is normally done in hospitals.

Antibody testing is used to identify those who have been infected for at least 7 days, or have recovered from a previous illness (either with symptoms, or a “silent infection” which went unnoticed). 

*For the technically minded, accuracy is a function of:

Relative specificity IgM 96%

Relative sensitivity IgM 85%

Relative specificity IgG 98%

Relative sensitivity IgG 100%

 

 

Dr. Anthony Crichton-Smith- GP

 

 

 

 

admin COVID-19 4

Everybody is talking about it… But what can we really do to protect ourselves from the coronavirus?

We know that this virus will not stop on its own and to date we also have no vaccine to immunize the population against the coronavirus. We can only count on the measures taken by the authorities to put an end to this epidemic and help, on our scale, to prevent infected people from transmitting the virus to those around them.

This means that the same measures should be followed as with any respiratory virus (cold, flu, etc.) but, this time, with a little more application and dedication:

– Avoid shaking hands or kissing everyone to say hello: of course, it is difficult to implement at first, but … this will avoid many infections!

– Wash your hands regularly and thoroughly.

– Cough in the hollow of your elbow or, better yet, in a tissue (which you will throw before washing your hands).

– Avoid as much as possible closed public places (shopping centers) and ventilate your home regularly if someone is sick.

– Avoid visiting fragile people (the elderly, young children, asthma sufferers, etc.) if you are sick: this will prevent contagion and put you in a delicate situation for your health.  

If your initial cold worsens in an unusual way (no clinical improvement after a few days, persistence of fever for more than 3 days, respiratory distress….): Consult your doctor without delay. Ideally, move with a paper mask to avoid infecting more people until the diagnosis is confirmed (flu or other).

Bérénice Ibarra Ottino

admin Uncategorized, Uncategorized, Vaccines 5

Why should we be vaccinating children against HPV?

Four out of five people will get HPV at some time in their lives and yet most of them do not even know they are infected!

We know that most (not all) HPV infections go away on their own, with no health complications that persist. However, we don’t know which of those infections will turn into cancer. Therefore, the best way to prevent HPV infection and the potential cancers it can cause is to get vaccinated. With the vaccine, we can reduce the risk of six different types of cancer:

  • Cervical, vaginal and vulvar cancer in women
  • Penile cancer in men
  • Throat cancers in men and women
  • Anus cancer in men and women
  • Genital warts in men and women
  • At what age should we get vaccinated?

It is recommended to administer the HPV vaccine before children are exposed to the virus, that is, before having sex. The vaccination age is usually at 11 or 12 years of age, but you can start getting vaccinated as soon as at 9 years old. It is ideal that the vaccination schedule be completed by reaching 13 years of age since at that young age the body develops more protection against HPV than in the last years of adolescence and the first years after having completed 20 years of age.

What is the HPV vaccination schedule?

If the first dose is given before the age of 15: only two separate injections / doses of 6 to 12 months will be needed

In contrast, children who receive the first injection of the vaccine series at age 15 or older, and those with weakened immune systems will need three injections of the HPV vaccine. The three injections will be administered according to the following schedule: the 2nd dose 2 months after the first and the 3rd dose between 6 and 12 months after the 1st dose.

What side effects may appear?

The most common side effects of the vaccine are mild, and are the same as those that may occur after the administration of other vaccines: fever, headache, as well as pain and redness in the arm where the injection was given.

Children and adolescents who are allergic to yeast or who are allergic to any other component of the vaccine that causes anaphylaxis should not receive the HPV vaccine.

Will my insurance cover the costs of vaccination?

Most medical insurance covers the cost of the HPV vaccine series but depends on each company, so it is best to contact your insurer directly.

Without financing, the public sale price of each dose of Gardasil 9 is 175 euros

 

Bérénice Ibarra Ottino

admin Uncategorized, Uncategorized, Vaccines 1

The Flu: All you need to know

The flu is a contagious respiratory disease. Caused by a virus, it is transmitted very easily through the air (coughing and sneezing), hands or through contaminated objects. To prevent its spread we must take some basic hygiene measures (hand washing, sneezing into the inner elbow or in a handkerchief, airing the house regularly, …).

There are several types of influenza viruses

As stated by the World Health Organization (WHO), there are four types of seasonal influenza virus: A, B, C and D.

– Types A and B are the cause of seasonal epidemics, hence they are included in vaccines.

-C viruses are detected less frequently and also cause only minor infections.

– Type D viruses do not affect humans, only cattle.

 

Is it necessary to get vaccinated every year?

The flu virus has a high mutation capacity and the types of flu viruses that circulate are changing from year to year. Thus, our defenses cannot recognize and protect us, which can cause disease again every new winter season.

For this reason, every year  a different vaccine is made, adapted to the changes that the virus has experienced and to those strains that are circulating. WHO, after studying the reports of epidemiological surveillance centers spread throughout the world, decides each year what will be the composition of vaccines to protect us in the most effective way.

 

What vaccines to choose?

In Spain, both trivalent influenza vaccines and tetravalent vaccines and only injectable preparations are available.

The difference between the trivalent flu vaccine and the tetravalent vaccine lies in the number of influenza virus strains included in it.

-The trivalent vaccine contains three strains every year: two of type A and one of type B.

-The tetravalent vaccine includes four: two of type A and two of type B, of which one is of the B / Victoria lineage and another of the B / Yamagata.

To an extent it is difficult to know in advance which lineage the B strains circulating during the season will belong to, but the tetravalent vaccine allows to increase the level of protection. In addition, tetravalent vaccines have shown in studies to be as safe as trivalent vaccines. This means that they can be used, both one and the other, in the same situations.

 

What vaccine is recommended to use?

Given the level of scientific evidence available, the AEP Vaccine Advisory Committee advises, preferably and whenever available, tetravalent influenza vaccines. Of course, if you do not have access to it, the recommendation is to administer trivalent vaccines.

 

Who should get vaccinated?

Children from 6 months to 4 years (59 months);
People 50 years of age and older (because they are more likely to suffer from chronic conditions that put them at high risk of presenting a serious case of influenza disease).
People with chronic lung diseases (such as asthma), heart disease (except hypertension), kidney, liver, hematological, neurological or metabolic disorders (including diabetes mellitus);
People immunosuppressed for any cause (including immunosuppression caused by medications or the human immunodeficiency virus);
Women who are pregnant or will be during the flu season and women who gave birth until two weeks ago;
Persons 6 months to 18 years of age who receive medications containing aspirin or salicylates and who are at risk of having Reye’s syndrome after influenza virus infection;
Residents of nursing homes and other chronic care facilities;
Native Americans / Alaska Natives
people with morbid obesity (body mass index [BMI] of 40 or higher);
health care staff;
People in contact with low mobility people at home and caregivers of children under 5 and adults over 50. Special emphasis on people who are in contact with children under 6 months or with people with certain medical conditions that put them at increased risk of serious complications from influenza.

 

 Special consideration about egg allergy

People allergic to eggs can receive any approved influenza vaccine recommended and according to their age (IIV, RIV4 or LAIV4). People with a clinical history of severe egg allergy (those who have had other symptoms besides hives after being exposed to eggs) should receive the influenza vaccine in a medical setting and under the supervision of a health care provider who is able to recognize and manage severe allergic reactions.

Bérénice Ibarra Ottino

admin Respiratory health 11

Stop Smoking Program

Better Breathing for Life offers a unique evidenced based STOP SMOKING programme

“Smokers are 5 times more likely to quit for good with dedicated support compared to will power alone” 


We offer you a bespoke STOP SMOKING NOW programme in the Marbella area.  This unique programme utilises the beneficial effects of a natural herbal product made from the seeds of the “Golden Rain Tree” (Cytisus Laburnum).

This plant based product has been recognised as the closest substance to nicotine and is called Cytisine. In the brain it acts just like nicotine and stimulates the release of pleasure chemicals such as dopamine, which means that withdrawal symptoms from nicotine are greatly reduced. However, it has NONE of the side effects of smoking.

When combined with a stop smoking behaviour change programme, smokers who use Cytisine (taken as a small tablet), are more likely to stop smoking completely at 4 weeks than those who use patches (nicotine replacement therapy). Even after 6 months Cytisine is more effective than   patches and when compared to a dummy tablet or “will power” Cytisine doubles your chance of success.

For best results Cytisine should be taken as part of a stop smoking programme, incorporating education, action planning and behaviour change techniques.

Rachel Garrod Ph.D is a trained smoking cessation counsellor and respiratory specialist.

This comprehensive stop smoking programme consisting of;

  • Assessment of blood pressure and lung function measures.
  • Provision of herbal tablets (Cytisine) proven to reduce the urge to smoke and aid long term quitting
  • 3 specialised coaching sessions to help you stop smoking including hypnotherapy focused on facilitating sub-conscious activity to enable long term cessation of smoking

Comprehensive programme €350 per person

 

Please contact the clinic if interested.

admin Respiratory health 1

Quit smoking – with a little help from the Golden Rain Tree. 

Do you want to stop smoking? Like many of us you´ve probably tried numerous treatments such as patches, gum, acupuncture, hypnosis, etc – but – you´re still hooked. There are so many reasons not to smoke. Yet it´s one of the hardest addictions to give up.  And living here in Marbella doesn´t make it any easier!

But now there is another treatment that is generating interest among the scientific world. From the seeds of the “Golden Rain Tree” (Cytisus Laburnum) there is a product that has been in use for over fifty years in Eastern Europe and during the Second World War Russian soldiers even called it “false tobacco”.

In the West, until recently, this treatment was largely unknown as no proper testing or trials had been done. This plant based product has been recognised as the closest substance to nicotine and is called Cytisine. In the brain it acts just like nicotine and stimulates the release of pleasure chemicals such as dopamine, which means that withdrawal symptoms from nicotine are significantly reduced.

A large study, published in the highly respected medical journal, New England Journal of Medicine, has shown some exciting results. Cytisine (taken as a small tablet) in combination with what´s known as behavioural support was compared to nicotine replacement therapy, in this case patches. After a month more smokers had stopped completely on cytisine compared to patches (40 % versus 31%) and after 6 months and the cytisine group still showed clear benefit compared to patches. In other studies cytisine has been shown to double your chances of quitting compared with placebo (dummy tablet).

For best results cytisine should be taken as part of a behaviour change programme, incorporating education, peer support and behaviour change techniques. So if you want to stop smoking this year, why not take a helping hand from nature ?

Rachel Garrod PhD

admin Respiratory health 6

I have a lung disease – Am I able to fly?

Flying, particularly long haul can be a considerable worry for people with respiratory problems. Whilst mobility issues can be dealt with fairly easily through pre-ordering of a cart and/or wheelchair at the airport, the question of oxygen requirements during a flight can be trickier to address.

Normally we breathe 21% oxygen from the air, however this decreases at higher altitudes. In an aeroplane the air is pressurised to ensure we have enough oxygen, but at higher altitudes (> 8000 feet) the amount of oxygen falls to around 15%. Whilst for most people this is still sufficient to breathe comfortably, those with an underlying respiratory disease such as Chronic Obstructive Pulmonary Disease or Fibrosis, may find they require additional oxygen. If you already use oxygen you will of course need it when flying. But if you manage well without oxygen on the ground it can be harder to know how your body will respond in the air.

Here at Atlantic Clinic we provide a reliable and accurate method of assessing your oxygen needs during a flight. We simply ask you to perform a timed walking test (usually 6 minutes) whilst monitoring heart rate and oxygen levels with a non-invasive clip called a pulse oximeter. The level of desaturation (or fall in blood oxygen) will tell the physiotherapist whether oxygen should be worn or not.

The person wanting to fly will then be provided with a Fitness to Fly certificate and instructions on how to obtain oxygen for the flight, if indeed it turns out they need it.

 

Dr Rachel Garrod

PhD MSc MCSP

Consultant Physiotherapist

rachelgarrod1@gmail.com

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