Foetuses and placentas of pregnant women, especially those infected with COVID-19 at earlier points in the pandemic, were found to bear a greater risk of experiencing growth impairment or vascular lesions in organs and brain, according to a new research.
Foetuses and placentas of pregnant women, especially those infected with COVID-19 at earlier points in the pandemic, were found to bear a greater risk of experiencing growth impairment or vascular lesions in organs and brain, according to a new research.
According to the research, results demonstrate that the different strains of the virus that emerged during the pandemic led to varying degrees of damage, which was especially higher by those involving pre-Omicron variants. The detected placental lesions could potentially harm both development and health in some of the affected unborn children, the study said.
Using prenatal magnetic resonance imaging, a group of Medical University of Vienna, Austria, researchers examined the placentas and foetuses of women who tested positive for SARS-CoV-2 during pregnancy, the study said.
The research was published in the journal The Lancet Regional Health – Europe. While such damage occurs more infrequently and is less severe with the currently circulating Omicron sub-lineages, the study authors still advocate early detection measures for pregnant women who test positive for coronavirus.
Contrary to previous studies, in which SARS-CoV-2-related abnormalities were only identified postnatally and/or through histopathological procedures, the research team focused on prenatal imaging findings, the study said.
Using prenatal magnetic resonance imaging (MRI), 76 scans of placentas and foetuses of pregnant women were performed in the study: 38 following a confirmed SARS-CoV-2 infection (pre-Omicron or Omicron variants) and 38 in healthy control cases, the study said.
The study found that the placentas in both the pre-Omicron and the Omicron groups revealed abnormalities.
“Infections with pre-Omicron variants, such as Delta, led to significantly greater damage in the form of vascular events such as blood clots or bleeding than with the Omicron subvariants currently circulating through the population,” noted lead author Patric Kienast, outlining a key finding of the study.
The researchers attribute the varying extent of damage to the placenta caused by different virus strains to the fact that Omicron sub-lineages are less likely than their predecessors to result in severe cases, and to higher vaccination rates as the pandemic has progressed, the study said.
“In any case, our results showed that the two non-vaccinated study participants developed placental abnormalities following infection with SARS-CoV-2 Omicron, compared with just one out of six of the women who had received three doses of the vaccine,” confirmed senior author Gregor Kasprian.
Oxygen, nutrients and metabolic products are exchanged between mother and child in the placenta. Attached to the uterine wall, this organ forms such a strong barrier against the coronavirus that only 3 per cent or fewer of foetuses whose mothers test positive for SARS-CoV-2 are also infected, the study said.
But as the study shows, the placenta itself is not spared from complications caused by Covid-19. Subsequently, some unborn babies experience stunted growth or bleeding in the brain, the study said.
“This is why the placentas of pregnant women who have been infected with SARS-CoV-2 should be examined as soon as possible after testing positive using prenatal imaging techniques,” advised Daniela Prayer from Medical University of Vienna, citing the importance of scanning, particularly in the case of possible future coronavirus variants with mechanisms similar to Delta, for example.
By doing so, there is a chance to take measures to safeguard the health of the foetus in a worst case scenario, the study said.
The Union Budget 2023-24 is being presented at a time when the global economy is going through geo-political conflicts, rising inflation, and global recessionary inclinations.
Despite the uncertainties, the year 2023 holds a positive outlook for India’s pharmaceutical industry. The market has experienced significant growth during the past two decades, and pharma revenues worldwide totalled $1.42 trillion in 2021.
With the pandemic accentuating the significance of health and wellness, the Indian pharmaceutical industry is expecting expansion in the budget outlay and fund allocations in the upcoming Union Budget (2023-2024).
While the healthcare sector acquired a 16% hike in the budget allocation last year due to the pandemic crisis, the increase in the share of healthcare and pharma spending in the upcoming budget is imperative.
According to a recent EY FICCI report, as there has been a growing consensus over providing new innovative therapies to patients, the Indian pharmaceutical market is estimated to touch $130 billion in value by the end of 2030.
Meanwhile, the global market size of pharmaceutical products is estimated to cross over the $1 trillion mark in 2023. Thus, it is essential to allocate separate funds for R&D, formulation and API.
Additionally, it needs to put a deeper focus on quality manufacturing, and adoption of innovation and technology in terms of formulation manufacturing, diagnostics, packaging, medical devices among others.
The upcoming budget is also likely to focus on preventive healthcare, given the significant rise in non-communicable and lifestyle diseases in the country. Government incentives and grants for cost-intensive research are also anticipated.
Moreover, offering incentives to domestic API manufacturers and bringing about a reduction in GST and import duty on APIs is the need of the hour.
Further, given the increased reliance on imports towards medical equipment, incremental allocation towards manufacturing of healthcare equipment will help India become self-reliant. The government should come up with strategic plans to offer financial incentives to encourage the production of high-end medical devices in India.
Furthermore, the government may take measures to improve the ease of doing business in the pharmaceutical sector by simplifying the process and making it industry-friendly. Whilst the pandemic isn’t over yet, and its side effects long to stay here, the Union Budget (2023-2024) needs to continue focussing on strengthening the infrastructure of the healthcare sector and shift direction towards promoting Make in India pharmaceuticals for making India truly ‘Atmanirbhar’. We must become self-sufficient and competitive in KSMs and APIs to boost the growth of this sector.
The year 2022 saw several collaborations between the industry and academia, with both playing a pivotal role in helping the sector further strengthen its position in the global market. The same is expected in the coming year, along with the government and the industry partnering together for the greater good.
We must work together to ensure that Indian pharmacopoeia is acknowledged and appreciated worldwide. The government should make a roadmap and move forward so that more countries accept Indian pharmacopoeia.
The Pharmaceutical Inspection Cooperation Scheme (PICS) is bringing a great revolution in the GMP standards to establish the high quality in the drug product and thus India should become the member of PIC/S to raise its GMP standards as it is recognised as the ‘power house’ of pharmaceutical manufacturing. And for that, both regulators as well the industry need to upgrade themselves. To get PICS membership, our regulators, both at the central as well as at the state levels, need to undergo intense training programmes and our research laboratories need to be upgraded.
Similarly, at the industry level, pharma companies need to set up their facilities that comply with international regulatory requirements like the WHO GMP, US FDA among others.
A PICS membership reduces duplication of inspections, facilitates the industry in export, and provides huge market access among other benefits. As the industry expands its footprint across the world, it will need to continuously invest in upgrading manufacturing standards to keep its promise of being a high-quality, reliable supplier of medicines to the world.
The government has a role to play in terms of expanding the PLI scheme so that more local manufacturers can access incentives and support needed to play in the API sector, as well as formulations to cater to regulated export markets. Also, considering the rising need for robust intellectual property (IP) law and rights, we will need to work towards harmonising our regulatory requirements to global standards.
Similarly, at the industry level, pharma companies need to set up their facilities that comply with international regulatory requirements like the WHO GMP, US FDA among others.
A PICS membership reduces duplication of inspections, facilitates the industry in export, and provides huge market access among other benefits. As the industry expands its footprint across the world, it will need to continuously invest in upgrading manufacturing standards to keep its promise of being a high-quality, reliable supplier of medicines to the world.
The government has a role to play in terms of expanding the PLI scheme so that more local manufacturers can access incentives and support needed to play in the API sector, as well as formulations to cater to regulated export markets. Also, considering the rising need for robust intellectual property (IP) law and rights, we will need to work towards harmonising our regulatory requirements to global standards.
Nutritionist Juhi Kapoor in her recent Instagram post talks about superfoods that can help with micronutrient deficiency and relieve symptoms of chronic or persistent health issues.
Small changes in your diet can make a big difference in your overall health. Mornings especially are perfect to give your day a perfect nutritional start. Many of us may face micronutrient deficiencies that could be the cause behind some serious health issues. For instance, a lack of iron, folate and vitamins B12 and A can lead to anaemia. Vitamin D deficiency can lead to low blood calcium levels, rickets, softening of bones in adults. Nuts such as almond, cashew nuts, walnut, and peanuts are a good source of B-vitamins, folate and vitamin E. These tiny superfoods if eaten regularly can thus play a major role in your well-being. Health experts say that nutrients are better absorbed by the body when you soak these nuts. Soaking them overnight helps remove the phytic acid in these nuts which causes indigestion. Soaking nuts also improves their digestibility and helps better their taste and texture.
Nutritionist Juhi Kapoor in her recent Instagram posts has talked about superfoods that can help with micronutrient deficiency and relieve symptoms of chronic or persistent health issues.
1. Soaked almonds for PCOS, acne relief
Kapoor says eating soaked almonds can help relieve PCOS, acne and achieve glowing skin. Soak 5-7 almonds overnight, peel them in the morning and consume daily.
2. Soaked raisins and kesar for period troubles
For period pain and irregular periods, 6-8 soaked raisins and 2 strands kesar can be soaked overnight. It can be consumed the next morning.
3. Soaked black raisins for hair fall
For hair fall and immunity related problems, soak black raisins overnight and consume next morning.
4. Soaked walnuts for memory and concentration
Two walnuts can be soaked overnight and consumed in the morning to boost brain power, memory, and concentration. It is great for kids to boost their academic performance.
5. Soaked moong for women and kid’s health
Soak 2 tbsp moong and consume in the morning for better hair, muscle health and good Skin. It is especially great for teenagers and women.
6. Soaked figs for constipation
Two soaked figs can do wonders for your gut health. Kapoor says it can help relieve constipation especially in pregnant women and senior citizens.
HOW TO SOAK
– Wash thoroughly
– Soak overnight in clean drinking water
– Discard water in morning
– Consume walnuts/figs directly.
– Green moong can be left to sprout (cover with sieve or cloth) for 6-8 hours. Steam and consume with salad.
Flu and Covid-19, both being respiratory illnesses, have a lot in common in terms of symptoms and way of transmission. Here’s how you can know the difference between their symptoms.
Flu and Covid-19, both being respiratory illnesses, have a lot in common in terms of symptoms like fever, cough, sore throat, difficulty breathing, and how they are transmitted – through cough, sneeze or touching an infected object. So, you may not initially know if you are suffering from flu or Covid-19. The best way to know for sure is to get tested without delay. The primary difference between the two is that the flu and Covid-19 are caused by difference viruses. Covid-19 is caused by the SARS-CoV-2, while influenza viruses are responsible for flu. Flu may cause severe symptoms in elderly while Covid-19 can lead to severe disease even in those who are not in vulnerable group. Covid can infect a greater number of people than flu and the symptom onset is slightly slower. Good thing is there is a vaccine for both the infections and one must get their shots to prevent these infections.
We spoke to experts on difference between flu and Covid-19 symptoms and here’s what they said.
“The flu and Covid-19 are both respiratory illnesses, but they are caused by different viruses. Symptoms of the flu and Covid-19 can be similar, such as fever, cough, and fatigue, but there are some key differences. The flu typically causes more severe symptoms in the elderly and people with underlying health conditions, whereas Covid-19 can cause severe illness in people of all ages,” says Dr Shalini Joshi, Senior Consultant-Internal Medicine, Fortis Hospital Bannerghatta Road, Bangalore.
Different viruses
“Covid-19 and flu (Influenza) are contagious illnesses of the respiratory tract. They differ from each other in several aspects. These are caused by two different viruses, i.e., SARS CoV-2 and influenza virus, respectively,” says Dr Rohit Kumar Garg, Consultant, Department of Infectious Diseases, Amrita Hospital, Faridabad.
Loss of taste or smell
Dr Joshi says Covid-19 can cause loss of taste or smell, which is not a symptom of the flu.
“Although symptoms such as fever, cough, sore throat, body aches, headache, fatigue, vomiting, diarrhoea etc. are usual and common to both, COVID patients may also experience loss of smell, loss of taste,” says Dr Garg.
Symptom onset
“The time period from viral exposure to symptoms onset is shorter for flu (1-4 days) and somewhat longer for Covid (2–14 days). The exposed person starts spreading the SARS CoV-2 virus 2–3 days before symptoms onset, whereas in the flu, patients start spreading 1 day before symptoms,” says Dr Garg.
Which is more contagious?
“Patients remain infective for a longer duration after Covid than flu. SARS CoV-2 virus is more contagious than flu virus, i.e., it can infect many patients at a time, whereas only 1-2 patients at a time in case of flu,” says Dr Garg.
Symptoms and complications in Covid-19
“A Covid patient may also experience the formation of clot in blood vessels and cytokine release syndrome, in addition to other complications such as pneumonia, respiratory failure, multi-organ dysfunction, or sepsis etc. A Covid patient may experience symptoms such as cough, fatigue, shortness of breath, a high pulse rate, poor appetite, etc. for a long time after recovery from an acute illness,” says Dr Garg, adding, “SARS CoV-2 virus can cause serious complications even in healthy individuals, unlike the flu, which cause serious complications usually in patients with comorbid conditions.”
“It’s crucial to take the appropriate precautions to protect yourself and others from both viruses, the best way to prevent both is to get vaccinated, and practice good hygiene, such as washing your hands frequently and avoiding close contact with sick people. Flu (Influenza) is caused by a virus and most people recover on their own but it can lead to serious problems in high-risk patients. Therefore, we recommend yearly Influenza vaccination for elderly people, people living with chronic health diseases like diabetes, liver and kidney issues or weak immune systems. Consultation with a doctor is advised because the symptoms are quite similar. It is important to conduct appropriate tests for diagnosis and early treatment should be started by the health care professionals,” says Dr Shalini Joshi.
“There are specific antiviral treatments and vaccines for SARS CoV-2 and influenza viruses. Despite these differences, the key preventive strategies, i.e., social distancing, use of face masks, cough etiquettes, hand cleanliness, and vaccination, remain the same for both due to similarity in mode of transmission and route of infection, as well as the availability of effective vaccines against both of them, says Dr Rohit Kumar Garg.
Children with obesity are more likely to be diagnosed with depression, anxiety, or attention-deficit hyperactivity disorder (ADHD). But the nature of the relationship between obesity and these mental health conditions is not clear. Obesity might contribute to mental health symptoms, or vice versa.
According to a new study, childhood BMI is unlikely to have a significant impact on children’s mood or behavioural disorders.
The results suggest that some previous studies, which have shown a strong link between childhood obesity and mental health, may not have fully accounted for family genetics and environmental factors.
Children with obesity are more likely to be diagnosed with depression, anxiety, or attention-deficit hyperactivity disorder (ADHD). But the nature of the relationship between obesity and these mental health conditions is not clear. Obesity might contribute to mental health symptoms, or vice versa. Alternatively, a child’s environment might contribute to both obesity and mood and behavioural disorders.
“We need to better understand the relationship between childhood obesity and mental health,” says lead author Amanda Hughes, Senior Research Associate in Epidemiology at Bristol Medical School, University of Bristol, UK. “This requires teasing apart the contributions of child and parent genetics and the environmental factors affecting the whole family.”
Hughes and colleagues examined genetic and mental health data from 41,000 eight-year-old children and their parents from the Norwegian Mother, Father, and Child Cohort Study and Medical Birth Registry of Norway. They assessed the relationship between children’s body mass index (BMI) — a ratio of weight and height — and symptoms of depression, anxiety and ADHD. To help separate the effects of the children’s genetics from the influence of other factors that affect the whole family, they also accounted for parental genetics and BMI.
The analysis found a minimal effect of a child’s own BMI on their anxiety symptoms. There was also conflicting evidence about whether a child’s BMI influenced their depressive or ADHD symptoms. This suggests that policies aiming to reduce childhood obesity are unlikely to have a big impact on the prevalence of these conditions. “At least for this age group, the impact of a child’s own BMI appears small. For older children and adolescents, it could be more important,” says Neil Davies, Professor at University College London, UK.
When they looked at the effect of the parents’ BMI on the children’s mental health, the team found little evidence that the parents’ BMI affected children’s ADHD or anxiety symptoms. The data suggested that having a mother with a higher BMI might be linked with depressive symptoms in children, but there was little evidence of any link between the child’s mental health and the father’s BMI.
“Overall, the influence of a parent’s BMI on a child’s mental health seems to be limited. As a result, interventions to reduce parents’ BMIs are unlikely to have widespread benefits to children’s mental health,” says Alexandra Havdahl, Research Professor at the Norwegian Institute of Public Health, Norway. Havdahl is a co-senior author of the study alongside Neil Davies and Laura Howe, Professor of Epidemiology and Medical Statistics at Bristol Medical School.
“Our results suggest that interventions designed to reduce child obesity are unlikely to make big improvements in child mental health. On the other hand, policies which target social and environmental factors linked to higher body weights, and which target poor child mental health directly, may be more beneficial,” Hughes concludes.
The results suggest that critical period plasticity in the amygdala is increased and may be shifted to earlier developmental time-points. This could cause a ‘maladaptive’ form of plasticity and yet one that can be treated with therapeutic intervention at key developmental time points.
A new study suggests that therapeutic interventions to treat neurodevelopmental disorders may be more effective if done during the early stages of brain development.
“In order to stop the progression of neurodevelopmental disorders, it is important to identify how and when brain circuits are changing during development. Our study identifies when circuits are altered in addition to how brain circuits are corrected,” said the study’s senior author Molly Huntsman, PhD, associate professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences located on the University of Colorado Anschutz Medical Campus.
“Currently, there are no approved or effective therapies targeting specific pathophysiology underlying the clinical manifestations of FXS,” Huntsman said, adding, “We’re hoping to provide answers for when and how to treat FXS to help with therapeutic options eventually.”
The CU Skaggs School of Pharmacy researchers identified potential causal circuit-level changes during a critical period of brain development susceptible to therapeutic intervention. They focused on the amygdala — the brain region where fear and anxiety are processed.
Using a mouse model of FXS, they identified a critical period of increased circuit plasticity occurring in early brain development. They showed that fear-learning emerges in the brain during these periods of increased plasticity. At the same time, they demonstrated that early intervention ameliorates it.
The results suggest that critical period plasticity in the amygdala is increased and may be shifted to earlier developmental time-points. This could cause a ‘maladaptive’ form of plasticity and yet one that can be treated with therapeutic intervention at key developmental time points.
Age at the time of treatment, the study said, is important because early pharmacological intervention was shown as effective in reducing fear-learning in the mouse model.
“This is highly significant and addresses a critical barrier for understanding how circuits develop in a mouse model of autism and intellectual disability and even more important, for therapeutic intervention-directed treatment options,” Huntsman said.
Ischemic cardiac diseases reduces the heart’s ability to pump blood which might lead to heart attacks, or irregular heart rhythm and heart failure as well. Here’s all you need to know about its causes, risk factors, different symptoms in men and women, diagnosis and treatment.
A partial or total blockage of the arteries pumping the heart muscle with blood results in ischemic heart disease, a health condition that is sometimes also referred to as coronary heart disease. If the coronary arteries were thought of as a network of tubes, then as they progressively become blocked, the blood that is flowing through them, in this situation, is prevented from properly reaching its destination, the heart.
The prevalence of ischemic heart disease is currently decreasing in developed countries due to improved treatments and healthier lifestyles; but the same is increasing in developing countries. In either case, ischemic heart disease remains the leading cause of death among adults in both developing and developed countries.
Causes:
A significant population in both developed and developing nations are affected by ischemic heart disease, which is a prevalent condition. In an interview with HT Lifestyle, Dr Yogendra Singh, Associate Director at Max Super Speciality Hospital’s Department of Cardiology in Dehradun, explained, “Ischemic heart diseases occur when blood flow to the heart decreases, which prevents the heart which is a muscle from receiving enough oxygen. Ischemic cardiac diseases reduces the heart’s ability to pump blood which might lead to heart attacks, or irregular heart rhythm and heart failure as well. The decrease in blood flow is a result of blockage in the heart’s arteries. Under this condition, the treatment usually is to improve the blood flow in arteries by simultaneously reducing the blockage.”
Dr MM Yusuf, Consultant Cardiac Surgeon at Apollo Hospital in Chennai’s Greams Road, elaborated, “Ischemic Heart Disease (IHD) denotes, narrowing or blockage in the blood vessels over the heart, (Coronary arteries). These vessels supply blood to the heart muscles and enable good function. There are 3 blood vessels, 2 on the left and 1 on the right side of the heart. Triple vessel or multivessel coronary artery disease indicates disease in all these 3 vessels. These narrowing or blockages are caused by fat deposits within the blood vessel, which reduces blood supply to the heart muscle. This can lead to angina (chest pain), breathing difficulty or heart attack which can lead to death.”
Risk factors and symptoms:
Dr Yugal Kishore Mishra, Head of Cardiac Sciences and Chief Cardiovascular Surgeon at Manipal Hospital in Delhi’s Dwarka, revealed, “The risk of this condition rises with age and is common in the elderly. In terms of men and women, men are more likely to have ischemic heart disease as compared to women. According to various studies, men and women who are 65 to 94 years old are twice as likely to have coronary heart disease than those who are 35 to 64 years old. The most common symptom of ischemic heart disease in men is myocardial infarction (heart attack), while the most common symptom in women is angina pectoris.”
Talking about the common risk factors for ischemic heart disease, Dr MM Yusuf blamed diabetes, high blood pressure, high cholesterol, smoking and family history of IHD.
Diagnosis:
According to Dr Yogendra Singh, it is advised to consult a doctor for advice if one experiences persistent or severe chest pain. He said, “An ischemic cardiac condition can be diagnosed with the help of an ECG, stress test, echocardiogram, coronary angiography, and cardiac CT scan, which will show which artery or arteries are afflicted. Your doctor might advise drugs, surgery, or a combination of the two depending on the seriousness of your disease. Consume a balanced diet low in saturated fat, cholesterol and sodium to help treat coronary artery disease and reduce your risk of problems. Additionally, you’ll receive advice on how to exercise safely given your condition. Don’t think of lifestyle adjustments as temporary remedies. Instead, resolve to create lasting healthy behaviours.”
Treatment for Ischemic Heart Disease
Dr Yugal Kishore Mishra shared, “Increasing blood flow to the heart muscle is part of the treatment for ischemia heart disease. Treatment options include prescription drugs, an angioplasty procedure to unblock clogged arteries, or bypass surgery. The treatment of ischemic heart disease, there are a number of treatments in each class. To control any ischemic episodes, using medication is sometimes the best course of action. In other circumstances, when dealing with a more serious issue or if medication is not enough, it is recommended to unblock the artery.”
He added, “Sometimes, there can be numerous lesions or blocked coronary arteries that make angioplasty a challenge so in such cases a heart bypass surgery can be the best option to open up the blocked arteries of the heart. A robotic assisted bypass surgery of heart is considered to be the best option for heart disease. Robotic heart surgery is performed through very small chest incisions. Surgeons can perform open-heart surgery without as much trauma as they can with minimally invasive procedures using robot-controlled tools and microscopic instruments. In order to prevent a recurrence of angina or an infarction, this can be supported by long-term treatment (heart attack). To lower the risk of heart disease, a mix of lifestyle modifications and medication therapy is prescribed.”
As per Dr Yogendra Singh, treatment options include:
Medications
Angioplasty
Bypass Surgery
Explaining the process, he said, “A long, thin tube (catheter) is placed into the blocked area of your artery during coronary angioplasty. The artery is widened by inserting a wire carrying a tiny balloon there and inflating it. To keep the artery open, a tiny coil of wire mesh called a stent is typically employed. Drug eluting stents are safe and effective. This procedure can be performed radially from the groin to the thigh or from the wrist. As a result of it being easier, more accurate and less painful than the femoral technique, radial angioplasty is gaining more popularity.”
He added, “Contrarily, a coronary artery bypass surgery involves the creation of a graft that allows blood to move around a blocked or constricting coronary artery using a vascular from another region of your body. This kind of open-heart surgery is typically only performed on patients with several narrowed coronary arteries.”
Dr MM Yusuf suggested, “Sensible eating, regular exercise and good lifestyle would prevent IHD. Ischemic Heart Disease is widely prevalent in India. Patients with risk factors should have regular health checks and follow preventive measures, while patients with IHD should seek medical help early and take appropriate treatment. The outcomes of treatment are extremely good with minimally invasive treatment procedures hence, patients need not be worried and keep away from getting appropriate treatment.”
He recommended, “Patients affected with IHD can be treated depending on the severity of the coronary artery stenosis (narrowing / blockage). Minimal stenosis can be managed with medications and lifestyle modifications. Significant stenosis in 1 or 2 vessels can be treated with angioplasty and stent insertion. Much more severe and multiple blockages especially in diabetics or patients with reduced heart function is best treated by Coronary Artery Bypass Graft (CABG) surgery. Use of Internal Mammary Artery in CABG has the best long-term outcome.”
Traditionally, CABG was performed by splitting open the chest bone and patients would take 3 to 6 months to recover depending on their age and other co-morbid conditions. Dr MM Yusuf revealed, “Over the past decade minimally invasive cardiac surgery with the use of surgical robot (Robotic assist CABG) has significantly reduced the trauma and recovery in treating patients requiring CABG surgery. Patients undergoing robotic assisted CABG stay in hospital for 2 to 4 days and recover to full normal activity within 2 to 3 weeks. Over the years, CABG had been performed with the use of cardiopulmonary bypass (CPB) and cardioplegic arrest. With the advent of self-retaining coronary stabilizers and intracoronary shunts, CABG is being performed in many centers without the use of CPB-Off Pump CABG (OPCABG).”
He added, “However, conventional CABG has its own limitations in terms of being invasive and associated with morbidity. Stroke, bleeding, wound infections, arrhythmias, prolonged ICU stay and hospital stay has been the known common complications of conventional CABG. Minimally Invasive Direct Coronary Artery Bypass Surgery (MIDCAB) is gaining increasing popularity in recent years owing to its technique and lesser incidence of complications associated with conventional CABG and OPCABG surgery.”
He explained, “Conventional CABG uses median sternotomy. In contrast, MIDCAB is performed using anterolateral thoracotomy in the 4th or 5th intercostal space using a 5-7 cm incision. Thorax is entered through this incision. LIMA is harvested either under direct vision or using Robotic assistance or thoracoscope camera. Bypass Grafting is then performed under direct vision with the aid of MICS instruments – MICS retractor system, MICS stabilizer (Octopus Nuvo) and Heart positioner (Starfish NS). Intracoronary shunts and mister blower are used to keep the field bloodless. The notable advantages of MIDCAB surgery are decrease in incidence of post operative complications such as stroke, decrease in ICU stay & hospital stay, lesser blood product transfusion, lesser wound infection, quick recovery and better cosmoses. The disadvantages being longer learning curve and limited working space.”
Talking about Minimally Invasive Hybrid Coronary Artery Revascularization (MIHCR), he said, “Minimally Invasive Hybrid Coronary artery Revascularization (MIHCR) combines the benefits of PCI and OPCABG surgery. This involves IMA grafting to one or two major coronary arteries, usually the left coronaries through a left mini thoracotomy, followed by the stenting of the non-LAD vessels. MIHCR provides the advantages of reduced incidence of MACCE in the immediate post operative period with best long term outcome. This less invasive procedure minimizes the incidence of known complications of off pump coronary artery bypass surgery and hastens the recovery. Another added advantage with MIHCR is that the patency of IMA can be assessed while undergoing PCI to non- bypassed vessel. This provides an opportunity for the graft to be revised in case of need while the patient is still in hospital.”
He concluded, “Due to these advantages it is emerging as the method of choice among the younger population as it enables faster return to routine activities and also among the older group as it is less invasive and reduces post-operative complications.
There is a growing interest in MIHCR, although conventional open techniques remain more popular, a study to assess the early outcomes of MIHCR in our population is opted here.
A small study shows promise in deploying mRNA technology against melanoma, but fighting tumors is vastly more complex than tackling Covid.
The long-awaited cancer vaccine revolution is getting a little closer to reality. New data from Moderna Inc. and Merck & Co. suggest that after decades of failures, researchers are finally figuring out the right way to design a vaccine that can teach immune cells how to recognize and combat tumors.
Earlier this month, the companies said that when used in concert with Merck’s cancer immunotherapy Keytruda, Moderna’s mRNA cancer vaccine reduced the risk of certain skin cancers from returning or patient deaths by 44% compared with Keytruda alone.
That number justly generated a lot of excitement. It’s the first time an mRNA-based cancer vaccine has proven itself in a randomized study, and with an unambiguously positive outcome. If that result holds up in larger trials, it would be a huge advance both for the mRNA technology behind Covid vaccines and for the field of cancer vaccines in general.
But there are a lot of steps between achieving early, positive data for a subset of melanoma patients and developing a widely accessible, cost-effective treatment. Among the more daunting challenges: The vaccine needs to be tailored to the genetic makeup of an individual patient’s tumors.
The study was small, enrolling just 157 people at high risk of their late-stage skin cancer returning. (Moderna and Merck have yet to make available the full dataset, though they plan to do so at an upcoming conference.) Still, even if the results are slightly less dramatic in a bigger study, the vaccine could make a difference for patients. “That would be a substantial change,” translating into long-term remissions, says Julie Bauman, director of the George Washington University Cancer Center. Bauman led an earlier study of Moderna’s cancer vaccine.
The study enrolled melanoma patients who had undergone surgery to remove any signs of their cancer. Unlike vaccines the public is used to taking — mass-produced shots that aim to prevent people from catching a contagious disease like the flu or polio, Moderna’s cancer vaccine instead is intended to keep the disease from returning. It does that by training immune cells to recognize as dangerous proteins found on a patient’s own tumor cells.
The hope was that the vaccine would amplify the already substantial benefit of Keytruda, which blocks a method that cancer cells use to hide from the immune system. Amazingly, the combination worked.
Moderna already demonstrated its capacity for developing and manufacturing mRNA vaccines. It had been working on vaccines for cancer and infectious diseases for more than a decade when the coronavirus pandemic hit, prompting the company to pivot to developing a Covid shot that, along with a similar one developed by Pfizer Inc. and BioNTech, became the first widespread commercial application of mRNA technology.
Building a successful cancer vaccine will be much more difficult. Moderna starts with a biopsy of a patient’s tumor, which it then sequences and uses artificial intelligence to pick out the mutations likely allowing the cancer to thrive. Then, mRNAs encoded for the most relevant cancer-driving proteins are packed inside a delivery system called a lipid nanoparticle, the same kind of delivery method used in Covid vaccines.
From tumor biopsy to first vaccine dose, the process can take between eight and 10 weeks, says Moderna Chief Medical Officer Paul Burton. Repeating this over and over for each patient enrolled in the clinical trial was a major undertaking, he adds.
Now imagine doing that for a commercial drug earmarked for thousands rather than for a few hundred people in a controlled study. There are nearly 100,000 cases of melanoma annually in the US, according to the American Cancer Society. While most cases are curable when detected early, more than 7,500 people die every year of the disease.
Bringing down the “needle-to-needle” time between biopsy and immunization will be critical to ensuring the treatment isn’t just promising, but practical and accessible to anyone who might benefit from it. One way to speed things up would be to establish regional hubs to quickly process biopsies.
Another measure that eventually could accelerate the development of the melanoma vaccine would be to simplify the vaccine’s components. Currently, the vaccine targets a laundry list of 34 mutated proteins to garner the full effect. It would be worth figuring out whether returns start to diminish after, say, 15 or 20 proteins.
Researchers also would like to understand whether certain types of tumors rely on common drivers that, if discovered, could be the foundation for a more broadly designed vaccine that could have some tailor-made components sprinkled in.
Burton says that Moderna so far hasn’t seen any common drivers that could help generalize components of the vaccine, but that data are limited — and the hope is that some clues might emerge as the vaccine is used over the long term and many more people are treated.
Scientists also still need to study the best way to use this vaccine for long-term suppression of cancer, considering, for example, whether people need to continue taking it every three weeks for life, or if they can get by with a periodic boost. And if someone’s disease progresses, does the vaccine itself need to be retooled to match new mutations that might have cropped up?
Perhaps the biggest question right now is whether the effect seen in melanoma can be extended to other types of cancer. Moderna Chief Executive Officer Stephane Bancel told CNBC recently that the company is moving aggressively into Phase 3 studies with the belief that “anywhere Keytruda works, this should work.”
Keytruda, meanwhile, is approved to treat a long list of cancers beyond melanoma—so many, in fact, that it’s expected to bring in more than $24 billion in sales in 2023. Bancel suggested that the vaccine might even make possible responses in tumors where Keytruda has failed, either on its own or by acting synergistically with Merck’s drug.
That’s an optimistic claim—worth studying, but a feat that has eluded other cancer immunotherapies. Melanoma is what’s known as a “hot” tumor, or one that features many mutations and has plenty of immune cells milling about, ready to be pushed into doing their cancer-killing job. It’s reasonable to be hopeful that Moderna’s vaccine could extend Keytruda’s benefits in other hot tumors, such as those found in lung cancer.
But “cold” tumors, or ones without that crowd of immune cells ready to be activated, are a much tougher proposition. In an earlier small study of the Moderna vaccine in solid tumors, for example, none of the patients with colon cancer — a notoriously “cold” tumor — responded, Bauman says.
Another immense challenge is the very high likely cost of a personalized therapy on top of Keytruda, which on its own carries a list price of around $185,000 per year. The only upside to that hefty price tag is that the companies will be motivated to answer these questions as quickly as possible. Indeed, Bancel has said that Moderna plans to aggressively invest in cancer.
All that money flowing into Moderna’s cancer vaccine will teach the field not just about that one product, but how to design, test and use other ones. Let’s hope that’s the catalyst for the true cancer vaccine revolution, one that could convert cancer from a potentially lethal illness into a chronic, stable disease.
The unique and first of its kind Covid vaccine does not require an injection and is administered as nasal drops. All you want to know about nasal vaccines.
Bharat Biotech’s nasal vaccine, iNCOVACC, will soon be available as booster shot for eligible adults come fourth week of January. Nasal vaccines, which are sprayed into the nose directly, however, cannot be taken by those who have already taken their booster shots and is recommended as first booster shot. People who fear the jab can take a sigh of relief as the administration of these vaccines is quick and painless. This nasal vaccine will be administered to people twice with the gap of 28 days. Known as heterologous booster, any 18 + individual can take it who has already received covaxin or covishield vaccine earlier.
What is nasal vaccine
“In direction towards our efforts to prevent spread of covid 19, India had come up with a yet another novel nasal covid vaccine. It is a unique, first of its kind, covid vaccine as it does not require an injection instead it is administered as nasal drops. It has been cleared by DCGI, for administration, as heterologous booster, in 18+ individuals who have already received covaxin or covishield vaccine earlier,” says Dr. Gurmeet Singh Chabbra, Director Pulmonology Marengo QRG Hospital, Faridabad.
How is nasal vaccine given
It is an adeno virus vector based recombinant replication deficient stabilized spike protein vaccine. Heterologous booster vaccination means administration of vaccine other than the primary vaccination.
“It is given as 0.5ml dose (8 drops – 4 drops in each nostril) to be repeated after 4 weeks interval,” says Dr Chabbra.
How does it work
“Nasal vaccine stimulates immunity by development of neutralizing IgG, mucosal IgA and T cell response. It acts at the site of entry of covid virus – the nasal mucosa by local IgA antibody response and possibly preventing both infection to the individual and spread to others. It would help prevent spread from even asymptomatic and mild cases,” says Dr Chabbra.
Side effects of nasal vaccines
“Mild side effects may include headache, fever, running nose and sneezing. It is not to be given to those who are allergic to any of its component or had a severe allergic reaction to it in past and having acute infection or fever,” adds Dr Chabbra.
Addressing the annual general meeting of the Developing Countries Vaccine Manufacturers Network (DCVMN) virtually on Thursday, he flagged the issue of inequities in access to COVID-19 vaccines.
World Health Organization (WHO) director-general Dr Tedros Adhanom Ghebreyesus has said that global roll-out of more than 12 billion COVID-19 vaccine doses is the largest and fastest in human history.
Addressing the annual general meeting of the Developing Countries Vaccine Manufacturers Network (DCVMN) virtually on Thursday, he flagged the issue of inequities in access to COVID-19 vaccines.
The three-day event is being co-hosted by the Pune-based Serum Institute of India (SII), the world’s largest vaccine manufacturer by volume, said a statement.
“Global roll-out of more than 12 billion COVID-19 vaccine doses is the largest and fastest in history with an estimated 60 per cent doses produced by manufacturers in developing countries. Despite this achievement, stark inequities in access to COVID-19 vaccines remain,” he said.
“These inequities are due partly to the fact that globally vaccine production is too concentrated. To address this, the WHO and our partners have established the mRNA Tech Transfer hub in South Africa to facilitate the know-how in low & middle-income countries,” Ghebreyesus said.
Adar Poonawalla, CEO of SII, said it was a proud moment for his company to co-host the 23rd DCVMN annual general meeting in Pune.
“Today, the world is more aware and focused on chalking out an ambition-to-action roadmap for future pandemic preparedness. For that, building the infrastructure and regulations to ensure global equity and timely access to vaccines is the foremost priority,” Poonawalla said.
Union Minister for Health and Family Welfare Mansukh Mandaviya delivered the inaugural address.
DCVMN is an international alliance of manufacturers from developing countries who are engaged in innovation, research, development, manufacturing and supply of high-quality vaccines to 170 countries.
The organisation aims to protect people against known and emerging infectious diseases globally by increasing the production of high-quality vaccines in developing countries.
