The Medical Week In Review
Episode 3: 25 February 2022



 

Links from this Podcast

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

WHO announces first technology recipients of mRNA vaccine hub with strong support from African and European partners 

Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities The I-TECH Randomized Clinical Trial

Malawi polio case raises concerns the virus could reemerge in region (statnews.com)

Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study

Time to Retire the Concept of Transient Ischemic Attack 

Fixing a broken heart: These incredible images show how regenerative medicine can rebuild you 

The history of kidney transplantation  
 


Audio Transcript

This broadcast takes place as Russia is invading Ukraine. Amidst all the rhetoric, we would do well to remember the very real human cost of any war. May the world not look back in shame at this moment in time.

Welcome to the Medical Week in Review,

I’m your host Linda Ravenhill, and each week in this podcast I review a selection of clinical information and general healthcare stories that caught my attention, both internationally and here in South Africa. 

Links to all the content discuss in the podcast will be posted on the website – www.meded.co.za – under the “The Medical Week in Review” feature.”

Here is: your week in review for the week ending 25 February 2022.

 
As you know we start each week with a quick review of all matters COVID.

This week we’ve seen the easing of restrictions across the globe, even as Hong Kong is experiencing a surge that threatens to overwhelm its healthcare system.Let’s see how that works out for us all in the coming weeks.

Here in South Africa - on the 22nd of February which was when we pulled this data - we saw a week-on week decrease in cases.   Our 7-day average is sitting at 2,395cases. 
However, of you look at the day-on-day cases, Monday the 21st saw 1,456 new cases, 22rd saw 2,334 cases – just under an increase in 1000 daily cases.
I know it’s a relatively small number of cases, but it’s still an increase and one we need to keep an eye on as Corona restriction fatigue sets in.

As we do each week, we look to our sub-Saharan neighbours, who are all reporting very low figures: Botswana has reported 167, Namibia 27, Zimbabwe 340. Further afield – Kenya is reporting 31 and Nigeria 33. 

Again links to the data source, John Hopkins Novel Corona Data can be found on MedED


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


This leads us into the first of 2 Corona stories for the week, and that is the WHO announcing he first technology recipients of mRNA Vaccine HUB in Africa.  

To recap, this initiative arises out of the global mRNA tech transfer Hub which was established in 2021, with the stated aim of  assisting manufacturers in low- and middle-income countries to produce their own vaccines.

The six Africa recipients of this first transfer announced on the 18th of Feb, are Egypt, Kenya, Nigeria, Senegal, South Africa and Tunisia.
According to the WHO press release, the countries selected will receive assistance such as technological input, training, support and other expertise - depending on their individual requirements and capabilities.  

Excitingly, while this initial effort is focused on mRNA technologies and biologicals, it is hoped that expertise will be extended to the development of other vaccines for priority infectious diseases – HIV, TB and the like - together with drug development initiatives such as insulin production + cancer treatments.

Let’s hope that this will be the start in a long-overdue process towards global vaccine and pharmaceutical distribution parity.


Link: 
WHO announces first technology recipients of mRNA vaccine hub with strong support from African and European partners 

Our second Corona story is again one of those stories, that really shouldn’t be a story, yet here it is – a story.

New research published this week in JAMA, reviews the efficacy of Ivermectin treatment in COVID patients. Yip– it’s still a thing.  
Perhaps there is no better testament of the power of fake news than how it has ensured this one veterinary treatment has taken hold of global consciousness, to the extent that we are still running trials to disprove it as a treatment.

This particular trial - entitled Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities -  is a Malaysian trial that looked at a cohort of high-risk patients with COVID-19, who were given a 5-day course of oral ivermectin during the first week of their illness.

The primary outcome the researchers were looking for was the proportion of patients who progressed to severe disease - which they defined as the hypoxic stage requiring supplemental oxygen to maintain pulse oximetry oxygen saturation of 95% or higher.The secondary outcomes of the trial included the rates of mechanical ventilation, intensive care unit admission, 28-day in-hospital mortality, and adverse events.

And the big news?
They found that ivermectin did not reduce the risk of developing the severe disease compared with standard of care alone.

It would be great if we could finally move on from this ivermectin-does-it-doesn’t-it debate, and spend our research money where it matters. 


Link
Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities The I-TECH Randomized Clinical Trial
 

One of those places where it matters is helping to understand how type1 wild poliovirus travelled all the way from Pakistan to infect a 3-year-old girl in Malawi, 5 years after the African continent was declared polio-free. 

The child, who lives on the outskirts of the capital, Lilongwe, tested positive for the virus in November last year, when she presented with paralysis. 
 When her results were tested by South Africa’s National Institute of Communicable Disease and the CDC,  the virus’s genetic sequence was determined to have derived from a strain found in Pakistan’s Sindh Province in October 2019.

The big questions now are are how it arrived in the country, and who else has been infected along the way? 

Red flags have been raised for some time about the worrying decline seen globally in childhood vaccination rates. In fact I wrote an article just a few months ago in MedED,  about the disturbing increase in cases of pertussis – a vaccine-preventable disease – which has been linked to low vaccination rates.  The WHO and UNICEF estimate that in 2020, nearly 23 million children globally were unvaccinated or under-vaccinated against important childhood diseases. 

Various issues play a role in low vaccination rates, but on our continent, COVID specifically, has had a substantial impact on public vaccination programs. 

If we are to prevent what can only be termed  a tragic resurgence of this dread disease, a global multi-agency, multi-country, co-ordinated effort needs to be put in place urgently.  

Prudently, Malawi has declared this a public health emergency. Kudos to them for acting so decisively.

Just to mention, I saw this story first in STAT News on the 18th of Feb. Let’s see who picksit up on any of the major news networks.


Link:
Malawi polio case raises concerns the virus could reemerge in region (statnews.com)
 
Then continuing our focus on ageing, and specifically age-related cognitive issues, this week the BJM published the results of the Whitehall prospective cohort study – a 30 year-long research study - which looked into the association of midlife and later-life multimorbidity and the incidence of dementia.

So this study, commenced in 1985, tracked participants in the civil service departments in London, who were aged 35-55 at the time of the study commencing.
What they wanted to measure was the incidence of dementia in this group of people 30 years later – so that’s in 2019 - and to determine whether there was an association with dementia and multi morbidity overall,  and an association of subsequent dementia at 55, 60, 65, and 70 taking into account the competing risk of death. 

What they found was quite startling. 

According to the researchers, “Multimorbidity, particularly when onset is in midlife rather than late life, has a robust association with subsequent dementia. The increasingly younger age at onset of multimorbidity makes prevention of multimorbidity in people with a first chronic disease important.”

Given our rapidly ageing populations, and the recent Global Burden of Disease report that has the incidence of dementia set to triple by 2050, we need to start paying more attention to data like this as a public health priority.
So this is another study well worth a read. You can find the links on MedED


Link:
Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study
 

Our next story was again something that caught our eye in JAMA. Not an original research article, but an opinion piece by Drs Easton+ Johnston, who raise the issue of whether it is time to retire the concept of Transient Ischemic Attack
Their contention is basically that while the term TIA has proved useful in the past, it was also problematic given the varying application of its use. 

The main concern appears to be that the term was traditionally associated with ischemic episodes which were ‘transient’ and an not associated with brain injury. 
As brain imaging techniques have improved, and our understanding of cerebral ischemia has increased, it is now understood that braining injury almost always occurs in these events.  It is therefore time, they assert to re-evalute both the use of the term and more importantly the relevancy of the concept of TIA.

That’s sure to ruffle some feathers, but maybe by paying closer attention to those patients traditionally assigned the TIA label, we may improve their long-term outcomes with swifter more relevant treatment.


Link:
Time to Retire the Concept of Transient Ischemic Attack 

Then for our technology fix this week we looked at a story in BBC Science Focus Magazine entitled:Fixing a broken heart: How regenerative medicine can rebuild you

If you have a moment, have a read through this article and particularly have a look at the gorgeous imagery that accompanies the feature.

The story is about 8-cutting edge projects, which are set to receive millions of points from the British Heart Foundation in 2022 for research into novel treatments for heart failure.

The projecta identified include: A plaster grown from stem cells, which researchers hope could be applied to damaged heart tissue; the use of cloned cells in blood vessels to set-up new cardiac blood vessel networks; mRNA to strengthen heart muscle tissue, finally and the use of stem cells to copy the way cardiac muscle replaced in the womb.  
So some exciting stuff there to keep our eye on there



Link
Fixing a broken heart: These incredible images show how regenerative medicine can rebuild you 

 

And then the moment you’ve all been waiting for – it’s Medical Trivia time. This week - Organ transplants.

Any guesses for when the first human kidney transplant was done?
If you said 1939 you’d be right. 

Russian Yurri Voronoy conducted the first transplant using a deceased human donor. The kidney never worked however, and sadly the patient survived for only a couple of days.

Next up - Paris in1953, where Jean Hamburger conducted the first living donor transplant in which a 16 year old boy received his mother’s kidney.

And in 1954, Joseph Murray made the most significant breakthrough. His transplant was between monozygotic twins, lasted for 8 years, and won Murry the Nobel Prize for Medicine in 1990.

And now we’re looking at 3-D printing kidneys for transplant patients….

So , if you didn’t know now you do.

Link: 


And that is all for the Week in rReview. 

Links to all the stories featured here can be found on the Medical Week in the Review page on MedED.  If you liked this podcast, 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

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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