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What we know about ‘Kraken’ Covid Variant XBB.1.5; why it’s causing concern

Post author By Pragya sharma
Post date January 13, 2023
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A new Covid variant that was first detected last year has quickly become the dominant strain in the US — and picked up a creepy moniker along the way.

A new Covid variant that was first detected last year has quickly become the dominant strain in the US — and picked up a creepy moniker along the way. Nicknamed the ‘kraken variant’ by some, it surged through the nation and has now been identified in at least 37 other countries, according to the World Health Organization. Is it more dangerous? Does it spread more easily? And how will it affect China’s Covid outbreak?

Here are all your questions, answered:

What is the new variant?

XBB.1.5 is a descendant of the omicron XBB subvariant — which is itself a cross between two earlier strains: BA.2.75 and BA.2.10.1.

The original XBB variant has already caused waves of infection in countries including Singapore and India since the WHO first raised concern about it last October.

How fast is XBB.1.5 spreading?

While accounting for just 2% of all Covid cases at the start of December, the latest estimates from the US Centers for Disease Control and Prevention show that it surged to become the second-most dominant strain in the first week of January, responsible for about 28% of all national infections. In the northeast, that figure has jumped above 70%.

XBB.1.5 is “the most transmissible sub-variant which has been detected yet,” said the WHO’s Covid-19 technical lead, Maria Van Kerkhove, during a press conference on Jan. 4. Health authorities are warning it could be much more widespread than current data show, thanks to its undetected proliferation tied to a drop-off in testing.The US has accounted for the bulk of sequenced variant cases — around eight in 10 — reported across the world since October 2022, followed by the UK. The proportion of infections caused by XBB.1.5 is lower in other countries, although the picture may rapidly change. Estimates from the Wellcome Sanger Institute found that the variant made up around 4% of Covid infections in England as of mid-December, while Canada has found a handful of such cases.

In Europe, XBB.1.5 may drive an increase in the number of cases, though it’s unlikely to happen in January since it’s present in such low levels currently, according to a Jan. 9 statement from the European Centre for Disease Prevention and Control.

Scientists pointed out that the sub-variant has a much stronger affinity to ACE2, a key receptor for the virus, which allows it to bind more easily and boosts its transmissibility.

Is it more dangerous than previous variants?

There haven’t been significant differences in the severity of symptoms reported between cases caused by XBB.1.5 and previous variants. Like other strains that concerned scientists, however, it’s attracting attention because it is exhibiting signs of immunity escape. That means it has an ability to evade natural immunity or previous protection provided by vaccines, and re-infect people who have recovered from an earlier bout of Covid.

Still, data remains limited on XBB.1.5’s propensity to cause severe disease or death. The WHO has said the variant doesn’t carry mutations linked to changes in severity, although it notes that there is a lack of research findings to make that claim conclusively.

Previous therapies to tackle Covid — like monoclonal antibody treatments — were rendered ineffective by previous strains. That trend has continued with the new variant. Scientists in a recent peer-reviewed article published in the journal Cell warned that subvariants like XBB pose “serious threats” to current Covid vaccines, while the WHO has called XBB variants some of the “most antibody-resistant variants to date.” Higher transmissibility also means more people are likely to get infected, and thereby suffer severe outcomes.

It’s unclear if the US experience with XBB.1.5 will extend to other countries. America, unlike many other developed nations, suffers from low vaccination rates. Only 15% of the population aged five and above has received an updated bivalent booster dose. The rate is slightly better among the vulnerable elderly population, including those aged 65 and above, with fewer than four in 10 receiving the shot. Hospitalization rates for Covid are already rising, amid a surge in other winter-season infections like influenza.

Has it reached China yet and what will be its impact?

China, which is going through a major wave of infections after dismantling its stringent Covid Zero policy in December, has yet to report any domestic cases of XBB.1.5. Shanghai has detected a handful of infections caused by the variant and said all were imported cases. But health agencies across the world, including the WHO, have raised concerns that China isn’t providing enough genomic sequencing information to come to a definitive conclusion.

In the meantime, the country’s Covid wave is being driven by two other omicron strains: BA.5.2 and BF.7. Together they account for 97.5% of all local infections, according to genomic sequencing data from the Chinese Center for Disease Control and Prevention.

Authorities have tried to allay fears that XBB variants will drive new waves of infection in China, where experts are arguing that the recent mass outbreak will provide short-term protection. Still, many people — already spooked by the strained healthcare system and limited availability of treatments — aren’t convinced. A widely circulated viral post claiming the XBB variant may lead to vomiting and diarrhea led to an anti-diarrheal medication selling out across China as panicked buyers snapped it up.

Where did the ‘Kraken’ name come from?

Covid variants are currently named by an expert group convened by the WHO. It identifies so-called variants of concern that have potential global public health significance, such as reducing the effectiveness of current pandemic measures, using the Greek alphabet. Previous strains like alpha, beta and delta fell under the convention.

But the last Greek-named variant, omicron, emerged more than a year ago and left no room for the emergence of other, significantly different strains. Omicron has spawned multiple lineages, including XBB.1.5, and their names stem from a mix of alphabets and numbers known as “Pango.”

That has led to the rise in popularity of informal online nicknames, including “Kraken.” The moniker for XBB.1.5 was proposed by an evolutionary professor on Twitter to match the strength of the new strain with the mythological sea monster.

Long Covid symptoms fading for mild coronavirus infections, says new study

Post author By Pragya sharma
Post date January 12, 2023
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Long covid is defined as symptoms persisting or new symptoms appearing more than four weeks after initial infection. A new study reveals that most Long Covid symptoms that developed after a mild coronavirus infection lingered for several months but returned to normal within a year.

The effects of long Covid tend to resolve within a year of mild infection, with vaccinated people at lower risk of breathing difficulties compared with unvaccinated people, according to a study.

Researchers examined the health records of almost 2 million people in Israel who tested for Covid-19 over a 19-month period. Over 70 long Covid conditions were analyzed within a group of infected and matched uninfected members. They also compared conditions in vaccinated versus unvaccinated people.

Their study published in the BMJ medical journal found most symptoms that developed after a mild infection lingered for several months, but returned to normal within a year.

“The long Covid phenomenon has been feared and discussed since the beginning of the pandemic,” the researchers wrote. “This nationwide dataset of patients with mild Covid-19 suggests that mild disease does not lead to serious or chronic long term morbidity.”

Previous studies have indicated that vaccination tends to lead to milder cases of Covid infection and long Covid.

Long covid is defined as symptoms persisting or new symptoms appearing more than four weeks after initial infection. An estimated 1.5 million people in the UK, or 2.4% of the population, were suffering from long Covid symptoms in March. These include fatigue, shortness of breath, loss of smell, loss of taste and difficulty concentrating.

Some of the limitations of the study include incomplete measurement within the medical records, meaning the data might not fully reflect diagnoses and outcomes reported, according to the researchers.

“The general message that symptoms improve over time is encouraging,” said Peter Openshaw, professor of experimental medicine at Imperial College London, who was not part of the research team. “The study adds to the evidence that outcomes are improved by vaccination, even if vaccines don’t prevent viral transmission very well.”

Diabetes: 5 best and worst fruits for managing blood sugar

Post author By Pragya sharma
Post date January 10, 2023
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Some fruits are good for people with diabetes, while others are not. However, every fruit has its own benefits and should be consumed on a regular basis. Experts on best and worst fruits for managing your blood sugar levels.

People who are diagnosed with diabetes often hesitate in adding fruits to their daily diet fearing they could raise their blood sugar levels being sweet in taste. However, their fear is only partly true. Fruits are a storehouse of fibre, vitamins, antioxidants and all the essential nutrients that are important in maintaining gut health, immunity and overall health. But at the same time, they also have a type of sugar called fructose that is naturally present in fruits. In fact, studies claim that consumption of fruits regularly can cut risk of diabetes. This doesn’t mean though that people with diabetes can fill their plate with all sorts of fruits and consume them multiple times a day without fear of sugar spikes. There are certain fruits that are high in GI (glycaemic index) while some are low GI which means they are broken down slowly and raise blood sugar only gradually over a period of time. Once you know which fruits are more suitable for your blood sugar levels, you can consume them in the quantities recommended by your diabetologist. Even fruits with high GI can be consumed but in smaller quantities.

“Some fruits are good for people with diabetes, while others are not. However, every fruit has its own benefits and should be consumed on a regular basis, weekly, or seasonal basis. Like many other foods, fruit can make your blood sugar go up. Your HbA1c, or average blood sugar level, can also go up if you experience frequent spikes in your blood sugar. Despite the well-established health benefits of eating fresh fruits, the sugar content of fruits has raised questions about its effect on glucose levels and their suitability for people with diabetes,” says Dr V. Mohan – Chairman and Chief Diabetologist- Dr Mohan’s Diabetes Specialities Centre.

THE RIGHT QUANTITY OF FRUITS FOR PEOPLE WITH DIABETES

“There is nothing like the best and worst fruits for diabetics. Diabetics can eat all the fruits, but for the fruits with a higher glycaemic index, the portion size of those fruits needs to be controlled. Where the difficulty occurs is when fruits with a higher glycaemic index are ingested in excess. Therefore, if you have diabetes, you should consume 150–200 g of fruit every day. But if your sugar levels are higher, this quantity drops to 100 to 150 grams a day. The quantities of higher-glycaemic fruits can be around 100 grams. So, portion control is key when it comes to fruits,” says Dr Charu Dua, Chief Clinical Nutritionist, Amrita Hospital, Faridabad, on fruits for diabetes.

Dr Dua, however, adds that it is important that diabetic patients do not combine fruits with the main meals like breakfast, lunch, and dinner, because usually our food is rich in carbohydrates and fruits are the source of carbohydrates.

“It’s a good idea to have a fruit between meals, and it’s crucial to pair fruits with protein. So, if you combine fruits with nuts in the mid-morning, the absorption rate of carbohydrates converted into glucose and absorption are going to slow down. The easiest and healthiest alternative is to combine fruits with a protein, almonds, or one teaspoon of seeds. It’s also a good idea to pop and top it with cucumbers and tomatoes. However, adding nuts, such as peanuts or occasionally paneer, will delay the body’s absorption of glucose and prevent a surge in blood sugar after eating fruit,” says Dr Dua.

It’s important to keep in mind that if you have diabetes, you should eat fruits, chew them properly, and stay away from fruit juices because they are quickly absorbed and can raise your blood glucose levels. Consuming the fruit will also give you fibres, which assist in managing and regulating your blood sugar levels. So, have fruits and nuts in mid-morning time.

BEST FRUITS FOR PEOPLE WITH DIABETES

As per Dr Mohan, the best five recommended fruits for people with diabetes are apple, guava, orange, papaya and melons. He also explains why these fruits are good for managing the metabolic disorder.

– Firstly, these fruits are naturally low in fat, calories and sodium. Additionally, the majority of them are loaded with nutrients that we frequently fail to get enough of. Folate, Vitamin C, potassium, and dietary fibre are few examples of such nutrients.

– Potassium, which helps maintain healthy blood pressure, is abundant in these fruits.

– Vitamin C, which is essential for tissue growth and repair, wound healing, and maintaining healthy teeth and gums, is abundant in guava and citrus fruits.

– We get folate—a group of naturally occurring B vitamins known as B9—from citrus fruits, apple, melons, papaya which aid in the production of red blood cells.

“Whole fruits, not juice, give us a feeling of fullness with fewer calories. They also contain dietary fibre, which helps us digest food and maintain healthy bowel movements and lowers blood cholesterol and the risk of heart disease. So, please take whole fruit instead on fruit juices,” says Dr Mohan.

WORST FRUITS FOR PEOPLE WITH DIABETES

Five fruits that are to be eaten less frequently or in smaller quantities are mango, jack fruits, banana, chickoo, grapes according to Dr Mohan. He also explains why.

“These fruits usually increase the blood glucose level and to avoid spikes in blood sugar, people with diabetes must closely monitor their sugar intake,” says Dr Mohan, adding that it depends on how much fruit one eats.

“It is fine, if you take one or two slices or small quantities of these restricted fruits as sugar levels can rise if they are consumed in large quantities. We see several patients with uncontrolled diabetes after taking large quantities of these fruits every season. Hence, you can limit your consumption of these fruits to one or two slices, so that you can still enjoy these fruits. If you want to lower your blood glucose levels, take these fruits in the intervals between meals. You can also limit your consumption of cereals like rice and chapatis in lunch and dinner,” says Dr Mohan.

Dr Mohan says every person with diabetes has a different response to fruits and it’s imperative to check the impact of fruits on blood sugar levels.

“Please do check your blood sugar levels to see if these fruits have an effect on your blood sugar levels. If you want to add fruits, use a continuous glucose monitor sensor, you can easily see which fruits affect your glucose levels and which do not,” says the expert.

“All people with diabetes do not respond in a similar manner with respect to fruits. The body is able to tolerate the intake of fruits if your glucose level (diabetes)is under good control. In those with poor control, blood glucose levels tend to increase further with fruits,” concludes Dr Mohan.

Child’s weight has little effect on mood, behavioural disorders: Study

Post author By Pragya sharma
Post date January 9, 2023
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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.

Early intervention effective in treating neurodevelopmental disorders: Study

Post author By Pragya sharma
Post date January 5, 2023
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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.

The study, published in The Journal of Neuroscience, looks at Fragile X Syndrome (FXS), a pervasive neurodevelopmental disorder and a common cause of intellectual disability, autism and anxiety disorders.

“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 Heart Disease: Causes, risk factors, symptoms, diagnosis, treatment of coronary heart disease

Post author By Pragya sharma
Post date January 4, 2023
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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.

Booster dose of Covid-19 increases resilience of antibody response: Study

Post author By Pragya sharma
Post date January 3, 2023
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The most recent study explains how Pfizer and Moderna mRNA boosters affect our Covid-19 antibodies’ ability to remain over time. The researchers found that all patients, including those who had recovered from a Covid-19 infection, developed more robust antibodies in response to a booster.

Recent research from the University of Virginia School of Medicine discussed the benefits of a Covid-19 booster vaccine dose. The most recent study clarifies how Pfizer and Moderna mRNA boosters influence the persistence of our Covid-19 antibodies. According to the researchers, a booster produced more durable antibodies in all individuals, including those who had recovered from a Covid-19 infection.

The researchers have published their latest findings in the scientific journal Annals of Allergy, Asthma & Immunology. “These results fit with other recent reports and indicate that booster shots enhance the durability of vaccine-elicited antibodies,” said senior researcher Jeffrey Wilson, MD, PhD, of UVA Health’s Division of Asthma, Allergy and Immunology.

Tracking Covid-19 antibodies: Wilson and his collaborators looked at antibody levels following a booster in 117 UVA employee volunteers and compared those results with the levels seen in 228 volunteers after their primary vaccination series. Antibody levels one week to 31 days after the primary series and booster were similar, but the boosted antibodies stuck around longer regardless of whether the person had had Covid-19.

“Our initial thought was that that booster would lead to higher antibody levels than the primary vaccine series, but that was not what we found,” said researcher Samuel Ailsworth, the first author of a new scientific paper outlining the findings. “Instead, we found that the booster led to longer-lasting antibodies.”

Antibody levels naturally decline over time after an infection or after vaccination, but higher levels are thought to be more protective. Thus, longer-lasting antibodies would be expected to provide more sustained immunity against severe Covid-19.

The researchers found that the antibodies generated by the Moderna booster proved longer lasting than those generated by the Pfizer booster. Moderna’s antibody levels exceeded Pfizer’s out to five months, the end of the study period. Although the findings were statistically significant, Wilson notes that both mRNA vaccine boosters provide enhanced and fairly similar levels of protection against Covid-19 in recently published large epidemiologic studies. Because the frequency of Covid-19 infections in the community was relatively high when the boosters were being given, the authors also studied the effect of COVID-19 infection on antibody levels. The findings suggest that the “enhanced antibody durability observed after booster vaccination was not explained by hybrid immunity,” the researchers report in their paper.

The new results are the latest from Wilson’s team tracking the antibody response to the Covid-19 vaccines over time. The researchers previously found that after the primary vaccination series the antibodies generated by Pfizer’s Covid-19 vaccine rose more slowly and declined more quickly than those generated by the Moderna vaccine. That study also found that older recipients of the Pfizer vaccine generated fewer antibodies than did younger recipients – but this wasn’t the case for Moderna, where age did not appear to be a factor.

In the latest results, younger booster recipients initially generated more antibodies than did older recipients, but this difference disappeared with time. Wilson notes that this study adds to the accumulating evidence that boosters are important in protecting the community from Covid-19. “Although only about half of the U.S. population that is eligible for a booster has received one, it is increasingly clear that boosters enhance the protection that is conferred by the primary series mRNA vaccines alone,” he said.

High blood cholesterol increases risk of Alzheimer’s and heart disease: Study

Post author By Pragya sharma
Post date January 2, 2023
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Researchers from the University of Colorado School of Medicine and the Linda Crnic Institute for Down Syndrome have discovered that the harmful effects of cholesterol on the brain and blood vessels may be caused by a single mechanism.

Researchers at the Linda Crnic Institute for Down Syndrome and the University of Colorado School of Medicine have found that a single mechanism may underlie the damaging effect of cholesterol on the brain and on blood vessels. High levels of blood cholesterol increase the risk of both Alzheimer’s disease and heart disease, but it has been unclear exactly how cholesterol damages the brain to promote Alzheimer’s disease and blood vessels to promote atherosclerosis.

Using insights gained from studying two much rarer disorders, Down Syndrome and Niemann Pick-C disease, researchers at the Linda Crnic Institute for Down Syndrome and the Department of Neurology of the University of Colorado School of Medicine found that cholesterol wreaks havoc on the orderly process of cell division, leading to defective daughter cells throughout the body.

In the new study published this week in the on-line journal PLOS ONE, Antoneta Granic, PhD, and Huntington Potter, PhD, show that cholesterol, particularly in the LDL form, called ‘bad cholesterol’, causes cells in both humans and mice to divide incorrectly and distribute their already-duplicated chromosomes unequally to the next generation. The result is an accumulation of defective daughter cells with the wrong number of chromosomes and therefore the wrong number of genes. Instead of the correct two copies of each chromosome, and thus two copies of each gene, some cells acquired three copies and some only one.

Granic and Potter’s study of the effects of cholesterol on cell division included a prominent finding of cells carrying three copies of the chromosome (#21 in humans and #16 in mice) that encodes the amyloid peptide that is the key component of the neurotoxic amyloid filaments that accumulate in the brains of Alzheimer patients.

Human trisomy 21 cells are significant because people with Down syndrome have trisomy 21 in all of their cells from the moment of conception, and they all develop the brain pathology and many develop the dementia of Alzheimer’s disease by age 50. Earlier studies by Granic, Potter and others have shown that as many as 10% of cells in an Alzheimer patient, including neurons in the brain, have three copies of chromosome 21 instead of the usual two. Thus, Alzheimer’s disease is, in some ways, a form of acquired Down syndrome. Furthermore, mutant genes that cause inherited Alzheimer’s disease cause the same defect in chromosome segregation as does cholesterol, thus indicating the presence of a common cell division problem in both familial and ‘sporadic’ (non-familial) Alzheimer’s disease.

The new research also found trisomy 21 neurons in the brains of children with what, until now, was thought to be an unrelated neurodegenerative disease (Niemann Pick type C), caused by a mutation affecting cholesterol physiology. This result suggests that neurodegeneration itself might be linked to chromosome missegregation. Such a model is supported by the finding of Thomas Arendt, MD, and colleagues at the University of Leipzig that 90% of the neuronal cell death observed at autopsy in Alzheimer patients is due to the creation and selective loss of neurons with the wrong number of chromosomes.

Identifying the specific problem caused by cholesterol will lead to completely new approaches to therapy for many human diseases, including Alzheimer’s disease, atherosclerosis and possibly cancer, all of which show signs of defective cell division. Granic and Potter already have found a potentially simple approach to preventing cholesterol from causing cells to distribute their chromosomes unequally into their new daughter cells. Specifically, when cells in culture were first treated with ethanol, the subsequent exposure to bad cholesterol was without effect on cell division: Each daughter cell received the correct number of chromosomes.

Cancer vaccine hunt makes progress, finally

Post author By Pragya sharma
Post date December 31, 2022
No Comments on Cancer vaccine hunt makes progress, finally

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.

What is POTS; experts on symptoms of post Covid condition that causes heart palpitations

Post author By Pragya sharma
Post date December 30, 2022
No Comments on What is POTS; experts on symptoms of post Covid condition that causes heart palpitations

Many post Covid patients who mistakenly believe their rapid heartbeat is due to anxiety could be suffering from POTS. Know all the symptoms of the disorder.

Do you experience dizziness, fatigue or rapid heart beat while getting up from the bed or a chair after prolonged sitting? You could be suffering from Postural orthostatic tachycardia syndrome (POTS), a condition that causes the heart to beat faster than usual. Our autonomic nervous system or the part of the nervous system that controls muscles of internal organs such as heart, blood vessels, lungs, stomach, and intestines is usually tasked with maintaining a healthy balance between heart rate and blood pressure to keep the blood flowing at a regular pace. In POTS, however, this function gets disrupted. Many post Covid patients who may mistakenly believe their rapid heartbeat is due to anxiety could be suffering from POTS.

WHAT IS POTS

“When you move from laying down or sitting to standing up, POTS, a disorder that causes your heart to beat more quickly than usual, can occur,” says Dr. Rajiv Dang, Senior Director and HOD – Internal Medicine and Medical Director, Max Hospital Gurugram.

SYMPTOMS OF POTS

– Dizziness or lightheadedness after prolonged standing or sitting

– Fainting

– heart palpitations

– fatigue or exhaustion

– Feeling anxious

– Excessive sweating

– Headache

– Shortness of breath

POTS symptoms can worsen on hot days, doing strenuous activities or during menstruation.

HOW POTS IS A LONG COVID MANIFESTATIOn

“We have what is basically one of the manifestations of long Covid syndrome, Postural Orthostatic Tachycardia Syndrome. People visit the doctor with mild palpitations and a lot of patients feel that it is anxiety but it may not be anxiety. It may be a symptom of the long Covid called POTS, the palpitations and so on, but it may remain for two months, six months or maybe more but it settles over a period of time. You may treat each patient differently according to their symptoms,” says Dr Vasant Nagvekar, co-director of infectious disease at Sir HN Reliance Foundation Hospital.

No matter what posture your body is in, your autonomic nervous system normally maintains a healthy balance between your heart rate and blood pressure to keep your blood flowing at a regular pace.

“If you have POTS, your body is unable to balance the reaction of your heart rate and blood vessel constriction (squeezing). This signifies that your body is unable to maintain a constant and stable blood pressure level,” says Dr Dang.

“There is no hard evidence of the connection between Covid and POTS but we have witnessed that post Covid patients come with this issue and it could be an effect of long Covid,” says Dr Nagvekar.