USE OXYGEN JUDICIOUSLY, FOLLOW DOCTORS’ ADVICE: CORONA TIPS FROM TOP EXPERTS - The Daily Guardian
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USE OXYGEN JUDICIOUSLY, FOLLOW DOCTORS’ ADVICE: CORONA TIPS FROM TOP EXPERTS

Shalini Bhardwaj

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Seeing India hit record highs in Covid-19 cases every day has left a lot of people panicking and looking for advice on what to do if someone shows symptoms of the infection. Three of India’s best doctors—Dr Randeep Guleria, Dr Naresh Trehan and Dr Devi Shetty—provide answers to common queries and highlight the most important points that people must keep in mind amid the ongoing surge.

DR RANDEEP GULERIA, DIRECTOR, AIIMS-DELHI

More than 85% of Covid patients will recover without any specific treatment. Most will have symptoms like common cold, sore throat, etc. Over 5-7 days, they’ll recover with symptomatic treatment. Only 15% may advance to a moderate form of the disease.

Oxygen is a treatment, like a drug. Taking oxygen intermittently is an absolute waste of oxygen. There is no data that shows that this will be of any help to you and therefore you shouldn’t do it.

In healthy individuals with oxygen saturation of 93-94, there’s no need to take high flow oxygen just to maintain saturation at 98-99. It’s not going to be of any benefit. If it is less than 94, you need close monitoring, but you still may not need oxygen.

Do not consider Remdesivir to be a magic bullet. Most of us who are in home isolation or in the hospital don’t actually need any specific treatment. Only a small percentage requires Remdesivir.

In terms of the number of people who need oxygen and oxygen supply, we are well balanced. As a country, if we work together and use oxygen and Remdesivir judiciously, there will be no shortages anywhere.

The vaccine prevents you from getting the disease in the form of a severe illness. It may not prevent you from getting the infection. It is important to understand that even after taking the vaccine, we may get a positive report. That is why it is important to wear a mask even after the vaccine.

Cross-ventilation reduces the risk of infection in closed places. Don’t be in groups, whether any of you are positive or not.

DR NARESH TREHAN, CHAIRMAN AND MD, MEDANTA

Today we have enough oxygen, if we try to use it judiciously. I want to tell the public that if you don’t need oxygen, then don’t use it as a security blanket. Wasting oxygen will only lead to depriving someone who needs it.

We now have a protocol that Remdesivir is not to be given to everyone who tests positive. Only after doctors look at test results, symptoms and comorbidities of a patient, it can be given. Remdesivir isn’t a ‘Ram baan’; it only decreases the viral load in people who need it.

A lesser percentage of people require hospitalisation. Hospital beds should be utilised judiciously and responsibly. This responsibility rests on all of us.

DR DEVI SHETTY, CHAIRMAN, NARAYANA HEALTH

If you have any symptoms like body ache, cold, cough, indigestion and vomiting, I have one important message: get yourself tested for Covid-19. It is the most important thing.

In case you are positive, see a doctor and get his opinion. Do not panic; Covid-19 is common now. It is a problem that can be solved, provided you get medical help at an early stage and follow the doctor’s instructions.

There is a possibility that you may be asymptomatic. Doctors will tell you to stay at home, isolate yourself, wear a mask and check your oxygen saturation every six hours.

If your O2 saturation is above 94%, there is no problem. But if it is falling after exercise, you need to call a doctor. It’s important you get the right treatment at the right time.

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Medically Speaking

SUGARY BEVERAGE LINKED TO INCREASED RISK OF COLORECTAL CANCER IN WOMEN UNDER 50: STUDY

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If you are obsessed with sugar-sweetened drinks then you need to think twice before having them regularly.

A new study led by Washington University School of Medicine has found a link between drinking sugar-sweetened beverages and an increased risk of developing colorectal cancer in women under age 50. The findings suggest that heavy consumption of sugary drinks during adolescence (ages 13 to 18) and adulthood can increase the disease risk. The study, published in the journal Gut, provides more support for public health efforts that encourage people to reduce the amount of sugar they consume.

“Colorectal cancer in younger adults remains relatively rare, but the fact that the rates have been increasing over the past three decades — and we don’t understand why — is a major public health concern and a priority in cancer prevention,” said senior author Yin Cao, ScD, an associate professor of surgery and of medicine in the Division of Public Health Sciences at Washington University.

“Due to the increase in colorectal cancer at younger ages, the average age of colorectal cancer diagnosis has gone down from 72 years to 66 years. These cancers are more advanced at diagnosis and have different characteristics compared with cancers from older populations.

“Our lab is funded by the National Cancer Institute (NCI) and the National Comprehensive Cancer Network to identify risk factors, the molecular landscapes, and precision screening strategies for these cancers so that they can be detected earlier and even prevented,” said Cao, who also has a master’s of public health.

“In past work, we have shown that poor diet quality was associated with increased risk of early-onset colorectal cancer precursors, but we have not previously examined specific nutrients or foods.”

Compared with women who drank less than one 8-ounce serving per week of sugar-sweetened beverages, those who drank two or more servings per day had just over twice the risk of developing early-onset colorectal cancer, meaning it was diagnosed before age 50.

The researchers calculated a 16 per cent increase in risk for each 8-ounce serving per day. And from ages 13 to 18, an important time for growth and development, each daily serving was linked to a 32 per cent increased risk of eventually developing colorectal cancer before age 50.

Sugar-sweetened drink consumption has been linked to metabolic health problems, such as type 2 diabetes and obesity, including in children. But less is known about whether such high-sugar beverages could have a role in the increasing incidence of colorectal cancer in younger people. Like early-onset colorectal cancer rates, consumption of such drinks has increased over the past 20 years, with the highest consumption level found among adolescents and young adults ages 20 to 34.

The researchers analyzed data from the Nurses’ Health Study II, a large population study that tracked the health of nearly 116,500 female nurses from 1991 to 2015. Every four years, participants answered surveys that included questions about diet, including the types and estimated amounts of beverages they drank.

Of the total participants, over 41,000 also were asked to recall their beverage habits during their adolescence.

The researchers identified 109 diagnoses of early-onset colorectal cancer among the nearly 116,500 participants.

“Despite the small number of cases, there is still a strong signal to suggest that sugar intake, especially in early life, is playing a role down the road in increasing adulthood colorectal cancer risk before age 50,” said Cao, also a research member of Siteman Cancer Center.

“This study, combined with our past work linking obesity and metabolic conditions to a higher risk of early-onset colorectal cancer, suggests that metabolic problems, such as insulin resistance, may play an important role in the development of this cancer in younger adults.”

With the increasing rates in mind, the American Cancer Society has recently lowered the recommended age for a first screening colonoscopy to 45, down from the previously recommended age 50 for people at average risk. Those with additional risk factors, such as a family history of the disease, should start even earlier, according to the guidelines.

Since the study only included female nurses, most of whom were white, more work is needed to examine this link in people of more diverse races, ethnicities and genders.

While sugar-sweetened beverages were linked to an increased risk of early-onset colorectal cancer, some other drinks — including milk and coffee — were associated with a decreased risk.

This observational study can’t demonstrate that drinking sugary beverages causes this type of cancer or that drinking milk or coffee is protective, but the researchers said that replacing sweetened beverages with unsweetened drinks, such as milk and coffee, is a better choice for long-term health.

“Given this data, we recommend that people avoid sugar-sweetened beverages and instead choose drinks like milk and coffee without sweeteners,” Cao said.

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ORGAN TRANSPLANT RECIPIENTS REMAIN VULNERABLE TO COVID-19 EVEN AFTER SECOND VACCINE DOSE

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Researchers at Johns Hopkins have found that two doses of a vaccine against SARS-CoV-2 — the virus that causes COVID-19 — confers some protection for people who have received solid organ transplants, it’s still not enough to enable them to dispense with COVID safety measures including masks and physical distancing.

The findings that were published in the Journal of the American Medical Association (JAMA). This is a follow-up study to an earlier one published in March in JAMA, in which the researchers reported that only 17 per cent of the participating transplant recipients produced sufficient antibodies after just one dose of a two-dose COVID-19 vaccine regimen.

“While there was an increase in those with detectable antibodies — 54 per cent overall — after the second shot, the number of transplant recipients in our second study whose antibody levels reached high enough levels to ward off a SARS-CoV-2 infection was still well below what’s typically seen in people with healthy immune systems,” says study lead author Brian Boyarsky, M.D., a surgery resident at the Johns Hopkins University School of Medicine.

“Based on our findings, we recommend that transplant recipients and other immunocompromised patients continue to practice strict COVID-19 safety precautions, even after vaccination,” Boyarsky says.

People who receive solid organ transplants (such as hearts, lungs and kidneys) often must take drugs to suppress their immune systems and prevent rejection. Such regimens may interfere with a transplant recipient’s ability to make antibodies to foreign substances, including the protective ones produced in response to vaccines.

The new study evaluated this immunogenic response following the second dose of either of the two messenger RNA (mRNA) vaccines — made by Moderna and Pfizer-BioNTech — for 658 transplant recipients, none of whom had a prior diagnosis of COVID-19. The participants completed their two-dose regimen between Dec. 16, 2020, and March 13, 2021.

In the most recent study, the researchers found that only 98 of the 658 study participants — 15 per cent — had detectable antibodies to SARS-CoV-2 at 21 days after the first vaccine dose. This was comparable to the 17 per cent reported in the March study looking at the immune response after only one vaccine dose.

At 29 days following the second dose, the number of participants with detectable antibodies rose to 357 out of 658 — 54 per cent. After both vaccine doses were administered, 301 out of 658 participants — 46 per cent — had no detectable antibody at all while 259 — 39 per cent — only produced antibodies after the second shot.

The researchers also found that among the participants, the most likely to develop an antibody response were younger, did not take immunosuppressive regimens including anti-metabolite drugs and received the Moderna vaccine. These were similar to the associations seen in the March single-dose study.

“Given these observations, transplant recipients should not assume that two vaccine doses guarantee sufficient immunity against SARS-CoV-2 any more than it did after just one dose,” says study co-author Dorry Segev, M.D., PhD, the Marjory K. and Thomas Pozefsky Professor of Surgery and Epidemiology and director of the Epidemiology Research Group in Organ Transplantation at the Johns Hopkins University School of Medicine.

Segev says that future studies should seek to improve COVID-19 vaccine responses in this population, including additional booster doses or modulating the use of immunosuppressive medications so that sufficient antibody levels are achieved.

In addition to Boyarsky and Segev, the Johns Hopkins Medicine research team includes William Werbel, Robin Avery, Aaron Tobian, Allan Massie and Jacqueline Garonzik-Wang.

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New research analyzes more palatable alternatives to control SARS-CoV-2 spread

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At the beginning of the COVID-19 pandemic, intense social distancing and lockdown measures were the primary weapon in the fight against the spread of SARS-CoV-2, but they came with a monumental societal burden. New research from the Center for the Ecology of Infectious Diseases and the College of Public Health at the University of Georgia explores if there could have been a better way.

Through the findings, published in the journal Proceedings of the Royal Society B, the researchers analyzed more palatable alternatives to the kind of social distancing mandates that threw a wrench at how businesses, schools and even family gatherings work. The alternatives — widespread testing, contact tracing, quarantines, certification for non-infected people and other public health policy measures — can slow the spread when combined together, but only with significant investments and broad public compliance.

“I understand why government leaders quickly enacted strict social distancing mandates as the COVID-19 pandemic was rapidly spreading in 2020,” said lead author John Drake, director of the Center for the Ecology of Infectious Diseases and Distinguished Research Professor in the Odum School of Ecology.

“This was the best that we could do at the time. However, school and workplace closures, gathering limits and shelter-in-place orders have had extreme economic consequences. These are harsh, and we really need to find alternative solutions,” John added.

Drake worked with other researchers to develop two models. One targeted how to find infected people to limit transmission through active case finding (through testing of at-risk individuals), thorough contact tracing when cases arise, and quarantines for people infected and their traced contacts.

The second model focused on a strategy of limiting exposure by certifying healthy individuals.

“Each model was tested independently and in combination with general non-pharmaceutical interventions (NPIs),” said co-author Kyle Dahlin, a postdoctoral associate with the centre.

For this study, those interventions were defined as behavioural or generalized interventions that can be broadly adopted, such as wearing a face mask, hand washing, enhanced sick leave, micro distancing and contactless transactions.

“When we ran the model to evaluate the effectiveness of only using social distancing measures, like workplace closures, after the onset of the first wave, approximately half of the population eventually became infected,” said study co-author Andreas Handel, associate professor of biostatistics and epidemiology in UGA’s College of Public Health who helped design the models.

“When we combined social distancing with general interventions, SARS-CoV-2 transmission was slowed, but not enough for complete suppression.”

When they tested the model that actively looked for infection, they found that active case-finding had to identify approximately 95 per cent of infected persons to stop the viral spread.

When combined with NPIs, like face masks, the fraction of active cases that needed to be located dropped to 80 per cent. Considering that during the first wave of the pandemic in 2020, only 1 per cent to 10 per cent of positive cases were found, such an approach by itself wouldn’t work.

The researchers also determined that adding contact tracing and quarantine to active case finding and general NPIs did not drastically change the model’s success.

The model that targeted healthy people to limit exposure determined that to successfully control viral spread, SARS-CoV-2 test validity had to occur within a very narrow window of seven to 10 days with a waiting time of three days or less, and NPIs had to be strictly adopted. Otherwise, a large outbreak would occur.

Pej Rohani, Regents’ and Georgia Athletic Association Professor of Ecology and Infectious Diseases in the Odum School and College of Veterinary Medicine, said that the models’ conclusions indicated the need for continued research.

“These models are important because infectious disease ecologists and epidemiologists need to understand how SARS-CoV-2 transmission can be reduced using measures that do not have extreme societal consequences,” he said.

The CEID’s research highlighted the importance of a robust and widespread testing program, the general adoption of NPIs like face masks, and targeted measures to globally control the ongoing pandemic. These approaches are still extremely important as vaccines continue to be distributed.

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Benefits of deworming for expectant mothers to their infants

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Researchers from Syracuse University, the World Health Organization, and SUNY Upstate (The State University of New York Upstate Medical University) measured the impact of deworming medicine during pregnancy on the subsequent risk of neonatal mortality and low birthweight.

The study has been conducted on 95 Demographic Health Survey data collected on more than 800,000 births and the results are published in the current issue of the journal PLoS Neglected Tropical Diseases.

More than 25% of the world’s population (greater than 1.5 billion people) face the burden of soil-transmitted helminth (STH) infections, a species of an intestinal parasite whose eggs develop in the soil before finding a new host.

The main cause of this high infection rate is lack of access to adequate sanitation facilities (toilets) and the consequent contamination of the environment with human faeces. While universal access to adequate sanitation is one of the sustainable development goals, parasite burdens are still causing harm. Fortunately, deworming medicines are highly effective and safe.

When women receive deworming medicine during pregnancy, we find two specific benefits for the baby: first, the risk of neonatal mortality (a baby’s death within the first 4 weeks of life) decreases by an estimated 14%; second, the odds of low birthweight are an estimated 11% lower in countries with the lower transmission of soil-transmitted helminths. These results vary somewhat by transmission rate across different countries.

Given the low cost of deworming medicine and fundamental health advantages, these findings call for an increased global effort toward the widescale distribution of deworming medicine for pregnant women. Global effort toward reducing STH infections is affordable, and the benefits far outweigh the program costs.

A recent study has found that mothers receiving deworming treatment during pregnancy reduce by 14% the risk of their child dying within the first four weeks after birth. Another benefit is that treating pregnant women with anthelminthic medicines can avoid low birth weight.

The study, conducted on 95 Demographic Health Survey datasets and collected on more than 800 000 births, utilised birth histories to measure the impact of routine deworming medicine during antenatal care on subsequent neonatal mortality and low birth weight for births between 1998 and 2018 in 56 lower-income countries.

“Pregnant women who received deworming medication were associated with a 14% reduction in risk for neonatal mortality, with no difference between high and low transmission countries,” said Bhavneet Walia of the Department of Public Health, Syracuse University, New York, USA.

“We also found that in countries with low transmission of soil-transmitted helminths, the deworming treatment decreased the odds of low birth weight by 11%, although these somewhat varied in relation to transmission rates across different countries,” Bhavneet added.

Routine deworming during antenatal care decreases the risk of neonatal mortality and low birth weight: a retrospective cohort of survey data (to hyperlink) authored by Syracuse University, the World Health Organization (WHO) and SUNY Upstate is published in the journal, PLoS Neglected Tropical Diseases.

The researchers matched births on the probability of receiving deworming during pregnancy. They then modelled birth outcomes with the matched group to estimate the effect of deworming during antenatal care after accounting for various risk factors. They also tested for effect modification of soil-transmitted helminth prevalence on the impact of deworming during antenatal care.

“Intestinal worms impact the health of women and girls of reproductive age and this study supports the fact that treating pregnant women can be beneficial,” said Dr Antonio Montresor, Medical Officer, WHO Department of Control of Neglected Tropical Diseases.

He said, “WHO has long recommended the deworming women of reproductive age after their first trimester of pregnancy and in areas where the prevalence of worm infections is 20% or higher.”

Soil-transmitted helminths2 is transmitted by ingesting microscopic eggs that are passed in the faeces of infected people and disperse in the environment. Adult worms live in the intestines where they produce thousands of eggs each day. In areas that lack adequate sanitation, these eggs contaminate the soil.

More than 1.5 billion people, or 24% of the world’s population, are infected with soil-transmitted helminths. Infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China and East Asia.

Approximately 688 million girls and adult women of reproductive age live in areas that are endemic for intestinal worms, in more than 100 countries. The greatest number is found in sub-Saharan Africa, the Americas and Asia where reinfection is frequent in areas of high transmission.

WHO coordinates shipment of donated medicines to countries requesting them. They are then distributed freely by national disease control programs during mass treatment campaigns.

Periodic deworming should be available to children and to all pregnant women in endemic countries.

Deworming is not the only answer, however. A permanent solution can only be obtained by a substantial improvement in access to sanitation – a process that is normally slow and expensive.

With ANI inputs

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CHANGES IN PROTEINS PLAY CRUCIAL ROLE IN AGEING KIDNEYS: STUDY

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Studying protein changes in the kidneys as we age, as well as the transcription of genes into proteins, helps provide a full picture of the age-related processes that take place in these organs, says a recent study published in eLife.

Ageing causes many changes in the body and in essential organs such as the kidneys, which function less efficiently later in life. Age-related changes in the kidneys have mostly been reported by looking at the transcription of genes the process by which a segment of DNA is copied into RNA.

 The current study suggests that this approach, combined with studying changes in proteins, gives us a better understanding of age-related changes in the kidney and may point to new approaches for treating age-related kidney dysfunction.

“Physiological changes in kidney function during ageing are well documented, but little is known about the underlying molecular processes that drive this loss of function,” explains first author Yuka Takemon, who was a research assistant at the Jackson Laboratory in Bar Harbor, Maine, US, when the study was carried out and is now a PhD student at the Michael Smith Genome Sciences Centre, University of British Columbia, Canada.

 “Many previous studies of these physiological changes have looked at the transcription of genes into proteins by measuring messenger RNA (mRNA), but we wanted to see if we could gather more insights by combining this approach with studying protein levels in the kidney.”

In their study, Takemon and colleagues looked at age-related changes in kidney function in about 600 genetically diverse mice. They also measured changes in mRNA and proteins in kidney samples from about one-third of the animals.

They discovered an age-related pattern of changes in both mRNA and proteins in the mice that suggests the animals have increasing numbers of immune cells and inflammation in their kidneys, as well as decreased function in their mitochondria, which produce energy for the cells.

However, not all of the changes in proteins corresponded with changes in the mRNA, suggesting that some of the protein changes occur after the transcription of genes into RNA.

 This could mean that older kidneys become less efficient at building new proteins, or that proteins are broken down more quickly in older kidneys. If further studies confirm this, it could mean that therapies or interventions that promote protein building or slow protein breakdown may be beneficial for treating kidney diseases associated with ageing.

“Our study suggests that mRNA measurements alone provide an incomplete picture of molecular changes caused by ageing in the kidney,” concludes senior author Ron Korstanje, Associate Professor at the Jackson Laboratory. “Studying changes in proteins is also essential to understanding these ageing-related processes, and for designing possible new approaches for treating age-related diseases.” 

With ANI inputs

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AIR POLLUTION LINKED TO HIGH BP, HEART DISEASES IN CHILDREN

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A meta-analysis of 14 air pollution studies from around the world found that exposure to high levels of air pollutants during childhood increases the likelihood of high blood pressure in children and adolescents, and their risk for high blood pressure as adults, a new study finds. The findings are published in a special issue on air pollution in the Journal of the American Heart Association, an open-access journal of the American Heart Association.

 Other studies look at: the effects of diesel exhaust on the muscle sympathetic nerve; the impact of pollutants on high blood pressure; rates of hospital readmission for heart failure among those exposed to high levels of ambient air pollution; and risk of stroke and heart attack after long-term exposure to high levels of particulate matter. The studies include health outcomes of people who were exposed to pollutants in the United States, China and Europe.

 High blood pressure during childhood and adolescence is a risk factor for hypertension and heart disease in adulthood. Studies on air pollution and blood pressure in adolescents and children, however, have produced inconsistent conclusions.

  This systematic review and meta-analysis pooled information from 14 studies focused on the association between air pollution and blood pressure in youth. The large analysis included data for more than 350,000 children and adolescents (mean ages 5.4 to 12.7 years of age).

  “Our analysis is the first to closely examine previous research to assess both the quality and magnitude of the associations between air pollution and blood pressure values among children and adolescents,” said lead study author Yao Lu, M.D., PhD, professor of the Clinical Research Center at the Third Xiangya Hospital at Central South University in Changsha, China, and professor in the department of life science and medicine at King’s College London.

  “The findings provide evidence of a positive association between short- and long-term exposure to certain environmental air pollutants and blood pressure in children and adolescents.”

 The meta-analysis concluded:

 1. Short-term exposure to PM10 was significantly associated with elevated systolic blood pressure in youth (the top number on a blood pressure reading).

  2. Periods of long-term exposure to PM2.5, PM10 and nitrogen dioxide were also associated with elevated systolic blood pressure levels.

3. Higher diastolic blood pressure levels (the bottom number on a blood pressure reading) were associated with long-term exposure to PM2.5 and PM10.

  “To reduce the impact of environmental pollution on blood pressure in children and adolescents, efforts should be made to reduce their exposure to environmental pollutants,” said Lu. “Additionally, it is also very important to routinely measure blood pressure in children and adolescents, which can help us identify individuals with elevated blood pressure early.”

  The results of the analysis are limited to the studies included, and they did not include data on possible interactions between different pollutants, therefore, the results are not generalisable to all populations. Additionally, the analysis included the most common and more widely studied pollutants vs. air pollutants confirmed to have a heart health impact, of which there are fewer studies. 

With ANI inputs

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