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26 June 2022
Welcome to the Medical Week in Review for the week ending June 26 2022.
This week, we're writing our review as load shedding 6 rolls in over South Africa. As we've only had a few hours to compile all our content, you will forgive us if this week's edition is short and sweet. Here's hoping next week bring us all power… to survive Eskom!
Happy reading!
Quick Access Links
Matters COVID
Infectious Disease Update
Ageing and Age care
Focus on Paediatrics
Ophthalmology
Tech Talks
Ethics,Legalities and Medical Practice
Medical Trivia
Matters COVID
That said, we'll post a quick overview of the stats to keep our eye on any impact this may have on our national and sub-Saharan tally.
For the week ending June 26, 22, South Africa again recorded a decrease in cases from last week (1140), with 634 cases recorded for its 7-day average. We're making that our benchmark to determine what impact the lifting of restrictions may have in the weeks to come.
Onto our neighbours and Namibia recorded a dramatic drop with only 32 cases recorded vs the 176 cases recorded last week; Botswana again recorded raised figures from last week's 544 cases, almost matching South Africa's total with 612 cases recorded on the 25 June; Kenya recorded a slight increase, with 411 cases, up from 368 last week. Zimbabwe again saw a slight drop, recording 79 cases on their 7-day average total vs 107 cases last week; and finally, Nigeria recorded 55 cases vs 11 cases last week. ( All figures reflect 7-day averages)
And that's our COVID round-up for the week. Links to all our source articles as always listed below
1. COVID-19 Data Repository by the Center for Systems Science and Engineering ( CSSE) at Johns Hopkins University
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Infectious Disease Update
This week South Africa recorded its first case of Monkeypox. According to the NCID, the case was detected in a 30-year-old man from Gauteng. They report that the man had no travel history.
In a follow-up story to our report last week, the International Health Regulations Emergency Committee of the WHO, which met on the 23rd of June, did not declare Monkeypox a public health emergency of international concern. They recommended increasing vigilance concerning contact tracing of confirmed cases and monitoring all laboratory-confirmed cases. We do not have an update on the renaming of the virus we reported last week, but we are keeping an eye on that story for you.
You can access the WHO's ongoing multi-country update below.
In other stories of interest, the UK Health Security Agency posted an alert on the 22nd of June stating it had found "…poliovirus in sewage samples collected from the London Beckton Sewage Treatment Works."
According to the alert, it is customary to find up to 3 polioviruses each year in the ordinary course of surveillance of sewer systems. Those viruses are derived from travellers to the UK from overseas countries, who had received the live oral polio vaccine, and were not detected on an ongoing basis.
The current samples revealed several closely-related viruses in samples taken between February and May. Concerningly, the alert notes that "…the virus has continued to evolve and is now classified as a 'vaccine-derived' poliovirus type 2 (VDPV2), which on rare occasions can cause serious illness, such as paralysis, in people who are not fully vaccinated."5
You will remember the last few months have seen cases of the wild poliovirus in Africa, thought to be the Pakistan variant. The previous case of wild polio in the UK was detected in 1984
This is thought to be yet another impact of declining childhood vaccination rates. The UK Health and Safety Agency urges parents to ensure their children's vaccinations are up to date.
Links
2. Monkeypox case identified in South Africa (NCID)
3. Meeting of the International Health Regulations (2005) Emergency Committee regarding the multi-country monkeypox outbreak (WHO)
4. Multi-country monkeypox outbreak: situation update (WHO)
5. Poliovirus detected in sewage from North and East London
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Age and Age Care
This week the search for an effective treatment for Parkinson's disease received a significant boost. Researchers have determined that DNL201, a first-in-class CNS penetrant, has significantly reduced leucine-rich repeat kinase 2 (LRRK2) activity and restores lysosomal function in animal models. LRRKS is the most common genetic risk factor for Parkinson's disease. Its activity is thought to "impair lysosomal function"6 and contribute to the disease.
In human volunteers and patients, the treatment appears to have an impact on lysosomal function and was generally well tolerated
Mutations in leucine-rich repeat kinase 2 (LRRK2) are the most common genetic risk factors for Parkinson's disease (PD). Increased LRRK2 kinase activity is thought to impair lysosomal function and may contribute to the pathogenesis of PD.
These findings hold significant promise for developing a "disease-modifying therapeutic targeted for PD.” 6 Furthermore, the results support the advancement of studies that consider using LRRK2 inhibitors "in late-stage clinical studies in patients with Parkinson's disease."6
Links
6. Preclinical and clinical evaluation of the LRRK2 inhibitor DNL201 for Parkinson's disease ( Science)
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Focus on Paediatrics
A study published in JAMA Paediatrics this week looked at the fascinating evidence coming out of the states that pointed to a decline in cases of Kawasaki disease(KD) during the pandemic.
According to the researchers, an increase in multisystem inflammatory presentations was seen in children during COVID, which was initially thought to be KD. However, clinicians soon determined the disease profile reflected a new illness paradigm - multisystem inflammatory disease (MIS-C) - arising from exposure to the SARS-CoV-2 virus.
That established concurrently, instances of KD appeared to be declining.
The US recorded a 28% drop in cases during the period under review ( January 1, 2018, and December 31, 2020 ) "The 28.2% decline in KD cases nationally during 2020 (646 cases) compared with 2018 (894 cases) and 2019 (905 cases) was uneven across the United States."7 Indeed according to the study, this appeared to be a global trend.
While the etiology of KD is still a matter of speculation, respiratory pathogens are thought to be a contributory factor. Thus the reduced mobility and masking evidenced during the pandemic was hypothesised as a possible reason for the reduction in cases.
Specifically the researches conclude that "the pandemic has shown that limiting exposures to aerosols and large droplets through some combination of masking, social distancing, and hand hygiene can reduce the incidence of KD in diverse communities throughout the globe." 7
The research offers several promising opportunities for further studies into the eitilogy of Kawasaki disease.
Links
7. Epidemiological and Clinical Features of Kawasaki Disease During the COVID-19 Pandemic in the United States ( JAMA Pediatrics)
Ophthalmology
The costs of administration of the anti-VEGF treatments in patients with age-related macular degeneration is frequently an area of complaint or concern for both patient and ophthalmologist.
The researchers of a recent study published in JAMA Ophthalmology set out to determine if there were any significant cost implications for ranibizumab delivered via a port delivery system (PDS) and the intravitreal anti-VEGF treatments delivered intravenously.
In brief they found that the PDS cost more than the injections. Specifically:
"Ranibizumab PDS with 1 refill cost more than intravitreal ranibizumab or aflibercept injections if less than or equal to approximately 11 or 10 injections, respectively, are required within the first year. Long term, if less than 4.4 and 3.8 injections are needed per refill, intravitreal ranibizumab and aflibercept is lower cost. Ranibizumab PDS costs more than intravitreal bevacizumab injections throughout scenarios." 8
Links
8. Cost of Ranibizumab Port Delivery System vs Intravitreal Injections for Patients With Neovascular Age-Related Macular Degeneration ( JAMA Ophthalmology)
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Tech Talks CRISPR
Did you know that this year marks the 10th anniversary of CRISPR technology?
The technology marked an inflection point in medicine, with its potential to disrupt, insert, correct and delete genetic structures.
From its releatively quiet entrance onto the world stage in a paper published in Science on the 28 June 2022, the rapid deployment of CRISPR-based platforms across a wide range of companies, including the biotechs,
Various therapeutic modalities the most advanced of which include advances in sickle-cell therapies and cancer, offer new hope for many disesase.
You can access this fantastic interview in STAT news with two of its authors, Jennifer Doudna, who along with Emmanuelle Charpentier was awarded the Nobel prize in 2021for the discovery. A link to the original study is also posted below.
Links
9. CRISPR debuted 10 years ago, in a paper hardly anyone noticed. Jennifer Doudna reflects on the DNA scissors' first decade( STAT NEWS)
10. A Programmable Dual-RNA–Guided DNA Endonuclease in Adaptive Bacterial Immunity (Science)
Ethics, Legalities and Medical Practice
Links
11. Surveillance for Antimicrobial Resistance and consumption of antimicrobials in South Africa 2021.(DoH)
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Medical Trivia
In keeping with our antimicrobial feature, did you know that, following its first clinical use in the second world war, penicillin resistance had already started to develop. So extensive was this resistance that by the 1950s, less than a decade after its initial global use, the resistance threatened to undo the advances made up to that point, it became necessary to develop additional molecules such as the beta-lactum antibiotics.
Less than a decade later however in 1962 the UK recorded the first case of MRSA, and the rest is history
So if you didn't know, now you do
12. The Antibiotic Resistance Crisis.
And that is all for the Week in Review.
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All that's left is to say, wherever you are, stay safe, stay sane, and join us next week where we 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.
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