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Ulcer drug ranitidine bismuth citrate could halt coronavirus replication in patients

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Proposed Expert: Dr. DR Rai, MAMS, FCGP, IBMS
Internal Medicine Specialist, Hon. Prof. of College of Medical Practitioners, Kota

A recent news stated that Hong Kong researchers have found  that the common ulcer drug ranitidine bismuth citrate could halt coronavirus replication in patients. The news further reports that researchers are saying that the drug which contains the metal bismuth, works by interrupting the process by which the virus replicates inside cells. A research team led by Professor Hongzhe SUN, Norman & Cecilia Yip Professor in Bioinorganic Chemistry, Department of Chemistry, Faculty of Science, and Professor Kwok Yung Yuen, Henry Fok Professor in Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine of the University of Hong Kong, has discovered a novel antiviral strategy for treatment of COVID-19.1

They discovered that the viral helicase can be a druggable target and that bismuth(III) drugs or other metallodrugs have the potential for the treatment of SARS-CoV-2 infection. This ground-breaking work has been published online in Nature Microbiology.1 The researchers found bismuth(III) drugs, currently used in the treatment of other infectious diseases is showing efficacy to potently suppress SARS-CoV-2 replication and relieve viral-associated symptoms in an animal model. The findings provide a new and readily available therapeutic option with high clinical potential for infection with SARS-CoV-2. A 2007 report2 had also published similar findings and concluded that bismuth complexes including ranitidine bismuth citrate effectively inhibit the nucleoside triphosphate hydrolase and DNA unwinding activities of the SARS coronavirus (SCV) helicase and dramatically reduce SCV replication levels in infected cells. This suggests that bismuth‐based drugs should be further evaluated for the treatment of SCV infections in vivo.

Source:

1. Yuan S, et al. Nature Microbiology, 2020; DOI: 10.1038/s41564-020-00802-x
2. Yang N, et al. Angew Chem Int Ed Engl. 2007; 46(34): 6464–68. doi: 10.1002/anie.200701021

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Coronavirus

Vaccination can help us tide over the third wave

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The  second wave is declining, although up to 30-40,000 daily new cases continue to be recorded. India is far from being a COVID-19 free nation. Moreover, the looming third wave and alerts released by different State heads to be prepared for a third wave or to make adequate arrangements for the third wave in terms of oxygen cylinders, beds, critical care wards, etc. has kept us all on our toes and inside homes for fear of expediting the arrival of the third wave.

Eminent virologist and retired professor (CMC Vellore), Dr. T Jacob John, in a recent media interview said if the Government can do justice to the vaccination, in terms of making it available in abundance and everywhere, even the unlikely probability of a third wave can be mitigated, adding that in other words, the third wave can be and must be prevented with vaccination. Dr. John also believes that the two strong waves of COVID-19 pandemic in India would have created high herd-immunity, which is why even a moderate level of vaccination will surely avert the third wave.

We should continue to follow physical distancing protocols and avoid crowding indoors or outdoors as much as possible.

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Coronavirus

Complete vaccinated individuals three times less likely to get COVID-19

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In what comes as more evidence to back completing the (two-dose or one-dose) mandated course for vaccinations for COVID-19, a recent update published by the Imperial College London has shown that people who have received both doses of their coronavirus vaccine are three times less likely to get infected with COVID-19. These results from the 13th round of the Imperial-led REACT-1 study, a major coronavirus monitoring programme, are based on swab tests taken by almost 100,000 people in England between 24 June and 12 July. 

According to their website, REACT (REal-time Assessment of Community Transmission) is a series of studies that are using home testing to improve the understanding of how the COVID-19 pandemic is progressing across England. This major research programme was commissioned by the Department of Health and Social Care (DHSC) and is being carried out by Imperial College London in partnership with Ipsos MORI and Imperial College Healthcare NHS Trust.

The analysis by Imperial College London and Ipsos MORI, which had almost 100,000 volunteers taking part in the study in England between June 24 and July 12, suggests that double vaccinated people are also less likely to pass on the virus to others. Results have also indicated that people who were fully vaccinated were less likely to be carriers of infection to pass the virus on to others, because they have a lower viral load on average and therefore shed less virus. 

In his statement to the Press post release of study results, the UK Vaccines Minister Mr. Nadhim Zahawi also stated, “these results show the positive impact of the vaccination program with those who are double jabbed three times less likely than unvaccinated people to get the virus and less likely to pass on this awful disease to those around them”.

It is important to note that no vaccine has 100% efficacy but benefits outweigh the risks and therefore vaccination is an important step towards curbing the pandemic. Vaccination however, must also be complemented by COVID appropriate behavior.

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Fact Check

Hepatitis symptoms differ as per hepatitis type

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Viral hepatitis is mostly caused by the hepatotropic viruses ranging from A to E. Of these, hepatitis A and hepatitis E cause acute hepatitis, but not chronic hepatitis. Hepatitis B and C, on the other hand, can cause either an acute infection or a chronic infection. They are an important cause of liver cirrhosis and hepatocellular carcinoma.

Viral hepatitis is a silent disease as it is mostly asymptomatic in its early stages. This means that the infected persons are not taking the treatment that they need to and are also “silently” transmitting the infection to others. It therefore helps to understand the different clinical symptoms that each type of Hepatitis shows so that if a family member, friend, or you are seeing these symptoms, you should get checked immediately.

While Hep-A infection is an acute and self-limited illness, symptoms can include low grade fever, anorexia, nausea and vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough and coryza. These symptoms may precede onset of jaundice by 1-2 weeks.  Dark urine and clay-colored stools appear 1-5 days before the onset of clinical jaundice and these symptoms may decrease when jaundice becomes evident. The liver becomes enlarged and tender and there may be right upper quadrant pain and discomfort. Hepatitis A in children younger than six years is usually asymptomatic, whereas older children and adults are generally symptomatic.

In Hep-B, rashes, fever, or muscular and bony pains may develop in some cases followed by anorexia, nausea, jaundice, and right upper quadrant discomfort. Most patients with chronic hepatitis B are asymptomatic, while some patients have nonspecific symptoms such as fatigue.

Hepatitis C virus causes both acute and chronic hepatitis. Acute hepatitis C virus infection is the presence of clinical signs or symptoms of hepatitis within 6 months of exposure to the hepatitis C virus. Symptoms of acute hepatitis C are jaundice, nausea, dark urine, and right upper quadrant pain. However, most patients with acute hepatitis C are asymptomatic. Most patients with chronic hepatitis C infection have non-specific symptoms such as fatigue, nausea, anorexia, myalgias, arthralgias, weakness and weight loss.

In Hep-E, some patients may be asymptomatic while others may present with symptoms such as jaundice accompanied by malaise, anorexia, nausea, vomiting, abdominal pain, fever and hepatomegaly. Diarrhea, arthralgia, pruritus and urticarial rash may also be present in some patients.

Acute liver failure can occur; it occurs more frequently during pregnancy, mostly in the third trimester. The mortality rate is high and ranges from 15-25%.

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Coronavirus

Some drugs may reduce efficacy of COVID-19 vaccines

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Yes, this is true. Let us help you understand this better and how to curb the reduced efficacy as much as possible.

Immunosuppressive drugs are frequently prescribed for inflammatory diseases such as rheumatoid arthritis, multiple sclerosis, and ulcerative colitis. These drugs can impair the body’s response to the COVID-19 vaccines from Pfizer/BioNTech and Moderna, according to new data. A recent study pre-published on MedRxiv reports that in 133 fully vaccinated people with these conditions, antibody levels and virus neutralization were about three-fold lower than in a comparison group of vaccinated individuals not taking these medications.

However, by changing the timing of medications or getting booster shots, experts believe this problem can be curbed. Immunocompromised patients are also recommended to continue to follow precautions such as handwashing and physical distancing even after being vaccinated.

This is important because immunocompromised patients taking these medications may increase a person’s risk of COVID-19 symptoms and hospitalization if they contract the virus and these drugs may reduce the efficacy of COVID-19 vaccinations. Steroids such as prednisone and dexamethasone are a very commonly used immunosuppressive drugs . They are  mostly prescribed short-term for conditions such as allergic rashes, bronchitis, and sinus infections. However, these medicines, even if taken for short term, tend to increase people’s risk of infections their response to vaccines, such as the COVID-19 vaccine.

Therefore, it is important to inform your doctor of any medications you are taking, so that they can assess the efficacy of the vaccine and give you appropriate advice to be followed during the pandemic.

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Coronavirus

India may soon get a nasal vaccine

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Nasal vaccines have been in discussions since the early days of the pandemic because unlike conventional Coronavirus 2019 (COVID-19) vaccines, intranasal vaccines is non-invasive with high appeal to patients. Intranasal vaccines enable self-administration and can be designed to survive at ambient temperatures, thereby simplifying logistical aspects of transport and storage. In addition to these, nasal vaccines also display a superior advantage because the nasal mucosa is often the initial site of infection. 

Chairman and Managing Director of Bharat Biotech, Dr Krishna Ella has recently confirmed that their company, the makers of India’s Covaxin, is working on a combination of Covaxin followed by a nasal vaccine. He further added that, added to vaccine shots, the nasal vaccines will act as a Covid-19 booster dose and protect from infection. Speaking further on the subject, he added that the scientists at Bharat Biotech are working on a combination of Covaxin followed by a nasal vaccine so that Covaxin primes the system of innate immunity and then the boost by the nasal which produces three immune responses — the IGG, the IGA and then mucosal immunity. Combined together, these immunities are powerful and can protect a person from getting infected.

In technical terms, studies report that the disruption of nasal bacteria by intranasal application of antibiotics before influenza virus infection enhanced the virus-specific antibody response. Similarly, disruption of nasal bacteria by lysozyme enhanced antibody responses to intranasally administered influenza virus hemagglutinin (HA) vaccine, indicating a release of bacterial pathogen-associated molecular patterns (PAMPs) from disrupted nasal bacteria that act as mucosal adjuvants by activation of the MyD88 signaling pathway. 

Also, intranasal vaccination, which is administered through the nose, is needle-free, meaning that more people may be willing to get vaccinated. Experts believe that using both intramuscular and intranasal Covid vaccines may be effective in combating COVID-19.

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