The Medical Week In Review
Episode 5: 25 March 2022
Audio Transcript
Welcome to the Medical Week in Review.
I'm your host Linda Ravenhill. 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 discussed 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 March 22
First up as always - matters COVID. The past 10 days have been rather interesting, mostly confusing, but definitely not boring.
By now you’ll be well aware of the B.2 Omnicron variant, that is - I’d like to say inching - but it appears, with countries like the UK recording over a million cases in the last week - to be flooding its way across the globe.
Now depending on who you listen to, the variant is either more virulent or less virulent. Either way, there’s no doubt that it’s highly transmissible.
Here in South Africa, on the 22nd of March, there was an op-ed in the Daily Maverik – a local newspaper – written by a number of esteemed scientists and top medical professionals - namely Profs Marc Mendelson, Shabir Madhi, Jeremy Nel, Glenda Gray, Regina Osih and Francois Venter.
The article is entitled “ The incoherent and illogical new government Covid-19 regulations are the real state of disaster” and was written in response to the passing of new draft regulations dealing with the surveillance and control of notifiable medical conditions ( a paraphrase of the title) which was put in play on the 15th of March, and is open for public comment for the next 30 days.
So Prof Madhi et al. contend that the decisions are not based on science, given that despite our very low vaccination rates – which are sitting at less than 40% of the population - we have widespread population immunity in the country, which is protecting us from severe illness and hospitalisation. You may remember I discussed the paper by Prof Madhi last week in which they published the results of their trial backing up this conclusion. Anyway, they say that the regulations are causing more harm than good, that they are unrealistic, untenable, and confusing, to mention a few of their arguments.
They put forward a number of alternative recommendations such as removing all restrictions, and adding the SARS_COV-2 to existing influenza monitoring and surveillance programs, and returning the focus of the government and health departments to the collapse of our healthcare systems in general – such as the disgrace playing out in the Eastern Cape and don’t even get me started on Charlotte Maxleke hospital. I’ll leave you to read that comprehensive article – links as always on the MedED site
So that’s what we’re saying in South Africa. Now as you know in many countries in the world – such as Hong Kong – the COVID situation remains either dire or, in the case of some European countries, on a worrying uptick. One story I have not seen reported on was the report published in the Lancet which indicates that according to new data modelling, the true number of deaths from COVID at the end of 2021, was closer to 18 million – a far cry from the 5.8 million total we’ve been told to date.
Now this report is based on the excess mortality rate figures – you’ll remember last week too I mentioned the report in the Economist about this. This report is compiled by the Institute for Health Metrics and Evaluation (IHME) and as always there are those who agree and those who think these results are ludicrous, so I recommend you access the study and make up your own mind.
But what I really wanted to make you aware of is the statement by the WHO who at a press conference yesterday – the 23rd - says that several countries are now seeing their highest death rates since the beginning of the pandemic – and now is not the time to reduce surveillance, testing and sequencing. This is according to Maria Van Kerhove, who is the COVID technical lead at the WHO.
All very worrying if you consider that countries such as the UK and US have all scaled back on their reporting. There is a link to an excellent opinion piece in Nature from the 23rd which goes into more detail.
And finally, to pull the whole story together, you might want to look at the paper published in Nature Reviews Microbiology on the 14th of March, which says in a nutshell that less virulent Omnicron strain was really just a coincidence, and, I quote here that “ongoing rapid antigenic evolution is likely to produce new variants that may escape immunity and be more severe.”
As always, we’ll have to wait and see.
Finally, on the Corona front, our quick case-count round-up for sub-Saharan Africa. So the figures are as of 23rd of March are as follows:
In South Africa we are holding steady, with our 7-day average at 912 cases. Let’s see if that changes next week with the new regulations in play.
Our next-door neighbours are again all reporting very low figures: Botswana has recorded no cases for the past 7 days, Namibia recorded 12, Zimbabwe 187, Kenya 14 and Nigeria is recording a very slight increase in their 7-day average at 35 cases.
Again links to all the articles mentioned here can be found on MedED
Links
COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
The incoherent and illogical new government Covid-19 regulations are the real state of disaster
Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of the COVID-19 related mortality, 2020-21
This is no time to stop tracking COVID-19
COVID’s true death toll: much higher than official records
Antigenic evolution will lead to new SARS-CoV-2 variants with unpredictable severity
In stories that caught our eye this week other than COVID, today, the 24th of March is World TB day. And according to UNICEF, globally TB remains the leading cause of death from infectious diseases in children.
Now that came as a surprise to me I will admit, given the host of diseases that the children are exposed to. There are more than one million children infected annually, and the mortality rate is nearly 20% - which should really make us all sit up and take note. Now, I’m not sure if this next was done to coincide with World TB Day or not– there is no such thing as coincidence right, but this week the NEJM published an interesting study – the SHINE study that looked into the treatment protocols for children with non-severe, smear-negative, drug-susceptible tuberculosis.
So according to the study, TB management protocols for children and young adolescents are currently extrapolated from the guidelines for adults. Children are by and large excluded from clinical trials into the efficacy of anti-TB treatments – they give various reasons for that.
So what the researchers of this trial - Turkova et al. – wanted to establish is the existing 6-month protocol was relevant for children or whether a shorter 4-month treatment regimen would be as efficacious. You can immediately see the benefits of the shorter period– cost-efficiency, increased compliance, less burden on the family to name a few.
The results were encouraging – they found that 4-months of treatment in cases of non-severe TB, was not inferior to treatment over 6 months. So that holds significant promise for future protocols, and it’s a great trial to review.
You can find a short summary of the trial and access the full paper on MedED
Link:
Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children. A clinical trial summary
Onto matters ageing and the BMJ this week published a study entitled “Global, regional and national burden of disease and injuries for adults 70 years and older: a systematic analysis of the Global Burden of Disease 2019 study.
For some context, the Global Burden of Disease study considers data from 204 countries, and this particular data was for persons 70 years or older. This is the second such analysis I’ve looked at regarding the findings of the Global Burden of Disease study – we discussed the analysis into the increase in dementia a few weeks ago.
This analysis considers years of life lost, years lived with disability, disability-adjusted life years, life expectancy at 70, health-life expectancy at age 70 and the converse.
The researchers found, that, globally the number of persons 70 years or older continues to rise, which they attribute to decreases in chronic disease - I struggle a bit with this one as we are constantly hearing about the dramatic increase in chronic disease burden in the elderly. That said – obviously, in the higher income countries, access to care has improved and along with that, health outcomes.
Now for some truly mind-blowing stats: The 70−79-year-old age group grew 115.4%, while the proportion of adults aged 80-94 increased by 164.7%. The population aged ≥95 grew by 363.7%. And these figures were consistent across all regions under study.
So to contextualise it, in 2019, there were 168.3 million more people aged 70-79, 90.1 million more people aged 80-94, and 3.7 million more people aged ≥95 than in 1990.
I’ll unpack more of the analysis next week –but for now, I think those figures are sufficient to shore up the call I make every week for more attention to be paid to the very real social and economic challenges posed as we live longer.
Link:
10 March 22 | Global, regional, and national burden of diseases and injuries for adults 70 years and older:a systematic analysis of the 2019 Global Burden of Disease Study (BMJ)
Finally, for our last story, we pick up on a fascinating piece of research published in Science Translational Medicine, which looks at a group of scientists harnessing Listeria monocytogenes to deliver highly immunogenic tetanus toxoid proteins directly into tumour cells.
So far immunotherapy has not really been effective in treating aggressive pancreatic ductal adenocarcinoma, which is highly metastatic disease. But it appears that using listeria, combined with low dose of gemcitabine (GEM) to selectively deliver an immunogenic tetanus toxoid protein directly into the PDAC tumour cells, the scientists were able to significantly reduce the PDAC burden.
In fact, the scientists report that in mice models, mice treated with the Listeria and GEM treatment, mice with advanced PDAC showed a "reduced tumor burden by 80% and metastases by 87% after treatment and had an increased survival by 40% compared to nontreated mice.”
That’s quite astonishing. Let's see if it holds up in future trials.
Link
Listeria delivers tetanus toxoid protein to pancreatic tumors and induces cancer cell death in mice
And then the moment you've all been waiting for – it's Medical Trivia time.
This week we look at when oxygen first came to be viewed as necessary in medicine. Well, it might surprise you that it was quite late.
Carl Wilhelm Scheele, a German chemist, was the first to discover oxygen in 1771, when he generated what he called – fire air – by heating mercuric oxide, silver carbonate, magnesium nitrate, and other nitrate salts. But really we have Erasmus Darwin, the grandfather of Charles Darwin to thank for the word’s entry into common language when he made use of it in his popular book of poems, The Botanic Garden (1791).
However, it was Antoine Lavoisier who first identified its use and role in normal respiration around 1774. He showed that it was used during inhalation and that carbon dioxide was exhaled. Unfortunately, he was sent to the guillotine during the French revolution - like many at that time - when it was discovered that he used royal funds to support his laboratory. But it was one Thomas Beddoes, who is considered the father of respiratory therapy. He, according to the source article I read( and I quote here again) - “worked with the inventor James Watt to generate oxygen and other gases, and opened a ...."Pneumatic Institute in Bristol, England, in 1798, using oxygen and nitrous oxide to treat asthma, congestive heart failure, and other ailments.”
So, if you didn't know, now you do.
Link:
The Story of Oxygen
And that is all for the Week in Review.
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 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 5: 25 March 2022
Links from this Podcast
COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
The incoherent and illogical new government Covid-19 regulations are the real state of disaster
Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of the COVID-19 related mortality, 2020-21
This is no time to stop tracking COVID-19
COVID’s true death toll: much higher than official records
Antigenic evolution will lead to new SARS-CoV-2 variants with unpredictable severity
Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children. A clinical trial summary
10 March 22 | Global, regional, and national burden of diseases and injuries for adults 70 years and older:a systematic analysis of the 2019 Global Burden of Disease Study (BMJ)
Listeria delivers tetanus toxoid protein to pancreatic tumors and induces cancer cell death in mice
The Story of Oxygen
Audio Transcript
Welcome to the Medical Week in Review.
I'm your host Linda Ravenhill. 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 discussed 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 March 22
First up as always - matters COVID. The past 10 days have been rather interesting, mostly confusing, but definitely not boring.
By now you’ll be well aware of the B.2 Omnicron variant, that is - I’d like to say inching - but it appears, with countries like the UK recording over a million cases in the last week - to be flooding its way across the globe.
Now depending on who you listen to, the variant is either more virulent or less virulent. Either way, there’s no doubt that it’s highly transmissible.
Here in South Africa, on the 22nd of March, there was an op-ed in the Daily Maverik – a local newspaper – written by a number of esteemed scientists and top medical professionals - namely Profs Marc Mendelson, Shabir Madhi, Jeremy Nel, Glenda Gray, Regina Osih and Francois Venter.
The article is entitled “ The incoherent and illogical new government Covid-19 regulations are the real state of disaster” and was written in response to the passing of new draft regulations dealing with the surveillance and control of notifiable medical conditions ( a paraphrase of the title) which was put in play on the 15th of March, and is open for public comment for the next 30 days.
So Prof Madhi et al. contend that the decisions are not based on science, given that despite our very low vaccination rates – which are sitting at less than 40% of the population - we have widespread population immunity in the country, which is protecting us from severe illness and hospitalisation. You may remember I discussed the paper by Prof Madhi last week in which they published the results of their trial backing up this conclusion. Anyway, they say that the regulations are causing more harm than good, that they are unrealistic, untenable, and confusing, to mention a few of their arguments.
They put forward a number of alternative recommendations such as removing all restrictions, and adding the SARS_COV-2 to existing influenza monitoring and surveillance programs, and returning the focus of the government and health departments to the collapse of our healthcare systems in general – such as the disgrace playing out in the Eastern Cape and don’t even get me started on Charlotte Maxleke hospital. I’ll leave you to read that comprehensive article – links as always on the MedED site
So that’s what we’re saying in South Africa. Now as you know in many countries in the world – such as Hong Kong – the COVID situation remains either dire or, in the case of some European countries, on a worrying uptick. One story I have not seen reported on was the report published in the Lancet which indicates that according to new data modelling, the true number of deaths from COVID at the end of 2021, was closer to 18 million – a far cry from the 5.8 million total we’ve been told to date.
Now this report is based on the excess mortality rate figures – you’ll remember last week too I mentioned the report in the Economist about this. This report is compiled by the Institute for Health Metrics and Evaluation (IHME) and as always there are those who agree and those who think these results are ludicrous, so I recommend you access the study and make up your own mind.
But what I really wanted to make you aware of is the statement by the WHO who at a press conference yesterday – the 23rd - says that several countries are now seeing their highest death rates since the beginning of the pandemic – and now is not the time to reduce surveillance, testing and sequencing. This is according to Maria Van Kerhove, who is the COVID technical lead at the WHO.
All very worrying if you consider that countries such as the UK and US have all scaled back on their reporting. There is a link to an excellent opinion piece in Nature from the 23rd which goes into more detail.
And finally, to pull the whole story together, you might want to look at the paper published in Nature Reviews Microbiology on the 14th of March, which says in a nutshell that less virulent Omnicron strain was really just a coincidence, and, I quote here that “ongoing rapid antigenic evolution is likely to produce new variants that may escape immunity and be more severe.”
As always, we’ll have to wait and see.
Finally, on the Corona front, our quick case-count round-up for sub-Saharan Africa. So the figures are as of 23rd of March are as follows:
In South Africa we are holding steady, with our 7-day average at 912 cases. Let’s see if that changes next week with the new regulations in play.
Our next-door neighbours are again all reporting very low figures: Botswana has recorded no cases for the past 7 days, Namibia recorded 12, Zimbabwe 187, Kenya 14 and Nigeria is recording a very slight increase in their 7-day average at 35 cases.
Again links to all the articles mentioned here can be found on MedED
Links
COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
The incoherent and illogical new government Covid-19 regulations are the real state of disaster
Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of the COVID-19 related mortality, 2020-21
This is no time to stop tracking COVID-19
COVID’s true death toll: much higher than official records
Antigenic evolution will lead to new SARS-CoV-2 variants with unpredictable severity
In stories that caught our eye this week other than COVID, today, the 24th of March is World TB day. And according to UNICEF, globally TB remains the leading cause of death from infectious diseases in children.
Now that came as a surprise to me I will admit, given the host of diseases that the children are exposed to. There are more than one million children infected annually, and the mortality rate is nearly 20% - which should really make us all sit up and take note. Now, I’m not sure if this next was done to coincide with World TB Day or not– there is no such thing as coincidence right, but this week the NEJM published an interesting study – the SHINE study that looked into the treatment protocols for children with non-severe, smear-negative, drug-susceptible tuberculosis.
So according to the study, TB management protocols for children and young adolescents are currently extrapolated from the guidelines for adults. Children are by and large excluded from clinical trials into the efficacy of anti-TB treatments – they give various reasons for that.
So what the researchers of this trial - Turkova et al. – wanted to establish is the existing 6-month protocol was relevant for children or whether a shorter 4-month treatment regimen would be as efficacious. You can immediately see the benefits of the shorter period– cost-efficiency, increased compliance, less burden on the family to name a few.
The results were encouraging – they found that 4-months of treatment in cases of non-severe TB, was not inferior to treatment over 6 months. So that holds significant promise for future protocols, and it’s a great trial to review.
You can find a short summary of the trial and access the full paper on MedED
Link:
Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children. A clinical trial summary
Onto matters ageing and the BMJ this week published a study entitled “Global, regional and national burden of disease and injuries for adults 70 years and older: a systematic analysis of the Global Burden of Disease 2019 study.
For some context, the Global Burden of Disease study considers data from 204 countries, and this particular data was for persons 70 years or older. This is the second such analysis I’ve looked at regarding the findings of the Global Burden of Disease study – we discussed the analysis into the increase in dementia a few weeks ago.
This analysis considers years of life lost, years lived with disability, disability-adjusted life years, life expectancy at 70, health-life expectancy at age 70 and the converse.
The researchers found, that, globally the number of persons 70 years or older continues to rise, which they attribute to decreases in chronic disease - I struggle a bit with this one as we are constantly hearing about the dramatic increase in chronic disease burden in the elderly. That said – obviously, in the higher income countries, access to care has improved and along with that, health outcomes.
Now for some truly mind-blowing stats: The 70−79-year-old age group grew 115.4%, while the proportion of adults aged 80-94 increased by 164.7%. The population aged ≥95 grew by 363.7%. And these figures were consistent across all regions under study.
So to contextualise it, in 2019, there were 168.3 million more people aged 70-79, 90.1 million more people aged 80-94, and 3.7 million more people aged ≥95 than in 1990.
I’ll unpack more of the analysis next week –but for now, I think those figures are sufficient to shore up the call I make every week for more attention to be paid to the very real social and economic challenges posed as we live longer.
Link:
10 March 22 | Global, regional, and national burden of diseases and injuries for adults 70 years and older:a systematic analysis of the 2019 Global Burden of Disease Study (BMJ)
Finally, for our last story, we pick up on a fascinating piece of research published in Science Translational Medicine, which looks at a group of scientists harnessing Listeria monocytogenes to deliver highly immunogenic tetanus toxoid proteins directly into tumour cells.
So far immunotherapy has not really been effective in treating aggressive pancreatic ductal adenocarcinoma, which is highly metastatic disease. But it appears that using listeria, combined with low dose of gemcitabine (GEM) to selectively deliver an immunogenic tetanus toxoid protein directly into the PDAC tumour cells, the scientists were able to significantly reduce the PDAC burden.
In fact, the scientists report that in mice models, mice treated with the Listeria and GEM treatment, mice with advanced PDAC showed a "reduced tumor burden by 80% and metastases by 87% after treatment and had an increased survival by 40% compared to nontreated mice.”
That’s quite astonishing. Let's see if it holds up in future trials.
Link
Listeria delivers tetanus toxoid protein to pancreatic tumors and induces cancer cell death in mice
And then the moment you've all been waiting for – it's Medical Trivia time.
This week we look at when oxygen first came to be viewed as necessary in medicine. Well, it might surprise you that it was quite late.
Carl Wilhelm Scheele, a German chemist, was the first to discover oxygen in 1771, when he generated what he called – fire air – by heating mercuric oxide, silver carbonate, magnesium nitrate, and other nitrate salts. But really we have Erasmus Darwin, the grandfather of Charles Darwin to thank for the word’s entry into common language when he made use of it in his popular book of poems, The Botanic Garden (1791).
However, it was Antoine Lavoisier who first identified its use and role in normal respiration around 1774. He showed that it was used during inhalation and that carbon dioxide was exhaled. Unfortunately, he was sent to the guillotine during the French revolution - like many at that time - when it was discovered that he used royal funds to support his laboratory. But it was one Thomas Beddoes, who is considered the father of respiratory therapy. He, according to the source article I read( and I quote here again) - “worked with the inventor James Watt to generate oxygen and other gases, and opened a ...."Pneumatic Institute in Bristol, England, in 1798, using oxygen and nitrous oxide to treat asthma, congestive heart failure, and other ailments.”
So, if you didn't know, now you do.
Link:
The Story of Oxygen
And that is all for the Week in Review.
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 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.
