Splinter, First Aid: Condition, Treatments, and Pictures – First Aid Guide

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Images of Splinter, First Aid

Overview

A splinter, or sliver, is a particle of a foreign object, such as a small piece of wood, that has embedded itself in ones skin. Splinters can sometimes come out on their own or be pulled or milked (by gently squeezing on each side of the splinter) out easily, but others can be deeply embedded and difficult to remove. All splinters should be removed as promptly as possible. If a splinter becomes wet, it makes the area prone to infection.

First Aid Guide
Self-care measures to remove a splinter are as follows:

1. Wash your hands.
2. Clean tweezers and a needle by boiling them or by pouring antiseptic solution (eg, isopropyl alcohol) over them, and let them dry.
3. With the tweezers, attempt to pull the splinter out the same direction and angle that it went in the skin.
4. If the splinter cannot be removed by the tweezers because the tip is not accessible, use the needle to make a small hole above the splinter and/or use the needle to lift the splinter out.
5. Once the splinter is fully out, wash the area and bandage it with a clean, dry dressing.

Note: If the splinter is embedded in the skin under the nail, you can cut a V-shaped notch in the nail to improve access to the area.

Who’s at risk?

Splinters are very common and affect all people. Those who are exposed to unfinished wood or machines that produce slivers of wood or metal are most prone to splinters.

Signs and Symptoms

Splinters appear as an often small sliver of a foreign object, either fully or partially embedded into a person’s skin. Splinters can be small, large, smooth, jagged, deeply embedded, or only partially embedded. If the sliver is large or jagged, there may be bleeding and redness of the affected area. There may be no bleeding if the sliver is small or fairly smooth.

Slivers often occur on the hands and feet, but they can occur anywhere on the skin or eye that comes in contact with a sliver of a foreign object. Note: For splinters in the eye, see the topic Foreign Object in Eye or Skin.

When to Seek Medical Care

Seek medical care if:

• You are unable to remove the splinter or only part of a splinter was successfully removed by self-care measures and there is still a piece of the sliver in the skin.
• The skin around the splinter is particularly red, painful, swollen, or bloody.
• The site of a splinter appears to be infected (ie, it is increasingly painful or red, swollen, there is discharge, there is associated fever or swollen lymph nodes, or there is red streaking from the affected area toward the heart).
• Tetanus immunization is not up to date.

Treatments Your Physician May Prescribe

The physician will ensure that the splinter site is clean and free of debris.

If tetanus immunization is not up to date (ie, it has been more than 10 years since the last immunization), the physician will need to give a tetanus vaccine and booster promptly. (A tetanus immunization is only effective if given within 72 hours of trauma.) If you have had a tetanus vaccination within the last 5 years but the sliver came in contact with dirt or animal feces before it punctured the skin or the sliver is particularly deep or jagged, the physician may give a new tetanus vaccine and booster.

If the splinter site has become infected, the physician may need to treat the infection with antibiotics.

Trusted Links

MedlinePlus: Foreign Bodies

How to Remove a Splinter (and When to Call the Doctor) – Health Essentials from Cleveland Clinic

It’s a familiar situation for many parents: Your child is playing in the yard barefoot and comes in complaining that they stepped on something.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

You take a look at their foot. Sure enough, you notice a tiny splinter.

Should you grab the tweezers from the medicine cabinet, or take your child to urgent care to have it removed? Or does it even need to be taken out at all?

It is especially important to have organic material – say, a piece of wood or a thorn – removed as soon as possible, as it may become infected more quickly than inorganic material such as metal or glass, says pediatrician Kyle Mudd, DO. It should be removed that day, if possible.

When to leave it to a doctor

Once you’ve determined that a splinter needs to come out, it’s time to decide if you’re the best person for the job. Most often, you’ll be able to save a trip to the doctor by removing it yourself. But Dr. Mudd suggests leaving it to the pros if:

• The splinter has entered the skin near the eye or under the fingernail.
• You notice any signs of infection, like red or hardened skin, or discharge that is white or yellow.
• The splinter has entered the skin vertically. These can be especially difficult to remove at home, but doctors have additional tools that can help.
• The splinter is deep or has broken during attempts to remove it.
• You’ve tried unsuccessfully to remove it for more than 10 to 15 minutes.

Tools, tips and tricks

Wash. If you’re going to try to remove the splinter at home, the first step is to wash your hands and the affected area with soap and water.

Soak (optional). Soaking the splintered area in warm water for a few minutes before trying to take it out can make the skin more pliable but isn’t necessarily required, Dr. Mudd says. Younger children already tend to have soft skin, so if you do soak, you should only need to do it for a few minutes.

Sterilize. If the splinter has entered the skin fairly horizontally and part of it is sticking out, a pair of tweezers and a needle wiped down with rubbing alcohol can be helpful in getting it out. In a situation where the entire splinter is underneath the skin, a sterilized needle may be the best tool.

Remove. When you go to remove the splinter, don’t pinch the skin, Dr. Mudd cautions, because that can put pressure on the splinter and cause it to break into fragments.

“I tell people to visualize the splinter and use the needle to feather open the top layer of skin to expose the material you are trying to remove,” he explains. “Once the splinter is exposed, you may attempt to grab it using tweezers and pull it out along the same route that it entered the skin.”

Prevent infection. If you are successful in removing the splinter, wash the affected area with soap, put some antibiotic ointment or Vaseline over it, and cover it with a bandage.

Don’t panic. If you aren’t able to get the splinter out after 10 or 15 minutes of trying, it’s time to seek help from a medical professional. “You don’t want to cause unnecessary anxiety in your child,” Dr. Mudd says. “Head to urgent care or your pediatrician that day, if possible.”

Talk about tetanus

Regardless of how it’s removed, if your child gets a splinter, it’s important to make sure they are up to date on their tetanus vaccine, to prevent a rare but possible serious infection. The CDC recommends that children receive their childhood tetanus series including the DTaP immunizations at 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years old, in addition to a Tdap immunization at 11 to 12 years old. A tetanus booster is required every 10 years after this to help boost waning immunity.­­

How to Safely Remove a Splinter

A splinter is a tiny impaled object that can be removed at home without ever seeing a doctor. However, you shouldn’t ignore them. Splinters can become infected if left under the skin for too long.

Use these steps to see if it should be safe to remove the splinter yourself or whether you should see a doctor. One precaution is that splinters in or near the eye should only be removed by a healthcare provider.​

Verywell / Gary Ferster

Check for Signs of Infection First

Look for these signs of infection before trying to remove a splinter:

• Pus draining from the wound
• Redness
• Severe pain even without movement
• Swelling

If the splinter shows any signs it has become infected, see a doctor for removal.

The chances of a splinter becoming infected depend on what the splinter is: organic material — like animal spines or plant thorns — are more likely to cause infection or toxic reactions. ​

When you take a splinter out, make sure you get the whole thing. A splinter is usually a small piece of wood that broke into multiple parts, and it’s very easy to have more than one under the skin. A piece of a splinter left behind can become infected.

What You Will Need

Assemble these items:

• Disinfectant of choice (prep pad, swab, or liquid)
• Needle
• Pair of tweezers
• Soap and water

Steps to Remove a Splinter

1. Wash your hands thoroughly with soap and water before attempting to remove the splinter.
2. Clean a needle and a pair of tweezers with alcohol or another disinfectant.
3. Wash the wound and surrounding area with soap and warm water.
4. Use the needle to open up the skin above the splinter and expose the end of the splinter. If the splinter is fully embedded under the skin, a needle can be used to pierce the skin and gently push out part of the splinter. Never try to squeeze out a splinter because it can break into smaller pieces and cause an even bigger problem.
5. Grasp the end of the splinter with the tweezers and back it out of the skin at the same angle it went into the skin.
6. Wash the wound with warm water and soap. Apply petroleum jelly before applying a bandage.
7. If the wound is likely to get dirty after the splinter removal, cover it with a bandage until the skin is healed.

Tips

Usually, the pain of a splinter is more irritable than anything. However, if the area is very tender, try a bee-sting swab to dull the pain.

Splinters under a fingernail (subungal splinters) may present a bigger problem. If the tip of the splinter cannot be reached with tweezers, you have the option of going to see a doctor or not. A doctor will be able to snip away the nail and pull the splinter out.

The other option is to keep the area clean and wait until natural nail growth pushes the splinter out. Watch the area closely for signs of infection.

Make sure the person with the splinter is up to date on tetanus vaccination. If not, have the doctor remove the splinter when going in to get the vaccination.

Finally, splinters will work out of the skin naturally and may not need to be removed.

There’s no need to hurry if you are away from home and don’t have the necessary clean supplies. Wait until the proper cleanliness can be achieved to remove splinters.

A Word from Verywell

Splinter removal is the surgery of mom and dad. Ancient lore says you’ll win the hearts of the kings of the jungle by removing thorns from their paws. The same is true for your children. Just make sure you have the whole thing.

If you have any concern that a large splinter might not have been completely removed, don’t be afraid to see a doctor. A splinter doesn’t need an emergency room, but it does need to come all the way out.

Sliver or Splinter

Is this your child’s symptom?

• A foreign object stuck in the skin
• Some examples are a wood splinter, fishhook, glass sliver or needle

Symptoms of a Foreign Object in the Skin

• Pain. Most tiny slivers in the top layer of skin do not cause much pain. An example of these tiny slivers is plant stickers. Objects that are deeper or go straight down are usually painful to pressure. Objects in the foot are very painful with standing or walking.
• Foreign Object Sensation. Older children may complain about something being in the skin. (“I feel something in there.”)

Types of Foreign Bodies (Objects)

• Wood (Organic): splinters, cactus spines, thorns, toothpicks. These objects are irritating and become infected if not removed.
• Metallic: BBs, nails, sewing needles, pins, tacks
• Fiberglass slivers
• Fishhooks may have a barbed point that makes removal difficult
• Glass sliver
• Pencil lead (graphite, not lead)
• Plastic sliver

When to Call for Sliver or Splinter

Call Doctor or Seek Care Now

• Object is a BB
• Object is causing severe pain
• You want a doctor to take out the object
• You tried and can’t get the object out
• Wound looks infected (spreading redness)
• Fever occurs
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Deep puncture wound and last tetanus shot was more than 5 years ago
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Tiny, pain-free slivers near the surface that don’t need to be removed
• Tiny plant or cactus spines or fiberglass slivers that need to be removed
• Minor sliver, splinter or thorn that needs removal. You think you can do it at home.

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Minor Slivers and Splinters

1. Tiny, Pain-Free Slivers – Treatment:
   • Tiny, pain-free slivers near the skin surface can be left in.
   • They will slowly work their way out with normal shedding of the skin.
   • Sometimes, the body also will reject them by forming a little pimple. This will drain on its own. Or you can open up the pimple. Use a clean needle. The sliver will flow out with the pus.
2. Tiny Painful Plant Stickers – Treatment:
   • Plant stickers or cactus spines are hard to remove. Fiberglass slivers may also be hard to get out. Reason: They are fragile. Most often, they break when pressure is applied with a tweezers.
   • Tape. First, try touching the spot lightly with tape. The stickers should attach to the tape. You can use packaging tape, duct tape or another very sticky tape.
   • Wax Hair Remover. If tape doesn’t work, use wax hair remover. Put a thin layer on. Let it air dry for 5 minutes. You can also speed up the process with a hair dryer. Then peel it off with the stickers. Most will be removed. The others will usually work themselves out with normal shedding of the skin.
3. Needle and Tweezers for Slivers and Splinters:
   • For larger splinters, slivers or thorns, remove with a needle and tweezers.
   • Check the tweezers first. Be certain the ends (pickups) meet exactly. If they do not, bend them. Clean the tool with rubbing alcohol before using them.
   • Clean the skin around the sliver briefly with rubbing alcohol. Do this before trying to remove it. If you don’t have any, use soap and water. Caution: Don’t soak the spot if the foreign object is wood. Reason: can cause swelling of the splinter.
   • Use the needle to uncover the large end of the sliver. Use good lighting. A magnifying glass may help.
   • Grasp the end firmly with the tweezers. Pull it out at the same angle that it went in. Get a good grip the first time. This is important for slivers that go straight into the skin. This is also important for those trapped under the fingernail.
   • For slivers under a fingernail, sometimes part of the nail must be cut away. Use a fine scissors to expose the end of the sliver.
   • Slivers (where you can see all of it) often can be removed at home. Pull on the end. If the end breaks off, open the skin with a sterile needle. Go along the length of the sliver and flick it out.
4. Antibiotic Ointment:
   • Wash the area with soap and water before and after removal.
   • Use an antibiotic ointment (such as Polysporin) once after sliver is taken out. No prescription is needed. This will help to decrease the risk of infection.
5. Call Your Doctor If:
   • You can’t get the object out
   • Object is out, but pain gets worse
   • Starts to look infected
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 04/18/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Splinters and Other Foreign Bodies in the Skin

Definition

• A foreign body (FB) (eg, splinter, fishhook, sliver of glass) is embedded in the skin.

Symptoms of a Foreign Body in the Skin

• Pain: Most tiny slivers (eg, cactus spine) in the superficial skin do not cause much pain. Deeper or perpendicular FBs are usually painful to pressure. FBs in the foot are very painful with weight bearing.
• FB Sensation: Older children may report the sensation of something being in the skin (“I feel something there”).

Types of Foreign Bodies

• Wood/Organic FBs: Splinters, cactus spines, thorns, toothpicks.
• Metallic FBs: Bullets, BBs, nails, sewing needles, pins, tacks.
• Fiberglass spicules.
• Fishhooks: May have a barbed point that makes removal difficult.
• Glass.
• Pencil lead (graphite).
• Plastic FBs.

When to Call Your Doctor

Call Your Doctor Now (Night or Day) If

• Deeply embedded FB (eg, needle or toothpick in foot)
• FB has a barb (eg, fishhook)
• FB is a BB
• FB is causing severe pain
• You are reluctant to take out FB
• You can’t remove FB
• Site of sliver removal looks infected (redness, red streaks, swollen, pus)
• Fever occurs

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If

• You think your child needs to be seen
• Deep puncture wound and last tetanus shot was more than 5 years ago

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Parent Care at Home If

• Tiny, superficial, pain-free slivers that don’t need removal
• Tiny plant stickers, cactus spines, or fiberglass spicules that need removal
• Minor sliver, splinter, or thorn that needs removal and you think you can remove it

Home Care Advice for Minor Slivers

1. Tiny, Pain-Free Slivers: If superficial slivers are numerous, tiny, and pain free, they can be left in. Eventually they will work their way out with normal shedding of the skin, or the body will reject them by forming a little pimple that will drain on its own.
2. Tiny Painful Plant Stickers: Plant stickers (eg, stinging nettle), cactus spines, or fiberglass spicules are difficult to remove because they are fragile. Usually they break when pressure is applied with tweezers.

• Tape: First try to remove the small spines or spicules by touching the area lightly with packaging tape, duct tape, or another very sticky tape. If that doesn’t work, try wax hair remover.
• Wax Hair Remover: If tape doesn’t work, apply a layer of wax hair remover. Let it air-dry for 5 minutes or accelerate the process with a hair dryer. Then peel it off with the spicules. Most will be removed. The others will usually work themselves out with normal shedding of the skin.

Needle and Tweezers: For large slivers or thorns, remove with a needle and tweezers.

• Check the tweezers beforehand to be certain the ends (pickups) meet exactly (if they do not, bend them). Sterilize the tools with rubbing alcohol.
• Cleanse the skin surrounding the sliver briefly with rubbing alcohol before trying to remove it. If you don’t have any, use soap and water but don’t soak the area if FB is wood (Reason: can cause swelling of the splinter).
• Use the needle to completely expose the large end of the sliver. Use good lighting. A magnifying glass may help.
• Then grasp the end firmly with the tweezers and pull it out at the same angle that it went in. Getting a good grip the first time is especially important with slivers that go in perpendicular to the skin or those trapped under the fingernail.
• For slivers under a fingernail, sometimes a wedge of the nail must be cut away with fine scissors to expose the end of the sliver.
• Superficial horizontal slivers (where you can see all of it) usually can be removed by pulling on the end. If the end breaks off, open the skin with a sterile needle along the length of the sliver and flick it out.

• You can’t get it all out.
• Removed but pain becomes worse.
• Starts to look infected.
• Your child becomes worse.

And remember, contact your doctor if your child develops any of the “Call Your Doctor” symptoms.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

What Happens If You Don’t Take Out a Splinter?

It can be a freeing feeling to shuck off your shoes and walk outside barefoot during the warm spring and hot summer, until the deck sticks your exposed foot with a tiny, pointy gift: a splinter.

But it’s so tiny or so deeply stuck in the skin that you can’t get it out. So, what would happen if you just left it in?

It’s best not to wait and see, as leaving a splinter in the body can provide a passageway for infection, said Ashley Jones, a certified nurse practitioner at The Ohio State University Wexner Medical Center. [Do Rusty Nails Really Give You Tetanus?] 

The “skin is a physical barrier that prevents infections,” Jones told Live Science. So a splinter that breaks that skin “makes it easier for bacteria outside of the skin to actually get under the skin.” That bacteria may already be on the splinter, holding on for a free ride into the bloodstream, or it may make its way in through the open gates after the incursion.

One such infection is caused by the tetanus bacteria (clostridium tetani), which, if it makes its way into the body of a person who is not vaccinated or up to date on their tetanus boosters, can release toxins that harm the nervous system.

Because of the risk of infection, “I would generally recommend that you not leave a splinter in place,” Jones said. If you can’t easily grab it with tweezers and by applying a slow, steady pressure, “I would recommend just seeking health care,” she said.

Dr. Jefry Biehler, chair of pediatrics at Nicklaus Children’s Hospital in Miami, echoed this recommendation. If removing a deeply embedded splinter at home may result in a lot of bleeding, then head to a health care center, where professionals can remove the splinter using clean, sterile instruments, he said.

If the splinter isn’t removed, the body probably won’t absorb the invader or break it down. Rather, the body will likely try to push the splinter out, Biehler said. The splinter may cause an inflammatory reaction, which could mean swelling and redness in that area. What’s more, pockets of pus may form to help expel the splinter.

If the inflammatory response continues for a number of days or weeks, the area can sometimes develop a somewhat permanent bump or what’s called a “granuloma,” Jones added. This is kind of a protective bubble of immune cells that surround the foreign object the body wasn’t able to oust.

Sometimes the body can naturally expel a splinter from the skin without causing an inflammatory response, Biehler said. Other times, the splinter may stay in the skin forever.

Biehler noted that one of his nurse friends has had an inch-long thorn in her hand for the past 40 years. “You can feel it, she can move it … [but] it doesn’t cause her any pain,” he said. “She’s been fine for 40 years.” The splinter doesn’t carry as big of a risk of infection as when she first got it, because the skin closed on top of it, he added.

“It is a fine line between what needs to be seen [by a doctor], what needs to be removed and what can be left alone,” Biehler said. But in general, splinters you get around the house or those that come from plant materials, such as wood, “usually need to come out, because the body reacts to it.”

In any case, foreign bodies lodged in the skin — especially in children and the elderly, who may be more prone to infections — should be evaluated by a health care professional, he said.

Originally published on Live Science.

Burning Question: What happens if you don’t remove a splinter?

If you garden without gloves, or are partial to going barefoot in the backyard, chances are you’ve managed to collect a splinter.

For most of us, it’s a non-event. With tweezers or even your fingernails, you can pull the splinter from the skin’s surface and there is no cause for alarm.

But sometimes a splinter isn’t easily removed.

Is it safe to assume it will come out by itself, or can you leave it alone regardless?

It depends on several factors, says Dr Adam Sheridan, dermatologist and spokesman for the Australasian College of Dermatologists.

Horror stories aren’t common but when they do occur, generally the splinter has come from plant material.

“Nine times out of 10, splinters are trivial things. But the classic scenario where things go wrong and end up in our clinic relates to vegetable matter,” Dr Sheridan says.

“They are the ones that most often cause infection and an immune reaction. The splinter is seen as a living foreign body and we’re designed to reject that.”

A splinter of inert, non-living material like metal or glass is less likely to trigger an immune reaction, Dr Sheridan says.

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What is the infection risk?

While anything that pierces the skin can create a point of entry for microbes from outside the body, organic splinters are themselves likely to be carrying bacteria and fungi that can cause infections. The result can be pain, swelling and redness – or sometimes worse.

Rose thorns, for instance, may be coated with a fungus called Sporothrix and many a gardener has discovered the pitfalls of pruning the popular flower.

Red lumps in a line on the skin after a splinter can indicate fungal infection.(

Supplied: Len Moaven

)

“We’ll see people presenting with a painful nodule — like a non-healing lump — on their finger and it all goes back to them getting pierced by a rose thorn or a bit of mulch when they were working in the garden,” Dr Sheridan says.

“Twenty to 30 days later, they can get this line of red inflamed lumps right up their arm.”

The lumps occur in a pattern known as sporotrichoid spread, which follows the line of vessels in your body’s lymphatic system, which has a role in fighting infection.

These sores do not heal unless they are treated with anti-fungal medicine. They may last for years and can sometimes drain small amounts of pus.

Splinters from plants are also more likely to carry bacteria like Staphylococcus aureus or golden staph, Dr Sheridan says.

If this is the case, a splinter in the foot might result in a visible red streak up the leg around 24 hours later — again a result of inflammation in the lymph vessels.

If you develop fever and chills, that’s likely a sign of a severe bacterial infection.

Leave a thorn or splinter of wood in your body for a few months, and it’s likely to disintegrate and further stimulate your body’s immune response.

And any infection left untreated can spread and cause septicaemia or blood poisoning.

So leaving a splinter alone isn’t without risks.

To remove or not

While it’s hard to be definitive, Dr Sheridan’s general rule of thumb is that if a splinter is easy to get out, you should get it out, regardless of what it’s made of.

“You wouldn’t want someone digging around with dirty pliers,” he warns. But if it’s in the surface, and you can get it out fairly easily without breaking it up, “go for it”.

What’s your burning health question?

Are noisy joints a sign of arthritis? Will going vegetarian reduce your cancer risk? Does mould cause asthma?

We can’t diagnose your health problems, but if you’ve got a burning question of a general health nature, get in touch via [email protected] and we’ll take it to the experts.

If you can’t get it out, it’s in deep, or you think the splinter is vegetable matter, Dr Sheridan advises seeing your GP — ideally within 48 to 72 hours, before any infection has time to take hold.

You can probably be a bit more relaxed if you think the splinter is a bit of glass, metal or plastic, Dr Sheridan says, but it’s a good idea to keep an eye on it.

And bear in mind that splinters of any kind can be risky for anyone with medical conditions including diabetes, lowered immunity or diseased blood vessels.

Whatever the cause, a deep splinter that’s caused infection may need to be cut out under local anaesthetic, followed by careful washing of the area.

You may also require medication to ensure the infection doesn’t continue to spread, even after the splinter is gone.

Can splinters come out by themselves?

Movement of your body can see a splinter “work its way out”. The action of immune cells migrating to the area also achieves this result, although this can cause localised pain.

“You get a build-up of pus under pressure, an abscess, and if it bursts, the splinter can float out,'” Dr Sheridan says.

Home remedies for splinters

These common methods for removing splinters may increase infection risk.

• Place a piece of eggshell lining over affected area
• Soak the area in vinegar
• Place banana skin on the area
• Use baking soda paste on the area
• Place a piece of potato skin on the affected area

*If you want a natural treatment, Dr Sheridan suggests a dab of petroleum jelly to keep the area moist (which makes it easier for the splinter to come out by itself) and cover with a dressing if needed.

The natural process of cells in the surface skin layer being pushed out and replaced can eject a splinter too.

“Often when a splinter’s perceived as working its way out, it’s more that your skin’s turned over and the splinter’s ridden the escalator out, so to speak,'” Dr Sheridan says.

If the body can’t get rid of a splinter, it may “wall it off” to form an internal lump known as a granuloma.

The splinter can re-emerge at the surface, sometimes years later, or remain encased and “dormant”, Dr Sheridan says.

“I’ve had patients who do angle grinding, or something like that, and when you do surgery to remove an unrelated skin cancer, you can find little metal splinters within their exposed skin.”

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90,000 “I have tested positive for coronavirus.” What to do?

April 18, 2020

Photo author, Unian

Rapid tests for coronavirus from a Ukrainian manufacturer appeared in Ukrainian pharmacies. Estimated price – 450-600 UAH.

What to do in case of both positive and negative results, and how accurate such rapid tests are, tells BBC News Ukraine.

Tests and Tests

Two methods are currently used to diagnose COVID-19.

The first is PCR tests (polymerase chain reaction). This is one of the newest and most accurate diagnostic methods that can only be carried out in a laboratory. The result is usually ready in 5-7 hours.

The second method is express tests. For analysis, you need to take a swab from the nose or blood from a finger, and the result is known for 10-15 minutes.

Photo author, e-apteka.com.ua

Now in Ukraine they sell tests of Ukrainian production “AT-Coronavirus-test-MBA”. They can be done at home.To do this, you need to take some blood from your finger.

The kit includes a means for collecting blood, a test cassette, instructions. During the analysis, a drop of blood is left in the well of the test cassette until stripes appear.

Two stripes – positive, one negative.

Test – negative, am I healthy?

If the rapid test showed a negative result, this does not mean that the person is healthy. It only shows the presence of antibodies to coronavirus, which may appear on the 5th day after infection or later.That is, you can be infected, but still get a negative result.

Author of the photo, BBC

It is difficult to identify an infected patient in the first days: if a person fell ill yesterday, then today an express test will not show the disease.

“There is still a point in doing these rapid tests, because if a patient with pneumonia tests positive, then we are 95% sure that it is a coronavirus,” says Yuri Zhigarev, an infectious disease doctor.

What could go wrong?

The manufacturer’s instructions indicate that rapid tests are used only for preliminary diagnostics, “the test result must be confirmed by other methods” in conjunction with all clinical information, and only a doctor makes a decision on the diagnosis.

“Performing the test on your own carries the risk that patients will use it incorrectly,” warns the former head of the Ukrainian Ministry of Health Ulyana Suprun.

Photo author, BBC

For example, an unprepared person may take the wrong blood and put too little or too much blood into the well, incorrectly fix the time for reading the result, perform the test in unsuitable conditions for this.

“All of these factors affect the accuracy of the result.And it is very likely that a person without skills will not be able to fully comply with all the conditions at home. Because of this, people can get erroneous (positive or negative) results. In both cases, it is dangerous, “Suprun writes on Facebook.

What to do if the test is positive?

Do not panic. Tests can give erroneous results. the disease is easy and asymptomatic

As the Ministry of Health told BBC News Ukraine, the first three actions that a person with a positive test must perform: self-isolation, a call to the family doctor, outpatient treatment.

If symptoms worsen, call your family doctor and call an ambulance.

Since March 29, Ukraine has updated standards for the provision of medical care to patients with COVID-19.

According to them, patients with a mild form of the disease, who do not have the risk of complications, as well as recovering patients, do not require round-the-clock medical supervision and can be treated on an outpatient basis, that is, at home.

In this case, doctors must constantly monitor the condition of the patient and his contact persons by phone or come for an examination.

The Ministry of Health urges not to self-medicate and be sure to report a positive test result, if any.

If a person with a positive test remains on self-isolation, he does not violate anything, the Ministry of Health explained.

But if the infected knew that he was sick, hid it and infected others, he faces a fine of 17-51 thousand hryvnia or even imprisonment if his actions led to the death of people.

“Rapid tests should be available to family doctors and free of charge for patients, not on the shelves in pharmacies.If you have a reason to take a test, then it is better to contact your family doctor, and do not run straight to the pharmacy, “says Ulyana Suprun.

Treatment and care of venous trophic ulcers

Treatment of venous insufficiency and venous trophic ulcers is a team work in which the patient himself plays an important role. If the patient understands the essence of his illness and its causes, if the treatment is carried out continuously with the support of both the family doctor and the family nurse and specialist doctor, then this helps to recover even in the most severe cases.Since, unfortunately, the cause of the ulcer cannot be completely eliminated, the treatment of venous insufficiency must be lifelong to avoid the recurrence of ulcers.

This patient guide provides simple guidance on how to prevent ulcers and how to treat existing ulcers.

Venous trophic ulcer is a chronic, often poorly healing leg ulcer caused by venous disease. The ulcer usually develops in the lower third of the lower leg, near the ankle, on the inner side of the lower leg.

The causes of venous trophic ulcers are:

Vein dilatation, which can be caused by hereditary weakness of the connective tissue and is often present in many members of the same family. In the dilated veins of the lower extremities, the venous valves do not close completely, and part of the blood moving towards the heart flows back through the unclosed venous valves, and thus the blood pressure in the veins of the lower extremities, and especially in the lower leg, rises.
Less commonly, varicose veins occur as a consequence of some other condition (pregnancy, tumors in the abdominal cavity), due to which the flow of blood towards the heart is difficult.
Inflammation of the walls of the veins, which directly damages the valves of the veins and is the cause of venous insufficiency.

The blood circulation consists of arterial, venous and capillary parts. The arteries carry oxygenated and nutrient-rich blood to all tissues of the body.Veins are also a collecting system that transports blood back towards the heart. In the veins, blood flows from the veins of the lower extremities towards the heart. This movement is provided by venous valves that direct blood in one direction and a muscle pump (calf muscles), which work during physical activity.

If the veins are dilated and the venous valves are damaged due to previous inflammation, there is a backflow of blood and stagnation of blood in the lower part of the venous system. The vein wall becomes thinner and its permeability increases. This leads to edema in the lower extremities, especially in the ankle area. The swelling increases in the evening and decreases in the morning, after a person has been in a horizontal position for a long time. If the edema does not go away for a long time, red blood cells begin to leave the bloodstream through the thin wall of the veins, which stain the skin in a brownish-purple hue. The metabolism of the skin is disturbed, the skin and subcutaneous tissues become thinner, it becomes dry and eczema develops.If the edema is left untreated, a poorly healing venous trophic ulcer may develop (usually after microtrauma).

Figure 1. Normal and dilated (varicose) veins

• Heredity: Heredity has been shown to play an important role in the development of varicose veins. Often, problems with varicose veins occur in several generations of the same family. The first varicose veins can occur at a young age.
• Overweight: Being overweight or obese places an increased strain on the lower limbs, and the fat in the abdominal cavity interferes with the return of venous blood towards the heart.
• Gender: Venous insufficiency is most common in women.
• Age: The incidence of venous trophic ulcers usually increases with age.
• Prolonged standing and sitting: the movement of blood towards the heart provides, among other things, muscles. Physical activity triggers the muscle pump, which improves the movement of blood through the veins towards the heart. Long-term standing and sitting in one place increases congestion in the veins and causes swelling in the legs and feet.Therefore, varicose veins most often appear in workers who spend their working day on their feet or sitting (for example, hairdressers, salespeople, chauffeurs, office workers).
• Smoking impairs blood circulation.
• Pregnancy (s): In case of pregnancy, the fetus presses on the veins in the abdominal region and causes increased pressure in the lower extremities. The reason for the appearance of varicose veins can also be hormonal changes in the body during pregnancy.Pregnancy itself is not a cause of venous disease, but it can accelerate the onset of venous insufficiency. Each subsequent pregnancy increases the risk of developing venous insufficiency.

• The dilated veins on the lower extremities become clearly visible: both the capillary network, which takes on a cyanotic hue, and veins, which can be expanded to the width of the thickness of a finger, can be expanded.
• Pain and itching in the inner part of the lower leg, in the lower third of the lower leg.
• Towards evening, the feeling of heaviness and fatigue increases in the legs.
• Edema appears on the lower limb, especially on the ankle, which increases in the evening.

Photo 1. Dilated veins on the lower leg

The fact of edema can be established by pressing a finger on the front surface of the lower part of the lower leg. A dent will appear under the finger, which will disappear after a few minutes. The cause of edema is an increase in the permeability of the walls of venous vessels, due to the fact that the pressure in them increases.

Discoloration of the skin on the lower leg is a dangerous signal that chronic venous insufficiency has reached a phase during which there is an increased risk of ulceration.

Signs indicating the danger of ulcers:

• Redness around the ankle.
• Skin pigmentation (skin turned brown): due to chronic venous insufficiency, in addition to plasma (the transition of which causes edema), red blood cells also begin to pass through the walls of the venous vessels into the tissues, which change the skin color to brownish-purple.
• Sclerosis or hardening of the skin and subcutaneous tissue: an increase in blood pressure develops a hardening of the skin and subcutaneous tissue in the ankle, which makes the subcutaneous tissue and skin thinner, the lower leg becomes thinner compared to the calf muscle and the leg resembles an inverted champagne bottle. Thinning skin becomes very easily traumatized.
• Whitish spots: Characterized by bright white spots that appear against a background of skin pigmentation.
• Skin inflammation (eczema): The lower leg may develop a purple, itchy and painful rash. The surface of the skin can be dry or, conversely, damp.

Photo 2. Edema and changes in the skin of the left leg. The shin resembles an inverted champagne bottle.

Photo 3. Varicose (dry) eczema

Photo 4. Skin hyperpigmentation, against which atrophic spots are visible

Photo 5. Typical skin changes accompanying chronic venous insufficiency, ulcers are visible on their background

A venous trophic ulcer usually develops as a result of the long-term presence of increased pressure in the venous system, and with the help of effective preventive measures, the occurrence of ulcers can be avoided.

For this:

• Avoid swelling of the extremities: In the veins, blood flows from the extremities towards the heart, from bottom to top – i. e. in the direction opposite to gravity. This explains why edema occurs when a person with venous insufficiency sits or stands for a long time. By the morning, the swelling decreases, since the legs were in a horizontal position all night. A person can use the same principle to his advantage if during the day he finds time to lie down for a while with his legs raised.The congested veins are relieved by gravity. If the legs are raised above the level of the chest, then the swelling of the tissues in them will decrease.
• Move. The calves of the legs are said to contain the person’s “other heart”, which helps to pump blood towards the heart. The calf muscle helps blood circulation in the veins. Walking at a moderate pace or cycling helps the blood circulate better in the veins. If physical activity is not possible for any reason, the calf muscles can be made to work with the help of targeted flexion and extension of the toes.Long-term standing or sitting in one position is the most inappropriate for this disease, this position can lead to an increase in edema and aggravation of venous insufficiency.
• Avoid Excessive Heat: Veins are known to worsen, usually in the summer during warm weather. If possible, avoid hot steam rooms in the sauna, baths, washing in too warm water. It is recommended to shower with lukewarm water.
• Moisturize dry damaged skin with base creams.The odorless and dye-free creams sold in pharmacies help restore the required moisture and elasticity level in problem areas of the skin and do not cause allergies.
• Quit smoking and try to reduce your alcohol intake.
• Food must be healthy.
• Try to lose weight.
• Avoid injury. Use compression treatment (see details on page 15): chronic venous insufficiency requires compression treatment – daily and constant wearing of special compression stockings or bandages.Such medical medical stockings and elastic bandages change the blood exchange in the veins with the help of external pressure and make it more efficient. Stockings should be worn on the legs (or bandages) in the morning to prevent swelling during the day. Healing stockings or bandages should be removed in the evening before going to bed. Compression treatment is not applicable to bedridden patients. Do not forget that compression treatment is effective in preventing ulcers only when done continuously!
• Other treatment options for varicose veins: Talk to your family doctor about surgical options, which today mean more than just surgery.If necessary, the family doctor will write out a referral sheet for an appointment with a specialist doctor.

B a venous trophic ulcer occurs against the background of a previous long-term skin change, usually after a microtrauma (for example, a mosquito bite, a scratch) in the lower leg region. Edema and metabolic disorders in the tissue lead to the fact that the ulcer begins to gradually increase, its surface may initially be covered with a brownish or blackish crust. This is a sign of dead tissue or necrosis.From the ulcer, edematous fluid collected in the tissue is released, which is a good breeding ground for microbes on healthy skin and in the environment. In the ulcer, chronic inflammation begins to develop, which in turn increases edema and creates metabolic disorders in the tissues. There is a so-called “vicious circle” in which the resulting ulcer worsens the condition of the veins and this, in turn, is the cause of metabolic disorders in the ulcer and the surrounding tissue.

Although chronic venous insufficiency is the most common cause of chronic leg ulcers, there is a group of other diseases that also lead to leg ulcers.

Often, patients with ulcers worry if the ulcer can cause gangrene, which can lead to limb amputation. In fact, a venous ulcer does not cause gangrene. Gangrene occurs due to disturbances in the arterial circulation, as a result of which the tissues do not receive enough oxygen and nutrients. This circulatory disorder occurs due to narrowing or blockage of the arteries (arterial or ischemic ulcer). In this case, painful ulcers may develop on the lower limbs and most often on the feet.Circulatory insufficiency is usually indicated by a feeling of coldness in the legs, difficulty walking (the so-called variable claudication), and pain in the lower leg and feet.

Leg ulcers can also be those in which both the venous and arterial circulatory systems can be damaged.

In addition, there are some other conditions of the body that cause ulcers. In such cases, a thorough examination by a family doctor or an angiosurgeon should be carried out before starting compression therapy.

Be sure to inform your family doctor if you have diabetes, hypertension, neurological diseases, diseases of the joints and gastrointestinal tract, or if you have a malignant tumor. Your family doctor can help you find out the true cause of ulcers.

Medical compression treatment is carried out with an elastic bandage or medical stocking, which applies pressure from the outside and thus helps the venous valves and improves blood flow in the veins.Compression means do not need to be used at night. Compression
therapy is not applicable to bedridden patients.

Compression treatment is the main treatment for chronic venous insufficiency and venous trophic ulcers, eliminating the underlying cause of this disease. The most important thing in this treatment is its continuity.

Effect of compression treatment on the venous system:

• improves blood flow in the veins, making the work of venous valves more efficient
• reduces the volume of excess venous blood in the extremities
• reduces the return of blood (reflux) in superficial and / or deep veins
• reduces the increased blood pressure in the veins due to the disease.

Compression action on fabric:

• Reduces tissue pressure
• reduces inflammation
• promotes tissue healing

Special compression stockings or elastic bandages can be used as compression treatment.

Compression stockings are divided into compression classes

Compression class I, II, III and IV stockings are very effective in the treatment of venous insufficiency.The decision about which class of stockings to choose is made by the doctor depending on the level of venous insufficiency and the condition of the arteries of the lower extremities. In the case of concomitant arterial insufficiency, too much compression can lead to a deterioration in the blood supply to the legs.

Compression stockings are available from shops selling medical aids . Medical stocking must be selected individually according to the patient’s size.Since putting on the medicated stocking for the first time can be very difficult, ask the salesperson for help. If necessary, ask for aids to tighten the stocking.
Be sure to ask for how long and under what conditions the warranty for purchased medical stockings is valid.

When choosing compression stockings, make sure that the packaging of the stockings bears the EU mark. In this case, you can be sure that the stocking will give the necessary compression.

Photo 6 and 7.Correct position of the medical stocking and golf course

The upper edge of the medical stocking should not reach the groin, but only the height of the fold of the buttocks. Knee-highs should not be higher than two centimeters from the knee joint. Medical stockings have a wide, soft, fixed top (piping) that prevents the stockings from sliding down.

In addition to medical golf and stockings, you can also use medical tights. Preference should be given to medicated stockings and tights, but the constant wearing of medicated golf will certainly be better than refusing compression treatment.

There are also prophylactic stockings for the prevention of thrombosis, which are worn during and after surgery (usually white stockings). They are not suitable for the treatment of venous insufficiency!

How to wear compression stockings?

One of the reasons that compression treatment does not work is that the medicated stockings are very difficult to put on. Often, patients refuse compression stockings precisely because of the inconvenience of using them.

Indeed, in the beginning, the stockings are very tight. Since the leg is swollen, pulling on the stocking often fails. However, there are several medical aids that make it easier to put the medicated stocking on your leg. For example, there is a special frame on which a medical stocking is put on and then a leg is placed in it with a sliding motion.

In the case of a stocking without a sock, a pouch with a sliding surface or a silk handkerchief can be used as a medical aid, which is placed on the toe of the foot and the stocking is pulled in a sliding manner over the leg.Later, the auxiliary is removed through the open toe of the stocking.

In the case of a closed-toe stocking, you need to turn the medical stocking out, and, starting with the toes and feet, gradually pull the stocking up. You can use a special sliding film, which is fixed under the foot and on the lower leg, which will help when pulling on the medicated stocking.

Photos 8, 9, 10 and 11. Medical aids for pulling stockings

If putting on a medical stocking still fails, the reduction of edema should be started with the use of compression bandages.

Compression bandages are a good alternative to compression stockings in case a patient has problems putting on a compression stocking through an ulcer. Stretch elastic bandages with a width of more than 10 cm and a length of more than 7 meters should be preferred as they give the best result. If the bandage feels stiff and irritates the skin, a cotton tubular bandage, which is usually used under a cast, can be placed under the bandage. The bandage is placed on your leg in the morning right after you wake up, that is, at the moment when the swelling has not yet had time to form.Bandaging with strong pressure begins with the foot and moves upward in bandaging circles so that the next circle covers 2/3 of the previous one. The last circle of dressing is fixed with a plaster. To fix the bandage, you cannot use the pins in the bandage package – they are intended only to secure the bandage roll itself.

Compression medical devices must provide the necessary pressure: the greatest pressure should be in the lower third of the lower leg and it should decrease towards the heart.

Photo 12. A cotton tubular stocking and softening cotton are placed under the compression bandage

Photo 13. The bandage is started from the foot, immediately at the toes, slightly pulling the bandage. The strongest pressure should be in the ankle area

Photo 14. An elastic bandage is fixed on the lower leg with a plaster. To fix the bandage, you cannot use the pins supplied with the bandage package

Photo 15. Bandaging of the thigh area begins while standing from the upper part of the lower leg, upward pressure should decrease

Photo 16.Compression bandage

It is important to start treatment in the morning, when the limb is not yet swollen or the swelling is still small. The pressure can be increased gradually. The greatest pressure should be in the lower leg and decrease upward. In order to understand whether the amount of pressure acting in the ankle area is sufficient, it is necessary to place a cuff from a pressure measuring device on the lower part of the lower leg and pump it up to a pressure of 30 mm Hg. Art. – this will be for you a comparative indicator of the sensation of a sufficient level of pressure for a medical stocking.

From the point of view of achieving the ultimate goal of treatment, its constancy is very important. Medical stockings or compression dressings must be used every day and neither a visit to the doctor nor other events are exempt from these procedures. A single occurrence of edema is enough and the efforts aimed at the long-term treatment carried out before this will be wasted .

One of the reasons that compression treatment does not work is that medicated stockings are very difficult to put on.Often, patients refuse compression stockings precisely because of the inconvenience of using them. However, without constant treatment, improvement in the condition cannot be expected.

Physical activity plays a very important role in the treatment of venous insufficiency. Walking at a moderate pace helps pump blood upward better through the work of the calf muscles. Cycling trips are also valid. If physical activity is not possible for any reason, then flexion and extension exercises of the feet will help (see.Attachment 1). The most inappropriate for the patient is standing or sitting in one position for a long time. In such cases, the patient must find the opportunity to sometimes walk or lie down with raised legs – this is so that the veins, which are under great pressure, could be released from excess blood volume. Place pillows under your knees, legs and feet so that the feet are 20-30 cm higher than the buttocks and so that you can lie comfortably. It is advisable to lie in this position for at least 20-30 minutes, repeating such sessions several times a day if necessary.You need to walk at least 30 minutes a day.

The effectiveness of the use of food additives in the treatment of venous trophic ulcers has not been proven. If the patient feels that they are getting relief from the use of nutritional supplements, then the use of such supplements purchased from pharmacies is not contraindicated.

The intensity of pain in the case of an ulcer is very individual. In some cases, pain relievers are needed only before the dressing procedure, in other cases, the pain can be very severe and requires constant use of pain relievers.Discuss the use of pain relievers with your family doctor, as if the number of pain relievers to be taken is constantly increasing, it is better to use stronger pain relievers or combine them with other medications. If needed, help can be obtained from the pain counseling rooms available at major hospitals.

Dry and flaky skin on the lower legs is a common problem with vein diseases, which requires care. In such cases, help can be obtained by using over-the-counter base creams.Pharmacy creams are non-allergenic and restore natural moisture levels in dry skin areas. In the case of moist eczema, the use of zinc paste is recommended. If your skin does not improve, you should seek the advice of your family doctor.

Depending on its nature and the means of treatment used, the ulcer needs constant dressing, which can last for months or even years. Often the dressing is performed by a trained FHN or FH.At the same time, the patient himself and his relatives should have basic knowledge of the treatment of ulcers and be able to change the bandages on their own. Changing bandages on their own allows patients to be more flexible in their daily life plans, which is more convenient for them. For questions regarding ulcer treatment, you can contact your family nurse and family nurse.

Try to avoid choosing the wrong remedies for ulcer treatment, as treatment should depend on the condition of the ulcer and its phase of development.Do not use home remedies (plantain, cabbage leaves, baked onions, etc.) to treat ulcers.

• If necessary, take your prescribed pain relievers 15-20 minutes before changing the bandage.
• Wash your hands.
• First of all, carefully remove the bandage from the ulcer; if necessary, this can be done by soaking the bandage with water or saline. Because the dressing is soaked in ulcer secretions and bacteria, pack this dangerous infectious material in a plastic bag. Avoid reusing the dressing. Prefer sterile dressings when dressing.
• Rinse the ulcer with lukewarm water with light pressure under a shower, taking care to carefully remove the ulcer crust with a swab. If not in a shower, rinse the ulcer with lukewarm water, being careful to gently remove the crust of the ulcer with a clean swab. To date, there is no evidence that the use of antiseptics is better than the use of running warm water.Many antiseptics are really effective for ulcerative infections, but at the same time they inhibit the healing process. When cleaning ulcers, do not use hydrogen peroxide, since it has a scientifically proven toxic effect on tissue cells.
• Dry the surrounding tissue ulcers and the ulcer itself by lightly touching them with a swab (the ulcer cannot be rubbed hard).
• If necessary, apply cream to the surrounding dry skin.
• If the ulcer has a bad smell, redness or other signs of infection, the ulcer can be washed out with an alcohol-free antiseptic.
• In case of ulcer discharge, zinc products or other barrier creams (barrier creams) can be used to protect the surrounding skin.
• Place a suitable care product on the ulcer and secure with a bandage (the patch may in turn damage the delicate skin surrounding the ulcer). The FHN, ulcer nurse or home nurse will advise you which remedy to use, and this will depend on the phase of ulcer development, discharge from it, signs of inflammation and whether the remedy is right for you.
• Continue compression treatment.

Photo 17. Cleansing the ulcer with a swab

Photo 18. To remove the purulent, foul-smelling cover layer of the ulcer, use antiseptics to wash the ulcers

Photo 19. Dry the skin surrounding the ulcer by lightly touching the swab

Photo 20. Apply a protective cream to the skin surrounding the ulcer

Photo 21. Apply ulcer to the ulcer

Photo 22.Fix the ulcer care product with elastic
bandage without strong pressure, but securely

An ulcer goes through several phases in its healing, which require different means of ulcer care. Modern ulcer care products are formed from substances that allow you to change the dressing less often while providing a suitable environment for ulcer healing. Either the family nurse or the family nurse acts as a consultant on the choice of a particular remedy.

Most of the costs of ulcer care are compensated by the Health Insurance Fund on the basis of the digirecept prescribed by the family doctor or specialist doctor.

Do not keep the ulcer open! If the ulcer dries in the open air, the condition will worsen and the risk of infection increases.

Also, home remedies (like plantain, cabbage leaves, etc.) should not be applied to an open ulcer, since an open ulcer is the gateway to infection.

Since chronic venous trophic ulcer requires long-term treatment, there is always the possibility that ulcerative infection may occur during treatment. Signs of an exacerbation of a chronic infection are not necessarily redness, a purulent top layer, or a fever – the symptoms may be less noticeable.

See your doctor if:

• The ulcer became reddened, painful and its temperature increased
• Despite treatment, the ulcer began to enlarge.
• So-called “pockets” have developed at the edges of the ulcer.
• Purulent, profuse discharge with a bad odor follows from the ulcer.
• Feeling unwell and fever.

The family doctor may recommend the use of antibacterial remedies for ulcers or, if necessary, prescribe anti-inflammatory treatment.

Photo 23. Infected chronic ulcer

A chronic ulcer may take several months to heal despite effective treatment.Even though the ulcer will heal, the cause of the ulcer is still there. Often, after the ulcer has healed, patients no longer bother with compression treatment and refuse to use medical stockings and bandages. However, just one episode of edema is enough – and a new ulcer may develop. To avoid the emergence of a new ulcer, the key words are life-long and permanent compression treatment.

Photo 24. Healing ulcer

Leather plastics.For whom? Why? When?

If the treated ulcer does not heal within a period of four to six months, the specialist doctor will decide whether a skin plastic surgery is necessary. Skin plasty is a fairly simple operation that helps the ulcer heal, but does not correct the cause of its occurrence. Therefore, the operation is performed only for those patients who continue the compression treatment procedures after the ulcer has healed. A new ulcer (relapse) occurs in about half of patients and is caused precisely by the interruption of compression treatment after the ulcer has healed.Just a short-term jump in pressure in the veins is enough – and the transplanted skin dies off and a new ulcer appears.

Photos 25 and 26. Ulcer before skin grafting and ulcer covered with skin grafting

Often venous trophic ulcer is not the only problem of the patient. The patient may also have developed heart failure, diabetes and other diseases that can interfere with the healing of the ulcer. Discuss your health problems with your family doctor, who can help you keep your comorbidities under control.

Venous trophic ulcer is a long-term problem that complicates the patient’s daily life. In order to cope with it, the help of various specialists is needed. The key to solving the problem of ulcer healing lies in the hands of the patient himself, and to achieve success requires constant work according to the treatment plan prescribed by the doctor.

• The level of compression of the medical stockings required for you is determined by the doctor depending on the severity of the venous insufficiency and the condition of the arteries.
• Healing stockings are available at health stores. The sellers of these stores will be able to measure your leg and help you choose the right stocking.
• When choosing compression stockings, knee-highs or tights, make sure that the packaging or the stockings themselves bear the RAL-GZ 387: 2000 mark and the compression class (CCL 1-CCL 4). So you can be sure that the stocking will give gradual.

RAL-GZ 387: 2000 mark

• Different countries have different standards.Make sure that the purchased stockings have exactly the pressure that the doctor prescribed for you.

• Since putting on the medicated stocking for the first time can be very difficult, ask your dealer for help.
• Be sure to ask for how long and under what conditions the guarantee for medical stockings is valid.
• If you think that pulling on the stocking yourself may be too difficult for you, ask your dealer for aids.

Photo 1. Frame for pulling on the legs of the compression stocking

Photo 2. Foot pocket for pulling on a medical stocking with an open toe

Photo 3. A pull-out foot pocket designed for pulling on a medical stocking with open and closed toes

Photo 4. Gloves with a special coating for pulling medical stockings

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4. Newton, H. Top tips for managing venous leg ulcers. Wounds International, Vol3, 2012.
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6. Moffatt, C . Compression Therapy in Practice. Wounds UK, 2007.
7. Anderson, I . What is venous leg ulcer. Wounds Essentials, Vol4, 2009 .
8. Collins, L., Seraj, S., Jefferson, T . Diagnosis and Treatment of VenousUlcers http://www.aafp.org/afp/2010/0415/p989.html.
9. Leg Ulcrs. Patient information http // www. Circulationfoundation.org.uk.
10. Griffin, J. Assessment and management of venouslegulcers. Wound Care Today, 2014, Vol 1, No 1.
11. Carmel, J. E. Venous Ulcers. Acute and chronic wounds 2012, chapter 12, 194-2013.

90,000 All tests for coronavirus “on the shelves”: how to pass, what will show

During a pandemic, none of us has one hundred percent protection against infection.And the insidiousness of the new virus is that for some time (at least a few days) it may not make itself felt in any way, or it may even be asymptomatic. At the same time, all this time a person secretes a virus, which means that he can infect others. However, today, fortunately, there is a diagnosis that allows you to answer the question: are you infected, is there an active viral process in your body and have you met the virus before. Therefore, experts do not doubt the need for mass testing of the population, which will allow to end the chains of spread of infection, and therefore, to quickly get out of the conditions of self-isolation in which we live today.

MK.ru reviewed various test systems that today allow you to determine whether you are infected with the coronavirus, even if you have no symptoms, and whether you have met with it in the past. The degree of their accuracy varies, but one thing is certain: they are completely safe and are simply necessary for many.

PCR diagnostic method

In order to diagnose the presence of a virus in the body, PCR tests – polymerase chain reaction – first appeared. These tests detect the DNA of the virus in a person’s genetic material (saliva).

The procedure is performed only by a medical professional in a hospital or at the patient’s home.

There are two methods of sampling biomaterial for research from a patient:

– From the nasopharynx and oral cavity and the method of deep sampling of biomaterial from the throat.

Testing takes from a few hours to two days.

According to doctors, the accuracy of PCR tests for the new coronavirus is on average 30-60%.

What is important to know:

Conduct testing in the first days of the course of the disease;

Testing does not diagnose an infection if the virus has descended into the lungs and below;

It is good to carry out in patients with severe symptoms of the disease, high fever, cough – then this diagnostic method is most indicative.

For infected individuals tested in the second week, deep airway material taken with a suction catheter or expectorant material (sputum) can be used as an alternative.

The first PCR tests were developed on the basis of the “genetic passport” of the virus, which the Chinese submitted to the international genetic bank. Then there was no live virus strain in the country, so the first tests, which were registered in Russia in February, were not very sensitive.And yet they were approved at the international level and received the status of “reference”, which gives the right to apply them around the world and even compare the results with them as a standard. After the Russian Federation had its own live strain, our scientists developed several more test systems, which are widely used today to diagnose the virus in both patients and contact groups. And yet, in spite of everything, their sensitivity leaves much to be desired: the proportion of false-negative results is quite high.In addition, the accuracy of the test is highly dependent on the quality of the sampling (the nurse must take DNA samples from several places – the sinuses, throat, etc.).

According to the requirements of Rospotrebnadzor, if a patient is diagnosed with a coronavirus, two negative PCR tests are required for discharge and confirmation of recovery.

In April, rapid tests appeared in Russia that determine antibodies to Covid IgG and IgM to SARS-Cov-2 by blood analysis. IgM antibodies appear in the blood of an infected person along with the virus and last from six weeks to two months (in rare cases, up to six months), depending on the infection.Antibodies of the IgG class arise after the 10th day of illness (on the 14th day) and remain for a long time, and in many infectious diseases for life, and their presence to some pathogen in the blood indicates that a person has met with him. For example, with the SARS and MERS coronaviruses, it is known that they persist for three to five years.

Thus, testing for antibodies allows you to answer two questions at once: whether a person is currently infected (this will show the presence of positive IgM antibodies in the blood) and whether a person had an infection earlier and received immunity to re-infection (this will be indicated by the presence of antibodies IgG to the virus).

What is important to know: immunity is not developed forever, but only for the next six months or a year. Further reinfection is possible.

This type of test is presented in two formats: rapid tests for antibodies (ICA) and a conventional enzyme-linked immunosorbent assay (ELISA), which, on the one hand, determines whether a person has met a virus (whether there are antibodies), on the other hand, it shows that he might have immunity.

ELISA (IKhLA) (enzyme immunoassay and immunochemiluminescence analysis) is a laboratory test for blood from a vein, with the help of which the immune response to the virus is detected.

What is important to know:

the sampling of material is carried out in the clinic, as well as with the departure of the medical team to the house or office;

test results – within a few days;

blood is taken from the patient’s vein.

ELISA tests show the presence of immunoglobulins G in human plasma and indicate that the person has already been ill and has developed immunity to the virus.

But the patient receives the result in 1-2 days, and special laboratory equipment is required.

Using these tests, the titer (amount) of antibodies in plasma is also determined. On the one hand, the more of them in the blood, the higher the immunity to the virus. On the other hand, a high titer of antibodies gives a person the opportunity to become a plasma donor, that is, to save the lives of those who are seriously ill. In Moscow, the reception of plasma from donors has already begun, and doctors say the first results of treatment with its help are encouraging.

In testing for antibodies, efficiency is especially important for medical workers (those who have already been ill can work on the front line without fear), and for any other professions.

Government agencies and enterprises are beginning to actively test their employees with express tests.

A rapid antibody test (ICA) allows you to answer two questions at once: whether a person is currently infected (this will show the presence of positive IgM antibodies in the blood) and whether a person has had an infection earlier and has received immunity to re-infection (this will be said the presence of IgG antibodies to the virus).

IgM is the first immunoglobulin that the body begins to produce in response to infection at about the 5th day, and is detected in the acute phase;

IgG – appears in the blood on the 14th day and provides the main immune response, as well as determines the presence and level of protective immunity after an illness.

What is important to know:

It is possible and necessary to conduct testing for everyone who does not have a high fever and pronounced signs of the disease;

For research, blood is taken from a finger;

The term for obtaining the results is 10 minutes.

The widest range of applications today: ambulance, employee testing, testing in clinics and hospitals, at border crossings and at checkpoints.

For research, blood is taken from a finger.

The term for obtaining the result is 10 minutes.

The sampling of material is carried out in the clinic, without the need for laboratory equipment, as well as with the departure of the medical team or medical personnel at the employer’s office.

The Rapid Antibody Test is a small meter with test strips. The specialist places a drop of the patient’s blood with a drop of buffer solution into it, and after about 10-15 minutes, the result appears. If a person has one strip opposite the letter M, this means that there are “fast” antibodies in his blood, which are produced in the body as soon as the virus arrives.In other words, the M bar means that a person is in an active viral process.

If a strip is displayed opposite the letter G, it means that we have in front of us the owner of antibodies that the body has developed to fight the infection. Their presence with a high degree of probability indicates the formation of immunity to the virus.

If both strips are highlighted at once, then this indicates that the person is sick right now and sick for at least 8 days. Doctors recommend such a patient to undergo additional examination.

Today in Russia, express tests for antibodies are registered (they examine blood and give a result in a few minutes) and quantitative tests for antibodies that examine plasma, but the results can be obtained only after a few days.

According to an expert on public health and international health, immunologist Nikolai Kryuchkov, the massive use of rapid test systems is a significant event in the history of healthcare, and such experience will be in demand in the future for the rapid diagnosis of a large number of people.

If we talk about a specific test system, then its analytical characteristics are very important. For example, one of them is sensitivity. If it is high, it means that the test is determining the minimum amount of the target substance in order to give a positive answer. This characteristic is extremely important for testing for the presence of the virus in the blood of currently infected people, that is, for PCR diagnostics.

For antibody tests, specificity is more important than sensitivity.That is, the ability to identify exactly the agent that we are looking for. According to various estimates, the specificity of antibody tests on the Russian market ranges from 90 to 98%.

Both sensitivity and specificity are equally important for rapid tests. In fact, these are quality indicators.

Answer – GBUZNO “Nizhny Novgorod Regional Center for the Prevention and Control of AIDS and Infectious Diseases”

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Vadim

Hello. Tell me if a person who has had tuberculosis can get HIV. Because of the decline of immunity?

Answer:

Hello. HIV is a virus; it cannot arise by itself. Only as a result of transmission from person to person.

Olga

Good afternoon. The situation is as follows. I have gingivitis. Gum bleeding occurs when brushing teeth. I drank water from the same bottle with HIV + (does not take treatment). I know that infection is impossible through saliva, but what if there was blood in his saliva? What is the likelihood of infection in this case and how often should HIV tests be done?

Answer:

Hello. It is safe to share HIV-positive dishes and drink water from one bottle.Even if contaminated blood enters the bottle, the concentration in water becomes not dangerous.

All citizens over 18 years of age are recommended to be tested at least once a year. If there were dangerous situations (for example, unprotected sexual contact), then it is recommended to take tests in a month, three months, half a year and then every year.

Inna

Before taking blood from a vein in a child, a nurse opened a container with used instruments, the handle of which was opened with dirty gloves.Without changing gloves, she took blood. Is there a risk of infection? It is disturbing that after about 40 days the child had a sore throat with a plaque on the tonsils and a slight increase in lymph nodes in the tonsils. After a course of antibiotics, everything went away, Thank God! The temperature was up to 37.8. day.

Answer:

Good afternoon! In the situation you describe, the risk of contracting HIV is excluded. For the risk of infection to arise, it is necessary that a visible drop of contaminated blood gets into an open, bleeding wound.

Irina

Good afternoon, can you please tell me if there is a risk of HIV infection? I was in a cafe and wiped my lip with a napkin, then noticed that there was blood on the napkin, but I had two fresh cracks on my lip but did not bleed. The time from when the napkins were brought and before I used them took about 30 minutes. Tell me there were risks?

Answer:

Hello. HIV lives outside the body for only a few minutes. Infection is impossible.

Tolstenevv Larisa

I like your site very much

Answer:

Thank you!

Camila

Is it possible to get infected if you take (a glass and a glass should have been washed after it) from which an HIV-infected person drank and accidentally touched a wound with a finger that has been in it for 2 days, as I understand it
not fresh.. in half a minute treated with alcohol and iodine

Answer:

Hello. In the described case, there is no risk of infection.

Natalia

Good afternoon. I bought panties in an online store, received them for lunch. In the evening (5 hours after receiving) I measured them on a naked body. At the same time, I shaved in the morning and had wounds. Is there a risk of contracting HIV, since it is unclear whether anyone has measured them before me.

Answer:

Hello. Thus, you cannot become infected with HIV.HIV does not live outside the human body; it dies in a few minutes.

Evgeniya

Good afternoon!
Can you say something about COVID-19 vaccinations for people living with HIV? Is it worth it or not?

Answer:

Hello. The COVID-19 vaccine does not contain the contraindication “HIV”, but the general state of immunity is important. Talk to your doctor before getting vaccinated.

Alexander

Can I get the coronavirus vaccine if I have HIV?

Answer:

Hello.The COVID-19 vaccine does not contain the contraindication “HIV”, but the general state of immunity is important. Talk to your doctor before getting vaccinated.

Oleg

Hello, I injected with a syringe of a person suffering from hepatitis C. That drug addict used it 40 minutes ago, I didn’t seem to have injected much, the blood didn’t come out, just a little bit the syringe went into the skin and I pulled it out. What is the risk of infection?

Answer:

Good afternoon. In the situation you describe, there is a risk of contracting hepatitis C, to clarify the diagnosis, take tests for Hepatitis C, taking into account that from two weeks to six months the virus may not be detected during testing.

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90,000 HIV-infected people complain about disclosure of their diagnosis

HIV-positive patients from all over Russia complain about the disclosure of medical confidentiality by doctors about their status. According to patients, in clinics and antenatal clinics, their diagnosis is often indicated directly on the covers of medical records, where anyone can see it. The Ministry of Health admits that such marks are illegal.

In 1998 Russia adopted the International Classification of Diseases (ICD-10), according to which all diagnoses related to HIV are coded with special alphanumeric designations: Z21, R75, B20-B24.Information about the presence of HIV should be entered in the medical record, which is used in regular clinics and antenatal clinics. “Like any other diagnosis, this is confidential information,” Aleksandr Ezdakov, an activist who defends the rights of HIV patients, told Kommersant. “However, in recent years, we have received reports that doctors are writing HIV-related disease codes directly to cover of the medical card “. In 2014, a patient from Samara complained to Mr. Ezdakov that such a marker had been put on her at the clinic, and now outsiders will be able to find out about the diagnosis: “I myself saw another patient’s card on the table of the therapist, where Z21 was written in large size.And next to it is the full name and address of this person. “

As the activist found out, the Samara Ministry of Health issued an order “On improving work to identify HIV-infected”, where doctors were directly obliged to put such marks on the first page of medical records. Mr. Ezdakov asked about the legality of the order to the Ministry of Health of the Samara Region, the Federal Ministry of Health and the Prosecutor General’s Office. Both ministries agreed that medical institutions are obliged to protect information about the diagnosis from “unauthorized access”, but at the same time “placing on the front of the medical card information about the disease in an open or encrypted form cannot be considered a violation of the patient’s right.”

However, the local prosecutor’s office nevertheless recognized the order as illegal and filed a protest with the Samara Ministry of Health. A message appeared on the official website of the Samara ministry that the order was canceled. After that, the Ministry of Health of the Russian Federation also sent a letter to Alexander Ezdakov, which says that “coding labeling of the cover of HIV-positive patients is not provided.” “Then I thought: everyone won,” says the activist. “But the other day, a year later, I received a letter from another patient from the Samara region with the same problem.”According to the girl who sent the letter, she went to the antenatal clinic to register for pregnancy and presented a certificate from the AIDS center. “Now they write to me in large numbers in each direction Z21 – both on the map and on any analysis,” she complains. “I am very afraid that someone outside the queue or clinic will see the direction with this code.” The patient lives in a small town and hides her diagnosis because she fears discrimination, and now she is generally afraid to go to doctors.

Now Alexander Ezdakov is conducting a survey at the largest forums of people living with HIV (in total, there are about 760 thousand of them in Russia.people.— Kommersant ). As it turned out, in almost all regions, doctors continue to indicate information about the diagnosis of HIV-positive patients on the cover of the card. “They put Z21 in my consultation,” says Galina from the Moscow region. “But this probably didn’t seem enough, so they crossed out the cover diagonally with a bold red line. And they put the same signs on all analyzes.” In Ryazan, the Tula region, Yekaterinburg, Chuvashia, Chelyabinsk, B20 is written on maps with a red pen. “I asked the doctor why she writes this code on the general urine test.Answer: “So that the laboratory assistant was careful,” writes Natalya from Novosibirsk. “Apparently, without this they turn to blood and urine at random.” In some cases, doctors don’t bother with codes at all. analyzes in the same way “, – writes a patient from Udmurtia. Patients from Samara and the Moscow region indicate that they write HIV on the cover of the card.

“Any markings on the cards disclosing HIV status against the will of the patient himself are illegal,” Oleg Salagai, director of the department of public health and communications of the Ministry of Health of the Russian Federation, told Kommersant.“There is no point in writing the diagnosis on the front cover page,” says Anzhelika Podymova, head physician of the Sverdlovsk regional AIDS center. “The HIV diagnosis is recorded inside the card. In her opinion, such marks are only harmful: patients are afraid that outsiders will find out their diagnosis, and doctors will be wary of patients.

Anastasia Kuzina, Alexander Chernykh

Home rapid HIV test: when it is used in Germany | Analysis of events in political life and society in Germany | DW

December 1 is World AIDS Day.Germany has made great strides in the fight against HIV infection. One of the evidence of this is the decrease in the number of new infections. Both therapy and timely diagnosis play an important role here. Professor Norbert Brockmeyer, who also heads the Center for Sexual Health, spoke about the methods of diagnosing HIV / AIDS and the need for further medical education of the population in an interview with DW.

DW: Who is the home-based rapid HIV test for ?

Norbert Brockmeier: It is intended primarily for those who are afraid of being labeled if it becomes known that they have taken an HIV test.Now such people only need to come to the pharmacy to buy a rapid test. This is not as conspicuous as going to medical facilities.

– How does this test work?

Norbert Brockmeier

– This test is done at home. To do this, you need to take some blood from your finger. This is the same as for a blood sugar test. Then drop a drop of blood onto a small plate with a tube, in which it is processed with the appropriate antigens.After a short time, either two bright stripes will appear on the plate – with a positive result. Or only one – if the result is negative.

– Can a home test replace going to the doctor?

– No, a visit to the doctor will not be unnecessary. If the analysis is positive, in any case, you should consult a doctor. It is imperative to start therapy as early as possible. Then people with HIV infection will be able to live as long as healthy people.

– How reliable is this test?

– Tests for HIV infection, like any others, do not guarantee one hundred percent accuracy.For HIV, the guideline criterion is to pass the test twice. This means that in any case, it is necessary to double-check whether the test result is really positive. We have already had patients who tested positive at home. But when they came to our center, the second test showed the opposite result.

– Is the test at your center anonymous?

– You can send analyzes to the laboratory anonymously, more precisely, semi-anonymously.Then you will be informed by phone or SMS. And you will be able to find out if the test was positive or negative. And if he is positive, then of course you should get the appropriate treatment as soon as possible.

People who have undergone therapeutic procedures are no longer a source of infection. Great success has been in reducing the incidence of new infections. This is due to the wonderful therapy and to the fact that with successful treatment, the virus is no longer detected in the blood.

– How popular is the test?

– Overall, the test performed well.It is also in great demand at our Sexual Health Center in Bochum. But we cannot ignore one fact. The population knows what HIV is and that it is necessary to take measures to protect against this infection. But other sexually transmitted diseases are more common than HIV. However, the population knows much less about them.

– What other tests can be done at your Center?

– If a person comes to us, then, in addition to testing for HIV, we propose to carry out tests for sexually transmitted diseases.For example, chlamydia or gonorrhea. The risk of being infected with them is much higher than getting HIV infection. And we must clearly convey this to everyone. Anyone who is afraid that he is infected with HIV should be tested for other sexually transmitted and similar diseases.

See also:

• 10 stars infected with HIV

  Freddie Mercury

  One of the first and most famous victims of HIV infection was the British singer of Parsi origin, songwriter, vocalist of the rock band Queen Freddie Mercury.He died in 1991 at the age of 45 in the prime of his life. Just a day before his death, he announced that he had AIDS.

• 10 stars infected with HIV

  Rudolf Nureyev

  The famous Soviet and British ballet dancer Rudolf Nureyev asked for political asylum in 1961 during a tour of the troupe of the Leningrad Opera and Ballet Theater in Paris. He lived in the West for a little over 30 years. Nuriev died of AIDS on January 6, 1993 at the age of 54.For many years, the dancer hid and denied rumors about his illness.

• 10 stars infected with HIV

  Andreas Lundstadt

  The Swedish musician is famous not only in his homeland, but also in Europe. He founded the pop group Alcazar, for a long time was its main soloist. In 2007, he publicly admitted to being HIV positive. Lundstedt’s open statement was greeted with great approval by representatives of the world of politics and show business.

• 10 stars infected with HIV

  Andy Bell

  Another musician who announced his HIV status is Andy Bell.The Englishman made the corresponding public statement in 2004, although the diagnosis was made 6 years before coming out. The musician is known to make donations to HIV education and research.

• 10 stars infected with HIV

  Mary Fisher

  American photographer and writer Mary Fisher, openly declared her status, has been a Goodwill Ambassador for the United Nations Program on HIV and AIDS (UNAIDS) since 2006. She runs her own foundation dedicated to research and education in the field.

• 10 stars infected with HIV

  Irwin “Magic” Johnson

  There are many HIV-infected people among successful athletes. Irwin “Magic” Johnson is one of the most famous basketball players in NBA history. By his confession, he turned the idea of ​​people that HIV can only be infected by drug addicts and homosexuals. The former basketball player is involved in educational and charitable activities for people living with HIV like him.

• 10 stars infected with HIV

  Tommy Morrison

  The former heavyweight boxer who starred in Rocky 5 with Sylvester Stallone died on September 1, 2013 at the age of 44, presumably of AIDS. The athlete contracted HIV almost 20 years ago, but for a long time did not want to believe in it, refusing therapy.

• 10 stars infected with HIV

  Greg Luganis

  American Greg Luganis is one of the best divers, four-time Olympic winner and five-time world champion.He found out about his status in 1988, but continued to participate in the sport, winning two more Olympic gold medals. However, Luganis found the strength to openly admit that he was HIV positive only in 1995, when his autobiography was published.

• 10 stars infected with HIV

  Nadia Benaissa

  German singer Nadia Benaissa became famous for her performance in the pop group No Angels. In 2010, Nadia left the group after receiving a two-year suspended sentence for infecting a sexual partner with HIV.The singer is raising her daughter, who was born in October 1999. During pregnancy, Nadia was diagnosed with HIV. Today she leads an ordinary life and is involved in projects to combat AIDS.

• 10 stars infected with HIV

  Charlie Sheen

  American actor Charlie Sheen is known for numerous scandals in his personal and public life, including those related to drug abuse. On November 17, 2015, Charlie Sheen admitted to being infected with HIV. According to him, he was diagnosed about four years ago.The reason for coming out was the blackmail of one of the prostitutes, who demanded a huge sum of money for her silence.

  Author: Victor Weitz

90,000 The scientist said how long the immunity to COVID-19 lasts

The new coronavirus has posed many questions for epidemiologists, to which there are no answers yet. But they will be, the head of the Department of Epidemiology of Irkutsk State Medical University, Doctor of Medical Sciences, Professor Alexander Botvinkin (pictured) is sure.

For this, the university began testing the population of the region for immunity to COVID-19, the scientist told Rossiyskaya Gazeta.

The virus came in the winter

Alexander Dmitrievich, I understand correctly, you are not conducting mass testing, but scientific research?

Alexander Botvinkin : Yes. Having accumulated enough material and analyzed it, we could give a more objective picture of the spread of the infection and adjust the strategy to combat the spread of COVID-19.

Therefore, we do not set the task of mass testing the population of the region. We need to collect material sufficient for scientific analysis, using the power of the Professor’s Blade of the University and the results obtained in other clinics and laboratories in Irkutsk.

But you are not doing your research blindly, are you? You probably already have specific assumptions that you intend to test?

Alexander Botvinkin : If you analyze the official information on the number of people infected and the spread of COVID-19 in the region, you will notice that most of the cases are not detected among the local population.

These are guests from neighboring countries or other regions of Russia. A striking example is labor migrants arriving at construction sites in the Angara region. Why then there was no sharp increase in the number of coronavirus infected among the local population, although tens of thousands of people were examined? What is this – the result of preventive self-isolation measures at the beginning of the epidemic? Or other measures that reduce the likelihood of transmission? Or maybe a certain percentage of Siberians have already suffered from this disease and have immunity?

It is known that during the winter, many Irkutsk residents with symptoms of acute respiratory infection were found to have human coronaviruses, which could change the population’s susceptibility to COVID-19.

That is, you assume that the coronavirus could circulate in the Baikal region earlier, even before the pandemic was declared?

Alexander Botvinkin : Why not? We cannot ignore this possibility. As an argument, I can cite a historical fact. Since the discovery of the human immunodeficiency virus (HIV) in the 1970s, new laboratory tests have shown it to have been detected in blood samples from humans much earlier.Perhaps this is not a completely correct example, since HIV infection is chronic and transmitted in other ways. But he demonstrates that science needs to test different versions, not just the obvious.

Looking for antibodies

Does the test 100% detect the presence of antibodies to COVID-19?

Alexander Botvinkin : Unfortunately, any test can give both false positive and false negative results. Cross-reactions with related viruses, such as human coronaviruses, are not excluded.But in general, the enzyme-linked immunosorbent assay (ELISA) is considered a fairly specific and sensitive test. Quantitative estimates for test systems for antibodies to the new coronavirus are not yet available, since their widespread use is just beginning. However, it is known that antibodies are produced in the body in response to both a clinically expressed disease and after an asymptomatic course of infection.

From what moment of illness can these antibodies be detected?

Alexander Botvinkin : Antibodies of class M can be detected by the end of the first week after infection.This is the “first line of defense” and they disappear pretty quickly. In the future, class G immunoglobulins begin to be produced. They are found in the blood from the end of the second week after the disease.

The number of antibodies peaks in the second or third month after infection, and during this period they are represented mainly by class G immunoglobulins, which persist in the body for up to a year or more. It is the presence of class G immunoglobulins in the blood that indicates a past infection.

Therefore, laboratories often use test systems specifically to detect immunoglobulins G. For COVID-19, such a test system was developed by the Novosibirsk Scientific Center of Virology and Biotechnology “Vector”. And several more similar test systems are licensed.

How is the sampling of material and, in fact, the analysis for antibodies itself?

Alexander Botvinkin : Blood is taken from the patient’s vein. With the help of centrifugation or another method, serum is separated, which serves as a material for research.After collecting a sufficient number of samples for analysis, they are delivered to a certified laboratory. For the study, special devices are used – ELISA analyzers. The analysis itself takes several hours.

Why do people get an answer after a few days?

Alexander Botvinkin : While the answer to the patient about the presence or absence of antibodies to the COVID-19 virus in his body will indeed be given in four to five days. It takes time to work out the entire technological chain.In the future, the time frame for obtaining the result, I hope, will be reduced.

Himself a laboratory assistant

They say that test strips for COVID-19 antibodies are about to appear in pharmacies. Just a drop of blood from a finger can be applied and there is no need to go to the laboratory.

Alexander Botvinkin : Yes, these are so-called chromatographic tests that work on the principle of pregnancy tests. But their sensitivity is lower than the standard ELISA analysis. It is possible that they may appear in pharmacies.

But I don’t think it’s good when we are dealing with an infectious disease. Biological safety issues and the need for medical knowledge to correctly interpret the result must be taken into account. For example, antibodies can be detected 10-14 days after infection, when the person is still infectious.

Does the proliferation of ELISA tests, their relatively low cost and quick results, mean that in the future they will be used to diagnose the disease?

Alexander Botvinkin : I think not yet.An antibody test is not very useful for diagnosing a disease because antibodies can be detected one to two weeks after the onset of the disease. With the help of a PCR test (polymerase chain reaction) for the detection of COVID-19, it is possible to detect the virus earlier. And this test is more specific and sensitive. Although in China, after the 2002-2003 epidemic, articles were published on the feasibility of the parallel use of PCR and an antibody test. In the future, for a mass survey of the population, an ELISA test can be developed to determine not only antibodies, but also the virus.But at this stage, the main point of using enzyme immunoassay is to retrospectively assess the patterns of the spread of coronavirus among the population.

Waiting for a vaccine

Mathematical methods exist and are used to predict peaks, plateaus and declines in an epidemic. This is not enough? Need antibody tests too?

Alexander Botvinkin : The mathematical models on the basis of which the forecasts were made basically assumed that the coronavirus was spreading in a population that was completely susceptible to it.And everyone has an equal chance of getting infected and getting sick. But in a real situation, this is not always the case. It is well known that even during plague epidemics, not all residents of a city or country fell ill.

Yes, according to reports from a number of European countries, we see that the calculated curves of growth and decline in the number of patients have been confirmed. But there are other examples as well. For example, in our region, similar calculations, fortunately, did not come true. After the detection of the first cases, the number of cases during April increased much more slowly in comparison with the forecast.The increase in the incidence in May is largely due to the migration of the population from other regions, which was not taken into account in the forecast. It is very important to understand why this happened.

Today there is a lot of talk about the need for mass testing, including for antibodies to COVID-19. What do you think?

Alexander Botvinkin : I think there is no need for mass testing. For scientific conclusions, a sample survey of the population is sufficient.

It is practically important to examine medical workers – in case of a positive result, they will not need to undergo weekly PCR testing and will be much safer to work with patients.Apparently, the examination of the contacts could reduce the burden on the observation departments.

On the other hand, there are people interested in doing such a study. Someone wants to communicate with elderly relatives, knowing that they have already been ill and will not infect them. Someone is very uncomfortable walking in masks and respirators, and some are simply tired of being afraid.

Is there a risk of re-infection?

Alexander Botvinkin : According to the data accumulated by epidemiologists, such a risk is not completely excluded.The global spread of COVID-19 began recently, there is not enough information for final conclusions. However, there is no doubt that the likelihood of a second illness for a person in whose blood antibodies to coronavirus are found is very small, at least during the first year. In the future, immunity may weaken.

This is also true of the immunity that develops after vaccination. For example, those vaccinated against measles in childhood can become ill in adulthood after contact with a sick person.Therefore, revaccination and selective testing of the population for antibodies to the measles virus are envisaged. Similar problems will arise after the vaccination of the population against coronavirus infection begins. However, it must be understood that vaccination is the only reliable method of preventing respiratory infections. But so far we do not have a vaccine at our disposal.

And the spread of COVID-19 continues, and we have to endure restrictions in public life. And, of course, no one has canceled the sanitary and hygienic rules that have already become firmly established in our lives: avoid confined spaces with a large crowd of people, observe social distance, do not touch your face with your hands, wash your hands more often.And be healthy.