On Friday, India established a new milestone by administering more than 2 crore Covid-19 vaccinations in a single day. The country is the first in the world to reach such a large-scale vaccination target in one day.

Dr NK Arora, Chief of National Immunization Technical Advisory Group (NTAGI), praised the achievement saying, “I would like to congratulate India as a whole, as well as the citizens’ enthusiasm for immunisation. We know of nations like the United States and the United Kingdom that had large inventories of vaccines but individuals who were not ready to accept them. It’s happening at such a rapid speed that 1.37 lakh individuals may have already been vaccinated as we speak. This has been in the works since March 2020, and it will not be completed overnight.”

Taking into consideration the speed of vaccination, do you believe we are on the right track to vaccinate entire country by year end as previous government claims?

Dr NK Arora: People thought that it would take us 3 to 5 years to immunize the entire nation, but we achieved it. The reason behind this is that there are 4 to 5 sectors. Right from the beginning, there has been a philosophy of vaccine Atmanirbharta. Each and every vaccine administered in this country is Made In India and that is why we are not begging anyone else. Secondly, the preparation for rollout started in July when Corona vaccine centre planning was being done. Thirdly, we have a very expensive child immunization framework and infrastructure and this vaccination had been put on that. Fourthly, adults were being immunized for the first time and nobody was sure whether they will come up for vaccine or not. There was vaccine hesitancy even among the medical professionals for the first 6 to 8 weeks and there was a very proactive program to take care of that. Fifth, a major program for managing and keeping a record of this supply system was present.

Co-Win is a phenomenal platform and I believe country is very proud to have such digital platform for the management. Finally, we have a genomic surveillance program which is Cutting edge Technology, which is monitoring and picking up virus samples from all over the country to check how effective our vaccine is. I must recall here that we immunize 17 crore children every week under the Polio Immunisation Program, that is 2.5 crore children being immunized each day. If we can do that, we can do this also.

When can we expect children’s vaccination?

We are having meetings on prioritizing adults and children separately. We have 44 crore children below 18 years of age and 12 crore adolescents between the age of 12 to 17 years of age. From October onwards, we will prioritize those children who are likely to catch severe disease and possible unfortunate death. Healthy children do get infected just like adults but the possibility of severe infection and death is almost zero. Now schools are also opening, and once the parents, teachers and other adults are immunized, children will remain in a protective ring.

What is the status on the WHO approval on Covaxin?

Dr NK Arora: We should most probably get it by this week or the next week at maximum. Most of the paper work has been going on for quite some time and we have already provided the data for the safety of the vaccine and hope that it should be done as soon as possible and people might commute form October onwards.

Everyone is talking about the booster dose, what is the development on that front?

Dr NK Arora: In a meeting, we were just discussing about the efficacy of the vaccines and the vaccine tracker platform announced by the government last week. I would like to share that one dose is providing 97% protection from the virus, while two doses provide 98% efficacy and chances of hospitalization is reduced by 95%. Several parts of the country are conducting studies to see that it is not just the antibodies that provide protection because their decline is a natural process. We are looking at the ground situation and when the scientific evidence comes, we will start with the booster shots as well and we will also identify the subgroups that require special attention. We are regularly scanning through the scientific evidence of our country, not relying on data provided by USA or any other nation. We will work on this data only.

Indemnity was there regarding Pfizer and Moderna. Is that something that is under consideration or are we going to continue on the path of Atmanirbhar Bharat for the time being?

Dr NK Arora: We have our own DNA vaccine which is world’s first vaccine and we will have our own RNA vaccine by November most likely. Indemnity is a sticking issue but we have our own effective vaccines and the discussions are being carried out on our terms.

What would be your advice to the people this festive season?

Dr NK Arora: With folded hands, I would say that pandemic comes once in a century while festivals come each year. So we must have another year of discipline. Spend the days of festivities among your own family members which is safer. I may have been vaccinated but the virus can spread through me to others and similarly I could get infected too. Covid appropriate behaviour and social distancing does not only mean keeping an arm’s distance away from a person, but keeping away from the crowd. We have witnessed a spike during the festivities last time and hence I would really request that people celebrate festivals with discipline this year.

Would you second the claims on third wave or would you deny?

Dr NK Arora: 70 to 75 per cent of our population has already been infected will now. There will be a spike driven by lack of discipline. Whenever we have let our guards down, we will invite a surge. Fortunately, no new variant has come and it is a redeeming point. It will not be wise on our part to not be disciplined for the coming 6 to 8 weeks.

A team of researchers suggested that more mental health supports are needed for pregnant women after a survey found nearly three-quarters of individuals who had been pregnant during the pandemic reported moderate to high levels of distress and one in five experienced depressive symptoms. The findings appeared in the journal ‘Canadian Family Physician’. The researchers, led by clinicians at Unity Health Toronto, surveyed nearly 1,500 participants online, 87% of whom were Canadian—who had been pregnant during the pandemic. Nearly 69% of respondents reported moderate to high levels of distress and 20% had depressive symptoms.

“The high levels of distress highlight the importance of considering mental health centrally in support for this population,” said Dr Tali Bogler, study lead author and family physician and chair of family medicine obstetrics at St. Michael’s Hospital of Unity Health Toronto. “The findings also highlight the overall impact the pandemic has had on families and the downstream impact this will have,” she added. A limitation of the study is it didn’t have comparable data on distress levels among pregnant people prior to the pandemic. However, a population-based survey conducted in Japan before the pandemic found 28% to 32% of pregnant people reported distress.

Researchers also sought to learn more about the common sources of concern for pregnant women during the pandemic. Participants were provided with a list of 27 concerns. The top five concerns included hospital policies regarding support persons in labour; not being able to introduce their baby to loved ones; getting sick from Covid-19 while pregnant; not being able to rely on family or friends after labour for support; and conflicting medical information on Covid-19 in pregnancy and newborns, especially early in the pandemic. First-time parents were more concerned about the cancellation of in-person prenatal classes and hospital tours whereas second or third-time parents were more concerned about the transmission of Covid-19 from older children in the home. The authors said that family physicians are well placed to support perinatal mental health and can engage in screening practices and offer appropriate treatment such as counselling, public health nursing, and psychiatric appointments. They also recommend hospitals better utilise technology to help address parents’ concerns by arranging more virtual check-ins and hospital tours and provide more online resources with evidence-based information on Covid-19 relevant to expectant and new parents.

Some women say their periods changed after getting a Covid-19 vaccination. In a new study, Dr Victoria Male, a reproductive specialist at Imperial College London, has said that a link between menstrual changes after Covid-19 vaccination is plausible and should be investigated.

The findings of the study were published in the journal ‘BMJ’. Changes to periods or unexpected vaginal bleeding are not listed as common side effects of Covid-19 vaccination, she wrote. Yet more than 30,000 such reports had been made to the UK Medicines and Healthcare Products Regulatory Agency (MHRA) surveillance scheme for adverse drug reactions by 2 September.

However, most females found that their period returned to normal in the following cycle and, importantly, there is no evidence that Covid-19 vaccination adversely affects fertility. The MHRA states that its surveillance data does not support a link between changes to menstrual periods and Covid-19 vaccines, since the number of reports is low in relation to both the number of people vaccinated and the prevalence of menstrual disorders generally.

However, the way in which data is collected makes firm conclusions difficult, said Male. She argued that better equipped to compare rates of menstrual changes in vaccinated versus unvaccinated populations are needed and points out that the US National Institutes of Health (NIH) has made $1.67 million available to encourage this important research.

Reports of menstrual changes after Covid-19 vaccination have been made for both mRNA and adenovirus-vectored vaccines, she added, suggesting that, if there is a connection, it is likely to be a result of the immune response to vaccination, rather than to a specific vaccine component.

Indeed, the menstrual cycle may be affected by the body’s immune response to the virus itself, with one study showing menstrual disruption in around a quarter of women infected with SARS-CoV2. If a link between vaccination and menstrual changes is confirmed, this will allow individuals seeking vaccination to plan in advance for potentially altered cycles, she explained. In the meantime, she suggested clinicians encourage their patients to report any changes to periods or unexpected vaginal bleeding after vaccination to the MHRA’s scheme.

And anyone reporting a change in periods persisting over a number of cycles, or new vaginal bleeding after menopause, should be managed according to the usual clinical guidelines for these conditions. “One important lesson is that the effects of medical interventions on menstruation should not be an afterthought in future research,” she concluded.

In a study that included over 400 adults with normal BP, it was detected that those who had high levels of stress hormones—their urine was more likely to develop high BP over the next six to seven years. The findings of the study were published in the journal ‘Hypertension’. Higher levels of the stress hormone cortisol were also linked to an increased risk of cardiovascular events including heart attack and stroke.

Studies have shown that cumulative exposure to daily stressors and exposure to traumatic stress can increase cardiovascular disease risk. A growing body of research refers to the mind-heart-body connection, which suggests a person’s mind can positively or negatively affect cardiovascular health, risk factors and risk of disease events, and prognosis over time.

“The stress hormones norepinephrine, epinephrine, dopamine, and cortisol can increase with stress from life events, work, relationships, finances, and more. And we confirmed that stress is a key factor contributing to the risk of hypertension and cardiovascular events,” said study author Kosuke Inoue, MD, PhD, assistant professor of social epidemiology at Kyoto University in Kyoto, Japan. “Previous research focused on the relationship between stress hormone levels and hypertension or cardiovascular events in patients with existing hypertension. However, studies looking at adults without hypertension were lacking,” Inoue said. “It is crucial to examine the impact of stress on adults in the general population as it provides new information about whether routine measurement of stress hormones needs to be considered to prevent hypertension and CVD events,” he added.

Study subjects were part of the MESA Stress 1 study, a substudy of the Multi-Ethnic Study of Atherosclerosis (MESA), a large study of atherosclerosis risk factors among over 6,000 men and women from six US communities. As part of MESA exams 3 and 4 (conducted between July 2004 and October 2006), White, Black and Hispanic participants with normal BP from the New York and Los Angeles sites were invited to participate in the substudy MESA Stress 1. In this substudy, researchers analysed levels of norepinephrine, epinephrine, dopamine, and cortisol hormones that respond to stress levels. Hormone levels were measured in a 12-hour overnight urine test. The substudy included 412 adults aged between 48-87 years. About half of them were female, 54% were Hispanic, 22% were Black, and 24% were White. Participants were followed for three more visits (between September 2005 and June 2018) for the development of hypertension and cardiovascular events.

Norepinephrine, epinephrine, and dopamine are molecules known as catecholamines that maintain stability throughout the autonomic nervous system—the system that regulates involuntary body functions. Cortisol is a steroid hormone released when one experiences stress and is regulated by the hypothalamic-pituitary-adrenal axis, which modulates the stress response. “Although all of these hormones are produced in the adrenal gland, they have different roles and mechanisms to influence the cardiovascular system so it is crucial to study their relationship with hypertension and cardiovascular events, individually,” Inoue said. Their analysis of the relationship between stress hormones and the development of atherosclerosis found that over a median of the 6.5-years follow-up period, every time the levels of the four stress hormones doubled was associated with a 21%-31% increase in the risk of developing hypertension. During a median of 11.2-years of follow-up, there was a 90% increased risk of cardiovascular events with each doubling of cortisol levels. There was no association between cardiovascular events and catecholamines.

“It is challenging to study psychosocial stress since it is personal and its impact varies for each individual. We used a noninvasive measure, a single urine test, to determine whether such stress might help identify people in need of additional screening to prevent hypertension and possibly cardiovascular events,” Inoue said. “The next key research question is whether and in which populations increased testing of stress hormones could be helpful. Currently, these hormones are measured only when hypertension with an underlying cause or other related diseases are suspected,” he continued. “But if additional screening could help prevent hypertension and cardiovascular events, we may want to measure these hormone levels more frequently,” Inoue added.

A limitation of the study is it didn’t include people who had hypertension at the study’s start, which would have resulted in a larger study population. Another limitation is researchers measured stress hormones via a urine test only, and no other tests for stress hormone measurement were used.

A new study has found that most patients with mild Covid-19 infections produce antibodies that persist and protect them from reinfection for up to six months.

The findings of the Michigan Medicine study were published in the journal ‘Microbiology Spectrum’. Researchers analysed nearly 130 subjects with PCR-confirmed COVID-19 illness between three and six months after initial infection. Three patients were hospitalised while the rest were treated as outpatients and experienced mild infection, with symptoms including headaches, chills and loss of taste or smell. The results revealed approximately 90 percent of participants produced spike and nucleocapsid antibody responses, and all but one had persistent antibody levels at follow-up.

“Previously, there was a lot of concern that only those with severe Covid-19 produced strong antibody responses to infection,” said Charles Schuler, MD, lead author of the paper and clinical assistant professor of allergy and immunology at Michigan Medicine. “We’re showing that people with mild bouts of Covid-19 did really well after their infection, made antibodies, and kept them,” added Schuler.

The prospective study’s participants were either Michigan Medicine health care workers or patients with a high risk of exposure to Covid-19. Most subjects took part in the same research team’s previous study, which found that Covid antibody tests are effective at predicting prior infection. During the observation period, none of the subjects who produced antibodies were re-infected, compared to 15 antibody-negative patients. Schuler’s team also found that the antibodies’ ability to neutralize Covid-19 did not differ significantly from the first visit, which occurred three months after infection, to the second visit at the six-month mark.

“While some studies have suggested antibodies against Covid-19 wane over time, these findings provide strong prospective evidence for longer-term immunity for those who produce an immune response to mild infection,” said James Baker Jr, MD, senior author of the paper and founding director of the Mary H. Weiser Food Allergy Center at Michigan Medicine.

“To our knowledge, this is the first prospective study that demonstrates such a risk reduction for clinical reinfection in this specific type of population,” added Baker Jr. The team of researchers is now analysing samples of this subject group taken up to a year after infection to further evaluate antibody responses. Meanwhile, they concluded that individuals with Covid-19 can delay vaccination for 90 days after infection ends.

The Centers for Disease Control and Prevention recommends those treated with monoclonal antibodies or convalescent plasma should wait 90 days after receiving treatment before getting vaccinated, and others should wait until they have recovered from Covid-19 and “have met the criteria to discontinue isolation.”

A study conducted in Kentucky found that unvaccinated people who already had Covid-19 were 2.34 times more likely than fully vaccinated people to be infected again, suggesting “vaccination provides additional protection against reinfection.”

Additionally, the research was conducted between March 2020 and February 2021, months before the highly transmissible Delta variant became the dominant strain of Covid in the United States. Amid rising cases and hospitalisations, Schuler said, remaining unvaccinated comes with “a high price” for immunity.

“These results are encouraging for those who have already run the gauntlet of Covid-19 infection,” he said.

“However, I do not recommend citing this study as a reason not to be vaccinated for those never previously infected. Vaccination decreases infectiousness, the risk of hospitalization and deaths from Covid-19, without having the actual infection. Achieving natural immunity by deferring vaccination in favour of infection is not worth going through the discomfort, risk to yourself and risk to others,” he concluded.

In India, 20 percent people of 16-34 age group are treated for back and neck conditions in India. The percentage of young population going for back pain treatment is the highest, whereas, 45% people neglect their pain for more than 7 weeks which results to delayed treatment. Seeing the prevalence, the question arises how does lower back pain happen? Our lower back has a complex structure and it’s made up of the five lumbar vertebrae – L1 – L5. These are held together to form a column, by muscles and ligaments. The lumbar spine provides support for the back and takes most of the weight of the upper body. Therefore, the lower back is more prone to back pain than the upper back because the lower part of the back bears the mechanical load.

Here are the 10 prominent causes of lower back pain, and some of them are connected to the spinal cord and nerves and others are linked to conditions:

TRAUMA OR INJURY:

Injury to low back and occur with small simple falls at home for example while walking down fast from the stairs or slipping in the bathroom. While road traffic accidents can cause very bad back injuries right from simple fractures to complete spinal cord injuries paralysing people.

Sports injuries often result in sprains and tears in muscles/ ligaments of the lumbar spine. More violent injury can cause an intervertebral disc to move out of its place like a toothpaste coming out of the tube and it creates pressure on the spinal cord.

BAD POSTURE

Stooping or bad posture is the next most common cause of low back pain. Most people tend to slouch, while sitting for long hours and even while watching TV they do not take proper lumbar support. Long hours of continuous sitting can cause abnormal strain on the disc and can weaken the spinal muscles leading to back pain.

DEGENERATIVE DISEASE

With age, our joints gradually deteriorate due to general wear and tear. The inter vertebral discs also similarly start to shrink and the nerve roots become strained. Even mobility of the spine is lost and it becomes stiff. In such a scenario, the spinal canal becomes narrowed, causing a serious condition where intense pressure on the spinal cord causes pain, numbness and difficulty walking called as neurogenic claudication.

VITAMIN D DEFICIENCY

Recognised to be another major cause for unexplained low back pain, vitamin D deficiency has come as an epidermic and can simply be treated by checking and confirming the low levels and proper exercise and supplementation of vitamin D.

ARTHRITIS:

Osteoarthritis and other type of arthritis including Rheumatoid arthritis and ankylosing spondylitis eventually affect our lower back. When arthritis occurs, it causes inflammation within the joints, erosion of cartilage and bone and consequent pain weakness of muscles.

REFERRED PAIN FROM ABDOMEN OR KIDNEY STONES.

When there is no structural or functional issue in the spine, still low back can happen due to referred in from Intra abdominal organs and kidney stones. Kidney stones can cause pain in the mod and lower back.

PREGNANCY.

Backache or back pain is quite common during pregnancy, especially in the early stages. When a woman conceives, the ligaments become softer and it starts getting stretched to get her all set for the labour. This can put a strain on the joints of your lower back and pelvis, which can cause back pain.

SPINAL TUMOURS

Many spinal tumours don’t have any symptoms but there are some that cause extreme back pain and neurological shortfalls including numbness and weakness. The location of the tumour in the spine plays a crucial role. It actually destroys the healthy tissue such as the vertebrae (bones) in the spine, leading to back pain. About 70% of spinal tumors are located in the thoracic spine, which is located in the upper and middle part of the body.

CAUDA EQUINA SYNDROME

This is a emergency condition in which ruptured disc presses on the spinal cord causing symptoms in the lower limbs, and sometimes the bowel and bladder. If untreated it can result in permanent neurological damage and needs urgent surgical intervention.