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BA.2 sub-lineage of Omicron now dominant in Pune, says IISER

by Medically Speaking Team February 14, 2022

As per the genome sequencing data for Pune city, 100% of the samples sequenced by the Indian Institute of Science Education and Research (IISER) have tested positive for the Omicron variant of the SARS-CoV-2 virus which causes Covid-19. A month ago, most of the samples tested positive for the Delta sub-lineage which was fast replaced by Omicron, the primary variant driving the third wave numbers. Experts now believe that since the second half of January, the BA.2 variant has become completely dominant and whether or not and how these mutations affect the severity of symptoms and the transmission rate is yet to be studied.\

In plotting the number of samples sequenced at the institute and the sub-lineage reported by the institute, while the sub-lineage of Delta, AY lineage, was the most dominant strain in the samples up until mid-December 2021, Omicron fast started catching up and within a month, became the dominant strain. December 2021 and January 2022 saw a surge in the third wave when more new Covid-19 cases were reported, and Omicron was reported to be the primary variant. Within a few weeks, it was reported that Omicron, too, was mutating and reporting multiple sub-lineages such as BA 1 and BA 2. According to experts at IISER, Omicron has completely taken over since mid-January and 100% of the samples sequenced in the week between January 16 and 22 were Omicron and experts have now said that the BA.2 sub-lineage of the variant is the most dominant one currently.

Dr Krishanpal Karmodiya, lead scientist involved with the genome sequencing, said, “Currently, Omicron’s BA.2 is completely dominant. It is everywhere including in the hospitalised cases and also at our homes. However with the numbers going down, we do not think it is more transmissible or requires any specific change in treatment as there appears to be no specific change in the symptoms. There has been a drop in the number of cases currently and so, it would be too early to comment on the picture in February however we can say that in January, BA. 2 was the dominant strain.”

Although Omicron did drive the numbers, the data also showed that Delta and its sub-lineages continued to remain significant in the city’s samples up until the end of December 2021 for samples sequenced at the IISER laboratory.

February 14, 2022 0 comment

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WHO and other studies explain 3 unusual symptoms recorded in patients

by Medically Speaking Team February 14, 2022

written by Medically Speaking Team

Since Omicron differs from other COVID variations in how it travels, one of the most concerning aspects is that people infected with it exhibit a wide range of symptoms that are distinct from one another. While many people are reporting minor cold-like symptoms, some are reporting more serious problems. Symptoms and their causes are explained by the World Health Organization (WHO) and investigations undertaken by other organisations.

Various Symptoms

WHO’s top infectious disease expert Dr Maria Van Kerkhove has said that people who are infected with Omicron can have a range of symptoms. They can also have no symptoms at all, and be completely asymptomatic. Some even can develop severe diseases and people are also dying from Omicron.

“On average, we know that there is lesser risk of needing hospitalisation if you are infected with Omicron compared to Delta, but that does not mean that it is a mild disease,” he added during a Live Q&A session on COVID-19 and Omicron sub-variant BA.2 with Dr Abdi Mahamud on 8 February 2022.

During another discussion on the effects of Omicron and why it should not be taken lightly, Dr Maria Van Kerkhove said the more concerning thing with the Omicron-led wave has been that deaths are increasing for 5th week in a row. “Half a people, that we know of, have died (due to Covid,” he said, adding that deaths must be more than that cause the global health bodies don’t have adequate reporting systems around the world.

Most Omicron patients are reporting cold-like symptoms such as a sore throat, severe body pain, fatigue, severe headache, a study by UK-based tracker Zoe COVID app.

The ZOE COVID Study app is a not-for-profit initiative that was launched at the end of March 2020 to support vital COVID-19 research. The app was launched by health science company ZOE with scientific analysis provided by King’s College London.

February 14, 2022 0 comment

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Covid Case Update: India records 34,113 new cases

by Medically Speaking Team February 14, 2022

written by Medically Speaking Team

According to data from the Union health ministry, India recorded 34,113 new coronavirus infections on Monday, bringing the total to 4,26,65,534, while active cases dipped below 5 lakh after roughly 37 days.

For the eighth day in a row, COVID-19 cases have stayed below 1 lakh.

The death toll rose to 5,09,011 with 346 additional deaths, according to figures updated at 8 a.m.

The number of active cases has decreased to 4,78,882, accounting for 1.12% of all infections.

The national COVID-19 recovery rate has further improved to 97.68 per cent, the ministry said.

A reduction of 58,163 cases has been recorded in the active COVID-19 caseload in a span of 24 hours.

The daily positivity rate was recorded at 3.19 per cent.

The weekly positivity rate stood at 3.99 per cent, the ministry said.

The number of people who have recuperated from the viral disease has surged to 4,16,77,641.

The case fatality rate was recorded at 1.19 per cent, it said.

The cumulative doses administered in the country so far under the nationwide COVID-19 vaccination drive have exceeded 172.95 crore.

February 14, 2022 0 comment

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MOHFW seeks NMC opinion on consistent remuneration for medical interns

by Medically Speaking Team February 14, 2022

written by Medically Speaking Team

The National Medical Commission (NMC) has been asked to remark on a consistent stipend for MBBS interns at government and private medical institutions across the country, according to the Union Ministry of Health and Family Welfare.

This follows a letter from Binoy Viswam, Communist Party of India’s Rajya Sabha MP, to Mansukh Mandaviya, Union Minister for Health and Family Welfare on December 8, 2021. Mr. Mandaviya directed the Secretary, NMC, on January 27 to furnish its views “at the earliest”.

In his letter, Mr. Viswam had highlighted the lack of parity in stipend given to MBBS interns in private/deemed universities and those enrolled in government colleges. A stipend is paid to the interns as a matter of right and not charity. However, there was no equity across all medical institutions, he said.

Mr. Viswam pointed out that the NMC’s Draft Regulation Compulsory Rotating Internship, 2021, issued on April 21, 2021, and gazetted on November 18 in the same year, had said that all interns shall be paid stipend “as fixed by the appropriate fee fixation authority as applicable to the institution/university/State.”

The phrasing of this provision allowed for “ambiguity and arbitrariness in the award of stipend”, he said. It’s also possible that private college administrators may refuse to pay stipends to MBBS interns because they have total discretion and no safeguards in place. Mr. Viswam asserted that the repercussions of this could be observed in universities across the country, claiming that there were differences in the stipend amounts provided in government and private medical institutions.

According to sources, the erstwhile Medical Council of India (MCI), however, had come up with a public notice on January 25, 2019, on Graduate Medical Education Regulations, 1997. The Board of Governors that superseded the MCI was considering to include a provision which said that “All the candidates pursuing compulsory rotating internship at the institution from which MBBS course was completed, shall be paid stipend on par with the stipend being paid to the interns of the State Govt. Medical Institution/Central Government Medical Institution in the State/Union Territory where the institution is located.” However, it was not gazetted until the Board was dissolved.

In a decision dated October 29, 2015, the Kerala High Court ordered PMS College of Dental Science and Research, Thiruvananthapuram, to pay stipends to BDS interns at the same rate as government dental institutes in the state.

Mr. Viswam encouraged the Minister to confer with all stakeholders, including state governments, MBBS college administrations, medical experts, and MBBS students, in order to develop a strategy.

February 14, 2022 0 comment

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Most Cancers In Men & Women Are Related To Fat Intake: Expert

by Medically Speaking Team February 14, 2022

written by Medically Speaking Team

“Breast cancer and uterine cancer, these all are related to obesity and more fats or carbohydrates in diet and not taking a proper balanced diet”, Dr Sarika Gupta, Gynaecologist from Apollo Hospital said.

Here are a few snippets from the interview:

How important is it for a female to maintain good sexual and reproductive health ?

Dr.Sarika: Sexual and reproductive health is important for both male and female and sexual and reproductive health includes the knowledge and awareness about sexual practices, what is natural what is unnatural and information regarding reproduction, which includes fertility issues and infertility issues also. So, fertility issues are contraception and information about abortion and information regarding the problems or diseases that are spread by sexual contact which includes minor infections which can be cured with antibiotics but also sexually transmitted infections like hiv aids. It includes very serious diseases also and these contraception and abortion also can lead to serious issues. So, it is very important to have knowledge about sexual health and reproductive health.

What is the role of a good diet and a balanced lifestyle in maintaining a healthy reproductive system?

Dr.Sarika: So ,as you know diet is important for every part in body and specially because i am a specialist for female reproductive health so problem which arise with poor diet are hormonal problems, specially which is named as polycystic ovary syndrome , which is a life style disease, which is related to carbohydrates and metabolism problems and if somebody eating junk food and more carbohydrates. PCOD occurrs more in those who have a bad diet or exercising less and most importantly, many cancers in men and females are related to fat intake. In females, i would say breast cancer and uterine cancer, these all are related to obesity and more fats or carbohydrates in diet and not taking a proper balanced diet. Similarly in males also there are diseases which are caused by bad eating habits and other lifestyle like stress.

Every year about 6% of adult population in india is infected with sexually transmitted infections and reproductive tract infections. How often should a female get herself tested for the same and what are the tests recommended ? Moreover, what is the best way to protect oneself for such infections ?

Dr.Sarika: See it is a normal sexual infections, they are very common and they happen to most of the women who would have some kind of infections. If they are sexually active then they will have some or the other kind of sexually transmitted infections. It can be just the external infection that is the vaginal infection which is just outside. Sometimes, it can be internal also which is when it becomes serious. Patients can get hospitalised because of these infections, so that is why women should know, when she should visit a doctor. If she is not having any symptoms then also she should go to a gynaecologist every year and if she has an infection,if she has discharge which is curdy , which is associated with itching, she should go to the doctor instead of taking any kind of desi ilaaj or any medicine from the chemist . They should go to the doctor because if you are treating the infection incompletely then you will get regular infections . Sometimes the infection comes from the partner so we treat the partner also. If these things are not taken care of, then you might have infections like infertility.

A Key factor of reproductive health is menstruation. Very often, girls with young age experience irregular menstruation. What are the basic causes of irregular periods? And can it lead to or be a sign of other health problems? If so, when should one see a doctor??

Dr.Sarika: Yeah you are right , irregular menstruation is also a very common symptom and patients come to us. I think 50 percent who come to us , women and adolescent come to us with irregular periods. Periods can be prolonged that is happening every 40 to 45 days, 50 days or even in 2-3 months and it can be coming very earlier also. So sometimes, adolescent might come with bleeding coming after every 15 days or somebody can come if she is bleeding for like 15 or 20 days. So their are different kind of problems and i would tell everyone that if your periods are coming between 21 to 35 days and it is happening regularly at the same time, 3 to 5 days is ok , you don’t need to see a doctor. If you are bleeding for less then 7 days or your bleeding is or if you are having severe pain during periods which is affecting your day to day things. Then it is normal otherwise, if their is something strange from this normalcy then you can see a doctor and what is the reason, the reason for adolescents is that their cycle take sometime to regularise. So, the doctor have to first get a ultrasound and check what is the problem and if it is fine ,then we can observe the cycles as per what is the requirements. Most of the time it is hormonal medication also to regularise the cycle.

It is a very important day today, so what is your message to the viewers when it comes to discussing their sexual health considering the stigma around it .

Dr.Sarika: Yes , you are right there is a social stigma around it. Many times women and men also, if their is a small problem in the genital area or it is some discharge, swelling anything, they didn’t want to come to the doctor. They want to go to the chemist or ask their friends or something like that ,which can actually make their problems worse. You should know that it is very common. Its not only you who’s suffering .so, once in a year , I would say it is normal to have this kind of infection to a married women. Once in her age is fine , then go to the doctor, she will treat you , dont hesitate to go to a doctor . Nowadays it is also a stigma that doctor “how did i get it ? Should i think my partner is having infertility chance” so that is also not the case. It is actually very common and many other virus and infections are also very common. Sometimes infection just stays there, when the immunity is low ,it flares up. So, you can see the infection later, many years after the infection . So, there should be no stigma around it . It is very common and there are treatments which will actually treat you within few days.

February 14, 2022 0 comment

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Impact of Covid on Male Ferility

by Medically Speaking Team February 14, 2022

written by Medically Speaking Team

Studies published in last two years have shown many men who come up with this issue due to Covid, Dr (Prof) Anup Kumar, Chairman, Dept of Urology, Robotics and Kidney Transplant, Safdarjung Hospital.

How important is it for a man to maintain a good sexual and reproductive health?
Dr Anup Kumar: Maintaining a good sexual and reproductive health does not only affect their psychological aspect, but the overall quality of life including their job, their relationship with their spouse and other family members. But it is often ignored in India. Most men have a social stigma attached to it due to which they do not discuss it with a doctor.

What are the factors related to decreasing male fertility?
Dr Anup Kumar: 50 per cent of the infertility causes are in males. One of the reasons is genetic, which means that their spermatogenesis is defective by birth due to which they have immature sperms in their testes which is why they are not able to produce a child. Secondly, there is a condition known as varicocele which is dilation of the veins due to which temperature regulation of the testes is lost that affects the production of sperms and initially there is a decrease in sperm count and quality and eventually, they are unable to produce a child. Thirdly, extreme exposure to heat also affects spermatogenesis in the testes. Consumption of alcohol and tobacco produces free oxygen radicals which hampers spermatogenesis in the testes. Certain acquired causes like viral infections affect testes and decreases their production capacity. These are some of the causes but 30 per cent of the patients have no detectable cause which is idiopathic infertility that has been on the rise for the last many years and that is something we are worried about. These patients have some genetic causes, chromosomal defects and more so due to lifestyle issues like stress and anxiety. Covid has affected fertility in many males. Studies published in last two years have shown many men who come up with this issue due to Covid.

Explain a little more on that.
Dr Anup Kumar: Sars CoV infectiona causes generalized inflammation throughout the body hence affecting all the body parts and even forming blood clots in blood vessels. It affects the sperm production in the testes. It has been proved that Covid is detected in many body secretions including semen. Once the virus reaches the testes, it damages the spern production and causes inflammation throughout the tract and ultimately blocking it.

What are the implications of stress?
Dr Anup Kumar: Stress hampers the coitus potential of the male. They develop problems like Erectile Dysfunction, low libido, and when talking about ED, it is all psychological. When we perform tests on erectile reflex, they come out to be normal but when we analyse the stress and anxiety levels, men suffer the same due to financial or social issues which affects their sexual potential. Thirdly, they have premature ejaculation. All of these further decreases their morale which resists them from having sexual intercourse with their wife and ultimately the wife suffers and the male develops depression. This is therefore a vicious cycle.

Do men with infertility have recurring reproductive problems and is there a cure to this?
Dr Anup Kumar: Firstly they need a proper consultation with a doctor. Whenever a patient comes to us with ED or infertility, we rule out all the possible factors through methodical protocol. We eventually reach a conclusion that the person does not have an organic cause, but a psychological cause. Then we reach out to psychologist also and we give them proper counselling. Along with that we give them some medications also.

How does one protect oneself from STDs and how often should a male get himself tested for the same?
Dr Anup Kumar: We always counsel our male patients to use condoms during sex. Try to avoid multiple partners because the more partners you have, the more risk you develop of having a sexual infection.
If someone comes up with these problems, we first take the discharge from the patient’s urethra that is mostly a false malign discharge. We perform a microscopic examination on it for different responsible bacteria like chlamydia. If the patient suffers symptoms like loss of appetite or weight, we send the patient for the HIV test. Once we detect the problem, we prescribe the treatment accordingly. We have a set course of antibiotics for trychomonas and chlamydia that goes on for 10 to 14 days and we ask the patient not to have sexual intercourse with anyone for atleast 3-4 weeks. For HIV, we have different treatment called ART that is performed in a different clinic.

Are STDs contractible through any other factor than intercourse?
Dr Anup Kumar: Most of the time the cause for this is unprotected intercourse. HIV can also be procured through contaminated needle or blood transfusion.

February 14, 2022 0 comment

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USFDA approves Eli Lilly’s Covid antibody drug

by Medically Speaking Team February 12, 2022

written by Medically Speaking Team

The United States Food and Medication Administration approved Eli Lilly and Co’s (LLY.N) COVID-19 antibody drug for persons aged 12 and up who are at risk of severe disease on Friday, adding a tool that has been proven to work against the highly infectious Omicron strain.

The FDA has approved bebtelovimab for emergency use in individuals with mild-to-moderate COVID-19 who are at high risk of developing severe illness, which might result in hospitalisation or death.

Bebtelovimab should be used when alternative COVID-19 treatment options approved or authorized by the FDA are not accessible or clinically appropriate, the agency said.

The U.S. health regulator had in January revised the emergency use authorizations for Lilly’s antibody combination treatment and a rival therapy from Regeneron (REGN.O) after the drugs were found to be ineffective against the Omicron variant.

Lilly has said bebtelovimab retains activity against Omicron as well as its BA. 2 subvariant, which is said to be more transmissible.

The company on Thursday signed a supply deal with the U.S. government for up to 600,000 doses of bebtelovimab to be delivered by the end of March.

Bebtelovimab was originally discovered by AbCellera Biologics (ABCL.O) and later licensed and developed by Eli Lilly.

Source: Reuters

February 12, 2022 0 comment

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WHO approves Arthritis Drug for severe Covid-19 cases

by Medically Speaking Team February 12, 2022

written by Medically Speaking Team

The World Health Organization said on Friday that the arthritis therapy tocilizumab has been prequalified for use in patients hospitalised with severe Covid-19, in an effort to expand access to the costly medicine.
The monoclonal antibody, which is used in Roche’s anti-inflammatory medications, has been found to minimise the risk of mortality and hospitalisation duration in select individuals with severe Covid.

The World Health Organization, along with the United States and the European Union, has previously recommended its usage in hospital settings to treat severe Covid.

But it remains in short supply and is very expensive — a single dose reportedly goes for up to $600 in lower-income countries, WHO said, adding though that its prequalification should help make it more accessible.

The UN health agency said it had added three different compositions of the monoclonal antibody to its list of prequalified treatments for the pandemic disease, in a move aimed to spur more the production of more cheaper generic versions.

“The listings should pave the way for more companies coming forward to seek WHO prequalification, thereby increasing the number of quality-assured products and creating competition leading to potentially lower prices,” WHO said in a statement.

“The prequalification of these products will also facilitate low- and middle-income countries’ authorisation of them as Covid treatments,” it said.

WHO told AFP its prequalification process was primarily aimed at ensuring the quality, safety and efficacy of medical products procured to developing countries.

A prequalification provides assurances to countries that they are purchasing quality health products.

Prior to tocilizumab, the WHO has prequalified three different compositions for the steroid dexamethasone for treating Covid, as well as Gilead’s antiviral remdesivir, although that prequalification has since been suspended.

Tocilizumab has previously been authorised mostly for the treatment of arthritis in about 120 countries.

But during the pandemic, it has also been shown to suppress a dangerous “cytokine storm” — the over-reaction of the immune system to the coronavirus.

WHO pointed out that the patent for tocilizumab had expired for most uses.

This, it said, “means there should be no intellectual property barriers,” although it warned there was “low global availability for quality-assured biosimilars of the product”.

WHO said it was currently discussing with Roche how to lower prices and improve access in low- and middle-income countries.

But it stressed to AFP that while Friday’s prequalification was specifically for Roche products, “many generic companies are already producing tocilizumab, some of which have also applied for prequalification”.

“If they are found to comply with WHO standard… they can enter international markets.”

February 12, 2022 0 comment

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Omicron reinfections may occur but not dangerous: Experts

by Medically Speaking Team February 12, 2022

written by Medically Speaking Team

Many people get re-infected with Covid-19 within 2-3 weeks of their prior infection, but hospital authorities and health experts say the majority of these cases are minor and represent no threat to the country’s return to normalcy. Most specialists blame the Omicron variant’s “immune escape” capability for the higher likelihood of reinfection.

“It is not ideal, but it does not seem to be dangerous,” said Anurag Agrawal, director of the Institute of Genomics and Integrative Biology (IGIB).

Farah Ingale, director, internal medicine at Fortis Hiranandani Hospital Vashi, said the hospital is seeing new cases of reinfection, especially in the third wave, for which Omicron is responsible.

“We have seen patients getting infected again with the Omicron infection within two to three weeks…because the host immune system is not able to recognise and eliminate a pathogen,” she said. “Though mild, it (Omicron) is definitely known to cause reinfections.”
Responding to cases of reinfection, Indian Council of Medical Research (ICMR) director general Balram Bhargava on Thursday said infection by one variant of Covid-19 does not provide protection from other variants. Niti Aayog member VK Paul said, “It is a fact that the vaccine protection and natural immunity protection do not completely guarantee that one would not be reinfected again.”

He said that the issue is being constantly discussed across the world including India.

Suranjit Chatterjee, senior consultant at Indraprastha Apollo Hospital in New Delhi, said studies suggest that Omicron reinfection can be more common because of its immune escape ability. “Also it could always be a different variant or mutant causing it,” he said.

Ingale of Fortis Hiranandani said Omicron “has caused a lot of infections, superinfections, and reinfections, as well”.

This post has been published from a syndicate feed with some changes to the text and headline.

February 12, 2022 0 comment

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China approves Pfizer’s Covid drug Paxlovid

by Medically Speaking Team February 12, 2022

written by Medically Speaking Team

Pfizer’s COVID-19 therapy Paxlovid received conditional clearance from China’s medical goods authority on Saturday (Feb 12), making it the first oral anti-coronavirus tablet licenced in the nation to treat the disease.

Paxlovid has received conditional clearance from the National Medical Products Administration to treat people with mild to moderate COVID-19 and a high risk of advancing to a severe disease. It stated that more research on the medicine should be undertaken and reported to the authorities.

Paxlovid has so far been authorised in several countries including the United States and Israel, while the European Union has permitted member states to use it ahead of formal approval as an emergency measure against the Omicron variant.

Unlike COVID-19 vaccines, the drug does not target the ever-evolving spike protein that the coronavirus uses to invade cells. It is not immediately clear if China is already in talks with Pfizer to procure the pill. Pfizer did not reply to a Reuters request for comment.

The approval is a boost to Pfizer which expects US$22 billion in 2022 sales of the treatment.

Pfizer executives said the company is in active discussions with over 100 countries about Paxlovid, and has the capacity to provide 120 million courses if needed.

While a number of vaccines are available worldwide to help prevent infection and serious illness, including one made by Pfizer, there are limited treatment options for people infected with COVID-19.

Pfizer in December said final trial results showed its treatment reduced the chance of hospitalisation or death by 89 per cent in COVID-19 patients at risk of severe illness given the treatment within three days of the onset of symptoms, and by 88 per cent when given within five days of onset.

The United States is paying around US$530 for each course of Paxlovid and US$700 for each course of rival COVID-19 pill molnupiravir developed by Merck & Co.

China has yet to approve any foreign-produced COVID-19 vaccines, but has approved numerous locally created vaccines.

February 12, 2022 0 comment

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