The Medical Week In Review
Episode One: 14 January 2021



 

Links from this Podcast

COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
 Audio Interview: Covid-19 Takeaways at Podcast 100 | NEJM  

A living WHO guidelines on drugs for covid-19 | The BMJ 
Snake Envenomation | NEMJ 
Ultrarapid Nanopore Genome Sequencing in a Critical Care Setting| NEJM  

Colombia allows euthanasia of two people with non-terminal illness | BMJ 
Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019 | The Lancet Public Health 
No more annual flu shot? Scripps Research and collaborators find new target for universal influenza vaccine 
Anthrax toxins regulate pain signaling and can deliver molecular cargoes into ANTXR2+ DRG sensory neurons | Nature Neuroscience 
Theranos and the scientific community: at the bleeding edge | The Lancet 


Audio Transcript

You’re listening to the Medical Education Network, where we’ve been delivering quality medical education and information to Southern African healthcare practitioners since 2008.

Welcome to the Week in Review. I’m your host Linda Ravenhill and this is our inaugural podcast. Thank you for tuning in.

The Corona pandemic has vortexed the medical world into chaos. Not to be outmatched by the tsunami of Corona cases, the rate of medical information dispensed from pharma companies and the like, have created a similar deluge.It’s been exhausting and most of us will admit to suffering the twin evils of information overload, and the fear of missing something important. And that is not a comfortable place.

In response, for the last few months, we’ve been chatting to our community about what they would like to see from a medical education and information platform, and what would be most useful to them. This podcast is the result. 

Every week, we’ll bring you a round-up of clinical information and general healthcare stories that caught our attention, both internationally and here in South Africa. We promise to keep our review under 15 minutes so it will be easy to catch up while you’re grabbing a cup of coffee, or listen to on your way home from work.  We hope to be available on all your favourite podcast channels in the near future.

Links to all the content we discuss in the podcast will be posted on our website – www.meded.co.za – under the “Week in Review” feature” – so you can explore them at your leisure.

Formalities completed, here’s our review for the week ending on the 14th of January 2021.



- No surprise that the year has gotten off to a cracking start.  And no surprise either that Corona is still dominating the headlines.  
As we’re all inundated with Corona information, I won’t spend too much time on this subject, other than provide a quick overview – for history’s stake – of where we stand on the 14th of January, and highlight two articles you might find of interest.

Globally we’ve reached the milestone of 320 million cases, with the death toll sitting at 5,52 million cases. Europe remains the pack leader, with many countries still recording 100 thousand plus daily totals. Here in South Africa, we’re slowly decreasing our caseload. Today – the 14th -  we’ve recorded 5235 daily cases,  with a weekly average of 5461 per day.

In the rest of Africa, according to John Hopkins’s weekly new cases report,  Namibia recorded 350 weekly cases, Botswana 1118, and Zimbabwe 622. Further afield – Kenya recorded 1081 cases, Nigeria 429 and Rwanda 714
This data comes from the  Novel Coronavirus Cases collated report, -and this link is available on MedED

Link
 COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University



-Talking of milestones the New England Journal of Medicine has just broadcast the 100th episode of its Corona Virus podcast. In the episode, the editors take a look at what they’ve learned from studies published in the last 2 years and discuss where they think we’re headed as far as Corona is concerned. It’s full of fascinating insights, and we highly recommend it.  

Link: 
 Audio Interview: Covid-19 Takeaways at Podcast 100 | NEJM  



-For our final story on the Corona front, the BMJ has published the 8th version of their “ A living WHO guideline on drugs for covid-19.”
If you haven’t seen the previous versions, the guideline represents the findings of the WHO’s Guideline Development Group in an interactive format. 

This edition reports that the group found moderate certainty evidence that baricitinib improved survival and reduced the need for ventilation, with no observed increase in adverse effects. This is a must-access article for all practitioners.

Link

A living WHO guidelines on drugs for covid-19 | The BMJ 



-Moving on from COVID, this week we found a fascinating review, also in the NEJM, regarding developments in treatments for snake bites, which we thought were particularly relevant to our region. In 2009, according to the article, snake envenomation was recognized as a neglected tropical disease by the WHO and was elevated to Category A of the neglected tropical disease in 2017.

Currently, the majority of treatments available for snake bites are antivenoms, made using host sheep or horses,  but these treatments are extremely expensive to produce -  concerning given that developing countries are the countries most at risk. 
Researchers are now looking to use other animals -  including camels, chickens, and sharks as alternatives to develop humanizing animal antibodies.  There is also novel research being conducted into animal serums and some plant extracts which could neutralize the venom. The article offers a comprehensive overview of the subject and it’s well worth the read.  

Link:
Snake Envenomation | NEMJ 



-In the Critical Care arena, we noted an interesting trial regarding the use of genomic sequencing in the critical care setting. Entitled, “Ultrarapid Nanopore Genome Sequencing in a Critical Care Setting”  
the trial, also from NEJM – who clearly had a good week this week -  posits that a genetic diagnosis can guide clinical management and improve prognosis in critically ill patients. It describes the extremely rapid sequencing and analysis of the genomes of 12 patients, 5 of whom received a diagnosis. We’ll be watching this space with interest.

Link:
Ultrarapid Nanopore Genome Sequencing in a Critical Care Setting| NEJM  



-Talking of critical care, another very contentious subject – that of Euthanasia - this week Columbia allowed the euthanasia of two people who had non-terminal illnesses, making it the fourth country – after Canada, Belgium, and the Netherlands -  to permit voluntary euthanasia, to end suffering in people who may not otherwise be likely to die soon.

Here in South Africa, the battle for the right to die blazes on. We are still awaiting a ruling on the case of Dieter Harck, who has motor neuron disease,  and Sue Walter, a physician who has terminal cancer, which is before the Pretoria high court. Both are seeking the legal right to choose assisted dying when their illnesses become unendurable. At the time of this recording, we could not find any further updates on this ruling. If you know of any changes, please drop us a line using the Contact us form on meded.co.za

Link:

Colombia allows euthanasia of two people with non-terminal illness | BMJ 

 



-Moving on from one critical issue to another, this week, the Lancet featured  a concerning  study from the Global Burden of Disease 2019 Dementia Forecasting Collaborators, which indicates that the incidence of dementia is set to trebble to an estimated 153 million in 2050

Their forecast was attributable to the three dementia risk factors included in the GBD study - namely high body-mass index, high fasting plasma glucose and smoking. The researchers attribute the projected increases to population growth and population ageing, depending on region -  with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia

Link

Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019 | The Lancet Public Health 

 



- There were two stories published in December last year, which went pretty much unnoticed, but which we think are really important.

-The first is a fascinating study published in Nature by researchers from the Scripps Research, the University of Chicago, and the Icahn School of Medicine at Mount Sinai, which seems to bring us one step further to developing a universal flu vaccination. In the Corona hype, it may have been easy to forget that influenza is still one of the worlds biggest killers. The search for a universal vaccination has long been the focus of research, but a real breakthrough has been hindered by the mutational nature of these influenza viruses. The Scripps researchers  discovered a new set of antibodies that can neutralize influenza by binding to the anchor region of influenza HA.  
These antibodies recognized a variety of H1 influenza viruses, which account for many seasonal flu strains: some were also able to recognize pandemic H2 and H5 strains of influenza in lab tests, and in mice, the antibodies successfully protected against infection by three different H1 influenza viruses.

Link: 

No more annual flu shot? Scripps Research and collaborators find new target for universal influenza vaccine 

 


-The other study we think was overlooked was research out of Havard Medical School, published in Nature Neuroscience, which looked into using anthrax toxin to block multiple types of pain. The researchers engineered an anthrax protein vehicle to deliver different types of treatments into pain receptors to modulate nerve-cells, effectively altering signaling and blocking pain. They hypothesise that their finding could inform, and I quote here “ The design of therapies that selectively target pain-sensing fibers without the widespread systemic effects of opioids and other pain killers. : Given the epidemic of pain and it’s sequelae, that would be no small help!

Link: 

Anthrax toxins regulate pain signaling and can deliver molecular cargoes into ANTXR2+ DRG sensory neurons | Nature Neuroscience 

 
-And in case you missed it, Elizabeth Holmes -  she of  Theanos fame  -  has been found guilty of defrauding investors -  although interesting, not guilty on charges of defrauding the public.
Something that has always bothered me about the Thearos story was how the claims Theranos was making, managed to avoid vigorous scrutiny by the scientific community. Sure, there were a few voices of caution, but on the whole, the scientific community appeared to be, at least on the face of it, similarly caught up in the narrative of this 20-something’s brilliance. 

But as with all 20-20 hindsight - the red flags were there.  So did the scientific community sacrifice rigour for stardust?  The Lancet raises this thorny issue in this week’s editorial. 

Link

Theranos and the scientific community: at the bleeding edge | The Lancet 
 


We’ll end off with our Medical Trivia for the week.
January the 14th marks the birthday of  - Albert Schweitzer. He was, according to the Encyclopedia Brittanica, a German theologian, philosopher, organist, and mission doctor in equatorial Africa. He received the 1952 Nobel Prize for Peace for his efforts in behalf of “the Brotherhood of Nations.” 

It is also the birth date of Harold Shipman, British general practitioner, and serial killer who murdered about 250 of his patients – most of whom were elderly women.He remains one of history’s most prolific serial killers and is the only British doctor to have been found guilty of murdering his patients.

So if you didn’t know, now you do!


And that all for this week in review. 

Links to all the stories featured here can be found on our Medical Week in the Review page.  If you liked this podcast, please tell your friends about us. If there are stories you’d like us to focus on drop us a line using the contact details on www.meded.co.za

Wherever you are, stay safe, stay sane, and join us next week where we 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.
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