Do COVID vaccines cause heart inflammation?

Yes

COVID Vaccines have caused heart inflammation in a small minority of people.

But that does NOT mean Vaccines have to be avoided.

The benefits of vaccines are far higher than risk of side effects for vast majority of adult population.

People have not stopped traveling by car because of risk of road accidents. This is because benefits considerably outweigh the risks !

References

BBC news. Heart inflammation link to Pfizer and Moderna jabs
By James Gallagher
Health and science correspondent

BMJ. News Analysis.
Covid-19: Should we be worried about reports of myocarditis and pericarditis after mRNA vaccines?
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1635 (Published 24 June 2021)
Cite this as: BMJ 2021;373:n1635

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s personal views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is NOT previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice.

A new blood test for cancer

Cancer cells can float in a person’s blood. But finding them, in the past, used to be like “looking for a needle in a haystack”.

But new smart technology promises to detect these cancer cells easily and much early before a person develops symptoms. Detection of cancer cells at an early stage may be helpful for some patients.

A recently published study in the journal “Annals of Oncology” reports exciting results.

A Californian company called Grail has developed a blood test which seems to have a high degree of accuracy for detection of multiple cancers.

Times newspaper reports that “The NHS will begin a pilot scheme of the test with 140,000 people this year. If that is successful it will be used for millions of patients by 2025”

A word of caution though.

Just because something could be diagnosed early does not always mean that it is a good thing.

The most important thing is whether the early diagnosis can lead to better cure rates and a better quality of life.

If a test detects a cancer early but has no meaningful effect on quantity or quality of life, then it is not a good thing.

For example. Up to 80% of men have prostate cancer which can now be detected by a simple blood test called PSA. There is a good reason why we are NOT using the simple PSA test in every 80 year old.

Most 80 year old men die WITH prostate cancer rather than DUE to prostate cancer.

So why diagnose a cancer that is not causing symptoms if it is not going to make person live longer !

REFERENCES

Times. New blood test, created by Californian company Grail, detects cancers among over-50s. Kat Lay, Health Editor. Friday June 25 2021, 12.01am, The Times.

Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. E A Klein et al. Ann Oncol. 2021.

Guardian. Blood test that finds 50 types of cancer is accurate enough to be rolled out.
Diagnostic tool being piloted by NHS England shows ‘impressive results’ in spotting tumours in early stages
Blood tests’ development could help the NHS further.
Nadeem Badshah and agency
Fri 25 Jun 2021 06.00 BST

Daily Mail. NHS trials ‘holy grail’ blood test that can spot 50 kinds of cancer: Ground-breaking check that can accurately detect two thirds of deadly cancers early in healthy people could save thousands of lives a year. By Victoria Allen Science Correspondent For The Daily Mail
00:00, 25 Jun 2021 , updated 10:04, 25 Jun 2021

NHS. Should I have a PSA test?

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Would COVID Vaccination become mandatory for all adults ?

It is unlikely to become mandatory in most western countries. It almost certainly would not become mandatory in USA, where Vaccination seems to become tangled with highly divisive politics.

But it is not an impossible scenario in European countries.

It is possible that more countries would follow the example of Turkmenistan, which has a policy of “no jab, no job”

Also, it does not have to a direct government policy.

If the governments change the law to allow businesses to demand vaccination proof, then indirectly vaccination becomes mandatory for most people.

Private Businesses and Travel industry may decide to make vaccination mandatory for their employees and customers so as to avoid further disruption to their business.

In countries, such as Israel and U.K., where there is already high uptake of vaccination, a change in Law may not be needed at present.

But if the present surge in infections continue, and variants emerge, Governments may change their approach.

References

BMJ. Covid-19: Turkmenistan becomes first country to make vaccination mandatory for all adults
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1766 (Published 12 July 2021)
Cite this as: BMJ 2021;374:n1766

Daily Mail. Get ready for Covid jab passports at busy pubs that don’t do enough to tackle infections, warns Boris Johnson. By Daniel Martin Policy Editor For The Daily Mail
23:54, 12 Jul 2021 , updated 01:47, 13 Jul 2021

Daily Mail. Pingdemic pandemonium! Chaos at airports and on the railways as key workers are ordered to go into self-isolation by controversial app. By David Churchill, Transport Correspondent For The Daily Mail
23:51, 12 Jul 2021 , updated 23:59, 12 Jul 2021

Daily Mail. It IS full steam ahead on freedom day: Boris Johnson puts faith in the public’s common sense on July 19 – even though some doctors and scientists want to delay it. By Glen Owen and Anna Mikhailova For The Mail On Sunday
22:00, 10 Jul 2021 , updated 01:52, 11 Jul 2021

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s personal views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is NOT previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice.

Would we be having a third dose of COVID-19 Vaccine as a Booster ?

Yes, it is a possibility that a third booster dose of COVID vaccine would be offered later this year.

Vaccination has been tremendously successful so far. But it is too early to declare victory against the virus.

Data from Israel indicates that the current Pfizer vaccine, although still highly active, offers less protection against delta variant.

In June, the vaccine was found to be just 64 percent effective in preventing coronavirus infection whereas during May, when the delta strain was less prevalent, the vaccine was 94.3% effective.

So if more variants emerge, then vaccine boosters may be particularly needed for the vulnerable people.

References

Ministry data said to show Pfizer shot blocks majority of serious Delta cases. Figures reportedly indicate vaccine less effective against contagion from variant, but hospitalizations remain low; officials said weighing use of Moderna for 2nd dose for over 18s. By AMY SPIRO
Today, 10:23 am

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should you elect to wear masks when restrictions are lifted ?

U.K. is on course to lift almost all COVID restrictions in mid July 2021.

A U.K. minister has said that “wearing masks” would become a personal choice.

Just because there is a choice, it does not mean it is always good for you.

Government decisions are often made not only with scientific facts but also with economic and political considerations. Compulsory masks may not be liked by a section of society and Government has to take that into account in a democratic society.

Personally electing to wear masks in crowded public places could be sensible for the following reasons.

– There is some debate about the extent of protection a person gets wearing masks following the Danish mask study. But no robust scientific study has shown significant harm from wearing masks. So it is better to be safe and wear masks even if the extent of protection is debatable.

Infections are rising now and luckily, vaccines seem to have protected most people from getting severe COVID. But Vaccines are not 100% effective. Moreover, when infection rates go up further and society opens up more, there is a risk of variants emerging that may be partially vaccine resistant. So wearing masks may provide some protection.

– Not all people get poorly when they get COVID. But these people with COVID can still pass infection to other vulnerable family members and people who don’t have the protection from vaccines. So wearing a mask can stop people with mild COVID from spreading the infection to others.

– Some people do not want to wear masks because they think they are not at risk of death or hospitalisation. Remember, COVID related problems affect different people in different ways. Lot of people do recover from COVID without major problems. But some people do develop long-term symptoms from COVID. So it is better to wear masks for COVID protection.

References

1. BBC news. Covid-19: Masks will become personal choice, says Robert Jenrick
By Emma Harrison & Kathryn Snowdon
BBC News

2. Bloomberg. Face Masks in England to Become ‘Matter of Personal Choice’
By Andrew Atkinson
4 July 2021, 09:47 BST
Updated on 4 July 2021, 11:14 BST

3. Daily Mail. SAJID JAVID: The economic arguments for opening up Britain are well known. But, for me, the health case is equally compelling. By Sajid Javid For The Mail On Sunday 22:02, 03 Jul 2021 , updated 23:13, 03 Jul 2021

4. BBC news. Covid-19 in the UK: How many coronavirus cases are there in my area?
By The Visual and Data Journalism Team
BBC News

5. Daily Mail. Face masks do NOT protect the wearer from coronavirus, but will stop them from infecting other people, Danish study finds. By Mary Kekatos Senior Health Reporter For Dailymail.com and Reuters
15:26, 18 Nov 2020 , updated 18:02, 20 Nov 2020

6. BMJ. Danish mask study: masks, media, fact checkers, and the interpretation of scientific evidence. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4919 (Published 23 December 2020)
Cite this as: BMJ 2020;371:m4919

7. NICE. COVID-19 rapid guideline: managing the long-term effects of COVID-19
NICE guideline [NG188] Published: 18 December 2020

8. Coronavirus: When can we stop wearing face masks or coverings?
By Michelle Roberts
Health editor, BBC News online

9. Science. Implications of defective immune responses in SARS-CoV-2 vaccinated organ transplant recipients. Peter S. Heeger, Christian P. Larsen, Dorry L. Segev

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Is Aspirin useful for COVID-19 ?

No

Many drugs, which are commonly used for other diseases, have been tried in COVID

Aspirin was also tested and it was NOT helpful

Covid-19: Aspirin does not improve survival for patients admitted to hospital, trial reports
BMJ 2021; 373
doi: https://doi.org/10.1136/bmj.n1475 (Published 08 June 2021)
Cite this as: BMJ 2021;373:n1475

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Do face masks prevent COVID illness ?

Yes, good masks may help to reduce infections that are spread by airborne particles.

But not all masks are the same.

Cloth masks were promoted during 2020 when the proper surgical masks were in short supply . The effectiveness of cloth masks are not well studied and they are of varying quality depending who made them and how well they were made.

Properly manufactured surgical masks are better than home made cloth masks. But how much protection they can offer is a matter of scientific debate. Surgical masks have been found to give some protection against other respiratory viruses in past. But a recent Danish study found no significant benefit against COVID among the general public.

The high quality FFP3 masks which filter most of the inhaled air is superior to normal surgical masks. A recent study from Cambridge found that Heath care workers who used FFP3 masks had better protection from COVID compared to normal surgical masks in the Hospital.

Overall, clean, well manufactured masks are likely to of some benefit to the public rather than wearing no masks at all. In the hospital setting, FFP3 masks seem to provide superior protection to Health care staff working with COVID patients.

And most importantly people have to understand that masks are not to be used alone. Masks got to be used along with protective measures such as social distancing and Hand-washing.

References

CLOTH MASKS

BMJ. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1422 (Published 07 April 2020)
Cite this as: BMJ 2020;369:m1422

DANISH STUDY- SURGICAL MASKS

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers : A Randomized Controlled Trial
Henning Bundgaard et al. Ann Intern Med. 2021 Mar.

BMJ. Danish mask study: masks, media, fact checkers, and the interpretation of scientific evidence. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4919 (Published 23 December 2020)
Cite this as: BMJ 2020;371:m4919

BMJ. The curious case of the Danish mask study
BMJ 2020; 371
doi: https://doi.org/10.1136/bmj.m4586 (Published 26 November 2020)
Cite this as: BMJ 2020;371:m4586

Daily Mail. Face masks do NOT protect the wearer from coronavirus, but will stop them from infecting other people, Danish study finds. By Mary Kekatos Senior Health Reporter For Dailymail.com and Reuters
15:26, 18 Nov 2020 , updated 18:02, 20 Nov 2020

Spectator (magazine) https://www.spectator.co.uk/article/do-masks-stop-the-spread-of-covid-19-

Full fact.org. Danish study on mask efficacy only tells us half the story. 24 NOVEMBER 2020

Forbes. Lead Researcher Behind Controversial Danish Study Says You Should Still Wear A Mask
Leah Rosenbaum. Forbes Staff 18 Nov 2020. Critics of mask-wearing policies used a Danishstudy on mask-wearing to bolster their claims such policies are ineffective, but scientists, including those involved with the study, disagree.

JAMA Insights
February 10, 2021
Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2
John T. Brooks, MD1; Jay C. Butler, MD1
Author Affiliations
JAMA. 2021;325(10):998-999. doi:10.1001/jama.2021.1505

CAMBRIDGE REPORT ON HIGH QUALITY MASKS

BMJ. Covid-19: Upgrading to FFP3 respirators cuts infection risk, research finds
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1663 (Published 29 June 2021)
Cite this as: BMJ 2021;373:n1663. https://www.bmj.com/content/373/bmj.n1663

BBC news. Covid: Masks upgrade cuts infection risk, research finds
By David Shukman
Science editor

Guardian. Cambridge hospital’s mask upgrade appears to eliminate Covid risk to staff
Hospital infection study shows use of FFP3 respirators at Addenbrooke’s ‘may have cut ward-based infection to zero’
Nicola Davis and Denis Campbell
Tue 29 Jun 2021 10.49 BST

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should we continue to wear masks and be cautious in public places after July 19th ?

Yes, we should be cautious after the freedom day on July 19th and this is for the following reasons.

1. Vaccines are highly effective but they are NOT 100% effective.

2. Two doses are needed for full protection. Even though, more than two third of adults have had atleast one vaccine, only about half the U.K. population had double vaccination so far.

3. Vaccine Protection against New COVID variants may NOT be as good as it is now. For instance , vaccines are slightly less effective against the delta variant particularly after first dose.

4. Vaccine protection may decrease over time and Vaccines may not give the same level of protection as months pass by.

4. Being cautious now, may helps us to avoid lockdowns during Autumn and would help to save Christmas !

Of course, some people may feel strongly against any compulsory restrictions and hence it should not be made compulsory.

People, who are comfortable at being cautious, can try to wear masks and practice as much social distancing as possible in public places.

References

BBC News. Covid-19: End of England’s Covid rules still set for 19 July
By Hazel Shearing
BBC News

Daily Mail. Freedom Day ‘will see virtually ALL Covid curbs axed’: Ministers prepare full unlocking on July 19 with masks, social distancing and work from home advice dropped to save shattered businesses – but date will NOT be brought forward. By James Tapsfield, Political Editor For Mailonline
08:29, 23 Jun 2021 , updated 14:52, 23 Jun 2021

Daily Mail. Now Jacob Rees-Mogg joins the calls to DITCH masks as soon as restrictions are lifted: Three Cabinet members break ranks to urge PM to ditch face coverings amid calls for clarity. By Jack Maidment, Deputy Political Editor For Mailonline and James Tapsfield Political Editor For Mailonline
17:40, 24 Jun 2021 , updated 19:56, 24 Jun 2021

Guardian. Vaccines are not magic bullets – we’ll still have to take precautions
Zania Stamataki
To make the most of England’s vaccination rollout we may need to keep wearing masks even after restrictions are lifted
Dr Zania Sta. Tue 22 Jun 2021 06.00 BST

Public Health England. Press release
Vaccines highly effective against hospitalisation from Delta variant
New analysis by PHE shows for the first time that 2 doses of COVID-19 vaccines are highly effective against hospitalisation from the Delta (B.1.617.2) variant. Published 14 June 2021

Public Health England (page 39).
Investigation of SARS-CoV-2 variants of concern: technical briefings
Technical briefing documents on novel SARS-CoV-2 variants.
Last updated
25 June 2021

European Centre for Disease Prevention and Control. Immune responses and immunity to SARS-CoV-2.
(last update 18 May 2021)

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Have People died after COVID-19 vaccines ?

Yes, people have died after having COVID-19 vaccines.

Recently, a BBC Radio Newcastle presenter, Lisa Shaw was reported to have died after the Astra Zeneca COVID vaccine. Her family is blaming the COVID vaccine for causing clots and ultimately her death.

In India, a Popular Tamil actor and comedian died within 48 hours of receiving a COVID vaccine. His vaccination was broadcast live on TV to encourage public uptake of vaccination but his unfortunate death after vaccination probably ended up causing vaccine hesitancy in some people.

A news article in BMJ reports that the “Pfizer-covid-19 vaccine is “likely” to have been responsible for at least 10 deaths of frail elderly people in nursing homes in Norway”.

But, the most important thing to remember is that deaths are rare after COVID-19 vaccines.

Yes, there are true distressing accounts of vaccine side effects. But what you do not hear is the benefit most people have from vaccines.

Millions of people received vaccines so far with vast majority having no major side effects.

Consider this for context. Think about plane accidents. Millions of people travel by plane without any problems. If People fly safely and reach their destination, it is not headline news. People do not go around saying that they have traveled safely by plane and that they are alive !

But a aeroplane accident which happens rarely is front page news. It would be all over the 24 hour TV news channels across the world. Plane accidents are utterly and unimaginably devastating for those individuals and families involved. But the rare plane accidents do not make most other people avoid flying. The accidents do not mean that no one should travel by plane. The travel by planes has far more benefits than risks for majority of population.

Same with COVID vaccines. Serous Side effects are headline news even if they are very uncommon and rare. The available data indicate benefits are much greater than risks.

So think carefully before you refuse a vaccine.

References

Guardian. Lisa Shaw death: BBC presenter had blood clots after AstraZeneca jab, family says
(Radio Newcastle broadcaster had severe headaches a week after vaccine and fell seriously ill days later, relatives say).
Lisa Shaw
Lucy Campbell
Thu 27 May 2021 18.36 BST

BMJ. News. Covid-19: Pfizer-BioNTech vaccine is “likely” responsible for deaths of some elderly patients, Norwegian review finds
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1372 (Published 27 May 2021)
Cite this as: BMJ 2021;373:n1372

BMJ. Research. Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1088 (Published 13 May 2021)
Cite this as: BMJ 2021;373:n1088

BMJ. News. Covid-19: Risk of cerebral blood clots from disease is 10 times that from vaccination, study finds
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1005 (Published 16 April 2021)
Cite this as: BMJ 2021;373:n1005

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Vaccine Hesitancy

Worries about vaccines are nothing new. Anti_vaccination groups were formed in 1860s when small pox vaccination was made compulsory. Even when small pox was causing untold devastation, some people were opposed to it.

The Vaccine hesitancy of 19th century is somewhat excusable. Some of the worries were real, and not much was known about the safety of small pox vaccine at that time. Lot of people were ill-informed and did not have access to good sources of information. They didn’t know the immense potential of the vaccination to eliminate distressing diseases.

Vaccines have now successfully eradicated small pox. Many other devastating infectious diseases such as polio have been controlled in many countries across the globe due to the vaccines.

Some of the vaccine hesitancy in west is because western people are not fully aware of the devastating power of infectious diseases (at least until COVID-19 came to the world in 2020).

Vaccine hesitancy is also sustained by “confirmation bias” . Confirmation bias is the tendency of human beings to seek information that confirms what they believe in. If you distrust vaccines, you go looking for information that confirms you beliefs and you disregard information that proves vaccines are hugely beneficial.

Some people wish for a 100% safe vaccine. But there is no such thing as completely risk free vaccine. It is true Vaccines can cause serious side effects. It is true that Vaccines can cause long term side effects. It is true that Vaccines can rarely cause life threatening side effects and even deaths.

It is normal to worry about side effects of vaccines. But the potential for side effects should not be the reason to decline vaccination.

One has to look at benefits as well as risks. Some people focus on everything bad that can happen as a result of vaccines.

COVID-19 vaccines had an unusually short development period. This is because of the pandemic. The available evidence indicate that the benefits of the vaccines are far greater than risks. It is true that there is no long term safety data. But in the middle of a pandemic, which has caused untold misery to millions, waiting for perfect long term data is not an option.

If you are sceptical about vaccines, please do focus on benefits as well as risks. Do not focus on risks only.

References

BMJ. Practice Pointer. Covid-19 vaccination hesitancy. BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1138 (Published 20 May 2021)
Cite this as: BMJ 2021;373:n1138

BMJ. News. Covid-19: Pfizer-BioNTech vaccine is “likely” responsible for deaths of some elderly patients, Norwegian review finds.
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1372 (Published 27 May 2021)
Cite this as: BMJ 2021;373:n1372

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Should chemotherapy be used before radiotherpy for bladder cancer?

Yes, chemotherapy given before surgery or radiotherapy for invasive bladder cancer improves cure rates and survival rates.

But there is also strong U.K. data to show that Chemotherapy given along with Radiotherapy is useful because it makes radiotherapy work better .

Should chemotherapy be given before radiotherapy and then followed by more chemotherapy along with radiotherapy ?

There is lot of scientific debate on this question and well known U.K. experts are favouring this “double chemo” approach in-spite of inconclusive new data published in the European Urology journal.

The NICE guidelines on bladder cancer also favours this approach of “double” chemotherapy ( before as well as along radiotherapy).

It is a question that ideally needs to addressed in clinical trials .

Read my views expressed in a letter published in the Journal European Urology

Reference: Re: Syed A. Hussain,
Nuria Porta, Emma Hall, et al. Outcomes in Patients with Muscle-invasive Bladder Cancer Treated with Neoadjuvant Chemotherapy
Followed by (Chemo)radiotherapy in the BC2001 Trial. Eur Urol 2021;79:307–15

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

How effective are the COVID vaccines against the new Indian variant?

Everyone in U.K. hoped that we have turned the corner with this pandemic after the recent spike in infection from the Kent Variant,

But now comes the Variant from India. (the scientific name is B1.617.2 variant of concern).

The Indian variant appears to be more transmissible but no evidence yet that the Indian variant is inherently more deadly than the Kent variant.

Naturally, we are in a better place now than last year because of the vaccination.

But there is some evidence that spontaneous changes (mutations) in the B.1.617.2 variant virus may make it partially resistant to antibodies produced by vaccines.

So how effective are the current vaccines against this Variant from India?

Lab testing shows that the current vaccines can be still effective against the Indian variant but may not be highly effective as it is against the Kent/U.K. variant.

PHE data shows that after two doses, Pfizer vaccine is 88% effective against Indian variant compared to 93% effectiveness against the Kent strain.

After two doses, AstraZeneca jab is 60% effective against Indian variant compared to 66% effectiveness against the Kent variant.

But after the first dose, both vaccines were only 33% effective against Indian variant compared to around 50% efficacy against the Kent strain.

The vaccine protection is better with two doses of vaccine and that’s why the Govt is speeding up second vaccine dose in affected areas.

Fingers crossed, hope this strategy works !

References

BMJ. Covid-19: Caution urged while lockdown eases in England because of vaccine success
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1203 (Published 11 May 2021)
Cite this as: BMJ 2021;373:n1203

BMJ News Covid-19: UK cases of variant from India rise by 160% in a week
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1315 (Published 21 May 2021)
Cite this as: BMJ 2021;373:n1315

U.K. Govt. Most vulnerable offered second dose of COVID-19 vaccine earlier to help protect against variants. From: Department of Health and Social Care. Published 14 May 2021

Telegraph: Two doses of AstraZeneca vaccine provide over 80 per cent protection against Indian variant, PHE study finds.

Guardian. India Covid variant: is it a threat to the UK’s reopening plans?
Ian Sample Science editor
@iansample
Fri 14 May 2021 11.19 BST

Daily Mail. UK is in a ‘very good position’ against Covid variants as Pfizer says there is NO proof current jab needs updating to fight mutant strains. By Luke Andrews Health Reporter For Mailonline
16:30, 10 May 2021 , updated 18:12, 10 May 2021

Daily Mail. How deadly is India’s Covid variant and is it REALLY behind explosion of cases? Scientists say ‘perfect storm’ fuelled nation’s crisis and mutant strain just had a ‘head-start’ – as study shows vaccines DO work against it. By Connor Boyd Assistant Health Editor For Mailonline
16:26, 27 Apr 2021 , updated 08:17, 28 Apr 2021

Collier, DA et al. SARS-CoV-2 B.1.1.7 sensitivity to mRNA vaccine-elicited antibodies. Nature; 11 March 2021; DOI: 10.1038/s41586-021-03412-7

BBC. What is the India Covid variant and will vaccines work?
Soutik Biswas
India correspondent

BBC. Covid: Increasing confidence jabs work against Indian variant
By Doug Faulkner
BBC News

ONS. Coronavirus (COVID-19) Infection Survey, UK: 21 May 2021 (“early signs of a potential increase in the week ending 15 May 2021”)

BBC. Covid: Pfizer and AstraZeneca jabs effective against Indian variant – study
By Dulcie Lee
BBC News

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Can Mistletoe control cancer?

round white fruit

Photo by Pixabay on Pexels.com

No, there is no good clinical evidence to show that Mistletoe therapy improves life expectancy or quality of life of cancer patients.

Laboratory studies have indicated that Mistletoe might have some clinical activity. But activity seen in lab setting is not good enough for using it in actual patients.

The popularity of mistletoe extracts continues unabated despite their unproven efficacy in oncology.

The clinical evidence does not support use of Mistletoe as a standard therapy for cancer.

Mistletoe is best used as Christmas decoration only !

References:

1. Mistletoe and cancer: controversies and perspectives. Patrick J Mansky. Semin Oncol. 2002 Dec.

2. Is Mistletoe Treatment Beneficial in Invasive Breast Cancer? A New Approach to an Unresolved Problem. Peter Fritz et al. Anticancer Res. 2018 Mar.

3. Molecular mechanisms of mistletoe plant extract-induced apoptosis in acute lymphoblastic leukemia in vivo and in vitro. Georg Seifert et al. Cancer Lett. 2008.

4. From ill-defined extracts to the immunomodulatory lectin: will there be a reason for oncological application of mistletoe?H J Gabius et al. Planta Med. 1994 Feb.

 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 DO 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 may 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 Cervical cancer

Advanced Cervical cancer which has come back after surgery or radiotherpy is usually treated with chemotherapy.

There is a new immunotherapy treatment option for all advanced cervical cancer patients now .

At the European Society of Medical Oncology (ESMO 2021) virtual conference, an international team of investigators, presented trial data regarding this new immunotherapy drug called cemiplimab.

One group of patients in the trial received the immunotherapy drug cemiplimab every 3 wks and another group of patients received intravenous chemo (pemetrexed, vinorelbine, gemcitabine, irinotecan or topotecan).

Cemiplimab significantly improved survival of patients and was better than chemotherapy.

This new immunotherapy drug cemiplimab is already being used for skin cancers and vulval skin cancers. Very soon, it would be used in cervical cancer patients.

Reference

ESMO 2022 Virtual Plenary Resources:
RANDOMISED PHASE III TRIAL DATA ON THE EFFICACY AND SAFETY OF CEMIPLIMAB AS OPPOSED TO CHEMOTHERAPY IN PATIENTS WITH PROGRESSIVE ADVANCED CERVICAL CANCER. Presenter: Krishnansu S. Tewari, USA; Discussant: Mansoor Mirza, Denmark;

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

What has ‘Public health’ ever done for us ?

An apple a day might not keep the doctor away. But a good public health team can keep the doctors away for many people!

Public health is about prevention and promotion of health in the society.

Public health is largely responsible for the significant improvements in life expectancy over the last 150 years.

Providing people with clean drinking water, removal of rubbish from houses and streets, good sewage system, and vaccination has saved many millions of lives over the years.

The recent smoking ban in work-places, public places and indoor venues is a modern example of public health activity.

The one area where public health has not been hugely successful is obesity. It may be because of the reliance on nudging the individual to change rather than dealing with underlying structural problems.

Read my letter in BMJ and make your views known at the BMJ rapid response section.

Sundar S. Public health needs to go back to basics, not rely on nudge theory.

Toll-free link:
http://bmj.com/cgi/content/full/bmj.n1153?ijkey=CUQNozGH9yJeK57&keytype=ref

References:

BMJ. Lifestyle and socioeconomic group on health
Public health needs to go back to basics, not rely on nudge theory
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1153 (Published 06 May 2021)
Cite this as: BMJ 2021;373:n1153

BMJ. Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2161 (Published 08 June 2010)
Cite this as: BMJ 2010;340:c2161

BMJ. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n604 (Published 14 April 2021)
Cite this as: BMJ 2021;373:n604

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO 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 may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Does breast feeding the baby protect the mother from heart diseases in later life ?

Yes, it can.

A Study published in British Medical Journal found that “A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease”

The study also found that women who had certain pregnancy related complications were also at increased risk of heart disease in later life.

In addition, the study also found that taking contraceptive pills (combined pills) in younger age led to increased risk of heart disease and stroke in later life.

Awareness of these risks would help to take steps to reduce the risk from them.

References

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3502 (Published 07 October 2020). Cite this as: BMJ 2020;371:m3502. https://www.bmj.com/content/371/bmj.m3502

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 DO 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 may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Selenium can be harmful for Skin cancer patients

Nutritional supplements are often tried to prevent cancer. But well- designed rigorously conducted clinical trials have NOT shown any benefit in prevention of many cancers.

Selenium was suggested as a preventative supplement for skin cancer.

A clinical trial compared Selenium against placebo in United States. The results were disappointing.

Selenium supplementation was found to be ineffective at preventing Skin cancers.

To make matters worse, Selenium was found to Harmful and increased the the risk of getting some skin cancers such as squamous cell carcinoma.

Selenium Supplementation and Secondary Prevention of Nonmelanoma Skin Cancer in a Randomized Trial. Anna J. Duffield-Lillico, Elizabeth H. Slate, Mary E. Reid, Bruce W. Turnbull, Patricia A. Wilkins, Gerald F. Combs, Jr., H. Kim Park, Earl G. Gross, Gloria F. Graham, M. Suzanne Stratton… Show moreJNCI: Journal of the National Cancer Institute, Volume 95, Issue 19, 1 October 2003, Pages 1477–1481, https://doi.org/10.1093/jnci/djg061

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.

Vitamin D reduces risk of advanced cancer in normal-weight individuals.

“An ounce of prevention better than a pound of cure” is certainly true when it comes to cancer prevention.

Vitamin D, the “sunshine” vitamin has been proven to reduce risk of advanced cancers an large American study.

The study presented at the ASCO ( American Society of Clinical Oncology) virtual scientific symposium in 2020,

“The VITamin D and OmegA-3 TriaL (VITAL) was a high quality study. The study randomly assigned patients to Vitamin D3 supplements and/or omega-3 fatty acid supplements and/or both or placebo in 25,871 men and women.

The study found that “vitamin D supplementation decreased risk of developing advanced cancers by 17% compared with placebo ”

“Omega-3 supplementation did not reduce the incidence of advanced cancer.”

Reference:

Vitamin D Reduces Incidence of Advanced Cancers in Normal-Weight Individuals. ASCO Annual Meeting 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.

Anything potentially good from this COVID-19 pandemic?

It might seem foolish to ask the question “Anything good from this COVID-19 pandemic?” when so many people across the world has been so badly affected by the coronavirus pandemic.

There is some truth in the proverb that “every dark cloud has a silver lining” and no matter how bad the current pandemic is now, human spirit and endeavour would get something positive out of it.

One possible good thing that has come out of the pandemic is the “mRNA technology”.

Of the three vaccines so far, two of them the Pfizer vaccine and the Moderna vaccine are based on RNA technology.

The successful use of RNA technology for Coronavirus Vaccines would hopefully enable the versatile RNA technology to be further developed and successfully used a cancer treatment in near future.

Further clinical trials in cancer patients would be done to provide proof of their potential.

References:

Bloomberg. Technology & Ideas. mRNA Vaccines Could Vanquish Covid Today, Cancer Tomorrow.
The best news about the mRNA shots from BioNTech and Moderna is that the same technique could also defeat many other diseases.

MSKCC. In a Twist, Scientists Find Cancer Drivers Hiding in RNA, Not DNA.

Jerusalem Post Health & Science. Israeli scientists use mRNA COVID-19 vaccine technology to fight cancer. By MAAYAN JAFFE-HOFFMAN NOVEMBER 24, 2020 20:08

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 DO 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 may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Where can I find official detailed information about the three COVID vaccines (Pfizer, Astra Zeneca and Moderna)

You might have read information about the COVID vaccines on various news outlets and social media messages.

If you want complete summary information about vaccines approved by the regulatory authorities, click on the links below.

Two types of information leaflets accompany all licensed medicines.
– One is meant for health professionals and has lot of clinical information. (called SPC)
– The other is meant for patients and public and provides a summary of facts using lay terms.(called PIL).

The leaflets provide information about all common side effects observed in the trials.

Oxford Astra Zeneca: Professionals Version .

Oxford Astra Zeneca: Patient Version

Pfizer. Professionals Version

Pfizer. Patient Version

Moderna. Professionals Version

Moderna. Patient Version

FDA USA: Pfizer-BioNTech COVID-19 vaccine prescribing informationexternal

FDA USA: Moderna COVID-19 vaccine prescribing informationexternal

The above links reproduced below with longer titles and date of publication.

Please note when new significant information comes to light, the company and regulatory authorities are likely to update the information leaflets.

Oxford Vaccine : Information for Healthcare Professionals on COVID-19 Vaccine AstraZeneca
Updated 7 January 2021.

Oxford Vaccine: MHRA. Information for UK recipients on COVID 19 Vaccine AstraZeneca
Updated 7 January 2021.

Pfizer Vaccine. MHRA. Information for Healthcare Professionals on Pfizer/BioNTech COVID-19 vaccine
Updated 31 December 2020

Pfizer Vaccine. MHRA. Information for UK recipients on Pfizer/BioNTech COVID-19 vaccine
Updated 31 December 2020

Moderna. MHRA. Information for Healthcare Professionals on COVID-19 Vaccine Moderna
Updated 8 January 2021.

Moderna. MHRA. Information for UK recipients on COVID-19 Vaccine Moderna
Updated 8 January 2021.

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 DO 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 may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

A third Vaccine approved for protection against COVID-19 Coronavirus infection

Pfizer Vaccine and Astra Zeneca/Oxford Vaccine were approved last month by the UK regulatory authorities.

Now the regulatory authorities have approved a third vaccine. The third vaccine from Moderna along with two other vaccines should help to bring the pandemic to an end.

The Moderna vaccine is a new technology like the Pfizer Vaccine. (based on mRNA technology).

Like the two vaccines, the short term data for Moderna vaccine is very encouraging.

Over long term, one hopes that the protective effect of all the three vaccines is long lasting and that they remain effective against any new variants of coronavirus that might emerge in the coming months.

Overall, there is certainly ‘light at end of the tunnel’ and the world can emerge out of this horrific pandemic in a short period.

BBC. Moderna becomes third Covid vaccine approved in the UK
By Michelle Roberts
Health editor, BBC News online

BBC.Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK
By Michelle Roberts
Health editor, BBC News online
Published2 December 2020

BBC. Covid-19: Oxford-AstraZeneca vaccine approved for use in UK
By James Gallagher and Nick Triggle
BBC News
Published30 December 2020

MHRA. Oxford University/AstraZeneca COVID-19 vaccine approved.

MHRA. Moderna vaccine becomes third COVID-19 vaccine approved by UK regulator.

MHRA. UK medicines regulator gives approval for first UK COVID-19 vaccine.

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 DO 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 may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are not in way intended to be a substitute for professional advice.

Can a Vegan diet help weight loss?

Yes, Vegan diet can help weight loss.

Lot of diets promoted by Magazines, Social Media Influencers and Celebrities do not have strong scientific evidence in favour of them.

A scientifically sound trial published by the medical journal JAMA ( Journal of American Medical Association) recently, found the Vegan Diet helped weight loss and promoted Good metabolism.

The trial involving 244 participants found that over 16 weeks, body weight decreased on average by 5.9 kg in those having a Vegan Diet. That’s very impressive!

References: Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial
Hana Kahleova et al. JAMA Netw Open. 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.

New oral medication approved for Prostate Cancer

Advanced Prostate cancer can be successfully controlled for many years by hormone therapy.

Until now, the hormone therapy, which is widely used widely used, involved either hormone injections or hormone implants.

The FDA in USA has recently approved a new novel oral medication for prostate cancer. It acts quickly and has been proven to be highly active. It is taken as a daily oral medication. It is reasonably well tolerated.

It is not known when the medication would be approved in UK and Europe.

References

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

(2) FDA approval. FDA approves relugolix for advanced prostate cancer.

(3) Information about Relugolix. FDA: HIGHLIGHTS OF PRESCRIBING INFORMATION. and FULL PRESCRIBING INFORMATION.

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 DO 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 may 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 the new variant of Coronavirus more dangerous?

Yes and No

The new mutant is more dangerous because it is more easily transmissible from person to person. The new variant is now spreading very rapidly in London and South East of England.

But, so far, the new variant has NOT been found to be more deadly than the original version. The new variant does NOT seem to have substantially increased the risk of hospitalisation and death anymore than the original version of coronavirus.

Emergence of this new mutant (called variant VUI-202012/01 fall) is a certainly a worrying development in this pandemic.

The mutations has made the new strain 70 per cent more transmissible but scientists do not expect these mutations to reduce the effectiveness of vaccines.

Tests are being carried out to confirm that the existing vaccines would still have a high degree of protective affect.

It is an evolving area and we have to hope that the new variant doesn’t make things worse than they are now !

Covid-19: New coronavirus variant is identified in UK. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020)
Cite this as: BMJ 2020;371:m4857

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.

Should a patient avoid a surgeon on the surgeons’ birthday?

If you are going to have an emergency surgery, it may be worthwhile asking your surgeon whether it is their birthday on that day.

If you accept the findings of a recent study at face value, one should weigh up the pros and cons of seeking a different surgeon if one is available or request your surgeon to be extra careful.

An intriguing paper published in BMJ recently suggests so. The study looked at the outcome of Medicare patients who underwent emergency surgery in USA. It is a very large study in which 980876 procedures performed by 47489 surgeons were analyzed. Hence the study findings do need to be taken very seriously.

The study found that patients operated by surgeons on the surgeons’ birthday had a higher risk of death.

The study provocatively suggests, without any direct proof, that surgeons were possibly distracted on their birthdays and in their rush to go to their birthday celebration, they might have done “botched emergency surgeries” by not concentrating properly during surgery and by not providing good post-operative care.

The findings are entirely plausible from behavioural psychology point of view and the study authors seem to have done a thorough statistical analysis of various factors that could have spuriously affected the death rates.

Nevertheless, there remains a distinct possibility that the study findings are spurious. For instance, the scientific community is aware of the fact that if “any data is tortured enough”, the dataset will cough up spurious and unexpected results.

Apart from data dredging , one has to take findings from observational studies with a “pinch of salt”. That’s why we often see conflicting results about Nutrition published in Newspapers all the time.

Genuine Surgical errors can sometimes lead to death but much more commonly surgical errors can often lead to increase in rate of surgical complications. It is a bit of stretch for the study to suggest that surgeons all over the country are doing “ technically poor surgeries” everyday if that day happens to be their birthday and they are doing it in such a way to cause deaths without causing any surgical complications.

We don’t know whether the study inadvertently looked at male surgeons working on weekends at rural non-teaching hospitals as these factors could have a bearing on death rates.

Sad life events can adversely affect the work performance of any human being. But happy people are more productive at work. So the conclusion by the study that a happy event, such as a birthday, can adversely affect a surgeon’s performance deserves more scrutiny in a well designed study.

Read the full paper at BMJ website and share your views at the BMJ rapid response section.

References.(1). BMJ. Patient mortality after surgery on the surgeon’s birthday: observational study. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4381 (Published 10 December 2020)
Cite this as: BMJ 2020;371:m4381

(2) Conflicting healthy eating advice leaving public ‘clueless’, poll suggests. Rob Knight
Tuesday 16 July 2019 14:56

(3). Does Employee Happiness have an Impact on Productivity?. Saïd Business School WP 2019-13

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 red meat bad for heart?

Yes, red meat can increase the risk of developing heart disease.

A large study involving more than 43,000 men conducted at USA shows that “Red meat increased the risk of developing heart disease “.

In contrast , plant proteins such as nuts and lentils reduced the risk of developing heart disease.

References: Red meat intake and risk of coronary heart disease among US men: prospective cohort study.
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4141 (Published 02 December 2020)
Cite this as: BMJ 2020;371:m4141

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 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

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, 2020. DOI: 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, 2020. DOI: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.

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.

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.

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.

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.

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

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.

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.

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.

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.