[Vol 31] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 31

1. Zinc acts as a gatekeeper of the immune system

Previously zinc deficiency was not very prevalent, but nowadays, it is considered to be very common in developing countries. It is considered the 5th leading cause because of which one loses healthy years of life. Roughly 30% of the elderly population is known to be zinc-deficient. As zinc homeostasis is important in immunological reactions, i.e., the inflammatory and the oxidative stress response, several chronic diseases detected in the elderly are possibly related to zinc deficiency. Also, diseases such as diabetes, rheumatoid arthritis, atherosclerosis, impaired cognitive function and age-related macular degeneration might be due to zinc deficiency, which can worsen chronic inflammation and trigger oxidative stress. Anti-inflammatory and antioxidant properties of zinc are documented, but their underlying mechanisms are still not completely clear. There is a connection between altered zinc homeostasis and disease development and thus, zinc supplementation for a malfunctioning immune system is beneficial. Zinc deficiency can cause severe impairment of immune function, involving the adaptive and the innate immune system. A balanced zinc homeostasis is important for shielding against invading pathogens or protecting the human body against an overactive immune system triggering autoimmune diseases, allergies or chronic inflammation. Zinc plays a role of a gatekeeper of immune function as the sufficient function of practically all immune cells is highly zinc-dependent.

2. Health Ministry: Candidates of the vaccine to enter phase 3 of human trials

On Tuesday, the Ministry of Health and Family Welfare said that one of the three COVID-19 vaccine candidates would enter the third phase of pre-clinical human trials. The ministry officials said that the vaccine candidate entering the third phase has capitulated positive results in the inceptive phases of its trial. Dr V.K. Paul, head of the national task force on COVID-19, added that the other two vaccines are currently in phase-I or II of their preclinical trials. However, they did not reveal the names of the vaccines while sharing the status of their testing phase. The vaccine entering the third phase is Bharat Biotech’s Covaxin, jointly developed with the Indian Council of Medical Research (ICMR). The developments on the vaccine came a day after the National Expert Group on Vaccine Administration met five domestic COVID vaccine manufacturers to review the clinical trial stages of these vaccine candidates. The manufacturers included two whose products are not yet in the clinical trial stage in India.

3. Experts in South Asia develop genetic risk score for heart disease

MedGenome Lab has ushered a first-ever study on Indian population that proves a novel ‘CAD-PRS’ (coronary artery disease-genome-wide polygenic risk score) to accurately predict the risk of developing a coronary artery disease/myocardial infarction (MI) using a person’s genetic makeup. Dr. Vedam Ramprasad, CEO, MedGenome Labs said “Looking at all the available scientific evidence and our study results we are convinced that there exists a good opportunity to combine both clinical and genetic risks (polygenic risk score based) and significantly improve the primary prevention of coronary artery disease (CAD).We firmly believe that incorporating validated genetic risk scores would help in better stratification of high-risk individuals if implemented at population level.” The unique study is based on the principle of Genome-wide Polygenic Risk Score (PRS) which uses a genome-wide analysis of an individual to quantify the risk of developing heart disease. This finding lays the scientific and operational foundation for clinical implementation not just for CAD but for other diseases. Such findings and methods developed can be used to screen large populations and high-risk individuals at a cost less than 5000 INR.

4. Kidney cancer risk increases in diabetics, but only in slim

According to a new analysis from the Iowa Women’s Health Study (IWHS), diabetes increases the risk of kidney cancer in postmenopausal women, but paradoxically, only in nonobese women, as defined by body mass index (BMI) and waist circumference. Shuo Wang, PhD, of the School of Public Health, University of Minnesota, Minneapolis, and colleagues said, “Many studies have linked a history of diabetes to the increased risk of kidney cancer [but] it is unclear whether diabetes is a risk factor for kidney cancer independent of other risk factors such as obesity and hypertension. An association between diabetes and kidney cancer was not statistically significant among the whole cohort…a positive, statistically significant association was observed among nonobese women (BMI < 30 kg/m2) or waist circumference < 34.6 inches (87.9 cm). These findings should be validated in larger or pooled prospective studies. Patients with new-onset diabetes may require more thorough surveillance for cancer including kidney cancer.” The cohort for the current analysis included 36,975 women, mean age of 61.7 years, 6.4% of whom reported a diabetes diagnosis at baseline. Between 1986 and 2011, investigators identified 257 cases of kidney cancer in their cohort. The researchers further commented that, “Several characteristics were statistically significantly associated with kidney cancer risk and time-dependent diabetes was associated with an increased risk of kidney cancer in models 1 and 2. In line with this finding, we found an association among nonobese women…even in the fully adjusted model, but observed no association between diabetes and kidney cancer among obese women which could be explained by lower levels of IGF-1 among obese women.”

5. Chest pain in CAD patients linked to stress-induced brain activity

As per the data collected from a cohort study, reaction of the brain due to stress may be a significant contributor to chest pain in patients with coronary artery disease (CAD). Kasra Moazzami, MD, MPH, of Emory University in Atlanta, and his coauthors in Circulation: Cardiovascular Imaging said, “Although more research is needed, these results may potentially shift the paradigm by which angina is evaluated by refocusing clinical evaluation and management of psychological stress as adjunct to traditional cardiac evaluations.” The researchers launched a study of 148 patients with stable CAD. Their mean age was 62, 69% were male, and roughly 36% were Black. Angina symptoms were assessed at baseline and also after 2 years through the Seattle Angina Questionnaire’s angina frequency subscale. As the patients underwent stress testing that included both speech and arithmetic stressors, they also received eight brain scans via high-resolution positron emission tomography (HR-PET) brain imaging. Two scans occurred during each of the two control and two stress conditions. Subsequent analysis of these images evaluated regional blood flow relative to total brain flow. Each patient also underwent myocardial perfusion imaging (MPI) at rest, under stress conditions, and during conventional stress testing. At 2-year-follow-up, 28 (24%) of the 112 returning patients reported an increase in angina episodes. Those patients had a higher mean inferior frontal lobe activation with mental stress at baseline. cardiologist Nieca Goldberg, MD, of NYU Langone in New York City in an interview said, “Previous studies have linked mental stress with ischemia using nuclear stress testing. This study is unique in that it looked at brain activity associated with mental stress and was able to correlate that activity with angina. It shows that the heart and brain are connected.”

6. Vitamin D may not help in late life depression and boosting mood

Data from a large arbitrary controlled trial does not support the use of vitamin D3 supplementation for adults for the sole purpose of preventing depression. Olivia Okereke, MD, Massachusetts General Hospital, Boston, told an online medical news that, “The study is among the largest of its kind ever, and it was able to address whether vitamin D3 supplementation is useful for what we call ‘universal prevention’ of depression. These results tell us that there is no benefit to using vitamin D3 supplements for the sole purpose of preventing depression in the general population of middle-aged and older adults because of the high dose and long duration of treatment and the randomized placebo-controlled design, we can have high confidence in results.” The findings are based on 18,353 older adults (mean age, 67.5 years; 49% women) in the VITAL-DEP study; 16,657 were at risk for incident depression (ie, had no history of depression), and 1696 were at risk for recurrent depression (ie, had a history of depression but had not undergone treatment for depression within the past 2 years). The researchers reports that, “Cumulative incidence curves showed lack of separation between treatment groups over the entire follow-up.” Dr Olivia Okereke further added, “We cannot yet exclude the possibility of benefit of vitamin D3 for preventing depression among subgroups with certain health risk factors. We also know that vitamin D is essential for bone health, and this study does not tell us whether vitamin D3 is useful for prevention of other health outcomes.”

7. Study: 60% of children survived from Ewing’s sarcoma at BBCI

60% of children who were treated for Ewing’s sarcoma, which is one of the most common bone cancers during the stipulated five years, have survived, a study conducted at the Dr B Borooah Cancer Institute (BBCI), Guwahati, has found. The study done with patients attending paediatric cancer OPD of BBCI from 2013-2017 have shown that there was no significant difference in survival between patients with below and above poverty lines. In the study done at BBCI, Guwahati, it was observed that those patients who completed their treatment protocol had a better survival rate (68%) as compared to those who defaulted or refused treatment (14%). Dr Munlima Hazarika, professor of medical and paediatric oncology at BBCI, said, “These types of bone cancers are potentially curable, provided patients complete their planned treatment protocol. Ewing’s sarcoma most often affects bones in the legs, arms, or hip, and it usually causes pain, trouble with movement of the joints and swelling in the area of the cancer. So, awareness among general practitioners about this entity is needed for early diagnosis and referral for treatment. 87% of patients we treated with an intention to cure. Others came in a very advanced stage and could not be saved, although paediatric Ewing’s sarcoma is a curable malignancy. Depending on the type of surgery, the doctor might need to ‘rebuild’ part of the bone after surgery. Chemotherapy is used to kill these cancer cells or stop them from growing. People with Ewing’s sarcoma usually have chemotherapy both before and after surgery. Some people with Ewing’s sarcoma might be treated with radiation therapy instead of surgery.”

Reference Links:

  1. https://www.emedinexus.com/post/19754/
  2. https://health.economictimes.indiatimes.com/news/industry/vaccine-candidate-to-enter-phase-3-human-trial-health-ministry/77616065
  3. https://health.economictimes.indiatimes.com/news/diagnostics/experts-develop-a-breakthrough-genetic-risk-score-for-heart-disease-in-south-asia/77504684
  4. https://www.medscape.com/viewarticle/935648
  5. https://www.medscape.com/viewarticle/935761
  6. https://www.medscape.com/viewarticle/935327
  7. https://health.economictimes.indiatimes.com/news/industry/60-children-suffering-from-ewings-sarcoma-survived-at-bbci-study/77611987

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