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The Medical Week In Review
Episode 6: 22 May 2022
Welcome to the Medical Week in Review.
We're taking a break from our podcasting series to upgrade our audio technology to a new platform for the next few weeks. But that's no reason not to keep you up to date with what's happening around the world, the good old-fashioned way – a written newsletter. So that's what we will be doing till our new platform launches!
Now that you know what's happening with MedED, here is what has been happening in the world of medicine for the week ending 22 May 2022.
First up, as always, matters COVID, and despite what you might think given the waning media attention, the virus is still here. Many countries, including South Africa, are either in or entering the fifth wave. Indeed some countries appear never to have left the wave.
What has started to emerge over the last few weeks, however, is an increasing amount of research regarding the effects of the virus in the long-term, including the knock-on effect the pandemic had on other illnesses; the effects that long- COVID is having on several body systems, and the unexpected impacts of the vaccine.
Onto the weekly tally of cases for sub-Saharan Africa, and as of 22 May, here at home, the National Institute of Communicable Diseases recorded 6,375 positive cases for the last week, representing a 19.5% positivity rate. We are, therefore, still well in weeds locally. With our health system in a state of increasing disarray or downright failure, let's hope the virus continues to present in a milder form.
As far as our neighbours are concerned, except for Namibia, which recorded 4210 new cases on 22 May, they all appear to be recording very low 7-day average figures: Botswana recorded 41 cases, Kenya 21 cases, Zimbabwe 205 cases, and Nigeria – no cases. It all comes down to how and what you report and highlights again that all data should be considered in context.
Our COVID story for the week is the ongoing "should-we-shouldn't we" vaccine saga and its bedfellow, the fallout from taking the COVID vaccine.
A new piece of research published in the BMJ this week sought to answer whether the incidence of long-Covid increased or decreased when participants received a second vaccination post-infection. Entitled Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study, the observational cohort study reviewed 28 356 participants, aged between 18 - 68 years, who received at least one dose of either an adenovirus vector or an mRNA vaccine after testing positive for COVID infection.
The study found that participants who received the vaccine were less likely to experience long covid symptoms and the evidence even suggested a "sustained improvement after a second dose" over the median follow-up period of 67 days.
And that's our COVID round-up for the week. Links to all our source articles as always listed below
Links
COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study (BMJ)
Latest confirmed cases of COVID-10 in South Africa ( 20 May 2022) (NICD)
Next up: Yet another zoonotic infection making its way onto the global stage – Monkeypox
Most of us have been inundated with information regarding the infection. If not, the National Institute of Communicable Disease's website carries a full briefing on the clinical presentation and management strategies so I won't go into those details. Nonetheless, I thought it might be interesting to provide some context to the virus.
No cases have, as yet, been identified in South Africa. Fifteen countries – including the U.K., US, Spain, and Portugal – have reported a combined total of 140 cases.
The first of those cases was identified in the U.K. by a traveller from Nigeria, a country where monkeypox is endemic. According to the NICD, genomic sequencing determined that the strain identified in Portugal was the less virulent West African strain - the other being the Congo Basin strain - which is similar to the strain of the infection identified in the UK, Israel and Singapore in 2019
As far as prevention of the disease is concerned, in 2019, the U.S. Food and Drug Administration approved the first vaccine for monkeypox. That vaccine is also apparently effective against smallpox - and given global past-performance in the last two years, we can expect there to be a rush on whatever stock is available. While there is no vaccination approved for use in the E.U., according to an article in Financial Times, on the 22nd, the E.U.'s infectious-disease agency recommended that member states "….prepare strategies for possible vaccination programmes with the smallpox vaccine," and that is likely to have an impact on the availability of that vaccine for the purposes it was intended. (F.T., 22 May 2022)
Link:
Situation Update: Monkeypox ( NCID, Press Release 23 May 2022)(NCID)
Monkeypox: What do we know about the outbreaks in Europe and North America?(BMJ)
EU health agency advises member states to plan for monkeypox jabs (FT)
Wild Polio rears its head again: A follow-up story
As always, we try and follow up on articles reviewed previously. This week, given our focus on infectious diseases, we followed up on the confirmed case of the wild-polio virus found in a little girl in Malawi in February this year (2022). Malawi quickly reacted, declaring a public health emergency and implementing an extensive vaccination campaign. After that, no new cases were determined, and the spread of infection appeared to have halted. Until now.
Earlier this week, on 18 May, Mozambique recorded its first case of the wild poliovirus in a child in the country's north-eastern Tete province. Like the Malawi case, genomic sequencing showed this case was linked to the strain circulating in Pakistan in 2019.
While it is hardly unexpected that the virus has spread, and granted, it is still on a low scale, we would do well to pay attention and upgrade our vaccination program here in South Africa. A polio outbreak in this country would be devasting ( as in any country) and one we can ill afford.
As always, we'll keep an eye on that story for you.
Link:
Mozambique sees first wild polio case since 1992 (DW)
New hope for neurodegenerative diseases
This week saw the publication of a study in the journal Science, which looked into the effect that targeting the chemokine caspase 3 and the subsequent impact that had on CXCR5 and CXCL13 could have on either halting degeneration or fostering neuroregeneration.
The basis for the study was the need to understand better the molecular mechanisms which cause regenerative failure in ageing. The researchers highlighted the lack of knowledge in this field, which hamper the development of treatments for neuronal regeneration.
To this end, the scientists performed RNA sequencing on the dorsal root ganglia in sciatic nerve injury in mice and compared their findings in young mice with those in aged mice.
The RNA sequencing revealed enrichment in T-cell signalling before and after sciatic nerve injury in the mice. Specifically, and I'll quote here from the research:
This is a significant finding for the possibilities it poses for neurodegenerative disease of old age and for regenerative decline and injury evidenced in a host of degenerative diseases and trauma such as spinal injury.
Link
Reversible CD8 T cell–neuron cross-talk causes aging-dependent neuronal regenerative decline (Science)
Ethics, Legalities and Medical Practice
Finally in matters ethics and medical practice, and the state of healthcare in our country.
This week an open letter to the Health Department, published in the Daily Maverick, paediatrician Dr Tim De Maayer painted a bleak, heart-breaking, fury-inducing picture of the state of our public hospitals. In this letter, he asks how the administrators can simply ignore the dire situations witnessed every day in our hospitals.
As a practitioner in the Reheema Moosa Mother and Child Hospital in Johannesburg, he details the havoc that a lack of basic maintenance, load-shedding and water shortages are causing, and the impact it is having on the delivery of care to these most vulnerable of our population. As a former ICU healthcare worker, when I read about the NICU specialists intubating by cell phone light, the lack of essential equipment such as O2 monitors, and neonates lying in unheated incubators, anger is too simple a word to describe what I feel.
Shame on the health department, shame on our government.
Thank you to those public healthcare workers who persevere despite everything – the country owes you a debt that can never be repaid.
Link
Paediatrician Dr Tim De Maayer's open letter to Health Department heads: 'How do you manage to come to work every day, fail at your job of ensuring basic healthcare for the people you serve and still sleep at night?(DM)
And then the moment you've all been waiting for – it's Medical Trivia time.
This week in honour of the monkeypox outbreak, we look at smallpox and its eradication as a global infectious disease.
So as mentioned in the previous story, in 1980, the WHO declared that smallpox had been eradicated. This was no small feat considering that the disease has been around for at least 3000 years. Indeed, according to our source article from the WHO, smallpox scaring has been found on Egyptian mummies.
The earliest written record of a disease thought to be smallpox appeared in China in the 4th century C.E. The disease spread from China to Korea in the 6th Century) and then onto Japan, And as trade increased, so did the spread of the disease. So deadly was the contagion, that over 300 million people were thought to have perished in the 20 century alone.
Smallpox was only eradicated thanks to a 10-year global effort spearheaded by the World Health Organization that involved thousands of health workers around the world to administer half a billion vaccinations to stamp out smallpox.
There have indeed been no recorded cases of naturally occurring smallpox since the WHO made its declaration in 1980. Only small quantities of the virus exist in research laboratories in Russia and Atlanta, Georgia in the US.
So if you didn't know – now you do.
Link:
And that is all for the Week in Review.
f you liked this newsletter please tell your friends about it. If there are stories you’d like me to focus on drop me a line using the contact details on www.meded.co.za
All that's left is to say, wherever you are, stay safe, stay sane, and join me next week where I review the week in medicine.
This has been a production on the Medical Education Network – delivering quality medical education and information to Southern Africa since 2008. All thoughts and comments on this podcast remain that of its creators. Every effort has been made to fact check the information contained here. Any errors or misstatements that may occur are unintentional.
Episode 6: 22 May 2022
Welcome to the Medical Week in Review.
We're taking a break from our podcasting series to upgrade our audio technology to a new platform for the next few weeks. But that's no reason not to keep you up to date with what's happening around the world, the good old-fashioned way – a written newsletter. So that's what we will be doing till our new platform launches!
Now that you know what's happening with MedED, here is what has been happening in the world of medicine for the week ending 22 May 2022.
First up, as always, matters COVID, and despite what you might think given the waning media attention, the virus is still here. Many countries, including South Africa, are either in or entering the fifth wave. Indeed some countries appear never to have left the wave.
What has started to emerge over the last few weeks, however, is an increasing amount of research regarding the effects of the virus in the long-term, including the knock-on effect the pandemic had on other illnesses; the effects that long- COVID is having on several body systems, and the unexpected impacts of the vaccine.
Onto the weekly tally of cases for sub-Saharan Africa, and as of 22 May, here at home, the National Institute of Communicable Diseases recorded 6,375 positive cases for the last week, representing a 19.5% positivity rate. We are, therefore, still well in weeds locally. With our health system in a state of increasing disarray or downright failure, let's hope the virus continues to present in a milder form.
As far as our neighbours are concerned, except for Namibia, which recorded 4210 new cases on 22 May, they all appear to be recording very low 7-day average figures: Botswana recorded 41 cases, Kenya 21 cases, Zimbabwe 205 cases, and Nigeria – no cases. It all comes down to how and what you report and highlights again that all data should be considered in context.
Our COVID story for the week is the ongoing "should-we-shouldn't we" vaccine saga and its bedfellow, the fallout from taking the COVID vaccine.
A new piece of research published in the BMJ this week sought to answer whether the incidence of long-Covid increased or decreased when participants received a second vaccination post-infection. Entitled Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study, the observational cohort study reviewed 28 356 participants, aged between 18 - 68 years, who received at least one dose of either an adenovirus vector or an mRNA vaccine after testing positive for COVID infection.
The study found that participants who received the vaccine were less likely to experience long covid symptoms and the evidence even suggested a "sustained improvement after a second dose" over the median follow-up period of 67 days.
And that's our COVID round-up for the week. Links to all our source articles as always listed below
Links
COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study (BMJ)
Latest confirmed cases of COVID-10 in South Africa ( 20 May 2022) (NICD)
Next up: Yet another zoonotic infection making its way onto the global stage – Monkeypox
Most of us have been inundated with information regarding the infection. If not, the National Institute of Communicable Disease's website carries a full briefing on the clinical presentation and management strategies so I won't go into those details. Nonetheless, I thought it might be interesting to provide some context to the virus.
No cases have, as yet, been identified in South Africa. Fifteen countries – including the U.K., US, Spain, and Portugal – have reported a combined total of 140 cases.
The first of those cases was identified in the U.K. by a traveller from Nigeria, a country where monkeypox is endemic. According to the NICD, genomic sequencing determined that the strain identified in Portugal was the less virulent West African strain - the other being the Congo Basin strain - which is similar to the strain of the infection identified in the UK, Israel and Singapore in 2019
As far as prevention of the disease is concerned, in 2019, the U.S. Food and Drug Administration approved the first vaccine for monkeypox. That vaccine is also apparently effective against smallpox - and given global past-performance in the last two years, we can expect there to be a rush on whatever stock is available. While there is no vaccination approved for use in the E.U., according to an article in Financial Times, on the 22nd, the E.U.'s infectious-disease agency recommended that member states "….prepare strategies for possible vaccination programmes with the smallpox vaccine," and that is likely to have an impact on the availability of that vaccine for the purposes it was intended. (F.T., 22 May 2022)
Link:
Situation Update: Monkeypox ( NCID, Press Release 23 May 2022)(NCID)
Monkeypox: What do we know about the outbreaks in Europe and North America?(BMJ)
EU health agency advises member states to plan for monkeypox jabs (FT)
Wild Polio rears its head again: A follow-up story
As always, we try and follow up on articles reviewed previously. This week, given our focus on infectious diseases, we followed up on the confirmed case of the wild-polio virus found in a little girl in Malawi in February this year (2022). Malawi quickly reacted, declaring a public health emergency and implementing an extensive vaccination campaign. After that, no new cases were determined, and the spread of infection appeared to have halted. Until now.
Earlier this week, on 18 May, Mozambique recorded its first case of the wild poliovirus in a child in the country's north-eastern Tete province. Like the Malawi case, genomic sequencing showed this case was linked to the strain circulating in Pakistan in 2019.
While it is hardly unexpected that the virus has spread, and granted, it is still on a low scale, we would do well to pay attention and upgrade our vaccination program here in South Africa. A polio outbreak in this country would be devasting ( as in any country) and one we can ill afford.
As always, we'll keep an eye on that story for you.
Link:
Mozambique sees first wild polio case since 1992 (DW)
New hope for neurodegenerative diseases
This week saw the publication of a study in the journal Science, which looked into the effect that targeting the chemokine caspase 3 and the subsequent impact that had on CXCR5 and CXCL13 could have on either halting degeneration or fostering neuroregeneration.
The basis for the study was the need to understand better the molecular mechanisms which cause regenerative failure in ageing. The researchers highlighted the lack of knowledge in this field, which hamper the development of treatments for neuronal regeneration.
To this end, the scientists performed RNA sequencing on the dorsal root ganglia in sciatic nerve injury in mice and compared their findings in young mice with those in aged mice.
The RNA sequencing revealed enrichment in T-cell signalling before and after sciatic nerve injury in the mice. Specifically, and I'll quote here from the research:
"Lymphotoxin activated the transcription factor NF-κB, which induced expression of the chemokine CXCL13 by neurons. This in turn recruited CXCR5+CD8+ T cells to injured DRG neurons overexpressing major histocompatibility complex class I. CD8+ T cells repressed the axonal regeneration of DRG neurons via caspase 3 activation. CXCL13 neutralization prevented CXCR5+CD8+ T cell recruitment to the DRG and reversed aging-dependent regenerative decline, thereby promoting neurological recovery after SNI. Thus, axonal regeneration can be facilitated by antagonizing cross-talk between immune cells and neurons."
This is a significant finding for the possibilities it poses for neurodegenerative disease of old age and for regenerative decline and injury evidenced in a host of degenerative diseases and trauma such as spinal injury.
Link
Reversible CD8 T cell–neuron cross-talk causes aging-dependent neuronal regenerative decline (Science)
Ethics, Legalities and Medical Practice
Finally in matters ethics and medical practice, and the state of healthcare in our country.
This week an open letter to the Health Department, published in the Daily Maverick, paediatrician Dr Tim De Maayer painted a bleak, heart-breaking, fury-inducing picture of the state of our public hospitals. In this letter, he asks how the administrators can simply ignore the dire situations witnessed every day in our hospitals.
As a practitioner in the Reheema Moosa Mother and Child Hospital in Johannesburg, he details the havoc that a lack of basic maintenance, load-shedding and water shortages are causing, and the impact it is having on the delivery of care to these most vulnerable of our population. As a former ICU healthcare worker, when I read about the NICU specialists intubating by cell phone light, the lack of essential equipment such as O2 monitors, and neonates lying in unheated incubators, anger is too simple a word to describe what I feel.
Shame on the health department, shame on our government.
Thank you to those public healthcare workers who persevere despite everything – the country owes you a debt that can never be repaid.
Link
Paediatrician Dr Tim De Maayer's open letter to Health Department heads: 'How do you manage to come to work every day, fail at your job of ensuring basic healthcare for the people you serve and still sleep at night?(DM)
And then the moment you've all been waiting for – it's Medical Trivia time.
This week in honour of the monkeypox outbreak, we look at smallpox and its eradication as a global infectious disease.
So as mentioned in the previous story, in 1980, the WHO declared that smallpox had been eradicated. This was no small feat considering that the disease has been around for at least 3000 years. Indeed, according to our source article from the WHO, smallpox scaring has been found on Egyptian mummies.
The earliest written record of a disease thought to be smallpox appeared in China in the 4th century C.E. The disease spread from China to Korea in the 6th Century) and then onto Japan, And as trade increased, so did the spread of the disease. So deadly was the contagion, that over 300 million people were thought to have perished in the 20 century alone.
Smallpox was only eradicated thanks to a 10-year global effort spearheaded by the World Health Organization that involved thousands of health workers around the world to administer half a billion vaccinations to stamp out smallpox.
There have indeed been no recorded cases of naturally occurring smallpox since the WHO made its declaration in 1980. Only small quantities of the virus exist in research laboratories in Russia and Atlanta, Georgia in the US.
So if you didn't know – now you do.
Link:
Commemorating Smallpox Eradication – a legacy of hope, for COVID-19 and other diseases
Smallpox
And that is all for the Week in Review.
f you liked this newsletter please tell your friends about it. If there are stories you’d like me to focus on drop me a line using the contact details on www.meded.co.za
All that's left is to say, wherever you are, stay safe, stay sane, and join me next week where I review the week in medicine.
This has been a production on the Medical Education Network – delivering quality medical education and information to Southern Africa since 2008. All thoughts and comments on this podcast remain that of its creators. Every effort has been made to fact check the information contained here. Any errors or misstatements that may occur are unintentional.
