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The Medical Week In Review
Episode 7: 5 June 2022
Welcome to the Medical Week in Review.
As we mentioned last week, we’re taking a break from our podcasting to upgrade our audio platform and will be producing this review in a newsletter format for the foreseeable future.
Here is what has been happening in the world of medicine for the week ending 5th June
First up, as always, matters COVID and we seem to be holding steady.
'
As of 4 June 22, here at home (South Africa), we recorded a 7-day average of 2 126 cases, which is down 1 523 cases on last week's numbers (28th May 22).
As far as our neighbours are concerned, as of the 5th of June Namibia recorded 243 new 7-day average figures: Botswana recorded 143 cases, Kenya 108 cases, Zimbabwe 178 cases, and Nigeria the 3rd of June recording 17 cases.
Our COVID story for the week is an article published in the BMJ again, this one on the 1st of June, which indicates that an estimated 2 million people in the UK may be suffering from long-COVID. The data is based on self-reporting, and looked at some 296 869 cases, over a four-week period.
When probed regarding the effects they experienced post-COVID, 71% of the participants said long covid affects their day-to-day activities, while 20% said their activities have been significantly affected. Of the symptoms reported, fatigue was the most common ( 55%), followed by “shortness of breath (32%), a cough (23%), and muscle ache (23%).” 3 The majority of the participants had had COVID within the previous 12 weeks, with just under a sixth of the respondents having had COVID 2 years ago.
I found it interesting that 31% of the respondents had been infected in the Omnicron period versus 12% in the alpha period and 21% in the delta period.
Given that omicron is reportedly less severe, I wonder what, if anything can be deduced from these findings? As we said last week, now that the dust is settling on the crisis period of the pandemic, more information will start to emerge as to the long term impacts. I think we can expect to see similar data emerging globally.
And that's our COVID round-up for the week. Links to all our source articles as always listed below
Links
1. COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
2. Latest confirmed cases of COVID-10 in South Africa ( 7 June 2022) (NICD)
3. Covid-19: Two million people in the UK are estimated to be experiencing long covid, says ONS(BMJ)
Next up: Monkeypox & Measles in our midst
Keeping with our ongoing theme, let's take a look at Monkeypox, and approximately 1000 cases have now been reported globally. The WHO has maintained the alert level at moderate.
While the case count is low, it is the fact that they are occurring in non-endemic countries that is the cause of concern. I would warrant that the WHO is also very aware that it cannot afford another COVID situation, and so will act extremely cautiously in relation to it’s communication and management strategies in relation to the disease.
You can find out more about Monkeypox on the NCID website listed below.
On a more worrying note for South Africa, is the recent reports by the NCID of 4 cases of measles in the Gauteng area. Three of the cases have been reported in the Tshwane area, and are linked, while the fourth is on the West Rand in Gauteng. According to the press release by the NCID, the World Health Organization (WHO) considers, “two or more cases of measles in a health district within one month”,6 as a measles outbreak.
It is no secret that COVID played havoc with the vaccination programs globally, so all practitioners should be on high alert for additional cases. The full NCID press release is below.
Link:
5. Situation Update: Monkeypox ( NCID, Press Release 23 May 2022)(NCID)
6. Measles Alert ( 6 June 2022) (NCID)
Matters Ageing
This week I decided to focus on two trials related to ageing matters, both in the cognition sphere.
The first is a trial published in JAMA on the 23rd of May entitled 'Clinical Manifestations of Early-Onset Dementia With Lewy Bodies Compared With Late-Onset Dementia With Lewy Bodies and Early-Onset Alzheimer's Disease.'
The premise of the study is that early-onset dementia with Lewy Bodies (DLB) is poorly understood and therefore often misdiagnosed. Given the financial and social impacts of such a diagnosis, the researchers set out to determine if it was possible to clinically differentiate between early-onset dementia with Lewy bodies, late-onset dementia with Lewy bodies and early-onset Alzheimer's disease.
The retrospective case-control study was completed utilising data from patients with pathologically confirmed DLB or AD enrolled in the National Alzheimer’s Coordinating Center database from January 2005 to July 2017.
.
The researchers determined that there were clear symptoms that differentiated the three conditions. DLB differed from early-onset AD in a number of criteria, including “visual hallucinations, slowness, apathy and motor deterioration that preceded cognitive and behavioural symptoms.”7 Late-onset DLB had more amnesic features, which the researchers attributed to the “higher proportion of neocortical neuritic and diffuse plaques”7 that are seen in the late-onset compared to early-onset DLB.
It's a very useful trial and worth a read.
Link:
7. Clinical Manifestations of Early-Onset Dementia With Lewy Bodies Compared With Late-Onset Dementia With Lewy Bodies and Early-Onset Alzheimer's Disease
Matters Ageing Part Two
In my second trial, again from JAMA, but this time Jama Ophthalmology, and a recent paper which asked whether there was an association between retinal layer thickness and cognitive decline in older adults – which is in fact the name of the paper.
The paper originated from Korea, and considers a cohort of 403 participants, in a communal-dwelling situation, with a mean of 76.3 years [SD 6.6yrs].
The study found that there was indeed an association. A thinner baseline total macular RNFL thickness was associated with a larger decline in the CERAD and MMSE score in the period under investigation. In addition to quotee the study findings:”… participants with baseline total macular RNFL thickness below the lowest quartile cutoff value presented a greater decline in cognitive scores and a higher prevalence of cognitive impairment and Alzheimer's disease than those with RNFL thickness above the lowest quartile cutoff value.”8
The researchers note various trial limitations including other influencing factors such as hypertension, but nonetheless conclude that macular RNFL thickness may be considered a “noninvasive ocular biomarker for assessing changes in cognitive function in patients.”
So some interesting data coming out recently around diagnostics, or rather early diagnostics for Dementia and Alzheimers.
Link
8. Association Between Retinal Layer Thickness and Cognitive Decline in Older Adults
Innovations in Medical Practice
Link
9. Western Cape ‘Safety Dashboard’ launched for medical professionals to track rate of violent injuries(DM)
It's Medical Trivia time
And now it’s Medical Trivia time.
Out of curiosity this week I googled “history of zoonotic diseases” and found a treasure trove of information.
Taking biblical references out of the equation, the first major mention of a pandemic caused by zoonotic transfer, was in 429 BC. It was called the ‘plague of Athens’ and is thought to have killed nearly a quarter of the population of that city.
The symptoms described by Thucydides - an Athenian historian and general of the times - included “…high fever, facial erythema, pustular rash to ulcers on the skin (sometimes gangrenes), bleeding from gums, tongue and throat, conjunctivitis, cough, sneezing, runny nose, diarrhoea, severe vomiting, dehydration, sleeping distress; and some of those who survived lost their toes and fingers, vision or memory.”10
Based on the symptoms, epidemiologists believe the disease to have been epidemic louse-borne typhus.
Either way, it was catastrophic for the people of Athens and is believed to have contributed to its decline as a powerhouse of the time.
Our source article, ‘A History of Zoonoses and Sapronoses and Research into Them’ written by Zdenek Hubálek & Ivo Rudolf makes for interesting reading, given our current times.
So if you didn't know – now you do.
Link:
And that is all for the Week in Review.
If you liked this newsletter please tell your friends about it. If there are stories you’d like me to focus on drop me a line using the contact details on www.meded.co.za
All that's left is to say, wherever you are, stay safe, stay sane, and join me next week where I review the week in medicine.
This has been a production on the Medical Education Network – delivering quality medical education and information to Southern Africa since 2008. All thoughts and comments on this podcast remain that of its creators. Every effort has been made to fact check the information contained here. Any errors or misstatements that may occur are unintentional.
Episode 7: 5 June 2022
Welcome to the Medical Week in Review.
As we mentioned last week, we’re taking a break from our podcasting to upgrade our audio platform and will be producing this review in a newsletter format for the foreseeable future.
Here is what has been happening in the world of medicine for the week ending 5th June
First up, as always, matters COVID and we seem to be holding steady.
'
As of 4 June 22, here at home (South Africa), we recorded a 7-day average of 2 126 cases, which is down 1 523 cases on last week's numbers (28th May 22).
As far as our neighbours are concerned, as of the 5th of June Namibia recorded 243 new 7-day average figures: Botswana recorded 143 cases, Kenya 108 cases, Zimbabwe 178 cases, and Nigeria the 3rd of June recording 17 cases.
Our COVID story for the week is an article published in the BMJ again, this one on the 1st of June, which indicates that an estimated 2 million people in the UK may be suffering from long-COVID. The data is based on self-reporting, and looked at some 296 869 cases, over a four-week period.
When probed regarding the effects they experienced post-COVID, 71% of the participants said long covid affects their day-to-day activities, while 20% said their activities have been significantly affected. Of the symptoms reported, fatigue was the most common ( 55%), followed by “shortness of breath (32%), a cough (23%), and muscle ache (23%).” 3 The majority of the participants had had COVID within the previous 12 weeks, with just under a sixth of the respondents having had COVID 2 years ago.
I found it interesting that 31% of the respondents had been infected in the Omnicron period versus 12% in the alpha period and 21% in the delta period.
Given that omicron is reportedly less severe, I wonder what, if anything can be deduced from these findings? As we said last week, now that the dust is settling on the crisis period of the pandemic, more information will start to emerge as to the long term impacts. I think we can expect to see similar data emerging globally.
And that's our COVID round-up for the week. Links to all our source articles as always listed below
Links
1. COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
2. Latest confirmed cases of COVID-10 in South Africa ( 7 June 2022) (NICD)
3. Covid-19: Two million people in the UK are estimated to be experiencing long covid, says ONS(BMJ)
Next up: Monkeypox & Measles in our midst
Keeping with our ongoing theme, let's take a look at Monkeypox, and approximately 1000 cases have now been reported globally. The WHO has maintained the alert level at moderate.
While the case count is low, it is the fact that they are occurring in non-endemic countries that is the cause of concern. I would warrant that the WHO is also very aware that it cannot afford another COVID situation, and so will act extremely cautiously in relation to it’s communication and management strategies in relation to the disease.
You can find out more about Monkeypox on the NCID website listed below.
On a more worrying note for South Africa, is the recent reports by the NCID of 4 cases of measles in the Gauteng area. Three of the cases have been reported in the Tshwane area, and are linked, while the fourth is on the West Rand in Gauteng. According to the press release by the NCID, the World Health Organization (WHO) considers, “two or more cases of measles in a health district within one month”,6 as a measles outbreak.
It is no secret that COVID played havoc with the vaccination programs globally, so all practitioners should be on high alert for additional cases. The full NCID press release is below.
Link:
5. Situation Update: Monkeypox ( NCID, Press Release 23 May 2022)(NCID)
6. Measles Alert ( 6 June 2022) (NCID)
Matters Ageing
This week I decided to focus on two trials related to ageing matters, both in the cognition sphere.
The first is a trial published in JAMA on the 23rd of May entitled 'Clinical Manifestations of Early-Onset Dementia With Lewy Bodies Compared With Late-Onset Dementia With Lewy Bodies and Early-Onset Alzheimer's Disease.'
The premise of the study is that early-onset dementia with Lewy Bodies (DLB) is poorly understood and therefore often misdiagnosed. Given the financial and social impacts of such a diagnosis, the researchers set out to determine if it was possible to clinically differentiate between early-onset dementia with Lewy bodies, late-onset dementia with Lewy bodies and early-onset Alzheimer's disease.
The retrospective case-control study was completed utilising data from patients with pathologically confirmed DLB or AD enrolled in the National Alzheimer’s Coordinating Center database from January 2005 to July 2017.
.
The researchers determined that there were clear symptoms that differentiated the three conditions. DLB differed from early-onset AD in a number of criteria, including “visual hallucinations, slowness, apathy and motor deterioration that preceded cognitive and behavioural symptoms.”7 Late-onset DLB had more amnesic features, which the researchers attributed to the “higher proportion of neocortical neuritic and diffuse plaques”7 that are seen in the late-onset compared to early-onset DLB.
It's a very useful trial and worth a read.
Link:
7. Clinical Manifestations of Early-Onset Dementia With Lewy Bodies Compared With Late-Onset Dementia With Lewy Bodies and Early-Onset Alzheimer's Disease
Matters Ageing Part Two
In my second trial, again from JAMA, but this time Jama Ophthalmology, and a recent paper which asked whether there was an association between retinal layer thickness and cognitive decline in older adults – which is in fact the name of the paper.
The paper originated from Korea, and considers a cohort of 403 participants, in a communal-dwelling situation, with a mean of 76.3 years [SD 6.6yrs].
The study found that there was indeed an association. A thinner baseline total macular RNFL thickness was associated with a larger decline in the CERAD and MMSE score in the period under investigation. In addition to quotee the study findings:”… participants with baseline total macular RNFL thickness below the lowest quartile cutoff value presented a greater decline in cognitive scores and a higher prevalence of cognitive impairment and Alzheimer's disease than those with RNFL thickness above the lowest quartile cutoff value.”8
The researchers note various trial limitations including other influencing factors such as hypertension, but nonetheless conclude that macular RNFL thickness may be considered a “noninvasive ocular biomarker for assessing changes in cognitive function in patients.”
So some interesting data coming out recently around diagnostics, or rather early diagnostics for Dementia and Alzheimers.
Link
8. Association Between Retinal Layer Thickness and Cognitive Decline in Older Adults
Innovations in Medical Practice
Finally, an innovation coming out of the Western Cape, and that is the launch of a safety dashboard to track the incidence of violent injuries across the region. The project is an attempt to foster cross-departmental collaboration to improve service delivery.
According to our source article in the Daily Maverick, Information is drawn from the Hospital and Emergency Centre Tracking Information System (Hectis), which contains data inputted in real-time by emergency department staff.
The data will help shape future care strategies, identifying what skills are required and where and when to more efficiently manage care in emergency departments.
For example, according to the Daily Maeveirk, the data shows that 52% of injuries of pregnant women were caused by assaults, nearly half of which (47%) occurred in the second trimester. In terms of preparedness in the emergency room in those areas where this data holds true, you can clearly see the care benefits for example having access to neonatal paediatricians on call, and the creation of protocols to deal with this type of trauma.
And it is not only hospitals that will benefit, police departments too will benefit from the information which reflects what type of injuries are being reported in what areas. The article in the Maverick indicates that the Hectis system can be used to shape policing strategies as has been done in other countries.
A fantastic initiative that we’ll be keeping tabs on for you in the future. If you have experience with the system please reach out to us - we’d love to hear from you.
Link
9. Western Cape ‘Safety Dashboard’ launched for medical professionals to track rate of violent injuries(DM)
It's Medical Trivia time
And now it’s Medical Trivia time.
Out of curiosity this week I googled “history of zoonotic diseases” and found a treasure trove of information.
Taking biblical references out of the equation, the first major mention of a pandemic caused by zoonotic transfer, was in 429 BC. It was called the ‘plague of Athens’ and is thought to have killed nearly a quarter of the population of that city.
The symptoms described by Thucydides - an Athenian historian and general of the times - included “…high fever, facial erythema, pustular rash to ulcers on the skin (sometimes gangrenes), bleeding from gums, tongue and throat, conjunctivitis, cough, sneezing, runny nose, diarrhoea, severe vomiting, dehydration, sleeping distress; and some of those who survived lost their toes and fingers, vision or memory.”10
Based on the symptoms, epidemiologists believe the disease to have been epidemic louse-borne typhus.
Either way, it was catastrophic for the people of Athens and is believed to have contributed to its decline as a powerhouse of the time.
Our source article, ‘A History of Zoonoses and Sapronoses and Research into Them’ written by Zdenek Hubálek & Ivo Rudolf makes for interesting reading, given our current times.
So if you didn't know – now you do.
Link:
10. A History of Zoonoses and Sapronoses and Research into Them
And that is all for the Week in Review.
If you liked this newsletter please tell your friends about it. If there are stories you’d like me to focus on drop me a line using the contact details on www.meded.co.za
All that's left is to say, wherever you are, stay safe, stay sane, and join me next week where I review the week in medicine.
This has been a production on the Medical Education Network – delivering quality medical education and information to Southern Africa since 2008. All thoughts and comments on this podcast remain that of its creators. Every effort has been made to fact check the information contained here. Any errors or misstatements that may occur are unintentional.
