A dangerous new trend has emerged on social media, which involves a new COVID ‘cure’ by gargling the widely used antiseptic, povidone-iodine (PVP).
This trend has been sparked by an online video in Thai which has been widely shared on social media, featuring someone who claims to be a doctor. However this has been debunked. The trend is also cause for concern as the PVP may accidentally be swallowed.
PVP, also sold under the name Betadine, is used for disinfection in surgical procedures and wound treatment. Gargling with 0.5% PVP has been shown to reduce the symptoms of sore throat associated with COVID, but has not been adequately shown to relieve any other symptoms. The immediate side effects of ingesting any PVP antiseptic include nausea, vomiting, general weakness, and diarrhoea. In severe cases, PVP ingestion can result in acute renal failure, cardiovascular collapse, liver function impairment, shortness of breath, low blood pressure, and even death.
In one study, researchers assessed the usage of 0.5% povidone-iodine mouthwash in patients as a way of reducing viral load during dental procedures, reducing possible exposure of healthcare workers. However, there is no evidence beyond in vitro testing that it actually reduces viral load in the throat.
An official statement on the Betadine website reads as follows: “Betadine® Antiseptic First Aid products have not been approved to treat coronavirus. Products should only be used to help prevent infection in minor cuts, scrapes and burns. Betadine Antiseptic products have not been demonstrated to be effective for the treatment or prevention of COVID-19 or any other viruses.”
With greater long-term cancer survival, previous standards of cancer follow-up care and support may no longer meet current needs.
The side-effects of anticancer medicines and impacts of the illness itself that sometimes persist after the end of treatment can hinder a return to normal life after beating cancer. A study presented at the ESMO Congress 2021 showed that a significant proportion of survivors continue to suffer from burdensome symptoms for several years and reveal widespread dissatisfaction with the assistance provided.
Prof Dorothy Keefe, CEO of Australia’s national cancer agency, Cancer Australia, chair of the congress’s supportive and palliative care track, not involved in the study, underlined its importance in a context where survivorship research has lagged behind research on cancer treatment. “This is probably due to the increase in survival rates itself lagging behind the introduction of new therapies, but also to a lack of prioritisation compared to the need to develop a cure,” Keefe said, and highlighted the scale of the issue today: “We now have millions of cancer survivors in Australia, hundreds of millions around the world – and an ever-increasing number who could potentially have long-term side-effects.”
One of the most common symptoms experienced by patients and survivors alike is cancer-related fatigue (CRF), a persistent sense of exhaustion, not alleviated by sleep or rest and significantly interferes with the person’s usual functioning. The FiX study initially evaluated the patterns, severity and management of CRF among 2508 patients with 15 different types of cancer two years after the discovery of their illness. In a follow-up survey, 36 potential long-term problems, completed by participants around four years after diagnosis, almost 40% of survivors continued to report fatigue that they rated as a moderate or severe burden. As well as fatigue, over 40% of patients reported loss of physical capacity as a burden and over one third suffered from trouble sleeping, sexual problems, joint pains and anxiety.
Although there are recommendations for managing side-effects like CRF, study author Dr Martina Schmidt from the German Cancer Research Centre (DKFZ) in Heidelberg, Germany, drew attention to their lack of implementation and reported that more than one in three affected individuals in the study evaluated the support they were offered for fatigue as poor. “Despite increasing awareness of the effectiveness of mitigating measures like exercise to reduce fatigue, patients are still too often left alone to seek help for symptoms that cannot be directly addressed with medicines in the same way as something like pain, for which satisfaction with the support received was high in our study.”
Prof Keefe commented on the results, saying: “This research shows that a staggeringly high number of patients still suffer from significant health issues years after being declared disease-free. Their dissatisfaction with the care available is a wake-up call that we should be paying more attention to these individuals, trying to understand the mechanisms at play in order to identify interventions that could help them to better recover.”
According to Dr Schmidt, cancer follow-up care should therefore also incorporate more systematic screening for additional symptoms that can burden patients. “The first step should be to make sure that patients themselves are better informed about these potential issues early on, so they know that conditions like CRF are not only expected, but often manageable and that they should not wait for symptoms to disappear on their own,” she said.
Recognising that possible models of long-term support remain largely untested, Keefe further advocated that all patients should be provided with a survivorship care plan when they reach the end of their treatment. “Going forward, we need to develop these models of care in a way that minimises the burden on healthcare systems, implement them and research their impact so that we can come back in five years’ time and evaluate whether they have made a difference for cancer survivors,” she concluded.
“Disrupting this allergen sensing pathway could provide a unique opportunity to counteract type 2 immunity and alleviate allergic inflammation,” said senior author Marc Rothenberg, MD, PhD, Director, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center
In addition to Rothenberg, the research team included , Mark Rochman, PhD, Yrina Rochman, PhD, Julie Caldwell, PhD. Lydia Mack, MS, Jennifer Felton, PhD, Jeff Habel, PhD, Aleksey Porollo, PhD and Chandrashekhar Pasare, DVM, PhD.
Multiple allergens had been shown to induce a similar IL-33 response upon breaching the epithelial layer of mucosal membranes, a process which the researchers pinned down.
“This breakthrough was made possible by new insights into the role of ripoptosome signaling and caspases in allergic inflammation,” said Michael Brusilovsky, MMedSc, PhD, who was the first author of the study.
Specifically, the allergens trigger activity among an interlocked set of cell death-inducing signals called the ripoptosome. This signaling “platform” includes numerous components, but for allergic inflammatory reactions, the key player appears to be a molecular switch called caspase 8. The investigators named the pathway, “RipIL-33” as IL-33 is processed (ripped) by the ripoptosome.
How allergens are sensed has remained a mystery.
“The discovery of this surprising mechanism is the most important breakthrough in understanding how the innate immune system senses allergens to initiate a type 2 response and subsequent allergic inflammation,” said Pasare, one of the senior authors of the study.
In mice, inhibiting caspase 8 reduced the IL-33 response to allergens and limited bronchial inflammation in the lungs. Analysis revealed a similar process in humans/ “In the human allergic disease eosinophilic esophagitis (EoE), we found that ripoptosome activation markers and mature IL-33 levels dynamically correlated with the degree of esophageal eosinophilia and disease activity,” the study states.
The next steps include studying the RipIL-33 pathway in human allergic reaction and determining whether existing or new drugs could disrupt it.
GLP-1R agonists, a popular class of diabetes drugs, may also have a protective effect against glaucoma in diabetic patients, according to a new study published in the British Journal of Ophthalmology.
The researchers examined retrospective data of 1961 diabetic patients who were new users of this class of drugs and matched them to 4371 unexposed control subjects. After 150 days on average, 10 patients in the medicated group were newly diagnosed with glaucoma (0.5%) compared to 58 patients (1.3%) in the control group. These results indicate that GLP-1 receptor agonists could halve a diabetic patient’s risk of developing glaucoma.
The findings are supported by a Penn Medicine study from 2020, which found that GLP-1R agonists reduced neuroinflammation and prevented retinal ganglion cell death in mice. This class of drugs has also shown similarly protective effects against Alzheimer’s and Parkinson’s diseases in animal models, and clinical trials are underway to test the medications against neurodegenerative diseases in humans.
Glaucoma is the second leading cause of blindness worldwide, and people with diabetes are twice as likely to develop the condition.
“It was very encouraging to see that a popular diabetes medication could significantly reduce the risk of developing glaucoma, and our study suggests that these medications warrant further study in this patient population,” said Qi N. Cui, MD, PhD, with Brian VanderBeek, MD, MPH, both assistant professors of Ophthalmology at Penn.
An article in MedPage Today examines the potential for combination COVID vaccines.
Novavax and Moderna have recently announced the development of combination vaccines that would protect not only against COVID, but also against influenza. In the case of Moderna, they are testing a combination vaccine that also includes protection against respiratory syncytial virus (RSV) — a viral illness for which no vaccine is currently available, which would be a major advancement Because COVID vaccines can be administered simultaneously with other vaccines, albeit in separate injections, the next step would be to co-formulate them in the same injection with other vaccinations.
Combination vaccines are extremely valuable for several reasons, chief among them is convenience. If, during one visit to a provider, a person can get multiple vaccinations, it ensures uptake of all those vaccines without the need to schedule multiple visits or use multiple injections. A single needle puncture is better than multiple punctures, even for those who are not needle phobic. As more vaccines are developed, combination vaccines become critical in getting doses into arms with the minimum number of injections.
Combination vaccines have been around for a long time, and are the mainstay of routine vaccination. Today, children receive several combination vaccinations including the well-known MMR (measles, mumps, rubella) and DTap (diphtheria, tetanus, acellular pertussis). These types of vaccines have a long history with DTP, the first combination vaccine used in humans, dating to the 1940s. Pentacel immunises against five different pathogens at once. Such convenience, especially with hard-to-reach populations, is invaluable. Adults also receive combination vaccinations, most prominently the Tdap (tetanus, diphtheria, acellular pertussis) boosters. Many physicians wish there were more combination vaccination products available because they have the potential to significantly increase vaccination rates.
It is of course necessary to determine that combination vaccines are safe and effective. Because they contain more antigen, reactions at injection sites might be more pronounced, fever might be slightly higher, and tolerability lower. To avoid the risk of febrile seizures, infants do not get the MMRV (measles, mumps, rubella, varicella) vaccine, instead getting varicella separately. A combination vaccine’s components should not interfere with each other or blunt the immune response. This immune interference was a concern with vaccines combining Hib with DTap. For instance, vaccines with different storage conditions or delivery mechanisms (eg, subcutaneous vs intra-muscular; lipid nanoparticle encased) may not be the best candidates to combine. It is also important to combine vaccines that have compatible age or time-based schedules for administration.
As scientists explore a combination flu and COVID vaccine, they will be looking closely at all of these safety and efficacy considerations.
It’s important to emphasize, considering widespread disinformation from the anti-vaccine movement, that there is no “antigen overload” risk with combination vaccines. The human immune system is bombarded with antigens every day. We even become bacteremic, when we brush our teeth, or eat. The antigens contained in a combination vaccine are miniscule by comparison. In fact, the first ever vaccine, for smallpox, was packed with particles and impurities but was still incredibly efficacious and led to control and eventual elimination of one of humanity’s deadliest scourges.
It is likely to see individual attacks on COVID combination vaccines long before they are even available. We’ve previously seen such attacks on the MMR vaccine — these attacks became so pervasive that manufacturers started to produce the single vaccines again to placate people who were the victims of a concerted disinformation campaign. But we can learn from these past challenges. It will be important to fight disinformation about the COVID-19 combination vaccines early on, and encourage their uptake when they become available.
But one thing is certain: we should aim to make COVID vaccination convenient, normal, and easy. Proactively working on next generation vaccines that do this by combining with other vaccinations, altering the mode of delivery (eg, oral or nasal vaccines), or simplifying storage requirements are important tasks.
