[Vol 22] Medi-Scene: Your Weekly Health News Update

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MediScene Magazine Vol 22 1. Coronavirus Update: Cases rise to 3.5L with highest single-day deaths at 2k

On Tuesday there was a huge jump in the COVID-19 mortality rate and added 2,003 fatalities. These were earlier deaths that went unreported so far. Maharashtra and Delhi were the highest contributors to the numbers. This sudden spike means that India’s Covid-19 death toll had risen by 20% in a single day to 11,914. This further led to a fatality rate increasing to 3.4% from 2.9% in one day. Total number of cases in Mumbai was 3,167 on Tuesday from 2,250 on Monday, including 55 deaths in the last 24 hours. On similar lines, Delhi’s coronavirus cases surged from 437 to 1,837 on Tuesday, with the state health department reporting as many as 344 back-dated deaths. The health department said in the health bulletin that, “This cumulative figure includes all pending deaths reported to and audited by the death audit committee.” 

2. Hydroxychloroquine treatment to continue in patients with mild COVID-19 symptoms

Hydroxychloroquine has been proven to help prevent Covid-19 and was administered to healthcare and frontline workers. Recently, a lot of debate around its safety had erupted and was advised to be removed as a preventive measure.  Indian health authorities have said that Hydroxychloroquine (HCQ) will not be withdrawn as a treatment procedure for Covid-19 patients. A senior official in the drug controller’s office in an interview said, “We have just changed the clinical management guidelines last week. We are not considering any changes just because the US FDA has withdrawn the emergency use for HCQ.” The health ministry, experts from the Indian Council of Medical research and the Drug Controller General of India inspected the clinical management protocol for Covid-19 on June 13 and limited HCQ’s use to management of patients who have mild symptoms. Another drug controller officer added, “The review was felt necessary because of growing evidence on the drug. I don’t think there is any alarming evidence that has come forward that we need to follow suit.”

3. Acupuncture’s benefits for migraine is now supported by more evidence

Migraine affects almost 20% of the world’s population. Results from an arbitrary single-blind study showed participants receiving acupuncture underwent lesser migraine attacks compared to those who received sham or usual care. Patients who received manual acupuncture also had better quality of life and sleep quality scores. Study investigator Wei Wang, MD, PhD, professor, Department of Neurology, Tongji Hospital and Medical College, Huazhong University of Science and Technology told a medical journal in an interview that, “When discussing prophylactic treatment strategies for migraine, clinicians should present acupuncture as an option. This is especially important for patients who don’t respond well to drug treatment, can’t tolerate the adverse effects of drugs, or have contraindications.” The findings of this study were published in BMJ. The present-dat study compromised 147 patients out of which they were mostly female patients who were appointed from seven centers in China from June 2016 to November 2018. Dr Wang further added that, “It was important that the participants be ‘acupuncture naïve’ to help ensure successful masking of the sham group.” At baseline, the average of migraine days per month was recorded at 5.97 and the average number of migraine attacks per month was reported at 3.93. Patients were randomly assigned to receive manual acupuncture, sham acupuncture, or UC. Dr Wang further commented that, “Proper and effective manipulation of needles during manual acupuncture is important to induce “de-qi” feelings, a combination of bodily sensations induced by the needling. The intensity of these feelings plays a key role in the analgesic effects of manual acupuncture. Another important element of manual acupuncture is selection of appropriate acupoints. Previous acupuncture studies have used penetrating-sham acupuncture as a control. This typically involves needling at non-acupuncture points, needling irrelevant acupuncture points, or superficial needling. This approach could still produce a physiological effect in part due to the activation of the pain-inhibiting system in the spinal cord and diffuse noxious inhibitory controls.” 

4. Swine flu and COVID-19 can co-infect, making detection more difficult

With the monsoons coming in, there are high chances of human influenza A (swine flu) and covid-19 co-infecting according to the doctors. As influenza A is now endemic to some states and Covid-19 likely to become part of the viruses circulating in these parts, doctors notice that both viruses can stay in the same patient, which requires two tests to diagnose cases of coinfection. A Chinese doctor in their research publication said, “The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for coronavirus, which could further complicate recognition of the full extent of disease.” So far, India has not yet reported any coinfection of Covid-19 and swine flu, but many doctors navigate such a scenario is possible as there have been many cases of co-infection regarding diseases like chikungunya and dengue. Dr Suneetha Narreddy, consultant, infectious diseases, Apollo Hospitals said, “Coinfection with influenza A may be seen in a significant number of patients. If coinfection exists, then treatment of influenza A can improve Covid-19 outcomes.” Dr J Anish Anand, expert in internal medicine, makes a careful observation on the coinfection and commented, “Since there are no major case reports throughout the world of Covid-19 and influenza A coinfection, there is no need to panic.Superinfection of one bug over the other in any patient with low immunity can occur.” 

5. Type 2 Diabetes Linked to Increased Risk of Colorectal Cancer

A long study conducted on 12 million individuals born after 1931 and their parents, including 559,375 diabetic patients and 162,226 Colorectal Cancer patients incurs that those with type 2 diabetics who are below the age of 50 are at an increased risk of colorectal cancer. Dr. Mahdi Fallah of the German Cancer Research Center (DKFZ) in Heidelberg told an important news platform via email that, “Risk-adapted colorectal cancer screening can be offered to diabetic patients earlier than the general population, or at least as soon as they become eligible for colorectal cancer mass screening. So far, we know that diabetic patients should be screened earlier, but we do not know exactly how many years earlier.” Study co-leader Dr. Elham Kharazmi, also of DKFZ via email commented on the same saying, “Researchers with valid information on diabetic patients (especially by diabetes type), family history of colorectal cancer, and colorectal cancer outcome are encouraged to investigate the mechanism behind the association we found. This may eventually lead to prevention of early-onset colorectal cancer, which is globally on the rise among young adults.” Dr. Trilokesh Kidambi, director of the Colon Cancer Screening Program at City of Hope in Duarte, California, gave his inputs via an email to Reuters Health, “There is little doubt that these results are valid, as many of the patients I see with early-onset colon cancer or large, precancerous polyps do have a history of diabetes and other features of the metabolic syndrome. The primary limitation of this study is that it was unable to delineate the direct effect of diabetes on colon cancer risk and to separate this from other components of the metabolic syndrome such as obesity and high cholesterol, which are associated with and can contribute to risk of diabetes development. In other words, diabetes may represent the end product of several metabolic factors that increase a patient’s risk of developing colon cancer, as well as other well-known medical problems. Additionally, it is not clear if duration (i.e., the number of years the patient’s body has been exposed to higher blood sugar levels and changes in insulin levels) or severity (how well controlled the blood sugar has been) of diabetes influences the risk of colon cancer, which is critical to apply this type of data to the patients we see in practice. I would use this data as yet another reason to motivate my diabetic patients to try and control their disease through diet, exercise and medications, and if a diabetic patient came to my office concerning gastrointestinal symptoms, I would have a lower threshold to perform a colonoscopy.”

6. Changing your diet could help cut mood swings and bi-polar symptoms

In a recent single-center study, a nutritional mediation focused on fatty acids, when given to patients with bi-polar disorder showed significant progress. Bi-polr disorder patients who obtained a diet involving high omega-3 and low omega-6 fatty acids (H3-L6), in addition to usual care, manifested note-worthy depletion in mood swings, irritability and pain in comparison with their equivalents who received a diet with normal levels of omega-3 and omega-6 fatty acids. The age range amongst the patients varied from 20 years of age to 75, whereas 83% were women. For this research 41 patients received a high omega-3 fatty acid diet, while 41 others received a normal diet. Co-investigator of the study, Erika Saunders, MD, professor and chair of the Department of Psychiatry and Behavioral Health at Penn State College of Medicine, Hershey, in an interview with a medical journal told, “Our findings need replication and validation in other studies. While we got really exciting findings, it’s far from confirmatory or the last word on the subject. The fatty acids do two broad things. They incorporate into the membranes of neurons in the brain and they also create signaling molecules throughout the brain and the body that interact with the immune system and the inflammatory system. And we suspect that it is through those mechanisms that this composition of fatty acids is having an effect on mood stability, but lots more work needs to be done to figure that out. We were interested in looking at treatments that improved mood stability in bipolar disorder that are well-tolerated by patients and that can be added to pharmacological treatments. We studied this particular nutritional intervention because biologically it does some of the same things that effective medications for bipolar disorder do and it has been investigated as an effective treatment for conditions like migraine headaches, which has a lot of overlap and comorbidity with bipolar disorder.”

Reference Links

  1. https://health.economictimes.indiatimes.com/news/industry/2k-more-covid-deaths-cases-rise-to-3-5-lakh/76415991
  2. https://health.economictimes.indiatimes.com/news/diagnostics/india-not-to-stop-hydroxychloroquine-treatment-in-mild-cases/76416429
  3. https://www.medscape.com/viewarticle/927637?src=dpcs
  4. https://health.economictimes.indiatimes.com/news/diagnostics/covid-19-and-swine-flu-can-coinfect-make-diagnosis-difficult-docs/76396224
  5. https://www.medscape.com/viewarticle/932247
  6. https://www.medscape.com/viewarticle/931499

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