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www.grid.news/story/science/2022/08/12/beyond-paxlovid-fo...
Beyond Paxlovid for covid-19: Scientists are scrambling to make better covid antiviral medications
Here’s what the next generation of drugs might look like.
Antiviral drugs like remdesivir, molnupiravir and Paxlovid have undoubtedly saved lives and reduced the suffering wrought by covid-19 since they began rolling out in fall of 2020.
But they’re far from perfect, as President Joe Biden’s recent experience shows. After treatment with Paxlovid, his covid infection rebounded, though his symptoms were mild.
With the pandemic showing no signs of slowing, the hunt for the next generation of covid treatments is speeding up. Pfizer and Merck — the makers of Paxlovid and molnupiravir, respectively — already have potential drug candidates that work better, or are easier to take, in their development pipelines. And many smaller biotech companies are also entering the race. They include Enanta Pharmaceuticals, which earlier this month reported a successful Phase I clinical trial of its experimental covid drug. Meanwhile, the Biden administration said in June that it planned to spend more than $3 billion to accelerate the search for better covid antiviral drugs.
“I think the technical word to describe [the current covid] drugs would be suboptimal,” said Luis Schang, a virologist at Cornell University. The drugs, all of which stem from antivirals developed before SARS-CoV-2 existed, have been a first good stab at beating back the virus in the body, he said, “but they all have limitations.”
But in the history of antiviral drugs, less-than-perfect initial stabs are the norm, experts said, drawing parallels with efforts to develop effective treatments for conditions like HIV and hepatitis C.
“The first drug that we used against HIV, to be quite honest, was miserable,” Schang said. AZT, first approved in 1987, caused serious side effects, and its effectiveness wore off quickly — sometimes in just days — as the virus evolved resistance. It took nearly a decade of research for scientists to develop a breakthrough triple-drug therapy in 1996 that combined several antiviral drugs to combat resistance. But the regimes involved complicated dosing and serious side effects that hampered their use. Now, there are more than 30 antiviral drugs for HIV, and it’s possible to treat the condition with just one pill a day.
Those first-generation drugs were better than nothing, but it took years of research to find better options. “As the second-, third- and fourth-generation drugs were developed, the drugs got more potent, had less side effects and can be given less often,” said Sara Cherry, an immunologist at the Perelman School of Medicine at the University of Pennsylvania. “It really speaks to the fact that every development of a new drug can help mitigate all the things about the first generation that were imperfect.”
From the earliest days of the pandemic, researchers and pharmaceutical companies have suspected that the first covid drugs to market wouldn’t end up being the final word on treating the disease.
When clinical trial data showed remdesivir to be the first effective coronavirus drug, Anthony Fauci, Biden’s medical adviser and leader of the National Institute of Allergy and Infectious Disease since 1984, cautioned that this was just the beginning, reflecting on his involvement in early HIV drug research. “That was not the end game, because building on that every year after we did better and better, we had better drugs of the same type, and we had drugs against different targets,” Fauci said.
The second-generation covid antivirals closest to approval will likely target similar aspects of the coronavirus as existing drugs, but better. Pfizer is reportedly working on an improved version of Paxlovid that would make it less problematic for people taking other medications, and the Japanese company Shionogi developed a once-a-day drug that works similarly to Paxlovid (which must be taken multiple times a day), that could be approved within months. An infusion of research money into a long-neglected field is fueling experimentation, with many labs developing new ways of stopping SARS-CoV-2, some of which might work against many other viruses.
“In the future, I think that we’re going to have more drugs against similar targets, we’re going to have drugs against new targets. And hopefully, we’ll have combinations in the future that will really slam the virus,” Cherry said.
Many ways to stop a virus
Viruses are little more than tangled strands of genetic material (RNA, in SARS-CoV-2′s case) enclosed in a protein shell. They don’t have the ability to reproduce on their own and instead hijack the machinery of their hosts to copy themselves.
Antiviral drugs are designed to gum up this process. “Viruses that aren’t reproducing don’t cause acute disease, typically,” said Jeffrey Glenn, a gastroenterologist and molecular virologist at Stanford University. “So, we want to interfere with their ability to reproduce themselves.”
Most existing antiviral drugs, for any disease, aim to disrupt something about the virus itself. Many target viral polymerases, the proteins viruses use to make copies of their genetic material once they infect a host. Remdesivir, for instance, mimics the coronavirus’ genetic material, halting replication. Another common target is viral proteases, enzymes a virus needs to make proteins that make more viruses. The active ingredient in Paxlovid, which consists of two medications, inhibits a key enzyme needed to produce this replication machinery. The other ingredient slows the body’s metabolism of the active ingredient, helping it work longer.
“In cell culture, these all work quite well to block viral infection,” said Cherry. “But when you move into an organism, there’s a lot more complications,” she said. Our bodies might break down a drug too quickly for it to clear enough virus, or the drug may not reach peak concentration in the lung or respiratory tract, where viral replication is happening. With potentially billions of viral particles to counter, getting this concentration right really matters, Cherry said, and can take time to perfect.
Imperfect single antivirals can also foster the evolution of drug-resistant strains of a virus. By knocking down susceptible strains in an infected individual, the antiviral can give resistant strains a leg up, allowing them to flourish within that individual and spread. “The single drugs initially used for HIV evolved resistance generally quickly,” said Matthew Frieman, a coronavirus researcher at the University of Maryland. “It wasn’t until they started combining two and three and four drugs together, these drug cocktails, that scientists learned this worked much more efficiently.”
Combining multiple antiviral drugs makes it much harder for a virus to evolve resistance, since it’s being hit from many different angles at different stages of the replication cycle, Frieman said. The strategy is often simply more effective, too. “By hitting it at multiple steps in life cycle, you can really enhance the effects of any one of these drugs individually,” he said. “You can also generally use less of each drug, which can reduce side effects.”
Identifying drugs that might work together is one crucial step, and scientists have already begun testing different combinations in the lab. “The other part is combining together drugs developed by different companies,” Frieman said. “It becomes an issue of money and patent rights, which can be difficult.” Altogether, the process of developing combination therapy can take many years, he said.
There are currently no trials underway testing Paxlovid with other drugs, and some experts worry that combining molnupiravir, which works by introducing mutations into SARS-CoV-2′s genetic material, could breed resistant strains. Consequently, more antiviral drugs may need to get developed before combination therapies come online. Thankfully, scientists are looking for new targets at an unprecedented scale in antiviral research.
Finding new targets
Most antiviral drugs, for any condition, target two key factors of viral replication, polymerases and proteases. “I expect the next generation [of covid antivirals] will come from optimized protease and polymerase inhibitors,” said Schang. Some versions, which are easier to take and have fewer drug interactions, might be approved within months. But many scientists are starting to think beyond these targets.
“Antiviral therapies are heavily biased toward protease inhibitors and polymerase inhibitors,” said Schang, “and that’s resulted in a relative scarcity of chemical scaffolds that are known to have antiviral activity. That’s a major limitation moving forward. We have to have more chemical diversity.”
There are many ways to throw a wrench in viral replication. For example, before a virus can replicate, its viral RNA must be unwound by enzymes called helicases.“ There are lots of programs trying to develop helicase inhibitors against SARS-CoV-2,” Cherry said. Other scientists are working on ways of creating chinks into the coronavirus’ armor, designing antivirals that blow apart the protein shell that encases viral genetic material.
Other researchers are trying to design drugs that deprive viruses the opportunity to usurp our cells, by latching onto parts of human cells that the virus hijacks to invade or blocking access to human cellular components the virus needs to reproduce.
The approach is relatively new, and few drugs use it, but so-called host-directed antivirals could have advantages, said Glenn of Stanford. “Since you’re targeting something not under the virus’ control, we predict a high barrier to development of resistance,” he said. Such drugs might work against other viruses too. “If one virus has evolved to depend on a certain host function, it’s likely others have too,” he said.
Finally, there’s a third class of antivirals, called immune modulators, that seek to supercharge how our bodies naturally deal with infection. Interferons are proteins that whir into action at the first sign of an infection, kick-starting the immune response. Peginterferon lambda, a drug developed by Eiger Biopharmaceuticals, has shown exciting results in an early clinical trial. One shot of the drug cut risk of hospitalization by half when administered early in vaccinated patients and by 89 percent when administered early to unvaccinated patients. Glenn, who founded Eiger and sits on its board of directors, said the company plans to request emergency use authorization from the Food and Drug Administration.
Efficacy and ease of use aren’t the only factors that will shape the next iterations of covid antivirals. To be maximally effective, the drugs need to relatively inexpensive and easy to manufacture and distribute worldwide, Cherry said. “That’s actually not so trivial,” she said, but is key to ensuring the kind of equitable access that represents the world’s best bet toward controlling the pandemic.
But with unprecedented funding and interest in antivirals, many researchers are optimistic. Not only might the next generations of SARS-CoV-2 antivirals transform the nature of the pandemic, they might bolster our antiviral arsenal such that we’re better prepared for the next major infectious disease threat. “There’s no limit to the creativity and novelty of all these new targets,” Frieman said. “Which ones work and which ones won’t work, I don’t know, but I think that the future is really bright for the number of antivirals that will be developed in the next decade.”
With Melinda's prize container veggies - green, red & yellow peppers, 3 kinds of tomatoes, yellow & green beans, sitting on her deck has been "food for the soul and for the gut". The word "gut" comes from working for a gastroenterologist! 'Tongue-in-cheek', they are sometimes referred to as "Crop & Gizzard men" in the medical community!
Uma Sankari, Organizing Secretary, IAPEN Gastrointestinal Nutrition Congress - 2018 and Hon Secretary, IAPEN Pondicherry Regional Centre and Dietitian, Department of Surgical Gastroenterology, JIPMER, Dr. Subash Chandra Parija, Director, JIPMER, Dr. Biju Pottakkat, Organizing Chairman, IAPEN Gastrointestinal Nutrition Congress - IGINCON-2018 and Additional Professor & Head, Department of Surgical Gastroenterology, JIPMER and Dr. Parveen Malhotra, Nutrition Certification Board Member, IAPEN and Head of the Department of Medical Gastroenterology, PGIMS, Rohtak, Haryana
The Indian Association for Parenteral and Enteral Nutrition (IAPEN) is an organization in the field of parenteral and enteral nutrition and promotes basic research, clinical research, advanced education, organization of consensus statements about clinical care and quality control.
The IAPEN Gastrointestinal Nutrition Congress - 2018 is hosted and organised by Department of Surgical Gastroenterology, JIPMER and Department of Dietetics, JIPMER in collaboration with IAPEN – Pondicherry Regional Centre on 2nd and 3rd February 2018 at Academic Centre, JIPMER, Dhanvantri Nagar, Gorimedu, Puducherry 605 006.
Website: www.iapen.co.in/gi-nutrition/
The conference aims at bringing together gastroenterologists, surgeons, anesthesiologist, intensivists, dietitians and nutrition support clinicians to improve health through better nutrition and advanced education. This will catalyze promotion of inter-sectoral coordination, so as to arrive at comprehensive and sustainable strategies to address the problems faced in Nutrition Support for critically ill Patients.
The Organizers, Delegates and Media participated in this event made history as it is considered to be the first of its kind event on Gastrointestinal Nutrition in the Entire World till 2018.
Dr. Rajesh Singhania is the Best Doctor For Anal Fissure Treatment in Nagpur. Visit Shubham Nursing Home for more details. Visit - www.shubhamnursinghome.co.in/
when? ...
Friday (6/30) in the afternoon, and we're told to expect up to a 5-day recovery in the hospital and about 3 weeks for him to completely heal.
for what? ...
A G-tube (gastrostomy tube). It will be placed directly through the wall of Avery's stomach with a button on the outside (think of it as a gas cap to fuel his gas tank).
and why? ...
Avery's vocal cords became damaged or partially paralyzed during his month-long stay in the PICU this spring, so Avery came home with an NG (nasal gastric) tube and has received no oral feedings for 2.5 months. We had hoped his cords would have healed more quickly and the tube feedings would be very temporary. Now that the damage has been confirmed with a bronchoscopy earlier this month, we realize that it may still be a while before he will receive oral feedings. An NG tube is not intended for long term, so a G tube is necessary. It's relatively minor and it can easily be taken out once he no longer needs it. How long he'll need it is still unknown. We still have to meet with an ENT who may be able to help us understand the extent of the damage. Avery will soon do a barium swallow study to determine whether or not the epiglottis will still close off and keep food and liquid from entering his airways. Regardless of the results of the study, it will take a lot of time to get Avery back up to consuming the amount of calories he needs to continue to thrive. We will be working with Avery's ENT, pulmonologist, gastroenterologist, speech pathologist, and pediatrician to get him back to full oral feedings as soon as possible. Meanwhile, I think he will be happy to remove that irritating tube running through his sinuses and down his throat, and he'll be thrilled to have much less tape on his face again. The G-tube will ultimately be much more comfortable for Avery and will also allow him to be more mobile.
We're hopeful that this is the last surgery that Avery has to endure, at least while he's just a little squirt.
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
Photo
NYC
07-25-2012
Looking for a Doctor in Bergen County, NJ? Old Hook Medical Associates have the best primary care physicians, specialty doctors & medical professionals in NJ specializing in diabetes treatment, cardiology, & endocrinology. Book an appointment today!. Visit: www.oldhookmedical.com
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
The Indian Association for Parenteral and Enteral Nutrition (IAPEN) is an organization in the field of parenteral and enteral nutrition and promotes basic research, clinical research, advanced education, organization of consensus statements about clinical care and quality control.
The IAPEN Gastrointestinal Nutrition Congress - 2018 is hosted and organised by Department of Surgical Gastroenterology, JIPMER and Department of Dietetics, JIPMER in collaboration with IAPEN – Pondicherry Regional Centre on 2nd and 3rd February 2018 at Academic Centre, JIPMER, Dhanvantri Nagar, Gorimedu, Puducherry 605 006.
Website: www.iapen.co.in/gi-nutrition/
The conference aims at bringing together gastroenterologists, surgeons, anesthesiologist, intensivists, dietitians and nutrition support clinicians to improve health through better nutrition and advanced education. This will catalyze promotion of inter-sectoral coordination, so as to arrive at comprehensive and sustainable strategies to address the problems faced in Nutrition Support for critically ill Patients.
The Organizers, Delegates and Media participated in this event made history as it is considered to be the first of its kind event on Gastrointestinal Nutrition in the Entire World till 2018.
The Workshop on Critical Care Nutrition is hosted and organised by IAPEN – Mumbai Regional Centre on 11th September at The
Leela Mumbai, Andheri Kurla Road, Sahar, Andheri East, Mumbai, Maharashtra 400059
Organizing Secretary: Dr. Shilpa Varma, Organizing Secretary, Workshop on Critical Care Nutrition, Dadabhai # Road No 2, Near Azad Nagar
Metro Station, Diagonally Opposite Andheri Sports Complex, Off J. P Road, Andheri West, Mumbai 400058
1. Pediatric and Neonatal Critical Care Nutrition, Dr. Vinay Joshi and Dr Preetha Joshi, Consultants, Department of
Neonatology, PICU & Paediatric Cardiac ICU,Kokilaben Dhirubhai Ambani Hospital, Mumbai, Priya Karkera, Pediatric Nutritionist, Apollo Hospitals - Navi Mumbai, Plot #13, Parsik Hill Road, Off Uran Road, Sector - 23, CBD Belapur,
Opp. Nerul Wonders Park Navi Mumbai - 400 614
2. Critical care in adults and organ transplant, Dr. Ravi Mohanka, Chief Surgeon and Head of Department of Liver
Transplant and Hepato-Biliary Surgery at Global Hospitals, Mumbai, 3. Critical Care Nutrition in Day to Day Problems In ICU, Dr. Sanjeev Khanna, Gastroenterologist Lilavati hospital, Holy Family Hospital. 4. Immunonutrition, Dr. Shweta Rastogi, Clinical Dietician, Mumbai, 5. Burns Critical Care, Dr. Sunil Keswani, Medical Director, National Burns Centre, Sector - 13, Plot No. 1, Samarth Ramdas Swami Marg, Airoli, Navi Mumbai - 400 078. 6. Critical Care Nutrition in Burns patients Ruchira Ranadive, Critical care dietitian, National Burns Center, Mumbai
.
Colonoscopies save lives, both by catching colorectal cancer early when it is more treatable as well as by finding and removing precancerous polyps before a malignancy occurs. Have you or someone you love been putting off a screening?
There have been many improvements in the procedure in recent years, including same-day prep now available at Jefferson. In this photograph gastroenterologist Sonali S. Sakaria, MD performs a colonoscopy at Jefferson’s Methodist Hospital: sm.tjuh.org/loI
Calvin is another mate of mine. We spend too much time working and hardly have a chance to relax.
We met up this weekend for a quick lunch of phở and got talking about cars. He's thinking about getting a black Golf GTI. Sounds like a sweet ride to me! He better keep it locked in his garage. Otherwise I might have to "borrow" it for a nice little spin around town.
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
Practice of surgery has undergone a sea change in the recent past. Organ transplantation and minimal access surgery have been the recent advances in the field of surgery and have taken the surgical field by storm. Advances in technology added a lot of strength to this progression.
Hand in hand many rapid advances have also taken place in the field of anesthesia, critical care and more importantly in nutrition and not much is talked about these areas in surgical conferences. And it is about time to do just that. We at SIMS (SRM Institutes for Medical Science) have taken this responsibility to hold a two day national conference in Chennai titled “ EnhaNS – ERAS and Nutrition for surgeons” on behalf of the lifelong learning initiative of IAPEN. This conference will address issues like ERAS (Enhanced Recovery After Surgery) and its components namely the pre-operative , per-operative and post-operative interventions enabling patient to recover quickly from surgery and get back home early.
The program will comprise of panel discussions, didactic lectures and video presentations by very eminent faculty and the whole idea is to demystify and simplify nutrition and critical care as much as possible for the benefit of post-graduates and practitioners in general surgery, anesthesiology, critical care and also nutrition and dietetics.
We request you to be a part of this academic exercise and benefit from it and we shall promise to work hard and leave no stone unturned to make this conference as useful and as simple as possible. We assure you that at the end of this conference you will all be well versed with issues like enteral nutrition, parenteral nutrition, antibiotic protocols, IV fluid management, avoidance and management of paralytic ileus, pain management, feeding practices in surgical patients and many more. Two of the interesting panel discussions will be titled ‘ Nutrition before and after bariatric surgery ’ ‘Nutrition and liver transplantation’.
Dr.P.C. Vijayakumar, Organizing President, EnhaNS 2015, Hon President, IAPEN, Chennai Chapter, Intensivist & Anaesthiologist, Sooriya Hospital, 1/1A, Arunachalam Road, Saligramam-600093, Chennai, Tamil Nadu, Dr. Patta Radhakrishna, Organizing Chairman, EnhaNS-2015, Surgical Gastroenterologist and a Laparoscopic Surgeon, SIMS Chennai, Dr. V.Surendranath, Organizing Secretary, EnhaNS 2015, Anaesthiologist, SIMS Hospital, Chennai
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
This is a working document for the Best of Texas redesign project. This photo represents the current design for the bestoftexas.com/medical-and-dental/ page, titled Doctors, Dentists, Chiropractors and Specialists in Texas
The following meta data has been assigned to this page:
Title: Doctors, Dentists, Chiropractors and Specialists in Texas
Description: Your teeth and health cannot be cared for by just anyone. Perhaps you're looking for the best medical and/or dental facilities between home and work. In need of regular oral hygiene checkups or need to find a gastroenterologist with their own medical laboratory, we can help. Listed are some of the best dental providers and lists of dentists.
Keywords: Allergy, chiropractor, dentists, dermatologist, family practice, laboratories, lasik, MRI, OBGYN, Pediactricians, Pharmacy, Podiatrists, Rehab, Physical Therapy, Therapy, Ultrasound, Veterinarian, Weight loss solutions, Dallas, Texas, Houston, El Paso, Canton, Denton, San Antonio, DFW, Waco
This is a screenshot from a page on the Best of Texas web project that I am working on. I'm using this for personal record-keeping. Since these are from a public internet, there's no reason why anyone wouldn't be able to use them so consider these photos to be licensed under a creative commons, share-alike license for non-commercial purposes. Feel fee to use them but please give credit to Best of Texas and link back to the Best of Texas website at www.bestoftexas.com/
This is a working document for the Best of Texas redesign project. This photo represents the current design for the bestoftexas.com/medical-and-dental/ page, titled Doctors, Dentists, Chiropractors and Specialists in Texas
The following meta data has been assigned to this page:
Title: Doctors, Dentists, Chiropractors and Specialists in Texas
Description: Your teeth and health cannot be cared for by just anyone. Perhaps you're looking for the best medical and/or dental facilities between home and work. In need of regular oral hygiene checkups or need to find a gastroenterologist with their own medical laboratory, we can help. Listed are some of the best dental providers and lists of dentists.
Keywords: Allergy, chiropractor, dentists, dermatologist, family practice, laboratories, lasik, MRI, OBGYN, Pediactricians, Pharmacy, Podiatrists, Rehab, Physical Therapy, Therapy, Ultrasound, Veterinarian, Weight loss solutions, Dallas, Texas, Houston, El Paso, Canton, Denton, San Antonio, DFW, Waco
This is a screenshot from a page on the Best of Texas web project that I am working on. I'm using this for personal record-keeping. Since these are from a public internet, there's no reason why anyone wouldn't be able to use them so consider these photos to be licensed under a creative commons, share-alike license for non-commercial purposes. Feel fee to use them but please give credit to Best of Texas and link back to the Best of Texas website at www.bestoftexas.com/
Looking for a Doctor in Bergen County, NJ? Old Hook Medical Associates have the best primary care physicians, specialty doctors & medical professionals in NJ specializing in diabetes treatment, cardiology, & endocrinology. Book an appointment today!. Visit: www.oldhookmedical.com
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
The Indian Association for Parenteral and Enteral Nutrition (IAPEN) is an organization in the field of parenteral and enteral nutrition and promotes basic research, clinical research, advanced education, organization of consensus statements about clinical care and quality control.
The IAPEN Gastrointestinal Nutrition Congress - 2018 is hosted and organised by Department of Surgical Gastroenterology, JIPMER and Department of Dietetics, JIPMER in collaboration with IAPEN – Pondicherry Regional Centre on 2nd and 3rd February 2018 at Academic Centre, JIPMER, Dhanvantri Nagar, Gorimedu, Puducherry 605 006.
Website: www.iapen.co.in/gi-nutrition/
The conference aims at bringing together gastroenterologists, surgeons, anesthesiologist, intensivists, dietitians and nutrition support clinicians to improve health through better nutrition and advanced education. This will catalyze promotion of inter-sectoral coordination, so as to arrive at comprehensive and sustainable strategies to address the problems faced in Nutrition Support for critically ill Patients.
The Organizers, Delegates and Media participated in this event made history as it is considered to be the first of its kind event on Gastrointestinal Nutrition in the Entire World till 2018.
This is a working document for the Best of Texas redesign project. This photo represents the current design for the bestoftexas.com/medical-and-dental/ page, titled Doctors, Dentists, Chiropractors and Specialists in Texas
The following meta data has been assigned to this page:
Title: Doctors, Dentists, Chiropractors and Specialists in Texas
Description: Your teeth and health cannot be cared for by just anyone. Perhaps you're looking for the best medical and/or dental facilities between home and work. In need of regular oral hygiene checkups or need to find a gastroenterologist with their own medical laboratory, we can help. Listed are some of the best dental providers and lists of dentists.
Keywords: Allergy, chiropractor, dentists, dermatologist, family practice, laboratories, lasik, MRI, OBGYN, Pediactricians, Pharmacy, Podiatrists, Rehab, Physical Therapy, Therapy, Ultrasound, Veterinarian, Weight loss solutions, Dallas, Texas, Houston, El Paso, Canton, Denton, San Antonio, DFW, Waco
This is a screenshot from a page on the Best of Texas web project that I am working on. I'm using this for personal record-keeping. Since these are from a public internet, there's no reason why anyone wouldn't be able to use them so consider these photos to be licensed under a creative commons, share-alike license for non-commercial purposes. Feel fee to use them but please give credit to Best of Texas and link back to the Best of Texas website at www.bestoftexas.com/
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
This is a working document for the Best of Texas redesign project. This photo represents the current design for the bestoftexas.com/medical-and-dental/ page, titled Doctors, Dentists, Chiropractors and Specialists in Texas
The following meta data has been assigned to this page:
Title: Doctors, Dentists, Chiropractors and Specialists in Texas
Description: Your teeth and health cannot be cared for by just anyone. Perhaps you're looking for the best medical and/or dental facilities between home and work. In need of regular oral hygiene checkups or need to find a gastroenterologist with their own medical laboratory, we can help. Listed are some of the best dental providers and lists of dentists.
Keywords: Allergy, chiropractor, dentists, dermatologist, family practice, laboratories, lasik, MRI, OBGYN, Pediactricians, Pharmacy, Podiatrists, Rehab, Physical Therapy, Therapy, Ultrasound, Veterinarian, Weight loss solutions, Dallas, Texas, Houston, El Paso, Canton, Denton, San Antonio, DFW, Waco
This is a screenshot from a page on the Best of Texas web project that I am working on. I'm using this for personal record-keeping. Since these are from a public internet, there's no reason why anyone wouldn't be able to use them so consider these photos to be licensed under a creative commons, share-alike license for non-commercial purposes. Feel fee to use them but please give credit to Best of Texas and link back to the Best of Texas website at www.bestoftexas.com/
McLeod Health welcomes Interventional Gastroenterologist Veeral M. Oza, MD to the medical staff of McLeod Regional Medical Center. Dr. Oza joins fellow physicians Dr. Timothy Spurling and Dr. Jeffrey Dorociak as part of McLeod Physician Associates in practice at Florence Gastroenterology Associates.
Medical School:
Rush University College of Medicine, Chicago, IL/2009
Residency:
Internal Medicine
George Washington University Hospital, Washington, DC/2012
Fellowship:
Gastroenterology
The Ohio State University Medical Center, Columbus, OH/2015
Advanced Fellowship:
Advanced Endoscopy
Yale University Medical Center, New Haven, CT/2016
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
This was the first sight to greet me as I stepped out of the Montreal airport. Oh gastroenterologists! I wish you had all been in my hotel, tending me gently.
The Indian Association for Parenteral and Enteral Nutrition (IAPEN) is an organization in the field of parenteral and enteral nutrition and promotes basic research, clinical research, advanced education, organization of consensus statements about clinical care and quality control.
The IAPEN Gastrointestinal Nutrition Congress - 2018 is hosted and organised by Department of Surgical Gastroenterology, JIPMER and Department of Dietetics, JIPMER in collaboration with IAPEN – Pondicherry Regional Centre on 2nd and 3rd February 2018 at Academic Centre, JIPMER, Dhanvantri Nagar, Gorimedu, Puducherry 605 006.
Website: www.iapen.co.in/gi-nutrition/
The conference aims at bringing together gastroenterologists, surgeons, anesthesiologist, intensivists, dietitians and nutrition support clinicians to improve health through better nutrition and advanced education. This will catalyze promotion of inter-sectoral coordination, so as to arrive at comprehensive and sustainable strategies to address the problems faced in Nutrition Support for critically ill Patients.
The Organizers, Delegates and Media participated in this event made history as it is considered to be the first of its kind event on Gastrointestinal Nutrition in the Entire World till 2018.
The Indian Association for Parenteral and Enteral Nutrition (IAPEN) is an organization in the field of parenteral and enteral nutrition and promotes basic research, clinical research, advanced education, organization of consensus statements about clinical care and quality control.
The IAPEN Gastrointestinal Nutrition Congress - 2018 is hosted and organised by Department of Surgical Gastroenterology, JIPMER and Department of Dietetics, JIPMER in collaboration with IAPEN – Pondicherry Regional Centre on 2nd and 3rd February 2018 at Academic Centre, JIPMER, Dhanvantri Nagar, Gorimedu, Puducherry 605 006.
Website: www.iapen.co.in/gi-nutrition/
The conference aims at bringing together gastroenterologists, surgeons, anesthesiologist, intensivists, dietitians and nutrition support clinicians to improve health through better nutrition and advanced education. This will catalyze promotion of inter-sectoral coordination, so as to arrive at comprehensive and sustainable strategies to address the problems faced in Nutrition Support for critically ill Patients.
The Organizers, Delegates and Media participated in this event made history as it is considered to be the first of its kind event on Gastrointestinal Nutrition in the Entire World till 2018.
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
GTWL: Movie Titles
I went to the doctor today because my stomach has slowly been rejecting me as it's host body. With all of my symptoms and everything, the gastroenterologist said that I needed a colonoscopy. Fun stuff.
This is a working document for the Best of Texas redesign project. This photo represents the current design for the bestoftexas.com/medical-and-dental/ page, titled Doctors, Dentists, Chiropractors and Specialists in Texas
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Title: Doctors, Dentists, Chiropractors and Specialists in Texas
Description: Your teeth and health cannot be cared for by just anyone. Perhaps you're looking for the best medical and/or dental facilities between home and work. In need of regular oral hygiene checkups or need to find a gastroenterologist with their own medical laboratory, we can help. Listed are some of the best dental providers and lists of dentists.
Keywords: Allergy, chiropractor, dentists, dermatologist, family practice, laboratories, lasik, MRI, OBGYN, Pediactricians, Pharmacy, Podiatrists, Rehab, Physical Therapy, Therapy, Ultrasound, Veterinarian, Weight loss solutions, Dallas, Texas, Houston, El Paso, Canton, Denton, San Antonio, DFW, Waco
This is a screenshot from a page on the Best of Texas web project that I am working on. I'm using this for personal record-keeping. Since these are from a public internet, there's no reason why anyone wouldn't be able to use them so consider these photos to be licensed under a creative commons, share-alike license for non-commercial purposes. Feel fee to use them but please give credit to Best of Texas and link back to the Best of Texas website at www.bestoftexas.com/
Coming up on 20 years of practicing medicine and all I feel at this point is distain for a legal system that will stop at nothing to distort the truth and a medical system that struggles to stay afloat in a sea of government overregulation and insurance strong-arming. I have come to the conclusion that for the last few years we have no longer been improving the care of patients, but only the care of charts and records. We create “feel good” programs with “catch phrase” names to make the care that is being delivered look more attractive. We don’t need more doctors, we need more advertising specialists! After 20 years of practice I find myself feeling the brunt of a first malpractice suit. A complicated patient that had seen numerous gastroenterologist (and other physicians) before she fell into my lap as an unassigned hospital admission. I saw the patient in consultation and quickly realized that she had complex issues that I felt strongly could lead potentially lead to serious morbidity. Practicing in a small 90 bed suburban hospital, and noting that the patient had had more than one surgery in the past which had failed to correct her problems, I felt strongly that the patient needed to be moved to a University level hospital. They would be more in line to deal with her potentially serious issues and chronic problems in major part due to previous surgeries. The patient initially accepted the offer to be transferred and then refused it. She was discharged and over the course of the next 5 months, never attempted follow up, and never went to one of the many nearby University hospitals to be evaluated. She represented to another hospital 5 months later and ended up dying of complications of her disease. The attorneys are trying to suggest that had I worked her up further I might have convinced her to go elsewhere! I have struggled with the issue of responsibility for some time. Just where does one’s responsibility begin and end when talking to a rational adult? I’m not certain I can continue to provide care under these circumstances. I don’t know what alternatives I have, but this whole mess sickens me. I’m not certain I can put up with any of this much longer…
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
Now that the gastroenterologist has determined I have acid damage in my esophagus, stomach, and duodenum, I started a prescription acid reducer, but until it kicks in, I'm keeping a bottle of this at the office. In addition to avoiding foods that cause dental pain and kidney stones, I need to stay away from foods that trigger acid reflux. I can't eat anything any more! :(
Colonoscopy screening performed in NYC by Dr. Hon-Ming Eng MD Gastroenterologist, early detection is important and can save lives, all are highly encouraged to be screened.
www.zocdoc.com/doctor/hon-ming-eng-md-6636
07-26-2012
how's that for an obscure literary reference for you. probably my favorite short (and i mean short) story in existence. really.
if you haven't googled the title yet, you really should.
really.
oh, and i love her eyes, too.
this is from day three of our road trip to kansas. you can see the whole trip here as it gets loaded.
Crohn's Disease and Pregnancy
You can have a healthy pregnancy and delivery even if you have Crohn’s disease. The key is to work closely with your doctor and follow your treatment plan so you and your baby can stay healthy.
If you're thinking about becoming pregnant, talk to both your OB-GYN and your gastroenterologist.
Does Crohn's Disease Affect Conception?
If you have active Crohn's disease, you may have a harder time getting pregnant than you would when it's in remission. Ideally, you should be in good health and in remission when you get pregnant.
If a man who wants to become a father is taking sulfasalazine (Azulfidine) for Crohn's disease, they should ask their doctor to change their medication. Sulfasalazine can cause a lower sperm count.
The drug methotrexate is deadly to unborn babies and newborns. If a man is taking methotrexate for Crohn's disease, they should stop taking it for 3 months before attempting conception. Women with Crohn's disease should avoid methotrexate before getting pregnant and while pregnant. If you are taking methotrexate after giving birth, you should not breastfeed.
If both parents have IBD, the child has about a 1 in 3 chance of having IBD. If only one parent has Crohn's disease, the chance of the baby getting the condition is about 9%.
How Does Crohn's Disease Affect Pregnancy?
For some people, pregnancy has a positive effect on Crohn's disease. Pregnancy can lessen the symptoms.
When Dr. Jason Hou, a Houston VAMC Gastroenterologist with four young children, found his family and home in danger because of flood waters, other doctors in the Gastroenterology department reached out to him with an outpouring of support.
Dr. Hou’s home took on about two feet of water. Other doctors, Fellows, reached out to him and asked how they could help. A crew made up of Drs. Tariq Hammad, Mark Salem, Jason Cano, Phil Levine, Gene Kligman, and Derek Lin volunteered to help with the removal of damaged belonging and drywall.
“I would like to thank the staff who took the time to come to my house and help in the clean-up,” said Dr. Hou. “The outpouring of support during the flood shows the kind of staff we have here at the Houston VA hospital."