The Medical Week In Review
Episode 2: 21 January 2021



 

Links from this Podcast

New era of health science for Africa ( Health-enews.org) 
Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non–Critically Ill Hospitalized Patients With COVID-19: A Randomized Clinical Trial | Anticoagulation | JAMA | JAMA Network 
Editorial: Antiplatelet Therapy in Patients With COVID-19—More Is Less? (JAMA) 
Association of Telomere Length With Risk of Disease and Mortality (JAMA) 
Global Burden of Microbial resistance in 2019: a systematic analysis (Lancet)  
Antimicrobial resistance: time to repurpose the Global Fund - The Lancet  
Randomzed Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes (NEJM) 
Hydroxychloroquine for Primary Progressive Multiple Sclerosis (Annals of Neurology Journals) 
Malaria drug 'shows promise' for hard-to-treat multiple sclerosis - BBC Science Focus Magazine  
Taking down online scientific misinformation isn’t necessary, as most people don’t believe it, says Royal Society of Medicine.”  
Deltacron: the story of the variant that wasn’t

 


Audio Transcript

Welcome to the Medical Week in Review, where each we bring you a round-up of clinical information and general healthcare stories that caught our attention, both internationally and here in South Africa.

I'm your host Linda Ravenhill and here is your week in review for the week ending 21 January 2022.
 

As promised in our inaugural post, we are not going to deluge you with Corona stories, as there is so much information out there already.
What we will do, for historical record sake, is note where we stand globally, and in Africa, as far as the Corona data are concerned.

At the end of this week (21 Jan)  - and this again is from the John Hopkins data –globally we've recorded 342 million cases - 22 million more than last week - and 5,58m deaths as measured against 5,52 million last week.

In South Africa, our trend continues downwards with a 7 day average of 3477 daily cases recorded, which is a significant decrease  
Our neighbours are also recording low numbers for their 7-day averages: Namibia recorded 151 cases, Botswana 895, Zimbabwe 332, Kenya recorded a significant reduction at 448 case, Nigeria 274 and finally, Rwanda recorded  462.

So, compared to last week most of the African countries in our list are recording a 50% lowering of their cases from the week ending 14th Jan. Again  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


In stories not directly related to Corona, but still with a nod to the disease, this week saw an exciting new development in health science for Africa, with the opening of the new vaccine plant in Brackenfell in the Cape.

Sponsored by health technology billionaire Dr Patrick Soon-Shiong, the NantSA vaccine plant is the largest in Africa, and is expected to produce a billion COVID-19 vaccine doses by 2025.  That's 4 short years away for those of you still waking up!    The facility will also product produce additional vaccines such as those for cancer, and next-generation cell-based immunotherapies. 

It's great to see overseas SA business giants giving back to the country ….. hint, hint Elon Musk.

Link: 
New era of health science for Africa ( Health-enews.org


Moving onto clinical trials that caught our eye, this week, JAMA published a paper entitled Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non–Critically Ill Hospitalized Patients With COVID-19: A Randomized Clinical Trial

The trial as it says, looked at the effect a P2Y12 inhibitor has when added to anticoagulant therapy on clinical outcomes in non–critically ill patients hospitalized for COVID-19

So just a reminder  - P2Y12 receptor blockers are a group of antiplatelet drugs which includes drugs such as clopidogrel and ticlopidine,

The authors - Jeffrey Berger, Lucy Kornblith, and Michelle Gong et al, conducted a randomized trial that, according to the Findings summary of the trial, included 562 patients, and compared the use of a therapeutic dose of heparin plus a P2Y12 inhibitor, to the use of a therapeutic dose of heparin only - usual care.

Their research showed, and I quote here “ that the administration of the P2Y12 did not increase the odds of improvement in the number of days alive and free of cardiovascular or respiratory organ support within 21 days during index hospitalization and the posterior probability of futility  - defined as an odds ratio less than 1.2 – was 96%.

There is also an accompanying editorial   Antiplatelet Therapy in Patients With COVID-19—More Is Less?  Links to both articles are on MedED

Link
Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non–Critically Ill Hospitalized Patients With COVID-19: A Randomized Clinical Trial | Anticoagulation | JAMA | JAMA Network 

Editorial: Antiplatelet Therapy in Patients With COVID-19—More Is Less? 


Then last week we brought you a story about the use of genomic sequencing to determine outcomes in critically ill patients, and we said we’d keep an eye on developments in the space for you. 

We didn’t have to wait long it appears. This week it was the turn of Jama Internal Medicine, who published research by  Carolin Schneider, Kai Markus Schneider and Alexander Teumer entitled, Association of Telomere Length With Risk of Disease and Mortality

According to the abstract, the cohort study looked at UK Biobank data from more than 450 000 individuals. The researchers found "that reduced baseline leukocyte telomere length was associated with increased overall and various disease-specific mortalities.  The study identified more than 200 disorders that were significantly overrepresented or underrepresented in participants with shorter leukocyte telomere length."

The conclusion from the data was that shorter leukocyte telomere length,  was indeed associated with a small risk increase of overall mortality, but a higher risk of mortality was associated with specific organs and disease. 

Interest in this area of medicine is certainly growing, and the implications of its application are numerous. In the not too distant future, we’ll hope to be interviewing a medical ethicist on the practical concerns around this. We’ll keep you posted on that and any additional studies we find regarding this.

Link:
Association of Telomere Length With Risk of Disease and Mortality 

Then, the ‘big’ news story of the week – sadly it appears to be breaking news despite age-old clarion calls -  is the study from Lancet this week concerning the shocking data concerning antimicrobial resistance globally.

The 2019 study- entitled – Global Burden of Microbial resistance in 2019: a systematic analysis -   looked at 204 countries, territories and related regions, and found that the deaths of 4.95 million people were associated with drug-resistant bacterial infections, and of those 4.95 million,  1.27 million deaths were directly caused by AMR.

Of the 23 bacterial pathogens considered in the data—Escherichia coli is accountable for most deaths, and of the 88 pathogen–drug combinations, meticillin-resistant Staphylococcus aureus caused the highest number of deaths.
It should come as no surprise that Sub-Saharan Africa and south Asia have the highest burden of AMR, which the researchers attributed to, and I quote, ”  high infection rates and a lack of access to antibiotics, compounded by serious data gaps."

The message just does not seem to be getting through to the powers that be, that this is a catastrophe in the making. That’s not to say that measures have not been put in place in an attempt to address both the AMR issue as a whole and the specific circumstance occurring in developing countries. The Global Antimicrobial Resistance and Use Surveillance System was launched by WHO in 2015 and there is the  Fleming Fund, which is an aid programme supporting efforts to combat AMR across 24 countries across Africa and Asia to tackle but it appears the real political willpower is still lacking.

There's is an opinion piece in the Lancet that accompanies this study – entitled  Antimicrobial resistance: time to repurpose the Global Fund - The Lancet , which discusses this in more depth.

Link:
Global Burden of Microbial resistance in 2019: a systematic analysis  

Antimicrobial resistance: time to repurpose the Global Fund - The Lancet  


From one epidemic to another, that of the rise in Childhood Diabetes.

The NEJM posted a very interesting paper this week entitled Randomzed Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes, which promises exciting possibilities for everyone involved in the care of these children, not to mention the children themselves.

This study looked at children between the ages of 1- 7, who had type 1 diabetes and who were receiving insulin-pump therapy.
According to the  study, "the children received treatment in two 16-week periods, in random order, in which the closed-loop system was compared with sensor-augmented pump therapy." 
The researchers report,  "that the use of the hybrid closed-loop system significantly improved glycemic control in very young children with type 1 diabetes, without increasing the time spent in hypoglycemia."
So that is a really promising development.

The NEJM also has a pretty nifty explanatory video accompanying this research – showing the closed-loop system is and how it works -  worth a watch.

Link:
Randomzed Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes 


Finally, a story we found via the BBC Science Focus, which looks at a  study published in the Annals of Neurology Journal showing promising results using the malaria drug Hydroxychloroquine to treat primary progressive multiple sclerosis or PPMS. PPMS is notoriously difficult to treat, as it does not typically respond well to immunomodulatory or immunosuppressive treatment. 

According to the trial synopsis, Chronic activation of microglia has been implicated in the pathophysiology of PPMS,  and hydroxychloroquine (HCQ) is known to reduce the activity of human microglia and has neuroprotective effects in vitro. It is this that was of interest to the researchers

The authors -  Marcus  Koch , Sharanjit Kaur and Kyla Sage et al, studied the effect of the use of the drug for primary progressive multiple sclerosis. They found that treatment with hydrochorloquine, was associated with reduced disability worsening in people with PPMS, and therefore conclude the drug may be a promising alternative treatment for patients with PPMS.  

Isn’t it interesting how these so-called ‘old-drugs’ are making a come-back for new therapeutic applications?

Link
Hydroxychloroquine for Primary Progressive Multiple Sclerosis (Annals of Neurology Journals) 

Malaria drug 'shows promise' for hard-to-treat multiple sclerosis - BBC Science Focus Magazine  


Finally, as we do each week, we take a look at technology and healthcare. 

This week, a story in the BMJ online,  that seems to have passed largely without comment - or rather comment that we could find - caught our eye.

Entitled “Taking down online scientific misinformation isn’t necessary, as most people don’t believe it, says Royal Society of Medicine.”  

The article looks at a study conducted by the Society in the  UK, which seemed to indicated that and I quote here “Most people in the UK agree with the scientific consensus on key issues such as vaccination and climate change and believe that the internet has improved the public’s understanding of science.

Now I don’t know about you, but I’m not convinced. 

To support my argument, I offer up a story about a story that should never have been a story – namely Deltacron.

If you have never heard of it – you are not missing out -  but for our story’s purposes, the gist of the saga was that a Virologist at the University of Cyprus announced, on the 7th of January 2022, that he and his team had identified several SARS-CoV-2 genomes that featured elements of both the Delta and Omicron variants.
The science backing the announcement was faulty, and it wasn’t long before the scientific community went into overdrive, debunking the possibility of the Cyprus data pointing to a new variant.
As it turns out, it was most likely the result of contamination in the lab and 72 hours after the team uploaded the genomic sequence, it was removed from public viewing. 

And that should have been the end of the saga, but for the fact that on the 8th of January, Bloomberg picked up the story, and within hours it was international news.  

Now I know this is story is different to the wilful spreading of misinformation of the likes of Carlson Tucker, the prophet of nonsense at Fox News, that Viagra had apparently “awakened a nurse from her Corona induced coma”.
But the Deltacron story s still misinformation, and I'm not convinced that it is fair or ethical, to leave the public, who are not necessarily equipped with the info we have, to make those judgement calls.   

But that's just me - What do you think?
 I recommend you read the full paper of the Royal Society and the Deltacron story from Nature - the links as always in on meded – and  if you feel strongly, why not pop us a line on the contact form at Meded and let's have a conversation

Link: 
Taking down online scientific misinformation isn’t necessary, as most people don’t believe it, says Royal Society of Medicine.”  

Deltacron: the story of the variant that wasn’t


And now for the moment, you’ve all been waiting for – it’s trivia time.

This week we’re going back, way back, to 2600 BC, to the time of Imhotep – Egyptian chancellor to the Pharaoh Djoser, probable architect of Djoser's step pyramid - which changed the way pyramids were built -  and high priest of the sun god Ra at Heliopolis. 

Now in addition to his master building skills, Imhotep was said to have described the diagnosis and treatment of 200 diseases during his lifetime!
That’s a pretty hard act to follow, even if you discount the pyramid building.

From deserts to cold weather - do you know who John Snow is? Well, he’s not a character out of Game of Thrones so you can discount that one, but we in Africa owe a lot to this man,

John Snow was the first to establish that cholera was a waterborne disease significantly changing the way the disease was managed and treated.
Until  Mr Snow came along, cholera was thought to spread through the air. But Snow was convinced it had something to do with contaminated water.
In 1854, there was a cholera outbreak in London which killed more than 550 people.
By meticulously plotting the location of the cases, Snow was able to pinpoint a water pump, which the infected people had all used either to drink from or carry water to their houses.
Further investigation showed that the well used by the pump had become contaminated by a cesspit, one of many during that time that were routinely built under houses to remove human waste.

So we have Mr Snow to thank for what we now know about the spread of cholera

So if you didn’t know, now you do.

And that is 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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