Month: January 2021

SA Experts Confirm That COVID Variant is More Contagious

A panel of South African experts confirmed on Monday that the SA strain of COVID is 50% more transmissible than previous strains.

Collecting data from the main infection clusters around the country, the experts came to the conclusion that while more contagious, the new variant is not more lethal. 

“There is no evidence the new COVID variant is more severe than the original variant,” said epidemiologist Professor Salim Abdool Karim, co-chair of the Ministry of Health’s scientific committee.

However, the SA healthy system has been strained by the sheer number of cases. Concerns over more transmissible variants have prompted the UK government to switch to administering the first dose of two-dose vaccines such as the one from Pfizer, and leaving an extended period before a second dose is administered, even though protection will wane over time.

Another panel member, Dr Waasila Jassat, said that although hospital admissions had increased, the overall death rate had not, supporting the case for the variant not being more lethal.

The spread of the variant in December prompted the government to reinstate its lockdown. It also resulted in many countries banning flights from South Africa in a bid to stem the variant. Prof Karim said that it was not yet known if current vaccines would protect against the SA variant, although studies were underway.

Another panel member, virologist Professor Alex Sigal stated: “The world has underestimated this virus.” He added that it was evolving and adapting to humans.

The experts also urged that it should not be referred to as the “South African variant”. The variant could have turned up anywhere in the world, and it was only thanks to the country’s excellent genomic surveillance that it was picked up at all, they said.

Source: Medical Xpress

Nearly a Third of COVID Patients Are Readmitted to Hospital

According to a study reported by The Telegraph, almost a third of COVID patients are readmitted to hospital later. The new study, still on the MedRxiv preprint server and not yet peer reviewed, was conducted by Leicester University and the Office for National Statistics (ONS).

Approximately 1 in 10 people who are infected with COVID go on to develop long COVID symptoms, which include breathlessness, excessive fatigue and muscle aches. This appears to be causing hospital readmissions – and deaths.

The study looked at 47 780 individuals with a primary diagnosis of COVID who had a hospital visit between 1 January 2020 and 31 August 2020, and a COVID-negative control group admitted over the same period. The mean follow-up time was 140 days for those with a COVID diagnosis, and during this team 29.4% were readmitted and 12.3% died. The study also found a higher risk in those under 70 and of ethnic minority groups in the UK, most notably in respiratory diseases.

Study author Kamlesh Khunti, professor of primary care diabetes and vascular medicine at Leicester University, said: “This is the largest study of people discharged from hospital after being admitted with Covid.

“People seem to be going home, getting long-term effects, coming back in and dying. We see nearly 30 per cent have been readmitted, and that’s a lot of people. The numbers are so large.”The message here is we really need to prepare for long Covid. It’s a mammoth task to follow up with these patients and the NHS is really pushed at the moment, but some sort of monitoring needs to be arranged.”

One finding which surprised the team was that many patients went back in and had a new diagnosis, such as liver, heart or kidney conditions, as well as diabetes. This means, according to Prof Khunti, that it is important for patients to receive follow-up and protective therapies such as statins or aspirin, adding: “We don’t know if it’s because Covid destroyed the beta cells which make insulin and you get Type 1 diabetes, or whether it causes insulin resistance, and you develop Type 2, but we are seeing these surprising new diagnoses of diabetes.”

Source: Yahoo News

Taurine Boosts Microbiotic Defences in the Gut

A new study has discovered that taurine has a role in triggering the gut’s microbiota to identify and destroy invading bacteria, such as Klebsiella pneumoniae, a bacteria commonly found in the gut and responsible for a variety of infections.

It is already known that gut microbiota can protect against infection, but it is not well understood how they accomplish this. A better of understanding of how they confer protection will aid the development of replacements for current antibiotic drugs, which currently harm gut microbiota and whose effectiveness is waning.

Taurine is a complementary (non-essential amino acid, involved in helping break down fats and is present in bile acid. Most taurine is produced by the body but some is also required in the diet. Certain seafoods, seaweed, poultry and beef are good sources of taurine.

The scientists believed that the taurine helped prevent against bacterial colonisation by producing hydrogen sulphide, but during their research they also discovered that a single infection was sufficient to prepare the gut microbiota to resist a second infection. The liver and gallbladder which produce and store bile acids, can develop long-term protection against infection.

While investigating further, the researchers discovered a particular type of bacteria, Deltaproteobacteria, which protected the gut against colonisation by infectious bacteria and which was activated by taurine. Taurine fed to mice in drinking water helped to shield against infection by boosting the function of the protective bacteria, but those fed bismuth subsalicylate (a common over-the-counter diarrhoea treatment), the infection protection diminished, because bismuth suppresses hydrogen sulphide production in the gut.

Source: News-Medical.Net

Parkinson’s Disease Spotted in Advance with Health Checkup

A study by the University of Nagoya has shown that general health checkups may be effective at spotting early signs of Parkinson’s disease (PD) in advance.

Specifically, the prodromal stage shows sex differences, with the markers for males being decreased cholesterol and haematocrit (the percentage of red blood cells in blood) levels, while in females it is increased blood pressure. PD is the second most common disease affecting the nervous system after Alzheimer’s disease, is caused by a deficiency in the neurotransmitter dopamine. By the stage where sufferers experience motor symptoms such as tremors, stiffness, bradykinesia (slowness of movement), more than half of all dopaminergic neurons have been lost. Postural instability occurs in the late stage. Several processes have been implicated in PD, such as mitochondrial dysfunction, defective protein clearance mechanisms, and neuroinflammation, but it is not clear how these factors interact.

Prior studies have shown that non-motor symptoms including constipation, rapid eye movement sleep behaviour disorder, impairment of sense of smell, and depression, emerge in patients with PD 10 to 20 years before the onset of motor symptoms – meaning that PD may be detectable in advance with other measures.

“If we can detect biological changes in the patients’ bodies well before the onset of the motor symptoms, we can start medical treatments in an early stage,” said Prof Masahisa Katsuno of the Graduate School of Medicine at Nagoya University.

The team used health checkup data from 22 male and 23 female patients with PD, dating to before they were diagnosed with the disease. They supplemented this with data from 60 male and 60 female healthy individuals who had checkup data for at least four years.The checkup data was compared between healthy individuals and PD patients to establish a baseline, and then were examined for longitudinal changes prior to the onset of PD. They found that in the premotor stage, blood pressure increased in females, while in males total and low-density cholesterol levels and haematocrit decreased.

“In this study, we found that blood pressure, haematocrit, and serum cholesterol levels are potential biomarkers of Parkinson’s disease before the onset of its motor symptoms,” said Prof Katsuno. “This finding indicates that general health checkups can help detect early signs of developing Parkinson’s disease.”  Based on the findings, the team is now working to identify individuals at risk of developing PD in an attempt to forestall the development of their disease.

Source: Medical Xpress

Journal information: Katsunori Yokoi et al. Longitudinal analysis of premotor anthropometric and serological markers of Parkinson’s disease, Scientific Reports (2020). DOI: 10.1038/s41598-020-77415-1

Religiosity-based Stress Linked to Cardiovascular Risk in South Asians

In a new study, the Study on Stress, Spirituality and Health (SSSH) linked proteomics from religiosity-based stress to cardiovascular disease (CVD) risk markers. This study marks the first investigation of protein levels associated with religion and spirituality in any group.

South Asians have an elevated CVD risk compared to other racial/ethnic groups, with the biological risk factors attributable to type 2 diabetes risk factors, and the rest stemming from traditional risk factors which show no enhancements as compared to other racial/ethnic groups.

“Before we can develop the best interventions to reduce CVD disparities, we need to understand the biological pathways through which health disparities are produced,” said principal investigator and co-senior author Alexandra Shields, PhD, associate professor of Medicine at Harvard Medical School (HMS). “As this study shows, psychosocial factors—and religious or spiritual struggles in particular—can affect biological processes that lead to CVD in this high-risk population. Spirituality can also serve as a resource for resilience and have a protective effect. Given that many of the minority communities that experience higher levels of CVD also report higher levels of religiosity and spirituality, studies such as the SSSH may help identify new leverage points, such as spiritually focused psychotherapy for those in spiritual distress, that could reduce risk of CVD for such individuals.”

The study had 100 South Asian participants, 50 diagnosed with CVD and 50 without. The participants were drawn from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, which is following 1164 South Asian participants to investigate the factors that lead to heart disease among this racial/ethnic group. Three proteins were found to be involved in CVD risk after adjustment for diabetes (Contactin-5 [CNTN5], Low affinity immunoglobulin gamma Fc region receptor II-a [FCGR2A], and Complement factor B [CFB]), and of these, the expression of two (Contactin-5 and Complement factor B) were slightly modified by religious struggles interacting with adverse life events.

The results indicate that there may be unique protein expressions associated with CVD among individuals of South Asian descent, and these associations may be affected by religious struggles, such as feeling abandoned by God. “Understanding the pathways of this mechanism at the molecular level using proteomics technology is crucial to developing potential interventions that can help reduce CVD incidence in this population,” says Long H. Ngo, PhD., lead author and co-director of Biostatistics in the Division of General Medicine at BIDMC and associate professor of Medicine at HMS.

Co-senior author Towia Libermann, PhD, at Beth Israel Deaconess Medical Center, added: “The kinds of blood-based protein biomarkers used in this study are particularly effective in assessing CVD risk because they carry clinical information about risk of disease and are the most commonly used molecules for diagnostic applications.

Source: Medical Xpress

Journal information: Long H. Ngo et al, Plasma protein expression profiles, cardiovascular disease, and religious struggles among South Asians in the MASALA study, Scientific Reports (2021). DOI: 10.1038/s41598-020-79429-1

SA Government Aims for a Corruption-free Vaccine Programme

In the past week, President Cyril Ramaphosa and health minister Zweli Mkhize have undertaken a publicity drive to demonstrate how the government is working to ensure a tightly controlled vaccine drive that is not plagued by corruption. This is to avoid a repeat of the corruption in PPE acquisition last year, with some R10.5 billion being investigated for looting, with an Auditor-General report finding some items being purchased at five times the going price.

These efforts include centralised transactions which involve the auditor-general looking out for any discrepancies. Vaccine acquisition and roll-out planning will be handled by the government, with the private sector being tapped for storage and distribution. “What we have done is to get the Treasury and the Department of Health’s office of the chief procurement officer to oversee any form of transaction that is going to happen.

“Right now the procurement of the vaccines is within government. It makes it easier because it’s a tight-knit set of people, the prices are known, the manufacturers are known, the deviation is specific and it’s not the same as what we had in PPE where there were so many vendors, suppliers and so many different prices,” he said.

Furthermore, there will be consultation with the Attorney General. “We are going to say [to the AG]… these are the risks we have identified and ask them to analyse our plans and see if there are further risks we must be aware of and how we can work together to prevent any risk of looting,” Mkhize said.

Medical aid schemes have voiced concerns over the process, having sourced vaccines for their members as well as contributing to the vaccination costs of those not covered by any medical aid scheme.

President Ramaphosa said that South Africa would have pre-paid like other countries to secure vaccines, even given the risks of them failing, if it had the funds to do so.

However, he affirmed that there are funds available to buy the vaccination scheme, saying: “we are going to have the money, it will come from Treasury. There is just no way we can say, when it comes to saving the lives of South Africans, that we don’t have the money. The money will be there. It has to be there to save the lives of South Africans. That one will be my bottom line.”

The Covax programme will provide a vaccine for 10% of the population in the second quarter of 2021, for which a deposit of R283 million has been paid. A further 1.5-million vaccine doses have been secured from AstraZeneca and 9-million from Johnson & Johnson (J&J). The J&J vaccine only requires a single dose to confer immunity, so should be able to cover 9 million people.

“J&J will be producing through Aspen here at home, and we are hoping to get the bulk of our supply from there, once the production starts,” said Ramaphosa.

Source: Times Live

Poor Diet is an Important Factor of Childhood Obesity

A Baylor University study has shown that market-bought food in addition to the traditional diet reliably predicted obesity in Amazonian children, a result that has important insights into the global childhood obesity epidemic.

Globally, 6% of girls and 8% of boys in 2016 were obese, compared to 1% in 1975. In South Africa, 13% of children under the age of five are obese.

“The importance of a poor diet versus low energy expenditure on the development of childhood obesity remains unclear,” said lead author Samuel Urlacher, PhD, of Baylor University. “Using gold-standard measures of energy expenditure, we show that relatively lean, rural forager-horticulturalist children in the Amazon spend approximately the same total number of calories each day as their much fatter peri-urban counterparts and, notably, even the same number of calories each day as children living in the industrialised United States.”

Factors such as income and access to running water were used to establish market integration. Children’s physical activity was measured with wearable devices and immune activity by measuring biomarkers obtained from minimally invasive finger-prick blood samples. Most importantly, children’s daily energy expenditure was measured with the “doubly labeled water” stable isotope-tracking method and children’s resting energy expenditure using respirometry. These are both participant-friendly, gold-standard techniques.

A third of peri-urban children were overweight, while zero rural children were, and peri-urban children on average had 65% more body fat than rural children. Peri-urban and rural children had similar levels of physical activity, and market integration, immune activity and physical activity had no effect on expenditure between rural and peri-urban children’s energy expenditure, in common with previous studies. Compared to rural children, peri-urban children spent 108 less calories while at rest, which is thought to be due to lower immune activity. Most importantly, variation in market foods was related to children’s level of body fat.

“Our findings are in line with a growing body of research pointing toward poor diet being the most important factor underlying the development of childhood obesity,” Urlacher said. “Exercise is absolutely still a critical part of this equation and is essential for living a healthy life, but diet increasingly appears to be most directly related to children’s adiposity and long-term energy balance.”

The researchers plan to follow the children longitudinally to record any development obesity and cardiovascular problems.

Source: News-Medical.Net

EU Angered by Pfizer Delay

Pfizer has said in a statement on Friday that the drop in production is the result of the company upgrading its manufacturing processes, and that there will be an overall increase in supply as a result.

“Although this will temporarily impact shipments in late January to early February, it will provide a significant increase in doses available for patients in late February and March,” Pfizer said.

The German health ministry has said the delays are surprising and regrettable, pointing out that it had secured binding mid-February delivery dates from the company. EU Commission President Ursula von der Leyen said that she had been given assurances by Pfizer’s chief executive that all orders for the first quarter would arrive. She had previously said that Pfizer had promised to double its delivery of doses to the EU to 600 million this year.

However, the EU also has agreements in place with Moderna to supply vaccines, and this is not wholly dependent on Pfizer. However, Johnson & Johnson is also falling behind in its vaccine delivery targets, amidst reports that the US has failed to meet vaccination goals for the end of 2020, and may struggle to meet this year’s goals. Meanwhile, the UK is expected to be slightly impacted by the drop in supply but remains on track to meets its February immunisation goals.

However, the EU has lagged behind the UK in its vaccination programme, for a number of reasons including the fact that the UK ordered and approved its vaccines sooner, while Brussels’ negotiations were slower. Much of the delay is due to the added bureaucracy of the 27 nation political confederation and its decision to acquire vaccines as a single entity instead of individual countries further exacerbated this.

According to Reuters, citing a participant at a meeting last week, a third of the EU’s 27 countries reported difficulties in securing enough vaccines for their vaccination programmes.

Source: BBC News

Itching in Severe Eczema Uses a Different Pathway

A study shows that there are two molecular pathways for conveying sensations of itching, with the itching of severe eczema following an unexpected route.

In normal eczema, cells in the skin convey the itching sensation, releasing histamines. This can be blocked with antihistamines.

“Years ago, we used to think that itch and pain were carried along the same subway lines in the nerves to the brain, but it turned out they weren’t, and these new findings show there’s another pathway entirely that’s causing these episodes of acute itching in eczema patients,” said principal investigator Brian S Kim, MD, Washington University School of Medicine. “The itch can be maddening. Patients may rate their chronic itch at around a 5 on a scale of 10, but that goes up to 10 during acute itch flares. Now that we know those acute flares are being transmitted in an entirely different way, we can target that pathway, and maybe we can help those patients.”

With severe itching in eczema, different cells in the blood are activated, transmitting great quantities of non-histamine molecules which also convey the itching sensation. This renders antihistamines usesles in trying to control the itch. The discovery of this new pathway offers new possibilities for treating other conditions as well. Recent studies have tried to block Immunoglobulin E (IgE) in response to allergies.

“We’ve connected acute itching in eczema to allergic reactions transmitted by an entirely different population of cells,” explained Kim. “In patients who experience episodes of acute itching, their bodies react in the same way as in people with acute allergy. If we can block this pathway with drugs, it might represent a strategy for treating not only itch but other problems, including perhaps hay fever and asthma.”

The team found that when mice with eczema made IgE in response to environmental allergens, they began to itch. However, instead of activating mast cells which produced histamine, the IgE activated basophils (a kind of white blood cell), activating a different nerve pathway to normal itching.

The discovery that eczema is exacerbated by allergens may help people avoid severe itching episodes, as well has helping the development of new targets for treatment.

Source: News-Medical.Net

Journal information: Wang, F., et al, A basophil-neuronal axis promotes itch. Cell, 2021 doi.org/10.1016/j.cell.2020.12.033.

Stellenbosch Doctors Urge Patience on Ivermectin

The South African public should be patient and wait for data on Ivermectin’s effectiveness against COVID, according to Stellenbosch doctors, who urge patience. The doctors wrote an article published in the South African Medical Journal explaining that further studies need to be completed before ivermectin can be authorised for use.

A veterinarian parasiticide that may have relevant antiviral and anti-inflammatory properties, ivermectin has gathered considerable attention for possible use in COVID prophylaxis and treatment since a number of small trials appeared to show effectiveness. However, close examination shows that they are very weak. Doubts have been raised over whether the necessary concentrations used in vitro can be achieved in vivo.

In their article, the doctors noted that several large randomised controlled trials are underway, and the results of these will allow the possible effectiveness of ivermectin to be gauged. “Data for Ivermectin from larger RCTs are expected in early 2021,” the doctors wrote. “These data are very promising, showing large treatment effects and acceptable adverse effect profiles for ivermectin against Covid-19, especially when combined in meta-analyses.”

They pointed out that the hoped-for effectiveness of other medications had not been borne out. “As a recent example, the widely proclaimed benefits of hydroxychloroquine and chloroquine from observational studies proved to be unfounded in larger RCTs,” they wrote.

Ivermectin use has been banned by the government, to considerable resistance. A number of organisations have already demanded that ivermectin be administered as a COVID treatment, including Black First Land First, the New Economic Rights Alliance and AfriForum. Afriforum is contemplating legal action to have ivermectin authorised. These calls have come despite the South African Health Products Regulatory Authority (SAHPRA) repeatedly counselled against the use of ivermectin.

The doctors cautioned that although the data trends indicated a possible efficacy for ivermectin, the optimal dosage if effective still needed to be determined: “Higher than standard Ivermectin doses appear to be safe in humans, but at the time of writing there is still much uncertainty regarding the human dose required to achieve antiviral activity and a favourable benefit-to-risk balance.”

Source: IOL