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Shortcuts for vaccine can risk large number of people: AIIMS Director

All India Institute of Medical Sciences Director Dr Randeep Guleria talks to The Daily Guardian about the status of ongoing vaccine trials at AIIMS, how important it is to follow proper guidelines during trials, and his concerns about Russia’s new vaccine claims.

Shalini Bhardwaj

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All India Institute of Medical Sciences Director Dr Randeep Guleria talks about the status of ongoing vaccine trials at AIIMS, how important it is to follow proper guidelines during trials, and his concerns about Russia’s new vaccine claims.

Q. Why is India experiencing a spike in Covid-19 cases?

A. Our numbers are high because the population is also large. But if you look at cases per million of the population, then the numbers are not that high. Right now, in smaller towns and states like Bihar, Uttar Pradesh and Karnataka, there is an increase in cases, but this will flatten gradually and show a downward trend.

Q. When do you think the graph will start declining?

A. It depends on how the virus behaves. If everyone maintains physical distancing, hand-washing, wearing masks and getting themselves tested as soon as they have symptoms, then this will happen much earlier. But since the lockdown lifted, people have started moving around, not wearing masks, not physically distancing — if this continues, then the cases will continuously increase because then people are allowing the virus to spread.

Q. Many scientists and doctors are uneasy with Russia’s vaccine and have questioned it. Do you think it may put people at risk?

A. Whenever you have a vaccine, there are two very important things: One is safety and the other is efficacy. If we look at safety, then it is quite short-term. This means any immediate reaction can occur early, within 24 to 48 hours, while some can occur later on. We also know vaccines which lead to neuro-related problems, while there are some reactions which occur with the infection. So, it has been shown that sometimes you get the vaccine-dependent enhancements that you have been vaccinated for but when you get Covid-19, immunity isn’t that high and it actually leads to a more severe infection. So, whenever you talk of a vaccine, you have to be sure that there won’t be long-term or short-term side effects and that there are no vaccine-related side effects with the infection. Because you are going to administer it to a large number of healthy people, it will be very unethical if you cause all those people to get a severe disease or the side effects of the vaccine, rather than safety from the disease. Safety is very important and one should also have good safety data. People are worried now because there is no data published by Russia or reviewed by WHO or any other international agency, which can say that there is good safety data as far as the vaccine is concerned. Secondly, how effective is the vaccine? Is it creating immunity which is longlasting or short-lasting, is it just for a few weeks or a month or a few years? That data is also not there. They should share this data with the world. If they have data on safety and efficacy, then it is a good thing. But without the data, people will obviously get worried, especially because in other vaccines, the data has been shared globally and is available in the public domain. This should also be made available in the public domain so that people can see, analyze and feel comfortable about the vaccine.

Q. What results have been seen in the vaccine trials at AIIMS? What stage have the ongoing trails reached?

A. The Bharat Biotech vaccine is already in the second phase. Initial signals are good and safe, but we have to wait for 28 days to see the safety and immunogenicity of people undergoing the trials. But a number of patients have received their second dose and they are being followed up. This has been done in multiple sites. So far, ten groups of people have been followed up but then the numbers will increase when we see the results after 28 days. So, you will get some data within the next few weeks.

Q. What kind of reactions have been noticed in people during the trials?

A. Some people had a reaction where the injections had been given. Other than that I don’t think that there are any serious reactions, which is why it is being continued now with the second dose and the follow-up.

Q. What about the Mycobacterium W (Mw) drug trials which were started in AIIMS before Covaxin trials?

A. Mw is also for immunity. There is some data which suggests that it may be helpful in treating Covid-19 or for improving immunity in severe Covid-19 infections. That study has also been conducted on different groups of patients, one for mild cases and another on serious patients. This is the drug which is being marketed by Cadila, whose trials are being conducted together with CSIR.

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New blood test predicts which Covid patients at severe risk

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Amid the ongoing battle with Covid-19, scientists have developed a score that can accurately predict which patients will develop a severe form of coronavirus. The measurement, called the Dublin-Boston score, is designed to enable clinicians to make more informed decisions when identifying patients who may benefit from therapies, such as steroids, and admission to intensive care units. Until this study, no Covid-19-specific prognostic scores were available to guide clinical decision-making.

 According to the findings, published in the journal EBioMedicine, the DublinBoston score can now accurately predict how severe the infection will be on Day 7 after measuring the patient’s blood for the first four days.

 “The Dublin-Boston score is easily calculated and can be applied to all hospitalised Covid-19 patients,” said study author Gerry McElvaney from the RCSI University in Ireland. 

The blood test works by measuring the levels of two molecules that send messages to the body’s immune system and control inflammation.

 One of these molecules, interleukin (IL)-6, is pro-inflammatory, and a different one, called IL-10, is anti-inflammatory. The levels of both are altered in severe Covid-19 patients. 

Based on the changes in the ratio of these two molecules over time, the researchers developed a point system where each 1-point increase was associated with 5.6 times increased odds for a more severe outcome.

 “More informed prognosis could help determine when to escalate or de-escalate care, a key component of the efficient allocation of resources during the current pandemic,” McElvaney said.

 “The score may also have a role in evaluating whether new therapies designed to decrease inflammation in Covid-19 actually provide benefit,” McElvaney added.

 With IANS inputs

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Delhi to be quack-free in 2021: New DMC chief

Shalini Bhardwaj

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Dr Arun Gupta has been re-elected as president of the Delhi Medical Council (DMC) for a second fiveyear term. Dr Gupta, a practising paediatrician for the last 30 years, worked for digitising medical processes during his previous tenure.

 Speaking of the DMC’s current goals, he said, “One of the mandates is to eradicate quackery. We have decided that by the end of the year 2021, Delhi will become the first anti-quackery state in India. We are working on it in collaboration with the Delhi Government. We don’t have any authentic data yet but more than 20,000 quacks are in Delhi only.” 

The DMC is responsible for handling and settling medico-legal issues against doctors. Currently, there are over 72,000 doctors registered with the council.

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National Medical Commission starts its website

Shalini Bhardwaj

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The National Medical Commission (NMC), constituted by the National Medical Commission Act, 2019, which came into force on 25 September, 2020, has launched its website. Citizens wishing to know about the National Medical Commission and its current medical working rules and regulations can log on to https:// www.nmc.org.in/.

 The NMC website also has highlights about its autonomous boards, members and organisational structure. The chairman of NMC is Dr Suresh Chandra Sharma and the commission has 33 members including the chairman, 10 ex-officio members and 22 part-time members. It also has four boards, the Under Graduate Medical Education Board, Post Graduate Medical Education Board, Medical Assessment and Rating Board, and Ethics and Medical Registration Board. The commission has 84 members from all over India as members of the medical advisory council.

 Cow dung chip will protect against mobile radiation: RKA chairman Rashtriya Kamdhenu Aayog (RKA) chairman, Vallabhbhai Kathiria, has launched a “chip” made of cow dung, claiming that it reduces radiation from mobile phones significantly.

 The chip, named Gausatva Kavach, has been manufactured by Rajkotbased Shrijee Gaushala. “This is a radiation chip. You can keep it in your mobile and it will reduce radiation. It will also keep you away from diseases,” said Vallabhbhai Kathiria during the launch of a nationwide campaign, ‘Kamdhenu Deepawali Abhiyan’

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India’s syringe makers to increase Covid-19 vaccine stocks

Shalini Bhardwaj

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India is one of the largest syringe makers in the world when it comes to 0.5 ml auto-disable syringes for intramuscular vaccination. With the current race towards procuring and distributing a Covid-19 vaccine, syringe manufacturers in the country are ramping up their capacities further by over 30% to meet the expected rise in global demand.

ISCON, Becton Dickinson, and Hindustan Syringes and Medical Device (HMD) are the three major Indian medical device companies which manufacture the 0.5 ml auto-disable syringes which would be required to administer a Covid-19 vaccine. The companies together have planned to expand their capacities to manufacture 1.4 billion pieces per annum by June 2021 next year.

“We are planning to ramp up our capacity to a billion 0.5 ml AD syringes and offer 50% to the Government of India and 50% as exports, which amounts to 200-250 million by June 2021 and another 250 million from June to December 2021,” said Rajiv Nath, Managing Director of Hindustan Syringes and Medical Devices Ltd.

“We have 70 million AD syringes in stock against our orders of standard immunisation campaign and can offer 100 million to Government of India by end of 2020, if needed,” he added.

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Efficacy of three primary diets in drug-resistant epilepsy

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Epilepsy that fails to get controlled by two antiseizure drugs is unlikely to respond to the addition of other medications. These children are designated to have drugresistant epilepsy. The principal treatment options for these children include either surgery or starting them on a ketogenic diet.

 The choice of surgery cannot be exercised in all patients: Epilepsy surgery is curative in specific diseases, and in certain conditions, it may be associated with permanent disabilities. Also, the expertise for performing epilepsy surgery is available only in a few centres across the country. The other option includes initiating a ketogenic diet.

 There are three main methods of providing these diets. The classical ketogenic diet often requires the patient to get admitted to the hospital, strict adherence to protocol and weighing the food items. The modified Atkins diet is less severe than the ketogenic diet. The low glycemic index therapy diet requires only minor diet modifications. So far, there has been adequate evidence about the efficacy of the ketogenic diet and the modified Atkins diet.

 The child neurology division of the department of paediatrics, All India Institute of Medical Sciences, carried out a first-of-itskind trial (The DIET Trial). They compared the three primary dietary therapies. This research showed that the seizure burden reduced by more than 50% in 67% of children receiving a ketogenic diet, 52% receiving a modified Atkins diet, and 59% of patients receiving a low glycemic index therapy diet. Also, the side effects were least with a low glycemic index therapy diet. 

Thus, this study adds a modified Atkins diet and low glycemic index therapy diet to the armamentarium for the management of drugresistant epilepsy. The added benefit is that since the study has been conducted in India, it can benefit a large population of drug-resistant epilepsy with local dietary menus. 

The writer is chief, child neurology at AIIMS.

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What happens when corona meets toxic air? CSIR to detect soon, says Dr Shekhar Mande

CSIR labs in Hyderabad and Chandigarh have collected samples from different locations and are working
on research regarding the effects of air pollution on the Covid-19 pandemic, says the CSIR Director General.

Shalini Bhardwaj

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With experts saying that rising pollution levels can worsen the effects of Covid-19, the Council of Scientific and Industrial Research (CSIR) has started its own research on the matter at the National Environmental Engineering Research Institute (NEERI), Nagpur. Director General of CSIR, Dr Shekhar C. Mande, speaks on the subject and about other Covid-related developments like the “Feluda test”, in an exclusive interview with The Daily Guardian. Excerpts: 

Q. Is CSIR going to do research on the link between air pollution and Covid-19?

 A. Of course, but the research will take some time to accomplish. Our labs are working on it already and the National Environmental Engineering Research Institute (NEERI) in Nagpur has started some work too.

 Q. When is CSIR expected to complete its research on whether Covid-19 is air-borne or not?

 A. Researchers have started compiling the results of the airborne study. They are conducting this research at two centres in Hyderabad and Chandigarh. Samples for the study have been collected from various places of India, from places like ICUs, hospital corridors, waiting rooms, places where healthcare workers are most at risk, high rise structures, etc. We are detecting how far this virus can travel. We have taken samples multiple times and are still sampling from different locations with different distances from patients, 4ft, 8ft and 12ft. Now, we have to wait for the results which are expected to come in the next ten days. 

Q. CSIR has tied-up with the UP government. Which projects are the CSIR going to focus on? 

A. We are going to work with the UP government on the types of projects which are required. If they have some ambitious plans on agriculture, the pharma industry or the environment, we will work as a knowledge partner. We are proposing some documents along with the UP government on pharma and we will be doing many other projects too. 

Q. When will “Feluda” come to the market? How does it work? 

A. It’s almost ready to enter the market. Feluda stands for FnCas9 Editor Linked Uniform Detection Assay. It detects active Covid-19 infection by using a CRISPR CAS 9-based readout on a paper strip. Detection takes place in less than an hour. It doesn’t require a real-time PCR machine, will be cheap, and can be performed at the point of care settings where a simple PCR machine is present. The virus has regenetic material RNA and we need to detect that particular RNA. We first do a reaction called RT-PCR (Reverse Transcription Polymerase Chain Reaction) in which we make DNA from RNA and amplify those copies of DNA. Then there is an enzyme which actually tries to match with the virus. It goes to the correct site and identifies the sequence for Covid. A paper strip is dipped into a solution, and if it is Covid-19 RNA, then you get a band that can be seen. The test gives its results in 45 minutes.

 Q. What should be the comprehensive distribution and delivery mechanism for vaccines?

 A. The Government of India is coming up with a very comprehensive plan and will take very considered decisions as a high priority. Those plans are pretty much in place and the people who have drawn these plans are technical experts in their area and therefore it’s going to be very robust. 

Q. In your opinion, who should get the vaccine first?

 A. People who are at high risk should get the vaccine first because they are handling Covid-19 patients every day. They deserve to get the vaccine first.

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