Is this the beginning of the end for COVID-19 ?

The superstitious might say “don’t jinx it by calling the end early”……..

So the answer is “may be”.

The good news from two Vaccine trials indicates that this might be “beginning of the end” for COVID-19.

Two recent press reports give rise to lot of optimism to the population that is getting weary with the lockdown. It is good to have a ray of hope among all the doom and gloom.

The covid-19 vaccine (mRNA-1273) from US biotech company Moderna was found to be 94.5% effective.

Another mRNA vaccine developed by Pfizer and BioNTech was reported to be 90% effective.

Now the caveats…. these are interim trial results and the trial results have not been subject to scrutiny by the wider scientific community as the full results are yet to be published.

Clinical Trials usually recruit motivated people without too many other medical problems. So one has to hope that these interim trial results can be replicated in the wider elderly population with lot of medical problems.

Update: Now a third Vaccine, the “Oxford Vaccine” has been found to be 90% effective when given as “a half and then full” schedule.

Update: summary so far at BMJ website.

Let’s hope that all the vaccines are very safe and highly effective when used in the real world population.

References: (1). Covid-19: Vaccine candidate may be more than 90% effective, interim results indicate. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4347 (Published 09 November 2020). Cite this as: BMJ 2020;371:m4347.

(2). Covid-19: Moderna vaccine is nearly 95% effective, trial involving high risk and elderly people shows. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4471 (Published 17 November 2020). Cite this as: BMJ 2020;371:m4471

(3). Covid-19: Oxford vaccine is up to 90% effective, interim analysis indicates
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4564 (Published 23 November 2020)
Cite this as: BMJ 2020;371:m4564

Covid-19: What do we know about the late stage vaccine candidates?. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4576 (Published 24 November 2020)
Cite this as: BMJ 2020;371:m4576

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Cancer treatment delays during the pandemic

The Staff at National Health Service in UK are doing an admirable job during the pandemic. In the particular, the frontline staff (“patient-facing”) are showing great courage in face of great difficulties and are primarily driven by altruism.

But the pressures of pandemic means many routine scans and hospital clinic appointments have been cancelled particularly during the first wave. There is a great worry about delayed diagnosis of cancer and delayed treatment of cancer.

A paper in BMJ reports that cancer patients survival can be significantly compromised.

But, as with everything else in life, things are not always what they look like at first impression. Even things that are logical and common sense at first glance do not turn out to be simple and clear.

Firstly, delays and cancellations of scans paradoxically could have psychologically benefited some cancer patients . This might seem counterintuitive or even an outrageous statement.

But there are some cancers which are being over diagnosed. A Cancer diagnosis does not always mean a death sentence. Some cancers do not cause problems for a long time or never in the life time of a person. These cancers do not need to be diagnosed promptly. Not being diagnosed with these cancers prevents the psychological burden of a cancer diagnosis. This “over diagnosis” would be expectedly less during pandemic.

Secondly, treatment delays could be caused by a cancer that is advanced and the need for time consuming additional investigations and procedures. Sometimes delays are caused by patients needing to see many medical specialists for the treatment. So it’s the aggressive cancer and the complex patient care that would cause the delay and is responsible for poor outcome rather than the delay by itself.

Read the BMJ article and make your views known.

Mortality due to cancer treatment delay: systematic review and meta-analysis
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4087 (Published 04 November 2020)
Cite this as: BMJ 2020;371:m4087

Overdiagnosis in Cancer
H. Gilbert Welch, William C. Black
JNCI: Journal of the National Cancer Institute, Volume 102, Issue 9, 5 May 2010, Pages 605–613, https://doi.org/10.1093/jnci/djq099

Disparities in head and neck cancer: assessing delay in treatment initiation
Urjeet A Patel et al. Laryngoscope. 2012 Aug.

Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, et al. (2019) . Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE 14(4): e0215108. doi:10.1371/journal.pone.0215108

Has politics corrupted science during the COVID-19 pandemic?

The Coronavirus pandemic has brought out the best in many people. Acts of selflessness became the norm rather than an exception. Altruistic acts abound at all levels of Society.

Overall, Society has made and is still making sacrifices for the benefit of the Vulnerable.

Appearances do matter during an pandemic. Leaders and People in Power are obliged to show that things are under control (or atleast give the impression that things are under control ) so as to prevent mass panic.

But politics seems to have gone beyond that and seems to have corrupted the science.

BMJ has courageously published a strongly worded editorial.

Read it and make your views known through the rapid response section of the Journal.

Covid-19: politicisation, “corruption,” and suppression of science.
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4425 (Published 13 November 2020)
Cite this as: BMJ 2020;371:m4425

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can Folic acid and Vitamin B12 Harm you ?

Yes , supplements can harm your health.

A study from Norway found that the combination can be harmful in certain people.

They report that “Treatment with folic acid plus vitamin B(12) was associated with increased cancer outcomes and deaths in patients with ischemic heart disease in Norway,”.

So avoid Vitamin supplementation if you have a well balanced healthy diet and no deficiency..

Reference

1. Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12. Marta Ebbing et al. JAMA. 2009.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Some good news amid the doom and gloom: People have Longer immunity to Coronavirus infection after recovering from it.

After someone has recovered from a Coronavirus infection, the body remembers how to fight the virus in future. This is called immunity and it is not known how long this immunity will last.

If the immunity is not long lasting, people can get coronavirus infection again during the second and even third wave.

The body’s immunity is made up of two types of cells: B cells and T cells. T cells and B cells are central to the human immune system.

B cells produce antibodies and previously in various studies , they were found to decline rapidly give rise to fear that people would get Coronavirus infection again and again.

Now a study has reported that T cell immunity can last more than 6 months in patients who have recovered from an infection.

This news is also good from a vaccine point of view. It gives us hope that sooner or later an effective vaccine would become available.

BMJ News.
Covid-19: T cell response lasts for at least six months after infection, study shows
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4257 (Published 02 November 2020)
Cite this as: BMJ 2020;371:m4257

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Are families of Healthcare workers at increased risk of hospital admission due to COVID-19 ?

Yes !

“Patient Facing” healthcare workers do admirably put them at harms way during this Coronavirus pandemic .

So health workers are at increased risk of getting admitted to hospital due to COVID-19.

But a recent Paper in BMJ says that families of healthcare workers are also at increased risk of hospital admission. In very few other lines of work, does the occupational hazard affect the families of workers as well.

The authors report “ …. patient facing healthcare workers and members of their households were, respectively, threefold and twofold more likely to be admitted to hospital. Healthcare workers and their households accounted for one in six of all admissions with covid-19 in the working age population (18-65 years).”

The paper says “Among admitted healthcare workers, one in eight were admitted into critical care and six (2.5%) died; in admitted household members, one in five were admitted to critical care and 18 (12.9%) died.”

Routine testing of healthcare workers and early testing of families as well as better access to effective PPE is urgently needed.

References : 1. Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3582 (Published 28 October 2020)Cite this as: BMJ 2020;371:m3582

2. Covid-19: risks to healthcare workers and their families. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3944 (Published 28 October 2020)Cite this as: BMJ 2020;371:m3944

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Scientific evidence for a healthy diet and prevention of diabetes

Simple things in life can be the most difficult; For instance, Regular Exercise and a balanced Diet for a healthy life.

What constitutes a healthy diet is common knowledge. For example eating Whole grains, Fresh Fruit and Vegetables )

But what is accepted as common knowledge is not always backed up by robust scientific evidence .

So it is good to see two scientific papers in a recent issue of British Medical Journal with one paper exploring the role of fruit and vegetable consumption on type 2 diabetes and another paper exploring the role of whole grain foods on risk of type 2 diabetes.

1. One study found that Vitamin C and carotenoids have a protective effect against diabetes ( eg diet rich in citrus fruits, tomatoes , root vegetables such as carrots )

A word of caution to those rushing to buy vitamin supplements from the authors : “fruit and vegetable intake, rather than vitamin supplements, is potentially beneficial for the prevention of type 2 diabetes”.

2. Another study found that “whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, significantly reduced the risk of developing diabetes.

References

1. Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2194 (Published 08 July 2020)

2. Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies .

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2206 (Published 08 July 2020)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Coronavirus re-infection and immunity

Many Viral infections give some sort of immunity to the person infected. For example, if a child has chicken pox, then the child develops immunity to further chicken pox. This immunity can even be life long for many children.

But some viral infections don’t result in significant immunity to further infection. For example, Flu and Common Cold viruses infections do not result in effective long immunity. That’s why flu vaccines are given yearly to vulnerable people.

It was hoped that a Coronavirus infection could result in at least some sort of long immunity to further infections.

A recent report of man who developed Coronavirus/ COVID-19 for the second time is worrying. If this is a widespread phenomenon and not an isolated case, then it has significant implications for the current pandemic.

Herd immunity, whereby many people are immune to further Coronavirus infection either through previous infection or Vaccination, was suggested as the way of ending the current pandemic.

This report, if confirmed to be true across significant sections of population, would indicate a much more longer duration of COVID-19 pandemic.

References:

1. BBC news: Covid reinfection: Man gets Covid twice and second hit ‘more severe’
By James Gallagher
Health and science correspondent

2. Lancet Infectious diseases. Genomic evidence for reinfection with SARS-CoV-2: a case study. Richard L Tillett, PhD, Joel R Sevinsky, PhD, Paul D Hartley, PhD, Heather Kerwin, MPH, Natalie Crawford, MD, Andrew Gorzalski, PhD, et al.
Published:October 12, 2020DOI:https://doi.org/10.1016/S1473-3099(20)30764-7

3. Lancet Infectious diseases. What reinfections mean for COVID-19. Akiko Iwasaki
Published:October 12, 2020DOI:https://doi.org/10.1016/S1473-3099(20)30783-0Edridge AWD

4. Edridge AWD, Kaczorowska et al.Seasonal coronavirus protective immunity is short-lasting.Nat Med. 2020; (published online Sept 14.)https://doi.org/10.1038/s41591-020-1083-1View in Article

5. Tillett RL et al. Genomic evidence for reinfection with SARS-CoV-2: a case study.Lancet Infect Dis. 2020; (published online Oct 12.)https://doi.org/10.1016/S1473-3099(20)30764-7View in Article

6. To KK-W et al. COVID-19 re-infection by a phylogenetically distinct SARS-coronavirus-2 strain confirmed by whole genome sequencing.Clin Infect Dis. 2020; (published online Aug 25.)https://doi.org/10.1093/cid/ciaa1275View in Article

7. Van Elslande J et al.Symptomatic SARS-CoV-2 reinfection by a phylogenetically distinct strain.Clin Infect Dis. 2020; (published online Sept 5.)https://doi.org/10.1093/cid/ciaa1330View in Article

8. Prado-Vivar B et al.COVID-19 re-infection by a phylogenetically distinct SARS-CoV-2 variant, first confirmed event in South America.SSRN. 2020; (published online Sept 8.) (preprint)https://doi.org/10.2139/ssrn.3686174View in Article

9. Dearlove B et al. A SARS-CoV-2 vaccine candidate would likely match all currently circulating variants.Proc Natl Acad Sci USA. 2020; 117: 23652-23662View in Article

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

How long can Coronavirus Virus Survive on doors, handles, furniture and fittings?

Coronavirus was previously known to survive for about 3 days at room temperatures. (On certain surfaces made of plastic and stainless steel).

Now an Australian team has found that Coronavirus can survive upto 28 days in Cold conditions. The results need to be interpreted with great caution as it tested virus under unusual artificial conditions and hence might not be relevant for real life situations

On the other hand , if the study is right, then it might indicate that the Pandemic can get worse during cold Winter before it gets better in Spring and Summer.

What can we do? In addition to Social distancing measures and Mask wearing, Frequent hand washing would stop the Virus from Spreading.

Every Week , we are learning more about the Virus. Let’s hope it comes to an end soon.

1. BBC news: Covid-19 virus ‘survives on some surfaces for 28 days’. https://www.bbc.co.uk/news/health-54500673

2. Daily Mail. https://www.dailymail.co.uk/news/article-8828459/Coronavirus-survive-MONTH-surfaces-including-banknotes-mobile-phone-screens.html

3. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
April 16, 2020
N Engl J Med 2020; 382:1564-1567
DOI: 10.1056/NEJMc2004973

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is high intensity exercise good for older people ?

Time is precious even for retired older people. People struggle to do longer duration of exercise every week.

Hence high intensity exercise – intense but short duration exercise- has become the favourite for busy individuals . ( See Mayo clinic Website and NHS website for Information about Exercise Intensity)

A Norwegian group compared high intensity exercise with medium intensity exercise in 1567 participants. The study involved a older population with an average age of 72.8 years.

People who did high intensity seem to have a trend towards longer life expectancy in the study.

Although study results are not definitive for all types of exercise, it’s terms of starting to do regular exercise , it’s never too late to start exercising !

References:

(1). Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial
BMJ 2020; 371
doi: https://doi.org/10.1136/bmj.m3485 (Published 07 October 2020)
Cite this as: BMJ 2020;371:m3485.

(2). BMJ blogs. It’s never too late for older adults to start exercising. October 7, 2020

(3). Physical activity trajectories and mortality: population based cohort study. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2323 (Published 26 June 2019)

(4) Mayo Clinic: Exercise intensity: How to measure it.

(5). NHS website: Physical activity guidelines for older adults.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Risk of Death from COVID-19: does ethnicity matter?

Yes, people from different ethnicities are affected in different ways by Coronavirus.

People of white ethnicity seems to be at lower risk.

People of black ethnicity seem to have higher risk of severe disease but seem to survive better than South Asians in UK.

South Asians who are hospitalised in UK due to severe disease seem to have the highest risk of death.

More work needs to be done to identify underlying the biological factors responsible for the increased risk of death in South Asians in UK.

BBC News. Covid: South Asian hospital patients ‘at greater risk of dying’

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.


The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Coronavirus : Why Hand hygiene is also important in addition to Face mask ?

The UK government’s slogan for controlling COVID-19 pandemic is “ ‘Hands. Face. Space

The reason hands are emphasised is because the Virus can stay alive on Human skin for many hours. So touching others by hugging or hand shaking can spread the virus.

A recent Japanese study found that Coronavirus can stay alive on skin surfaces for about 9 hours. They also found that alcohol gel can inactivate the virus in about 15 seconds !

References:

1. Survival of SARS-CoV-2 and influenza virus on the human skin: Importance of hand hygiene in COVID-19 Ryohei Hirose, Hiroshi Ikegaya, Yuji Naito, Naoto Watanabe, Takuma Yoshida, Risa Bandou, Tomo Daidoji, Yoshito Itoh, Takaaki NakayaClinical Infectious Diseases, ciaa1517, https://doi.org/10.1093/cid/ciaa1517 Published: 03 October 2020

2. Guardian: Coronavirus outbreakHands. Face. Space’: UK government to relaunch Covid-19 slogan.

3. Fox News: The coronavirus can survive on skin for this many hours, study suggests
Researchers found that SARS-CoV-2 outlived the influenza A virus on human skin
. Madeline Farber By Madeline Farber | Fox News

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.
The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Does intensive follow benefit Bowel cancer patients?

Photo by rawpixel.com on Pexels.com

The old adage “prevention is better than cure” is mostly true with regards to cancer if you can do it.

If you can’t prevent it , at least catch it early, has been the prime motive behind screening tests for breast, cervical, bowel, lung and prostate cancers. (“early is better”). Cancers that are detected at an early stage can offer a better chance of curative treatment.

So one might logically expect that intensive monitoring and early diagnosis of a cancer relapse or a secondary cancer after initial treatment can be immensely helpful.

But the evidence for intensive hospital follow-up visits and investigations is weak for most cancers except for some cancers such as Testicular Cancers which are highly curable.

Intensive monitoring after bowel cancer treatment can detect treatable cancers. To confirm the benefit of early detection of relapse by intensive monitoring , a trial was conducted comparing intensive follow up versus routine follow up ( in France and Belgium).

Data presented at ESMO ( European Society of Medical Oncology) shows that the intensive follow with scans can detect cancer recurrences which can be treated by further surgery. But unfortunately the intensive follow up did NOT lead to longer life expectancy.

The results might be counterintuitive but after an average follow up more than six years, this trial demonstrates that intensive follow is NOT always best. Scans might be done for psychological reassurance but they could end up causing significant anxiety.

When there are resource constraints (e.g low economic countries) , one has to be careful about frequents routine scans for those without symptoms.

During COVID-19, even in rich countries such as UK where there might be huge waiting lists, one has to consider prioritising scans for those who need most.

References

1. ESMO Daily reporter: INTENSIVE FOLLOW-UP INCREASES FREQUENCY OF CURATIVE INTENT SECONDARY SURGERY IN COLORECTAL CANCER.

2. DRE is useless for follow up of prostate cancer patients. https://www.bmj.com/rapid-response/2011/11/03/dre-useless-follow-prostate-cancer-patients

3. Cancer patients follow up and a new role for GPs. https://www.bmj.com/rapid-response/2011/11/03/cancer-patients-follow-and-new-role-gps

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

How should a doctor treat when evidence is uncertain?

Medicine is not always straight forward.

Photo by rawpixel.com on Pexels.com

Treatment of patients is often guided by evidence. Lot of medical treatments are logical and evidence for effectiveness is straightforward .

But sometimes evidence is patchy and uncertain. Sometimes doctors rely on experience and intuition.

From an ethical point, it might be helpful for doctors to think what would they do when they or their family are in the situation of their patient. Putting oneself in the shoes of the patient can sometimes help to deal with ethical dilemmas.

But some argue that doctors putting themselves in the shoes of patients is not ideal as emotions can cloud judgement.

What do you think?

Please read the BMJ article and my response.

On emotions and clinical judgment” has now been published online by BMJ.
Access the article at: http://bmj.com/cgi/content/full/bmj.m3723
Toll-free link:
http://bmj.com/cgi/content/full/bmj.m3723?ijkey=kWmoDxrWgKLTjgp&keytype=ref

Morgan M. Matt Morgan: Standing in the shoes of a relative may complicate decision making. BMJ2020;370:m3344.doi:10.1136/bmj.m3344 pmid:32873585FREE Full TextGoogle Scholar

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Once a week chemotherapy is not superior to Chemotherapy given once every 3-weeks

Advanced ovarian cancer is treated by chemotherapy. A pre ious study of Japanese ovarian cancer patients RT showed significantly increased survival in those treated with dose-dense weekly paclitaxel compared to the standard three-weekly schedule.

Data from an international trial called ICON8 was presented at the ESMO Virtual Congress 2020, this week.

The final analysis of ICON8 “provides conclusive evidence that although weekly dose-dense chemotherapy can be successfully administered as first-line treatment for ovarian cancer, it has no survival advantage over the standard chemotherapy given once every 3 weeks.

ICON8: Overall survival results in a GCIG phase III randomised controlled trial of weekly dose-dense chemotherapy in first line epithelial ovarian, fallopian tube or primary peritoneal carcinoma treatment. Citation. Annals of Oncology (2020) 31 (suppl_4): S551-S589. 10.1016/annonc/annonc276

ESMO Daily Reporter: OVARIAN CANCER: FIRST-LINE DOSE-DENSE CHEMOTHERAPY IS NOT SUPERIOR TO STANDARD 3-WEEKLY CHEMOTHERAPY.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Which is better for COVID-19 protection : face masks or face shields.

Various type of masks are used by public for protection against COVID-19.

Some wear cloth masks. Some use medical disposable masks. Some wear face shields particularly those working in shops.

Are they all the same?.

No

Recent evidence indicates that standard light-blue disposable surgical masks are the most effective at containing the Cornovirus.

Face shields were found to be failing when compared with standard ( triple layer) medical grade masks.

References

1. Face shields ineffective at trapping aerosols, says Japanese supercomputer. Guardian Newspaper. Justin McCurry in Tokyo. Tue 22 Sep 2020 07.19 BST. https://www.theguardian.com/world/2020/sep/22/face-shields-ineffective-trapping-aerosols-japanese-supercomputer-coronavirus

2. Do cloth masks work? Supercomputer Fugaku says yes.World’s fastest computer calculates that nonwoven fabric is best. YUKI MISUMI, Nikkei staff writer. August 25, 2020 00:34 JST. https://asia.nikkei.com/Business/Technology/Do-cloth-masks-work-Supercomputer-Fugaku-says-yes

3. Visualizing droplet dispersal for face shields and masks with exhalation valves. Physics of Fluids 32, 091701 (2020); https://doi.org/10.1063/5.0022968

4. Visualizing the effectiveness of face masks in obstructing respiratory jets. Siddhartha Verma, Manhar Dhanak, and John Frankenfield. https://aip.scitation.org/doi/10.1063/5.0022968
Phys Fluids (1994). 2020.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Olaparib, as a 3rd line treatment, improves survival of a subset of prostate cancer patients with certain genetic changes .

Some prostate cancers are inherited. Some of these cancers have changes in a gene called BRCA.

Some prostate cancers which are not inherited can sometimes have these BRCA changes as well.

Data presented at ESMO ( European Society of Medical Oncology) shows that the prostate cancers with BRCA gene changes derive the most benefit from Olaparib. When administered as a third line treatment ( after failure hormone injection, novel hormonal tablets and chemotherapy) , Olaparib makes these patients live longer.

ESMO Daily Reporter. PROFOUND: OVERALL SURVIVAL DATA WITH OLAPARIB HERALD PRACTICE-CHANGING TREATMENT OF METASTATIC PROSTATE CANCER.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Immunotherapy not highly effective in Ovarian cancers

Immunotherapy has made a significant difference to the lives of many cancer patients with Skin, Kidney, Bladder and Lung cancers.

But in ovarian cancer patients, the results of trials have been disappointing .

Data presented at ESMO ( European Society of Medical Oncology) shows that the Immunotherapy agents Pembrolizumab and Nivolumab do not make significant difference over and above chemotherapy.

A caveat though, patients who responded to Nivolumab has longer duration of response and Nivolumab was well tolerated. So this indicates a subset of patients may benefit from chemotherapy.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

A highly effective treatment for secondary brain cancer in some Lung cancer patients

Brain secondaries from many primary cancer is always difficult to treat.

Particularly brain secondaries from Lung cancer patients can be quite difficult to treat.

Whole Brain Radiotherpy was widely used in past to treat brain secondaries in Lung cancer patients until 2016.

In 2016, QUARTZ study reported that Radiotherapy provided“ little additional clinically significant benefit for this patient group”.

So very few treatment options existed for this group of patients.

So it’s reassuring to see that a new drug was found to be highly active in lung cancer patients with brain secondaries.

Data presented at ESMO ( European Society of Medical Oncology) shows that the Lorlatinib showed a staggering 82% response rate in a small sub-group of patients.

References 1. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30825-X/fulltext

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

A novel drug Osimertinib reduces risk of Brain cancer secondaries in lung cancer patients

Traditional intravenous Chemotherapy agents are often thought NOT to be highly effective in treating and preventing brain secondaries. This is because of the penal blood brain barrier.

Data presented at ESMO ( European Society of Medical Oncology) presidential symposium shows that the Osimertinib is highly active and significantly reduces risk of brain secondaries.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

New treatment combination for advanced Kidney cancers

The treatment of kidney cancer has dramatically changed in the last decade. More treatments are in pipeline and there was more exciting news this week.

Upfront immunotherapy in combination with other agents is very promising in 1st line treatment of advanced kidney cancers.

Data presented at ESMO ( European Society of Medical Oncology) shows that the combination of Nivolumab and Cabozantinib is better than Sunitinib alone.

Nivolumab and Cabozantinib” combo joins the other combos “Nivolumab and Ipililumab” and “Pembrolizumab and Axitinib “ as 1st line options

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Cancer and COVID-19

Cancer patients, as expected, did badly during the 1st wave of the COVID-19 pandemic

Data presented at ESMO ( European Society of Medical Oncology) shows that Cancers had – higher rates of Hospitalisation, higher risk of Complications and increased risk of Death.

Elderly cancer patients on the whole did very badly but surprisingly cancer patients under age of 50 did far worse than their peers without cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Immunotherapy not superior to Chemotherapy in 1st line treatment of bladder cancer

Immunotherapy has revolutionised the treatment of many advanced cancers such Skin cancer Melanoma and Kidney cancers.

Immunotherapy is a standard treatment for 2nd line treatment of bladder cancer.

Two recent trials presented at ESMO virtual meeting explored the use of immunotherapy in 1st line setting. (Pembrolizumab and Durvalumab).

Immunotherapy alone, or in combination with Chemotherapy was not superior even in patients selected by markers thought to favour immunotherapy alone.

For most bladder cancer patients immunotherapy remains a excellent 2nd line option or as a maintenance treatment option.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

New treatment for Advanced Uterine Cancer

Women with advanced uterine / endometrial cancer are usually treated with chemotherapy.

Those who failed chemotherapy or those who are fit for chemotherapy are sometimes treated with hormone treatment.

Letrozole is one such hormone treatment for those patients with hormone sensitive cancer.

In breast cancer, Letrozole efficacy can be improved by a treatment called Palboclicib.

A trial was done to check whether the same improvement can be observed in uterine cancer when the combination of Letrozole and Palboclicib is tried.

The trial data presented at the ESMO ( European Society of Medical Oncology) is very promising.

If large trials confirm this finding, the combination would be standard treatment in future.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Hope and incurable Cancer: does hope torment or does it help to cope?

A diagnosis of incurable and advanced cancer is often a massive shock to everyone.

Should we ask them to face reality , accept death and extinguish all hope.

Or should we be offering hope of living a bit longer with treatments while being honest with prognosis.

Hope can be tormenting to some.

Hope can be comforting to some.

What are you views?

Contribute your views at online rapid response @BMJ journal

Don’t torment me with hope. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3016 (Published 09 September 2020)Cite this as: BMJ 2020;370:m3016

In defence of Hope: https://www.bmj.com/content/370/bmj.m3016/rr-3

Do soft drinks increase the risk of an early death?

Yes.

Soft drinks do increase risk of an early death.

In a large study involving 451 743 individuals from 10 countries in Europe, the regular consumption of soft drinks increased the risk of death.

The increased risk was seen with both sugared drinks as well as artificially sweetened drinks. Worryingly the hazard from artificially sweetened drinks seems higher.

The take home message: drink more water !

References

1. JAMA . Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Intern Med. Published online September 3, 2019. doi:10.1001/jamainternmed.2019.2478.

2. Daily Mail. Just TWO glasses of diet drinks each day may raise the risk of an early death, reveals study by the World Health Organisation.

3. The Guardian. Soft drinks, including sugar-free, linked to increased risk of early death.

COVID-19 risk assessment of NHS members : is it an opportunity missed?

The National Health Service had recently embarked on a Risk assessment exercise of its staff to assess the Vulnerability of individual members to Coronavirus infection ( COVID-19).

The exercise is being done with good intentions. Given the unprecedented situation of the pandemic and lack of concrete data , the exercise seemed to have steered away from firm “one size fits all” type of recommendations.

Given the uncertainties with the currently available data on various forms of protection ( from simple surgical masks to shielding) , the exercise could have been a starting point for an nationwide intervention study .

An opportunity seems to have been missed and if there is a second wave, NHS might regret not learning from the first wave.

Please do add your opinion at the rapid response section of the BMJ.

References

1. Covid-19 risk assessment in BAME staff

Covid-19 risk assessment: a futile metaphorical strip search

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3251 (Published 26 August 2020)

Cite this as: BMJ 2020;370:m3251

2. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2743 (Published 15 July 2020)

Cite this as: BMJ 2020;370:m2743

3. Complete protection from covid-19 is possible for health workers

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2641 (Published 07 July 2020)

Cite this as: BMJ 2020;370:m2641

4. Two metres or one: what is the evidence for physical distancing in covid-19?

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3223 (Published 25 August 2020)

Cite this as: BMJ 2020;370:m3223

Can Hair dyes cause cancer?

Yes, there is a possible increased risk of some types of skin and breast cancer as well as ovarian cancer.

Permanent hair dyes are widely used. A recent study published in BMJ suggests that use of Hair dyes might be risky.

This large study from United States enrolled 117 200 women in the Nurses’ Health Study. The women reported on personal use of permanent hair dyes, and were followed for 36 years. So overall it is a high quality observational study.

Read the full paper and Caveats at the BMJ website.

References

Personal use of permanent hair dyes and cancer risk and mortality in US women: prospective cohort study

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2942 (Published 02 September 2020)

Cite this as: BMJ 2020;370:m2942

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

How to avoid catching Coronavirus indoors during the winter months?

At Offices and Shops, Ventilation is the Key.

If enough fresh air comes through and filters in Air conditioning units are serviced properly risks are manageable.

It could be risky if Ventilation is bad in large offices and Shops where is lot of people going in and out.

One infected person can easily spread to many other people if air is stuffy and stale and fresh air is not coming in to dilute the virus !

In private homes, where only family members are present, it is likely to be safe as long as a everyone of feeling well.

References

BBC news. Covid-19: Five ways to avoid catching the virus indoors. By David Shukman. BBC News science editor. Aug 2020.

CDC. Employer Information for Office Buildings.

WHO. Q&A: Ventilation and air conditioning in public spaces and buildings and COVID-19.

HSE. Air conditioning and ventilation during the coronavirus outbreak.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can Coffee cause abortion ?

Yes, it can .

Coffee can harm pregnancy. Coffee can cause miscarriage, stillbirth, lower birth weight, and preterm birth.

Hence various guidelines do advise reduction in coffee consumption during pregnancy.

A recent study in BMJ group journal goes further and suggests avoiding coffee altogether during pregnancy.

There are caveats but those who want to be very cautious should consider avoiding coffee during pregnancy just like one avoids alcohol during pregnancy.

References

1. Guardian Newspaper. No safe level of coffee drinking for pregnant women, study says.

2. BMJ Evidence-Based Medicine. Jack James RT al. Reykjavik University

3. Independent newspaper. No safe level of caffeine consumption for pregnant women and would-be mothers, study suggests

4. World Health Organization. Restricting caffeine intake during pregnancy.

5. UK. Food Standards Agency. Assessment of caffeine consumption, altered caffeine metabolism and pregnancy outcome.

5. NICE. National Institute for Health and Care Excellence. New recommended drinking guidelines welcomed by NICE.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

If you survive the Coronavirus, Can you get Coronavirus infection again ?

Yes, you can get infection again.

Last month, we had studies reporting that the immunity to Coronavirus fades quickly after recovering from an infection. The scientists have warned that re-infection is a risk.

Now, we have a case in Hong Kong where a patient seem to have been unlucky to get the infection again. It is a worrying report and suggests that coronavirus is going to be with us for a long time.

The only reassuring fact is that patient was free of symptoms during second infection. One has to hope that all re-infections are mild !

References

1. Sundar.blog. CAN YOU GET CORONAVIRUS INFECTION MORE THAN ONCE?

2. BBC. Hong Kong reports ‘first case’ of virus reinfection.

3. Clinical Infectious Diseases : report on twitter.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can you catch Coronavirus infection from Soft drink cans, Sandwich wrapper and Amazon Parcels?

Yes. Possible but chances are very small according to reports.

If someone sneezed or coughed near a parcel or food package and you touch it within a few hours, it is possible to get Coronavirus infection from parcels and packages.

But, in practice, most parcels and food packaging seem safe and no conclusive real world evidence has been published so far to indicate that packages spread infection widely.

In experimental conditions, Coronavirus has been shown to survive for upto 72 hours. The virus is “more stable on plastic and stainless steel than on copper and cardboard”.

In laboratory conditions “On copper, no viable SARS-CoV-2 virus was measured after 4 hours . On cardboard, no viable SARS-CoV-2 virus was measured after 24 hours”.

In the artificial conditions of the lab “The longest viability of viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 virus was approximately 5.6 hours on stainless steel and 6.8 hours on plastic”.

Solution: If you are worried , and if possible, you can try leaving parcels for 24hrs before touching them with bare hands. Alternatively, try wearing disposable gloves to remove packaging.

References

1.NEJM. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. April 16, 2020. N Engl J Med 2020; 382:1564-1567. DOI: 10.1056/NEJMc2004973

2. BBC. Coronavirus: What are the risks of catching it from food packaging?

3. CDC. How It Spreads.

Is Honey a better treatment for coughs and colds ?

Possibly yes, in some cases of viral infections , according to a paper published a BMJ group journal ( BMJ Evidence Based Medicine) .

The paper has been widely quoted in various newspapers today.

The BMJ group journal authors report: “Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections.

It provides a widely available and cheap alternative to antibiotics…….but further high quality, placebo controlled trials are needed.”

A word of caution: Honey has high sugar content. Diabetics need to be careful. People will allergies need to take care. Of course bacterial infections need antibiotics particularly in old and vulnerable!

References

1. BMJ Evidence Based Medicine. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis .

Abuelgasim H, Albury C, Lee J Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis BMJ Evidence-Based Medicine Published Online First: 18 August 2020. doi: 10.1136/bmjebm-2020-111336.

2. Guardian Newspaper:

3. Daily Mail.

4. BBC paper review .

5. Evening Express

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is weight loss a sign of cancer?

If you have been dieting and exercising to shed excess weight, then you can celebrate your success in achieving your goal.

But some poorly lose weight unintentionally . This type of weight loss that occurs without intention might be of concern in some people.

A recent article in BMJ advocates screening for cancer in some patients if they have weight loss and other symptoms in their chest and abdomen.

Male smokers over the age of 50 are one of the high risk groups !

Don’t ignore weight loss !

References

Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2651 (Published 13 August 2020)

Cite this as: BMJ 2020;370:m2651

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Are Routine blood tests essential during follow up of low grade Lymphoma?

Bloods tests have the potential to pick up various abnormalities including cancer related abnormalities during follow up of cancers.

But , many patients would be surprised to know that there is ongoing debate about usefulness of routine blood tests atleast in some cancers !

In a recent study, Australian investigators assessed the role of routine blood tests during monitoring of patients with low grade lymphoma.

They found that routine blood tests rarely found or detected disease progression in patients who did not have any symptoms.

References

Routine Blood Tests in Asymptomatic Patients With Indolent Lymphoma Have Limited Ability to Detect Clinically Significant Disease Progression. DOI: 10.1200/JOP.19.00771 JCO Oncology Practice – published online before print June 25, 2020. PMID: 32584701

Effectiveness of Routine Blood Testing in Detection of Disease During Active Surveillance for Indolent Non-Hodgkin Lymphoma. By Matthew Stenger. Posted: 7/16/2020 1:40:00 PM . Last Updated: 7/29/2020 1:59:00 PM

Utility of Routine Surveillance Laboratory Testing in Detecting Relapse in Patients With Classic Hodgkin Lymphoma in First Remission: Results From a Large Single-Institution Study. DOI: 10.1200/JOP.19.00733 JCO Oncology Practice – published online before print May 5, 2020. PMID: 32369413

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can a Protein rich diet lead to a longer life ?

Yes, a protein rich diet can lead a longer life and reduce risk deaths due to heart diseases.

Before you rush to relish your burger or steak , please note the evidence for beneficial effect is very much in favour of plant proteins than animal proteins.

So Befriend your Beans !

And Love your Lentils !

Reference

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2412 (Published 22 July 2020)

Cite this as: BMJ 2020;370:m2412

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can you get Coronavirus infection more than once?

If you are one of the unlucky ones to have already been infected with Coronavirus infection but recovered from it, can you become unlucky again and get another Coronavirus infection later this year ?

Unfortunately, the answer is a YES.

Some Viral infections can sometimes lead to life long immunity. For example, most people who had chicken pox as a child tend to have lifelong immunity and it would be uncommon to get chicken pox again. (except in some circumstances).

But infection with ‘Coronavirus causing COVID-19’ doesn’t seem led to long lasting immunity or resistance to a second Coronavirus infection.

A Newspaper report on a study by a team from King’s College London suggests that susceptibility to a second infection may occur as short as 3 months in some patients. This because the level of antibodies produced by the immune system after first infection start to fade away within a few months in some patients.

If confirmed, this is probably one of the most worrying news during this pandemic.

This study result could also affect Vaccine development and how frequently it may need to be administered.

References

Guardian Newspaper: Coronavirus outbreak. Immunity to Covid-19 could be lost in months, UK study suggests. Ian Sample. Science editor. @iansample. Sun 12 Jul 2020 17.31 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can Coronavirus linger in air, and cause COVID-19 by spreading through air ?

Normally many flu-like viruses spread by direct or close contact.

Because Virus containing droplets are heavier than air, scientifically it is thought that when someone coughs or sneezes, virus particles quickly fall to ground or surrounding objects.(“like a brick or stone falling to ground“).

But a group of scientists and WHO have raised the possibility that coronavirus can stay in air for longer periods, float around and cause more infections. (“float like a balloon“). This is called air-borne transmission.

What does it mean?

If confirmed– this means “closed spaces” are high risk even if you maintain 2 metre distance from an infected person. AVOID CLOSED SPACES.

As many people in UK do not wear masks in public places, there is a high chance of second wave of infections in the coming weeks as lock down is eased. WEAR A MASK.

It also means avoiding non-essential visitors to hospitals so that visitors cannot catch the infection or pass the infection to vulnerable patients. AVOID NON-ESSENTIAL VISITORS AT HOSPITALS.

If air borne transmission is confirmed, it is also bad news for the coming winter.

If Coronavirus is still in community and not eliminated by winter, air-borne transmission is likely to result in further wave of infections.

This is because Winter means more closed spaces and more chance of infection !!!!!!

STAY SAFE

References

1. Daily Mail Newspaper. Group of 239 scientists demand that WHO admit coronavirus is AIRBORNE -meaning the public should wear masks indoors and AC units should be fitted with filters .By Ariel Zilber For Dailymail.com and Reuters and Associated Press. 17:44, 05 Jul 2020 , updated 08:14, 06 Jul 2020

2. Guardian Newspaper. WHO underplaying risk of airborne spread of Covid-19, say scientists. Open letter says there is emerging evidence of potential for aerosol transmission. Hannah Devlin. Science correspondent. @hannahdev

3. Guardian Newspaper. Coronavirus outbreak Global report: WHO says ‘evidence emerging’ of airborne coronavirus spread. Martin Farrer and agencies.

4. BBC News. Coronavirus: WHO rethinking how Covid-19 spreads in air.

5. It is Time to Address Airborne Transmission of COVID-19. Lidia Morawska, Donald K Milton. Clinical Infectious Diseases, ciaa939, https://doi.org/10.1093/cid/ciaa939. Published: 06 July 2020

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can Vitamin D prevent respiratory infections such as COVID-19 ?

No conclusive evidence yet.

Some studies suggest a protective effect but two recent “official” reviews in UK has concluded the following.

(1). “The available evidence does not support vitamin D supplementation to prevent acute respiratory tract infections in the general UK population”.

(2). “There is currently no evidence to support vitamin D supplements reducing the risk or severity of covid-19″.

References

NICE. Covid 19 rapid evidence summary: vitamin D for covid-19 evidence summary. 29 June 2020. http://www.nice.org.uk/advice/es28/chapter/Key-messages.

Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583. doi:10.1136/bmj.i6583 pmid:28202713

Evidence does not support vitamin D for reducing respiratory infections, reviews conclude. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2629 (Published 30 June 2020). Cite this as: BMJ 2020;369:m2629

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Health effects of vitamin and mineral supplements

In Western countries, upto two thirds of people take vitamin and mineral supplements regularly.

Many people think it’s common sense to take supplements. Many people don’t realise mega doses of vitamins can cause harm. Paradoxically the people who don’t have a healthy diet are less likely to supplements than those who have a well balanced diet.

A recent article in BMJ reviews the evidence regarding “Health effects of vitamin and mineral supplements” and concludes that “Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases”.

This article is certainly a “food for thought”

Reference

Food for Thought 2020. Health effects of vitamin and mineral supplements. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2511 (Published 29 June 2020). Cite this as: BMJ 2020;369:m2511

Skeie G, Braaten T, Hjartåker A, et al. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr2009;63(Suppl 4):S226-38. doi:10.1038/ejcn.2009.83 pmid:19888276

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Dexamethasone: “There’s Lot more Life in that Old Dog Yet”

Dexamethasone is one of the commonly used steroids in Clinical practice. It is used to treat allergies; it is used as an anti-inflammatory drug for all sorts of inflammation affecting various part of body.

In cancer patients, Dexamethasone is certainly used widely. It is used as an anti-sickness drug, appetite stimulant, to reduce swelling around brain tumours, and as an anticancer drug in Prostate cancer.

Dexamethasone has now found to be useful in treatment of Corona Virus infection.

In one of the largest Covid-19 trial, the RECOVERY trial- this low cost drug has been found to improve survival of patients particularly those who need Ventilation.

A word of caution though, it did not benefit patients with mild infection due to Coronavirus.

References:

Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

New medication for prostate cancer

The Male hormone- Testosterone feeds the prostate cancer. Shutting down testosterone production in men can help to control prostate cancer.

Advanced prostate cancer is currently treated first by regular hormone injections.

The hormone injections reduce the Testosterone in men.

Now a new medication, called Relugolix, has been successfully tested in clinical trials. Relugolix, unlike other first line hormone injections , can be taken by mouth instead.

Relugolix also has the advantage of not only working rapidly but also has the advantage of stopping to work quickly when it is withdrawn. This is unlike the injections which take a while to work but also do not stop working quickly when injections are stopped.

References

NEJM. Oral Relugolix for Androgen-Deprivation Therapy in Advanced Prostate Cancer

Neal D Shore et al. N Engl J Med. 2020.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can Vitamin K help fight Coronavirus?

Possible but like every other observational study, take it with pinch of salt.

Further evidence from well conducted trials are needed before it can be recommended as a COVID treatment.

In mean time, it’s better to stick to natural sources of vitamin such as those mentioned in the newspaper article ( spinach, broccoli, green vegetables, blueberries, all types of fruit and vegetables).

Guardian Newspaper: Vitamin K could help fight coronavirus, study suggests

Scientists in Netherlands explore possible link between deficiency and Covid-19 deaths

Daniel Boffey. Fri 5 Jun 2020 14.50 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Chloroquine not useful for treating or preventing Coronavirus infections

Randomised Study is the considered as the gold standard for trials.

Placebos are dummy pills . Placebos are inactive drugs that look like the real drug but are essentially sugar coated dummy pills.

Trials which involve a placebo vs active drug comparison are considered one of the best trials for some clinical situations.

A “randomised trial” involving “Chloroquine ” and “placebo ” has been published in NEJM .

A randomised trial suggests Chloroquine is not better than a placebo in treatment of COVID.

Another randomised trial suggests, Hydroxycloroquine is not useful for prevention of COVID-19.

In summary, Hydroxycloroquine is not useful either as COVID-19 treatment or as a COVID-19 preventative drug as advocates in certain countries.

Please Note : Chloroquine and HydroxyChloroquine are different drugs but have broadly similar effects.

References

1. Guardian newspaper: Coronavirus outbreak. Hydroxychloroquine no better than placebo, Covid-19 study finds.

2. NEJM. https://www.nejm.org/

3. BMJ India Correspondent. Covid-19: Doctors criticise Indian research agency for recommending hydroxychloroquine prophylaxis. BMJ2020;369:m2170. doi:10.1136/bmj.m2170 pmid:32471832.

4. BMJ news: Covid-19: Hydroxychloroquine does not benefit hospitalised patients, UK trial finds. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2263 (Published 08 June 2020)

5. BMJ news. Covid-19: Hydroxychloroquine was ineffective as postexposure prophylaxis, study finds. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2242 (Published 05 June 2020)

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Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Does Eating Eggs lead to Heart problems?

No, Eating Eggs in moderation is not associated with increased Heart problems.

Heart diseases are one of major killers in Men and Women. In the past, Cholesterol was exclusively blamed for most of the Heart problems. Nowadays, such a simplistic view has been abandoned. We now know that Heart diseases are due to a complex set of poor diet and life style.

Previously Eggs which have lot of dietary cholesterol have been subject to lot of bad press.

A recent pooled analysis of good quality data shows that ” moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.”

So like everything else with regards to diet , moderation is the way to go !

Reference

Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m513 (Published 04 March 2020)

Cite this as: BMJ 2020;368:m513

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Cancer and COVID-19

Coronavirus infection seems to be more deadly in patients whose immune systems are not functioning very well.

So cancer patients who have reduced immunity due to chemotherapy are understandably at higher risk of death.

Among cancer patients, those patients whose cancer is progressing ( i.e cancer not under control ) seem to at even more from COVID-19.

A study presented at the ASCO ( American Society of Clinical Oncology) reports that ” after a COVID-19 diagnosis, patients with progressing cancer were found to be 5.2 times more likely to die within 30 days”.

So stay safe and consider shielding if your cancer is not under control .

Furthermore, there is lot of interest in use of Chloroquine, an anti-malaria drug for treatment of COVID-19. The study reports that “Treatment with the drug combination hydroxychloroquine and azithromycin was also strongly associated with greater risk of death”. So best to avoid unproven treatments outside a trial setting.

References

1. ASCO News. Early Data Show Cancer Progression Associated With Increased Risk of Death in Patients With COVID-19. May 28, 2020.

2. ASCO News. Chemo Within 3 Months of COVID-19 Diagnosis Associated With an Increased Risk of Death in Patients With Thoracic Cancer. May 2020.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is Chloroquine useful in treatment of Corona Virus?

Chloroquine and the related drug Hydroxy-Chloroquine are drugs commonly used to prevent and treat Malaria infections; and treat some Joint conditions.

During the initial stages of COVID-19 pandemic, there were some reports of Chloroquine being useful in treating Corona Virus.

A Chinese trial published in British Medical Journal BMJ now reports that ” Administration of hydroxychloroquine did not result in …. any meaningful antiviral benefits… compared to standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19

Chloroquine was not only useless but it had significant side effects in a minority. So Chloroquine or Hydroxy-Chloroquine should not be used routinely outside a clinical trial setting.

References

1. Hydroxychloroquine (HCQ). Wiki. https://en.m.wikipedia.org/wiki/Hydroxychloroquine

2. BMJ. Chloroquine and hydroxychloroquine in covid-19. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1432 (Published 08 April 2020)

3. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1849 (Published 14 May 2020)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Face Masks: Should Public wear face masks because of Corona Virus pandemic ?

Should Public wear face masks because of Corona Virus pandemic ?

Yes.

In some of the Asian Countries there has been universal acceptance of face masks even before Corona Virus pandemic. Hence, it is not surprising that there is wide spread use of face masks during this pandemic .

In USA, after initial hesitation, CDC now recommends use of cloth face masks by public.

In Germany, many states have made face masks compulsory.

In UK, there has been no official recommendation about widespread use of face masks.

With so many unknowns, it is prudent to follow the advice published in British Medical Journal : WEAR A MASK !!

References

1. USA CDC. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

2 Germany: BBC news. Coronavirus: Germany’s states make face masks compulsory. 22 April 2020. https://www.bbc.co.uk/news/world-europe-52382196

3. TIME Magazine. https://time.com/5815251/should-you-wear-a-mask-coronavirus/

4. BMJ paper. Analysis. Face masks for the public during the covid-19 crisis. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1435 (Published 09 April 2020). Cite this as: BMJ 2020;369:m1435

5. BMJ editorial. Editorial. Covid-19: should the public wear face masks?. Editorials. Covid-19: should the public wear face masks? BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1442 (Published 09 April 2020). Cite this as: BMJ 2020;369:m1442

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Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views expressed are not substitute for professional advice.

Does air pollution in cities make your jogging and walking less beneficial ?

Yes, air pollution is now being recognised as an important cause of death in major cities and towns.

So avoid major roads and very busy streets.

Any benefit you might accrue from exercise can be wiped out by heavy air pollution if you are jogging on a heavily congested road.

References

1. Telegraph: Pollution wipes out the benefits of exercise, study suggests

2. BMJ . Air pollution. Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6258 (Published 27 November 2019)

3. Telegraph. Does exercising in pollution do you more harm than good?

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Acupuncture for Migraine

Can Acupuncture help migraines?

Yes, says a Chinese trial published in British Medical Journal .

Many complementary and Alternative therapies have very thin evidence base ( if all present ).

The researchers are to be congratulated for doing a randomised trial and publishing results in a peer reviewed medical journal

References

Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m697 (Published 25 March 2020)

Cite this as: BMJ 2020;368:m697

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.