Seasonal Affective Disorder “Winter Blues”

Seasonal Affective Disorder “Winter Blues”

Seasonal Affective Disorder – Depression is one of the mental health problems that can affect people around the world. Mental health is a major issue for adolescents. WHO said up to half of mental health conditions start before the age of 14. Poor mental health is the leading cause of disability in young people, and accounts for a large proportion of the global disease burden during adolescence. Suicide is third leading cause of death in 15-19 years-old.1

Also Read Things People With Diabetes Must Know About the COVID-19 Vaccines


Seasonal affective disorder is a form of depression also known as SAD, seasonal depression or winter depression.2. Many people may experience mood changes begin and end when the seasons change.

In most cases, SAD symptoms start in the late fall or early winter and go away during the spring and summer; this is known as winter-pattern SAD or winter depression. Some people may experience depressive explodes during the spring and summer months; this is called summer-pattern SAD or summer depression and is less common. The occurrence and nature of seasonal rhythms in humans has received renewed interest since Seasonal Affective Disorder (SAD) was diagnosed in 1984.3(SAD Endocrinology journal)

An estimated 10 to 20 percent of recurrent depression cases follow a seasonal pattern. Although a summer pattern of recurrence is possible, the predominant pattern involves fall/winter depression with spring/summer remission. In U.S. community surveys, SAD prevalence ranges from 9.7 percent in New Hampshire to 1.4 percent in Florida. In North America, SAD prevalence increases with latitude, but the correlation is nonsignificant in other parts of the world.4(SAD Overview journal)

Symptoms  (SAD from NIH)

SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern. Therefore, the signs and symptoms of SAD include those associated with major depression, and some specific symptoms that differ for winter-pattern and summer-pattern SAD. Not every person with SAD will experience all of the symptoms listed below.

Symptoms of major depression may include: 

● Feeling depressed most of the day, nearly every day

● Losing interest in activities you once enjoyed

● Experiencing changes in appetite or weight

● Having problems with sleep

● Feeling sluggish or agitated

● Having low energy

● Feeling hopeless or worthless

● Having difficulty concentrating

● Having frequent thoughts of death or suicide

For winter-pattern SAD, additional specific symptoms may include:

● Oversleeping (hypersomnia)

● Overeating, particularly with a craving for carbohydrates

● Weight gain

● Social withdrawal (feeling like “hibernating”)

Specific symptoms for summer-pattern SAD  may include:

● Trouble sleeping (insomnia)

● Poor appetite, leading to weight loss

● Restlessness and agitation

● Anxiety

● Episodes of violent behavior

How is SAD Happen?

Many studies shows there are connection between the season changes and hormonal level in human body, especially hormone that arrange human’s mood like serotonin and melatonin  which is work to maintain our sleep-wake cycle. But pathogenic theories for SAD have focused on neurotransmitters, hormones, circadian rhythm dysregulation, genetic polymorphism, and psychological factors.(SAD overview).

One of first hypothesis about SAD was that the shorter winter photoperiod (light-dark cycle) led to depressive symptoms. A melatonin hypothesis in SAD explained in many animals, the photoperiod signal is mediated by the duration of nocturnal melatonin secretion, and light suppresses melatonin secretion.   However, the 24-hour melatonin rhythm in winter was no different between SAD patients and controls, and did not change with light treatment. Melatonin suppression alone is also not enough to produce a therapeutic response. Recent studies, however, have revived the photoperiod hypothesis. The nocturnal duration of melatonin secretion reflects changes in the photoperiod in humans. In normal subjects in naturalistic living conditions, no changes in melatonin profiles were found between summer and winter, suggesting that artificial indoor light may suppress the melatonin response to seasonal changes in photoperiod.

The phase-shift hypothesis proposes that the body’s sleep-wake cycle is phase-delayed in SAD with respect to the environmental light dark cycle, and is based on observations of delayed onset of sleep, melatonin, body temperature, and cortisol rhythms in some SAD patients. Individuals with SAD may respond to longer nights in winter with an extended duration of nocturnal melatonin release, a hormone that can promote sleep. When measuring active melatonin secretion under constant dim light, Wehr, et al.,21 found that individuals with SAD had a longer duration of melatonin release during winter than summer whereas controls did not. This is analogous to the lengthened duration of melatonin release in some mammals that signals seasonal changes in reproductive activity. It is possible that only humans with SAD have retained the ability to track seasons in this way, which might explain the seasonal presentation of SAD. Recent etiological models have attempted to integrate biological and psychological mechanisms in explaining SAD onset and maintenance. Young’s dual vulnerability model proposes two separate vulnerabilities among individuals with history of SAD: 1) a physiological vulnerability to experience atypical symptoms during the winter and 2) a psychological vulnerability to develop cognitive and affective symptoms of depression in reaction to the vegetative symptoms. Young devised this hypothesis based on his finding that individuals with SAD retrospectively recounted onset of fatigue, hypersomnia, and increased appetite prior to developing cognitive and affective symptoms. Different pathophysiological mechanisms may account for the different vulnerabilities proposed, leading to heterogeneity of findings from studies addressing the etiology and treatment of SAD.

In a phase-delay hypothesis, morning light therapy is predicted to be superior to evening light because morning light exposure results in a corrective phase-advance, while evening light exposure should further delay the circadian phase. Light exposure in the middle of the day generally has no effect on circadian rhythms, and hence should have no therapeutic effect. Initial studies used the dim-light melatonin onset (DLMO, the time that melatonin begins to be secreted by the pineal gland during controlled, dim-light conditions) as a marker of circadian phase because it is relatively free of masking effects. Patients with SAD were found to have phase-delayed DLMO compared with control subjects; furthermore, morning light exposure resulted in phase advances, while evening light exposure resulted in phase delays, and only the morning exposure led to clinical improvement.(pathopisiology of SAD journal)

Can SAD be cure?

Yes, it can be cured. Therefore, it needs a holistic treatment plan. Not only medication, but each area that contribute to be the cause of SAD must be treated as well. Treatments are available that can help many people with SAD. There are three main categories of the therapy :

  1. Light Therapy

Since the 1980s, light therapy has been a mainstay for the treatment of SAD. It aims to expose people with SAD to a bright light every day to make up for the diminished natural sunshine in the darker months.

For this treatment, the person sits in front of a very bright light box (10,000 lux) every day for about 30 to 45 minutes, usually first thing in the morning, from fall to spring. The light boxes, which are about 20 times brighter than ordinary indoor light, filter out the potentially damaging UV light, making this a safe treatment for most. However, people with certain eye diseases or people taking certain medications that increase sensitivity to sunlight may need to use alternative treatments or use light therapy under medical supervision. (Journal from NIH). A pooled analysis of light therapy studies 40 concluded that 53.3 percent of individuals with SAD met criteria for full remission with light therapy. However, only 43 percent of individuals with moderate to severe SAD symptoms remitted with light therapy. (SAD overview)

  • Antidepressant’s Drugs

SAD was mainly perform the major depression symptoms that its associated with disturbances in serotonin activity, antidepressant medications called selective serotonin reuptake inhibitors (SSRI’s) are also used to treat SAD when symptoms occur.

Clinically, antidepressants drugs are frequently used as an alternative to light therapy. (sad overview). Five-center Canadian study found comparable remission rates for light therapy plus pill placebo (54%) and fluoxetine  plus dim light placebo (50%). In a retrospective analysis of SAD outpatients in Finland, 73% of eight patients treated with moclebemide and 61 percent of 11 patients treated with fluoxetine responded over 6 weeks. Eight women with SAD due to randomized study had combined light therapy and citalopram or light therapy or light therapy and placebo found no difference in the two conditions at post-treatment, but greater efficacy for combination treatment 34 weeks later. (SAD overview)

  • Cognitive Behavioral Therapy

The CBT for SAD protocol involves 90 minutes sessions twice a week over six weeks (total of 12 sessions) delivered in group format. The behavioral component uses pleasant activity scheduling to counteract “hibernation” by developing wintertime interests. Negative cognitions are identified and challenged, including thoughts related to winter, light availability, seasonal environmental cues, and weather. Relapse-prevention emphasizes using CBT skills during subsequent fall/winter seasons in response to anticipatory negative thoughts about winter or SAD-related behavior changes.


Exercise and light therapy were associated with similar and significant reductions in depression severity and an increased rate of oxygen consumption relative to an untreated control group, suggesting that normalization of daily energy expenditure may underlie the efficacy of both treatments. Although morning exercise might be beneficial in the treatment of SAD, based on the assumption that it would induce a phase advance, these results suggest that the timing of exercise may not be important to the antidepressant effects of exercise on SAD. However, exercise late at night might be contraindicated in SAD because it can lead to a phase delay in the onset of melatonin release the following night in humans.56 In healthy controls, aerobic exercise performed under bright (2,500- to 4,000-lux) lights appears to be more beneficial than either exercise under typical indoor lighting or no exercise for atypical symptoms and vitality.


  1. New WHO guidelines on promoting mental health among adolescents.
  2. Felix Torres, M.D., MBA, DFAPA. Seasonal Affective Disorder. American Psychiatric Association.
  3. Seasonality in Affective Disorders. Anna Wirz-Justice. 2017. General and Comparative Endocrinology
  4. Kathryn A. Roecklein, Kelly J.Rohan, PhD. Seasonal Affective Disorder. 2005. Department of Medical and Clinical Psychology, Uniformed Services University of the Health Science in Bethesda,Maryland.
Things People With Diabetes Must Know About the COVID-19 Vaccines

Things People With Diabetes Must Know About the COVID-19 Vaccines

Things People With Diabetes
Source : Everydayhealth

People with diabetes are at a higher risk of developing complications of COVID-19, making it all the more important that they are vaccinated against the disease as soon as possible.

It’s a new year, and COVID-19 vaccines offer hope for those wanting to protect themselves, especially people with underlying health conditions such as diabetes.

You may have questions about these new vaccines, including when you can get them and what questions you should ask your doctor about them. Experts we talked with say the vaccines are safe, effective, and important for people with diabetes.

“The most important thing is that people with diabetes get vaccinated as soon as it becomes available to them,” says Robert Gabbay, MD, PhD, chief science and medical officer for the American Diabetes Association (ADA) in Arlington, Virginia.

Also Read Covid-19 Vaccine Updates

1. When Will I Be Able to Get the Vaccine if I Have Diabetes?

It depends on where you live. At a federal level, the Centers for Disease Control (CDC) makes recommendations about who should receive priority for vaccination. It is then up to each state to use those recommendations to plan for and distribute vaccines to counties and residents.

Even so, guidelines are changing. In mid-January, U.S Health and Human Services (HHS) Secretary Alex Azar said Americans 65 years and older and those who are younger but have underlying health conditions should receive priority, as AARP reports.

If your state is following the CDC’s recommendations, healthcare workers and nursing home residents are receiving first priority for the vaccine. Next, the CDC recommends vaccinating frontline workers such as firefighters, teachers, and grocery store workers, along with people over 75.

Then, the CDC recommends vaccinating people with type 2 diabetes and other underlying medical conditions due to their increased risk of severe COVID-19-associated illness.

People with type 1 diabetes do not currently have the same priority vaccination with the CDC. But groups including the Juvenile Diabetes Research Foundation (JDRF) and the ADA are advocating for this priority at a federal and state level.

Justin Gregory, MD, assistant professor of pediatrics at Vanderbilt Children’s Hospital in Nashville, who has type 1 diabetes, says that people with type 1 diabetes should have the same priority for vaccination as people with type 2 diabetes because both groups have a similarly increased risk for dangerous and deadly COVID-19 illness. 

In the end, states make their own decisions about vaccination priority, so check your state and local health department’s website to find out when you are eligible. The ADA has also assembled links to individual states’ vaccination plans as part of its COVID-19 Vaccination Guide.

2. Does Having Another Health Condition With Diabetes Affect My Place in Line?

Potentially. The CDC notes notes that the risk for hospitalization increases with the more “high-risk” medical conditions a person has — it’s 2.5 times for a person with one condition and 5 times for people with three or more conditions. Nevertheless, having comorbidities, such as heart and kidney disease, does not mean you will be allowed to get vaccinated before someone with only diabetes or another single health condition. Again, it comes down to where you live.

In Massachusetts, for example, people with two or more underlying conditions are prioritized to get a COVID-19 vaccine before those with only one condition. Other states do not designate priority by the number of underlying medical conditions.

3. Are COVID-19 Vaccines Free for People With Diabetes?

The COVID-19 vaccine is free for everyone, regardless of diabetes status, according to the CDC. However, some providers administering the vaccine may charge a fee, which can be reimbursed by your public or private health insurance, or by the Health Resources and Services Administration’s Provider Relief Fund if you do not have insurance.

4. Why Is It Important to Get the Vaccine if You Have Diabetes?

“It’s quite clear that people with diabetes do much worse than people without diabetes in terms of their outcomes with COVID,” says Dr. Gabbay. Early in the pandemic, a study from the CDC found that roughly half of people who died from COVID-19 under age 65 had diabetes. 

The protective effects of vaccines are critical for people with diabetes who are at increased risk for severe and deadly infection from COVID-19, says Dr. Gregory. His December 2020 study in Diabetes Care found that people with type 1 or type 2 diabetes are 3 times more likely to be hospitalized or experience severe COVID-19 illness compared with people without diabetes. 

Two studies from the United Kingdom showed similar risk. An October 2020 study in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 diabetes were 2 to 3 times more likely to die from COVID-19 in the hospital than people without diabetes. And a December 2020 study in The Lancet Diabetes & Endocrinology found that people with type 1 or type 2 were more likely to die or to be treated in the intensive care unit for COVID-19.

5. Are the Vaccines Safe and Effective for People With Diabetes?

Two COVID-19 vaccines are currently available in the United States — and people with diabetes were included in both the vaccine trials. Both require two doses spaced either 21 days (Pfizer-BioNTech vaccine) or 28 days (Moderna vaccine) apart. With their two doses completed, these vaccines are over 90 percent effective and received emergency use authorization from the U.S. Food and Drug Administration (FDA) in December 2020.

“We wanted to make sure we recruited a number of individuals who had the types of underlying medical conditions that can make COVID more severe,” says C. Buddy Creech, MD, MPH, director of the Vanderbilt Vaccine Research Program in Nashville and part of the phase 3 trials of the Moderna COVID-19 vaccine.

That included people with diabetes, hypertension, and obesity, says Dr. Creech. People with type 1, type 2, and gestational diabetes were included in the Moderna clinical trial, he adds. The FDA filing from Pfizer-BioNTech says the trial included but does not specify among types.

The vaccines were well-tolerated, highly efficacious, and elicited an immune response in people with underlying conditions, such as diabetes, says Creech.

“People with diabetes are going to be prioritized [for COVID-19 vaccination] because we know they’re at increased risk for disease. And they should feel confident that someone a whole lot like them was enrolled in the clinical trial so that we can say with a greater degree of certainty that they can effectively get this vaccine,” says Creech.

Gabbay says that the data do not suggest the COVID-19 vaccines pose particular risk for people with diabetes. He also says there is no reason to think there would be interactions with insulin or other medications that people with diabetes might take.

6. What Side Effects of the Vaccine Should People With Diabetes Pay Attention To?

In general, the most common side effects of both vaccines are pain, swelling, and redness at the injection site. Other common side effects are chills, tiredness, and headaches. Most of these side effects were mild, but some people had more severe reactions that interfered with daily activities.

Gabbay says side effects of the COVID-19 vaccines are similar to those of flu vaccines. For someone living with diabetes, keeping a sick-day kit with extra medications and supplies is beneficial in case you do not feel well.

7. What Questions Should People With Diabetes Ask Their Healthcare Teams About the COVID-19 Vaccines?

Gabbay says the first question patients should ask their providers about the COVID-19 vaccine is, “When can I get it?”

Be proactive in calling your provider to ask for the vaccine, says Gabbay. Check the websites of your state and local health departments to find out about local vaccine distribution. “Being patient, persistent, and informed is the best approach,” says Gabbay.


  2. By Kate Ruder Medically Reviewed by Justin Laube, MD

How Effective is a Single Vaccine Dose Against Covid-19 ?

How Effective is a Single Vaccine Dose Against Covid-19 ?

Single Vaccine Dose, How Effective it is ? – The cases are already beginning to emerge.

When 85-year-old Colin Horseman was admitted to Doncaster Royal Infirmary in late December, it was for a suspected kidney infection. But not long afterwards he caught Covid-19 – at the time, roughly one in four people in hospital with the virus had acquired it there. He developed severe symptoms and was eventually put on a ventilator. A few days later, he died.

At first glance, Horseman’s situation may seem fairly typical, though no less tragic for it. After all, at least 84,767 people have now succumbed to the disease in the UK alone at the time of writing. But, as his son recently explained in a local newspaper, less than three weeks earlier he had been among the first people in the world to receive the initial dose of a Covid-19 vaccine – the Pfizer-BioNTech version. He was due to receive the second dose two days prior to his death.

In fact, most vaccines require booster doses to work.

Take the MMR – measles, mumps and rubella – vaccine, which is given to babies around the world to prevent these deadly childhood infections. Around 40% of people who have received just one dose are not protected from all three viruses, compared to 4% of those who have had their second. People in the former group are four times more likely to catch measles than those in the latter – and there have been outbreaks in places where a high proportion of people have not completed the full MMR vaccination schedule.  

“The reason that people are so keen on boosters and consider them so vital is that they kind of send you into this whole other kind of fine-tuning mode of your immune response,” says Danny Altmann, professor of immunology at Imperial College London.

Also Read Covid-19 Vaccine Updates

How Booster Vaccines Work

When the immune system first encounters a vaccine, it activates two important types of white blood cell. First up are the plasma B cells, which primarily focus on making antibodies. Unfortunately, this cell type is short-lived, so although your body might be swimming in antibodies within just a few weeks, without the second shot this is often followed by a rapid decline.

Then there are the T cells, each of which is specifically tailored to identify a particular pathogen and kill it. Some of these, memory T cells, are able to linger in the body for decades until they stumble upon their target – meaning immunity from vaccines or infections can sometimes last a lifetime. But crucially, you usually won’t have many of this cell type until the second meeting. 

The booster dose is a way of re-exposing the body to the antigens – the molecules on pathogens that trigger the immune system. “So, once you’ve had your boost you’ll have a higher frequency of memory T cells and ditto to some extent for the size of the pool of memory B cells you’ll have. They’ll also be making higher quality antibodies.”

On second exposure to the same vaccine or pathogen, the B cells that remain from before are able to rapidly divide and create a menacing throng of descendants, leading to a second spike in the amount of antibodies circulating.

The second dose also initiates the process of “B cell maturation”, which involves selecting the immature ones with the best receptors for binding to a particular pathogen. This happens while they’re still in the bone marrow – where white blood cells are made – and afterwards they travel to the spleen to finish developing. This means B cells are not only more numerous afterwards, but the antibodies they produce are better targeted.

Memory T cells, meanwhile, also proliferate rapidly. They’re already thought to have played a critical role during the current pandemic, protecting some people from developing severe Covid-19. Though the virus may have only been circulating globally since around December 2019, there’s some evidence they may have “seen” other coronaviruses before, such as those that cause the common cold – allowing them to recognize Covid-19.



Delaying second dose of coronavirus vaccines is ‘risky gamble’: according to experts

Delaying second dose of coronavirus vaccines is ‘risky gamble’: according to experts

Delaying second dose of coronavirus vaccines is ‘risky gamble’: according to experts

Amid shortages in coronavirus vaccine supplies, some Canadian provinces have decided to delaying second dose of coronavirus, which experts have called a “risky approach” and “a gamble.”

Ontario’s government announced on Saturday that long-term care residents, staff and essential caregivers who have received their first doses of the Pfizer-BioNTech vaccine will now get the second jab within 21 to 27 days. Everyone else will receive their second dose after three weeks but before 42 days.

The time span between doses specified by Pfizer and BioNTech is 21 days.

This comes in the wake of a temporary delay in shipments of the Pfizer vaccine to Canada as the company is scaling up its European manufacturing capacity.

Last month, British Columbia said it was changing its second-dose schedule for both Pfizer and Moderna’s vaccines to 35 days to allow giving the first doses to as many people as possible right away. Moderna’s second booster shot is supposed to follow the first by 28 days.

Meanwhile, Quebec is pushing the time between the two doses to a maximum of three months in an attempt to vaccinate more seniors faster with a first injection.

These timeline changes have raised concerns and questions about the impact this may have on the effectiveness of the vaccines.

“There is a risk in this approach,” said Dr. Alberto Martin, professor of immunology at the University of Toronto.

It’s possible that a large fraction of these individuals will not develop full immunity and thereby waste many of these doses,” he told Global News.

While there is a buffer and wiggle room for a few days and weeks between vaccine doses, experts have cautioned against significant delays that deviate from the prescribed time period used in the clinical trials.

“The longer you spaced that interval, the higher risk (of) … maybe not getting the full immune response possible,” said Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare in Hamilton, in an interview with Global News.

However, since this is an experiment with no sufficient data, it still remains unclear what the exact impact of the delay will be, both Chagla and Martin said.

The World Health Organization (WHO) has advised that in case of shortages in vaccine supplies, the second Pfizer dose can be extended to up to six weeks or 42 days after the first, which is what Canada’s National Advisory Committee on Immunization (NACI) has also recommended.

Currently, there is no data on the maximum interval between doses or on medium- or long-term efficacy of COVID-19 vaccines, according to NACI.

NACI experts say delaying second dose of coronavirus up to six weeks, instead of three or four, could more quickly get at least some protection against COVID-19 to more people.

The United Kingdom, where a new, more contagious variant of COVID-19 began spreading last month, has gone against the advice of the drugmakers, as well as WHO, and delayed the second dose of Pfizer and AstraZeneca’s vaccine by up to 12 weeks.

The United States, meanwhile, is taking a different approach and sticking with the originally specified timeframe of 21 days between Pfizer’s shots and 28 days for Moderna.

In a statement on its website, the U.S. Food & Drug Administration says changes in the schedules of vaccine administration without appropriate supporting data can pose a “significant risk of placing public health at risk” and “undermining the historic vaccination efforts.”

Also Read What are the differences of these various COVID-19 vaccines?

Prioritizing The Elderly

When there is an unstable supply chain, most experts agree that the priority should be to give the elderly and long-term care residents the two doses on time.

Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital, said the focus in Ontario is to put all the resources into vaccinating those who are most vulnerable and at greatest risk of death.

We know that people in long-term care are typically older or have other health problems, (yet) are just less likely to mount the same immune responses as otherwise healthier, younger individuals. So, the goal is really to give those two vaccine doses as per that schedule to those who live in long-term care. I think that’s very reasonable,” he told Global News.

As for the rest of the population, provinces should not purposely delay the second dose beyond the 42-day mark, he added.

“That 42 days is the maximum, it’s not the goal, … and if people can be closer to that day 21 goal, the better,” Bogoch said.

According to recent modelling data from researchers at the University of Toronto, administering most of Canada’s coronavirus vaccines now, as opposed to reserving half of them to be used later as second doses for the first recipients, could prevent a significant amount of new symptomatic COVID-19 infections.

Dr. Anna Banerji, an infectious disease specialist at the University of Toronto, said it is actually better to spread the vaccine to as many people as quickly as possible with a first dose rather than reserving the second shot in case of shortages.

“If the end goal is to save lives and prevent hospitalization and vulnerable populations, then it’s better to get the vaccine out to all the people who are at high risk, like long-term care facilities, first rather than getting two to half the amount of people,” she told Global News.


2. Saba Aziz

Do I Have To Live With Stoma Forever ?

Do I Have To Live With Stoma Forever ?

Live With Stoma Forever ? – In the first blog about stoma before, I mentioned about stoma-forming surgery that could be permanent or temporary.

The formation of an intestinal stoma (usually ileostomy or colostomy) is an integral part of the surgical management of several pathologies of the gastrointestinal tract, in both emergency and elective patients.  A stoma may be created in a temporary or permanent role to reduce morbidity and mortality associated with several conditions of the gastrointestinal including perforation, inflammatory bowel disease, bowel obstruction and elective cancer operations.

Also Read What are the differences of these various COVID-19 vaccines?

A. History of Intestinal Stomas

In the pre-anaesthetic era the formation of intestinal stomas was uncommon. The names of the first few patients whose treatment comprised the forced creation of an intestinal fistula are known. The first among them was George Deppу, who had sustained an abdominal wound during the Battle of  Ramilles on 23 May 1706, after which he had a colostomy formed, which functioned for the remaining 14 years of his life. In 1737, the Queen of Great Britain, Caroline of Brandenburg-Ansbach, the wife of George II, had a spontaneous intestinal stoma (“Royal stoma”) after rupturing the membrane of strangulated umbilical hernia. Because the strangulation led not only to obstruction, but bowel gangrene as well, she died three days later. In 1750, William Cheselden operated on 73-year old Margaret White for strangulated umbilical hernia related to incoercible vomiting  and cut out 55 cm of the intestine, which was fixed at the level of the hernial orifice. Despite the horrible hygiene conditions, she survived and for a long time cared for the peristomal skin with a towel and a rag (Wu 2012, Cromar 1968 Kingsnorth 2006, Cheselden 1750). live with stoma forever

B. Types of Intestinal Stoma

Intestinal stomas can be temporary, diverting stomas designed to rest distal bowel, protect distal anastomoses (e.g. following low anterior resection) or to relieve obstruction.

Permanent stomas are indicated when primary anastomosis is not safe or possible due to the disease process (e.g. gross faecal contamination, poor blood supply or distal bowel resection precluding anastomosis as seen in abdominoperineal resection [APER] when the anus is removed).

Figure I. Different Types of Stoma

Indications for Intestinal Stomas

Table I
Table II

1. Colostomy. How it’s performed

The main surgical techniques are:

  • Open surgery (laparotomy), where the surgeon makes a long incision in the abdomen to access the colon
  • Laparoscopic (or keyhole) surgery, where the surgeon makes several smaller incisions and uses a miniature video camera and special surgical instruments to access the colon

Where possible, keyhole surgery is the preferred choice. This is because research has shown that patients recover quicker and have reduced risk of complications. However, in emergency situations, such as a bowel obstruction, the staff and equipment needed for a keyhole operation may not be available, so an open operation needs to be performed. live with stoma forever

There are 2 main ways a colostomy can be formed, a loop colostomy and an end colostomy.

1.1 Loop Colostomy

To form a loop colostomy, a loop of colon is pulled out through an incision in your abdomen. This section of colon is opened up and stitched to the skin to form an opening called a stoma. The stoma will have 2 openings, but they will be close together and you may not be able to see both.

One of the openings is connected to the functioning part of your bowel. This is where waste products leave your body after the operation. The other opening is connected to the “inactive” part of your bowel, leading to your rectum. This opening only produces small amounts of mucus.

The position of the stoma depends on which section of the colon is diverted, although it’s usually on the left-hand side of your abdomen, below your belt line. If the operation is planned in advance, you’ll meet a specialist and stoma nurse before the operation to discuss possible locations for the stoma. This may not be possible if the operation is performed as an emergency.

The stoma will appear large at first, as the effects of surgery cause it to swell. It usually shrinks during the weeks after surgery, reaching its final size after about 8 weeks. The stoma will be red and moist. It has no nerve endings, so it isn’t painful to touch. It may bleed when touched, but this is entirely normal and no cause for concern. In some cases, a support device (called a rod or bridge) may be used to hold the loop of colon in place while it heals. This will usually be removed after a few days.

A loop colostomy is usually formed temporarily to treat conditions such as diverticulitisCrohn’s disease and bowel cancer.

1.2 End Colostomy

To form an end colostomy, one end of the colon is pulled out through an incision in your abdomen and stitched to the skin to create a stoma.

Like when a loop colostomy is formed, the position of the stoma depends on which section of the colon is diverted. However, it’s usually on the left-hand side of your abdomen, below your belt line.The stoma will have one opening, through which waste products pass. The other end of the colon, which goes down to your rectum, is sealed and left inside your tummy.

End colostomies are often permanent, although temporary end colostomies are sometimes formed as an emergency to treat bowel obstructions, colon injuries or bowel cancer.

Figure 2: (a)End Colostomy and (b)Loop Colostomy

2. Ileostomy, How it’s performed  

2.1 End Ileostomy

An end ileostomy normally involves removing the whole of the colon (large intestine) through a cut in your abdomen. The end of the small intestine (ileum) is brought out of the tummy through a smaller cut and stitched on to the skin to form a stoma. Over time, the stitches dissolve and the stoma heals on to the skin.

After the operation, waste material comes out of the opening in the tummy into a bag that goes over the stoma. This type of ileostomy is often, but not always, permanent.

2.2 Loop Ileostomy

To form a loop ileostomy, a loop of small intestine is pulled out through a cut in your tummy. This section of intestine is then opened up and stitched to the skin to form a stoma. The colon and rectum are left in place. In these cases, the stoma will have 2 openings, although they’ll be close together and you may not be able to see both.

One of the openings is connected to the functioning part of your bowel. This is where waste products leave your body after the operation.

The other opening is connected to the “inactive” part of your bowel that leads down to your rectum.

The loop ileostomy is usually temporary and may be reversed during a second operation at a later date.

Figure 3 completed J-pouch procedure using two loops from the small intestine

2.3  Ileo-anal Pouch

In some cases, it may be possible to have a permanent internal ileo-anal pouch, also known as a J pouch, formed instead of an ileostomy. An ileo-anal pouch is created from the ileum and joined to the anus, so waste material passes out of your body in the normal way.

The pouch stores the waste material until you have a poo. The area around the pouch usually needs to heal before it’s used, so a temporary loop ileostomy may be created above the pouch.

A second, smaller, operation is usually carried out a few months later to close the loop ileostomy.

C. So, I have a chance to not live with my STOMA forever, right?

Due to the explanation above, we can conclude that not all stoma-formed surgery will end up with having stoma forever. There is a chance for stoma patient to have stoma closure/reversal.

The decision to have a reversal operation depends on how much and which part of the bowel has been removed. If very little of the rectum remains, then it is likely that bowel control will be impaired. Your healthcare professional will advise whether stoma reversal is possible, it is estimated that around 35% of ostomates have a temporary stoma.

The main considerations for the stoma reversal are: Journal Reversal of Stoma

  1. The doctors must be happy that you are fit enough for another operation.  n
  2. The bowel that your temporary stoma was created to protect has healed or improved since the first operation.
  3. The anal sphincters which control the flow from your bowels are working, so that loss of control of your bowels (faecal incontinence) will not develop afterwards.

Depending on what operation you have had, the surgeon may need to perform a rectal examination, and possibly arrange some further test before making this decision.

D. What does the surgery involve?

The closure of your stoma is ‘technically’ not as demanding as your previous surgery when the stoma was created. This operation involves making a cut around the stoma, to free it from the tummy wall and stitching the bowel back together to restore continuity, the stitching may be referred to as an anastomosis. The joined bowel is dropped back inside the tummy. This is followed by the stitching of the tummy wall muscles and skin. It is still considered a significant operation. Very occasionally it is necessary to reopen the original laparotomy wound scar to be able to reverse the stoma.

  • Colostomy and Ileostomy Reversal

Basically, both colostomy or Ileostomy have the same procedure during closure/reversal surgery.

If your colostomy/ileostomy is intended to be temporary, further surgery will be needed to reverse it at a later date.

The reversal operation will only be carried out when you’re in good health and fully recovered from the effects of the colostomy formation operation. This will usually be at least 12 weeks or more after the initial surgery.

However, the reversal may need to be delayed for longer if you require further treatment such as chemotherapy, or haven’t recovered from the original operation when the colostomy was formed. There’s no time limit for having the stoma reversed and some people may live with their colostomy for several years before it’s reversed.

In some cases, reversing a colostomy may not be recommended. For example, if the muscles that control your anus (sphincter muscles) were damaged after surgery, reversing the colostomy may cause bowel incontinence.

Reversing a loop colostomy is a relatively straightforward process. An incision is made around the stoma to allow the surgeon to gain access to the inside of your abdomen. The upper section of your colon is reattached to the remaining section of your colon.

Reversing ileostomy A cut is made around the stoma (like colostomy reversal surgery) and the section of small intestine is pulled out of the tummy. The area that had been divided to form the stoma is then stitched back together and placed back inside the abdomen. But the surgeon will need to make a larger incision to locate and reattach the small and large intestines.

It’s also possible to reverse an end colostomy. However, the surgeon needs to make a larger incision to locate and reattach the 2 sections of the colon. Therefore, it takes longer to recover from this type of surgery and there’s a greater risk of complications.

E. What to expect after surgery

You may have a drip in your arm to give you fluids until you are drinking.  Once you are awake you can eat and drink normally, you may find small, light, low fiber meals are better tolerated. Most people are moderately sore at the reversal site afterwards, but this can be managed with pain killers. You may feel distended following the procedure, some patients describe this as a  feeling of being “bruised and bloated” but as the swelling decreases this discomfort will ease.

Possible side effects after stoma closure:

  • Diarrhea – After the reversal it is common to experience liquid bowel motions for the first few days up to a few weeks before it settles down. In a small percentage of patients it can take up to 6 months before the bowel motions become more firm. It is fairly common to pass looser and more frequent stools than you may have been used to previously. Adjusting the food you eat and taking bowel slowing medication can help with this.
  • Frequency and urgency – It is normal to have erratic bowel movements for several weeks after this operation. You may find that you need to go to the toilet more urgently and also more often. This can be more of a problem for those who have had a low join or anastomosis in the bowel and for those who have had pelvic radiotherapy and/ or were already suffering from a weak sphincter muscle. The patients who have weak pelvic floor and anal sphincter muscles may leak gas, liquid or solid stools.  Performing pelvic floor exercises may help to regain continence but need to be practiced at least five times a day and over a few months to be of benefit. When done correctly, these exercises can build up and strengthen the muscles to help you to hold both gas and stool in the back passage. Good hygiene and a light barrier cream may be useful to prevent the skin becoming sore if you are experiencing loose and frequent stools.
Figure 4 Representative abdominal images. (a)before ileostomy reversal, (b)before and (c)after application of NPWT(Negative-Pressure Wound Therapy), and (d)3 days, (e)30 days, and (f)90 days after ileostomy reversal. (Journal: 10.1007 Evaluation of negative‑pressure wound therapy for surgical site infections after ileostomy closure in colorectal cancer patients: a prospective multicenter study)


  2. . History of Medicine 6(2): 111-117
  3. Ileostomy how it’s performed. January 20th  2020
  4. . Ostomy Day: 9 myths about having stoma. January 20th 2020

live with stoma forever live with stoma forever live with stoma forever live with stoma forever

Live With Stoma ? What Would it be ?

Live With Stoma ? What Would it be ?

Live with stoma – In Europe, approximately 700,000 people are living with a stoma, and in the USA, more than 1 million people have a stoma. In the United Kingdom (UK), a national audit shows that just under 11,500 patients diagnosed with rectal cancer each year have a stoma formed and a UK charity website indicates that each year, around 2000 people with inflammatory bowel disease (IBD) have a stoma formed.

It’s never been easy living your life with something hanging in your tummy, right? Even before you get that stoma, preparing the surgery itself was challenging for you both mentally or even physically. You might feel anxiety, fear or even loss of confidence. That’s okay, that’s normal for us who doesn’t know nothing about stoma.

Live with stoma pouch ? What would it be ? Some of you might feel depressed only by seeing your tummy, or maybe you are having problems with how to deal with that stoma thing. Stoma affect the patients’ quality of life although they help them to continue their lives

Both physically or mentally reasons, someone with stoma needs support to continuing their lives. As a person who have the stoma, or as a caregiver, or a family members who took care of it you must be understand and known many things that usually happen after you get the stoma.

Also Read Cajuput Essential (Melaleuca Cajuputi) Essential Oil Against Covid-19 Virus (SARS-CoV-2). Can It Really Inhibit Covid-19 Virus?

Here below the most common problems that effect of daily living activity on patients with stoma.

Daily Living Activities n%
Social LifeDifficulty in performing their religious duties2953.7
 Restricted their exercises2750.0
FoodingFeeding Time Arrangements2851.9
 Food/Beverage restriction1527.8
HygieneDifficulties in bathing3055.6
 Changed their clothing style2953.7
Problems of Stoma CarePlacement of stoma adapter in the skin627.3
 Skin Cleaning522.7
 Change of Stoma Bag418.2
 Apply Stoma Powder318.2
Stoma ProblemsDiarrhea2037.0
Psychological problemsFear937.5
 Low self-esteem625.0
 Getting away from friends/family414.8

*This descriptive study was carried out in the general surgery clinic of an university hospital in İzmir between the 1 January 2016 and 1 June 2016. The sample of the study consisted of 54 patients who were in the general surgery clinic at the time of the study, who were over 18 years of age, who had a stoma duration of at least one month.

Beside all the problems above there are still many questions that commonly the stoma’s patient asked based on what they really concern about. I would love to share this information to you, and I hope it will help you.

1. My Skin is Itchy and Irritated, what can cause and what should I do then

This can be a problem for many people that live with stoma. Redness on the skin around the stoma can be from several sources. Some of the more common reasons can include irritation from stool, sensitivity/allergy to the products you are using, or yeast.

Most commonly with an ileostomy , redness to the skin around the stoma, accompanied by burning and itching, is the result of stool having direct contact with the skin. Stool from an ileostomy is corrosive and can cause damage to the skin within a short period of time. Damaged skin will often result in itchiness and burning, particularly when the stoma is functioning. You may also notice small amounts of bleeding from the skin if the irritation has been for a prolonged period of time.

There are several possible reasons why the skin may be exposed to the stool. The opening of the flange may be too large for the size of the stoma. You should ensure that the opening of the flange is the correct size. Most ostomy suppliers have measuring devices that can help you to determine the correct size of flange opening. You can also reserve the release paper from the back of your flange (usually paper or plastic), and place it over your stoma, making sure your stoma is centered in the middle of the opening. Look in a mirror and measure the gap between the base of your stoma and the inner edge of the release paper. If you are having difficulty measuring the gap or determining the correct size, contact your nurse to help you.

Skin exposure may also be the result of an inappropriate appliance. Different characteristics of the stoma, and different characteristics of the skin around the stoma may prevent you from obtaining a “good seal” with your appliance. If you don’t have a good seal, this can allow stool to leak under your flange and to come in contact with your skin. You may require an alternative type of appliance (e.g. perhaps switching from a flat flange to one with convexity) or the addition of another product (such as a barrier ring) to help prevent leakage and skin exposure. Sometimes, a light dusting of stoma powder can dry the skin enough to provide an adequate pouching surface. Many patients also report success with something as simple as a light coating of calamine lotion, another well-known drying agent. The most important course of action is to determine if the pouch in use is the best for that stoma and for that patient’s contours.

The redness and itchiness may also be the result of a yeast infection to the skin.  Yeast infections tend to be bright red (in the initial stages; the color will change as the infection resolves), have irregular borders or edges, and will likely have several smaller pink dots on the skin away from the main part of the redness /infection. These are called satellite lesions and are new areas of yeast growth. Yeast likes to grow in moist, dark, warm places, like under an ostomy appliance. Yeast will sometimes start after someone has been on antibiotics. It can also result from frequent soaks in hot-tubs or baths, or with excessive perspiration, like in warm weather or with exercise. Yeast is easily treated with a silver based powder. The powder is applied directly onto the skin, and must be “sealed” with a skin barrier wipe. If you don’t seal the powder, the flange will not adhere to your skin. Equally, you should not use a cream based anti-fungal preparation as this will also prevent the flange from adhering. You will need to apply the powder for about a two week period. Usually, you do not need to change your flange more often than normal while using the powder. You should also check other common body sites for signs of yeast, such as under breasts, in the groin, or axillae (underarms). If you notice yeast in these areas, you will need to treat as well (though here, a cream based preparation is okay) to prevent re-infection under your flange.

If all those problems persist, make sure contact your doctor.

2. I’m Having Leakage. What can I do now?

To help solve the issue, we would ask several questions including the current pouching system being used, and the frequency of it being changed. Other questions that would assist us in problem solving might be—How are you preparing your skin before putting on your pouch? If the products are not being properly applied, it could cause adherence issues. Are you cleaning out your pouch or do you put anything in it? Most important, where is the leakage occurring? If it’s always in the same area, evaluate the area for any creases or uneven surfaces such as scar tissue, incisions, or your belly button that may cause an uneven surface under the barrier. If this is the cause, you might try a barrier ring as a filler to even out the surface area. However, make sure that the stoma size is correct in the barrier. You’ll know it’s a correct fit when the barrier fits where the skin and the stoma meet. There should be no skin exposed between the stoma and the opening of the barrier.

3. I’m not sure with My Food. What I should and What I shouldn’t Eat?

You are still having the possibility to taste your normal food or your favorite food even after you got a stoma. Although, you may get some advice from your doctor or your stoma nurse for maintaining your proper diet after your surgery.

Follow the guidelines below for the first few weeks after your surgery. This will help prevent discomfort while your colon heals.

  • Eat small, frequent meals. Try to have 6 small meals throughout the day instead of 3 large ones.
  • Eat slowly and chew your food well.
  • Drink 8 to 10 (8-ounce) glasses of liquids every day.
  • Eat mostly bland, low-fiber foods. Read the “Recommended foods” section for more information.
  • When you add foods back to your diet, introduce them one at a time.

It’s best to eat mostly bland, low-fiber foods for the first few weeks after your surgery. Bland foods are cooked, easy-to-digest foods that aren’t spicy, heavy, or fried. Eating bland foods will help you avoid uncomfortable symptoms such as diarrhea (loose or watery bowel movements), bloating, and gas.

Milk and Dairy
Foods to include in your dietFoods to limit
Non-fat (skim) or low-fat (1% or 2%)*Powdered milk*Non-dairy milks (such as soy milk and almond milk)Lactose-free dairy products (such as Lactaid products)Yogurt*Cheese*Low-fat ice cream or sherbetEggs*High-fat milk and dairy products, such as: Whole milkRegular Ice Cream or sherbetMilk and dairy products with lactose (if you have diarrhea after having them)

*If you have diarrhea after having these products, try non-dairy milks or lactose-free cheese or yogurt instead.

**When trying eggs, start with a small amount (such as 1 egg). Eggs may cause a bad odor (smell) when you open your pouch.

Meats and proteins
Foods to include in your dietFoods to limit
Lean animal proteins, such as:Meat without visible fatSkinless poultryFish*Nuts and nut butter (such as peanut)High-fat foods, such as fried meat, poultry, or fishHigh-fiber foods, such as dried or canned legumes (beans)

*When trying fish, nuts, and nut butter, start with small amounts. These foods may cuase odor when you open your pouch.

Foods to include in your dietFoods to limit
Low fiber food, such as: White bread, pasta, and riceBagels, rolls, and crackers made from white or refined flourCereals made from white or refined flour, such as Cream of Wheat, Rice Chex, and Rice KrispiesWhole grains, such as whole wheat bread, brown rice, bran cereal, quinoa, and buckwheat
Foods to include in your dietFoods to limit
Low-fiber foods, such as: Well-cooked vegetables without skins or seeds, such as peeled potatoes, peeled zucchini with the seeds removed, and peeled tomatoes with the seeds removedLettuceStrained vegetable juiceHigh-fiber foods, such as raw vegetables (except lettuce)
Foods to include in your dietFoods to limit
Pulp-free fruit juice (except prune juice and grape juice)Peeled fruit (such as a peeled apple)Canned fruit (except pineapple)Fruits with thick skins. Examples include:Soft melons, such as watermelon and honeydewOrange without the membrane (the thin clear or white part around each orange section)Ripe bananaRaw fruits with the skin. Examples include:ApplesStrawberriesBlueberriesGrapesPrune juiceGrape juice

That’s it about live with stoma, hope this article will help you.

Also Read Corona Virus Transmission and The Phenomenon of False Informations Spread Related to COVID-19


  1. Gill Hubbard, Claire Taylor, Angus J.M.Watson, Julie Munro.2020.A Physical Activity Intervention to Improve the Quality of Life of Patients with a Stoma: a Feasibility Study. Hubbard et al.Pilot and Feasibility Studies.6:12.
  2. Esma Özşaker, Tuğçe Yeşilyaprak.2018.The Problems of Patients with Stoma and its Effects on Daily Living Activities.Medical Science and Discovery.5(12):393-8.
  3. Skin Irritation. Canadian Society ofIntestinal Research.
  4. Peristomal Skin. Hollister.

live with stoma live with stoma live with stoma live with stoma live with stoma

Indonesia COVID vaccination to start Wednesday using Sinovac drug

Indonesia COVID vaccination to start Wednesday using Sinovac drug

Indonesia Covid Vaccination – Country is first, outside China, to greenlight those vaccines for emergency use.

JAKARTA — Indonesia’s food and drugs agency on Monday approved the COVID-19 vaccine developed by China’s Sinovac Biotech for emergency use, paving the way for the archipelago to begin its planned mass vaccination program.

Indonesia is the first country outside of China to green light the Sinovac vaccine.

Interim data from a late-stage human trial in Indonesia showed the jabs to be 65.3% effective, said Penny Lukito, head of the agency, BPOM. That is lower than the 78% efficacy rate reported in a similar trial in Brazil, and the 91.25% efficacy rate shown in tests in Turkey.

But the figure is above the World Health Organization’s recommended 50% efficacy rate.

“Safety data for the [Sinovac’s] vaccine were obtained from phase three clinical studies in Indonesia, Turkey, and Brazil,” said Lukito, explaining the decision. “Overall, it shows that the [Sinovac] vaccine is safe with the incidence of side effects being mild to moderate in the form of pain, irritation, swelling, muscle aches, fatigue, and fever.”

The Indonesian Ulema Council — the country’s top Islamic body — gave the Sinovac vaccine halal status last week. That move together with BPOM’s decision clear the way for the Indonesian government to start mass vaccination as planned from Wednesday, offering a beacon of hope to a country still struggling to contain the spread of the virus.

Indonesia added another 8,692 new cases on Monday, taking its total to 836,718. It also reported that another 214 people had died of the disease over the last 24 hours, taking its death toll to 24,343. The government on Monday extended its existing ban on foreign visitors for two more weeks. The initial ban was set to end on Jan. 14.

The country had received 3 million vaccine doses from Sinovac, and as of last week, 1.2 million doses had been distributed to 34 provinces. Health Minister Budi Gunadi Sadikin said Monday that the country is set to receive 15 million doses of bulk vaccines from Sinovac on Tuesday.

President Joko Widodo will receive the first shot, followed by 1.3 million health care workers.

Unlike other countries that have begun vaccinating its vulnerable, elderly population first, Indonesia is prioritizing its working-age population, or those in the 18 to 59 age group, in the hope of kick-starting economic activity.

The president is 59. Vice President Ma’ruf Amin, who is 77, will not be receiving the vaccination for now, according to his spokesperson.

The health ministry has set a target of vaccinating 181 million of Indonesia’s 270 million people in 12 months. The country has so far managed to secure 229 million doses of COVID-19 vaccines from Sinovac, Novavax and global vaccine program COVAX. It is in talks to secure 50 million doses each from AstraZeneca and Pfizer.

BPOM as well as the Indonesian Ulema Council will need to authorize the use of the other vaccines when they become available.

So what do you think about Indonesia Covid Vaccination ?

What are the differences of these various COVID-19 vaccines?

What are the differences of these various COVID-19 vaccines?


Various COVID 19 vaccines in Beijing-based biopharmaceutical company Sinovac is behind the CoronaVac, an inactivated vaccine.

It works by using killed viral particles to expose the body’s immune system to the virus without risking a serious disease response.

By comparison the Moderna and Pfizer vaccines being developed in the West are mRNA vaccines. This means part of the coronavirus’ genetic code is injected into the body, triggering the body to begin making viral proteins, but not the whole virus, which is enough to train the immune system to attack.

On paper, one of Sinovac’s main advantages is that it can be stored in a standard refrigerator at 2-8 degrees Celsius, like the Oxford vaccine, which is made from a genetically engineered virus that causes the common cold in chimpanzees.1

While the three COVID-19 vaccines – from Pfizer/BioNtech, Moderna and Oxford/AstraZeneca – look set to be the most common ones for Europeans.

While they all have the same goal, there are substantial differences between the jabs, from their composition and reported effectiveness, to their price and ease of conservation and distribution.

It means that both Sinovac and the Oxford-AstraZeneca vaccine are a lot more useful to developing countries that might not be able to store large amounts of vaccine at such low temperatures.

Pfizer/BioNtech and Moderna

The Pfizer vaccine, like the Moderna one, use innovative messenger RNA technology. In short, this technology teaches our cells how to produce a protein, which is what makes the immune system react.

It is claimed their efficiency in successfully fighting COVID-19, at up to 95%, is higher than that of AstraZeneca.

Both, however, are more expensive.

The big drawback of Pfizer’s jab is that it needs to be stored in the extreme cold, at temperatures as low as -70C to -80C. Moderna’s can remain stable for 30 days at a temperature of between 2C and 8C, but for longer periods it will have to be frozen at -20C.


Compared to Pfizer and Moderna, AstraZeneca’s jab uses a more traditional vaccine technique, using an attenuated version of the virus that causes the common cold in chimpanzees.

This virus has been genetically altered with a gene for a coronavirus protein to provoke the body’s immune reaction.

Its efficiency rate is lower at around 70%. But, under certain conditions, this can be as high as 90%.

But it is a lot cheaper and easier to store than Pfizer’s vaccine. The AstraZeneca vaccine can survive in a standard refrigerator for up to six months, whereas the Pfizer one needs temperatures of up to -80℃.2

That’s all for the various covid 19 vaccines hope this article help you!

Also Read Indonesia COVID vaccination to start Wednesday using Sinovac drug


  2. Carmen Menéndez  & Lucía Riera. 
News Link Updated From 11th August 2020