EDITORIALS & ARTICLES
9th May 2021
‘Black fungus’ in Covid patients
Recently, the black fungus is being detected relatively frequently among Covid-19 patients in some states.
- The experts in the national Covid-19 task force have issued an evidence-based advisory on the disease with a number of black fungus cases detected in Delhi, Maharashtra and Gujarat.
Black Fungus disease
- It is a rare but serious fungal infection known as mucormycosis.
- It is caused by a group of moulds known as mucormycetes present naturally in the environment.
- It mainly affects people who are on medication for health problems that reduces their ability to fight environmental pathogens.
- The sinuses or lungs of such individuals get affected after they inhale fungal spores from the air.
Effects of Black Fungus disease
- The warning signs include pain and redness around the eyes or nose, with fever, headache, coughing, shortness of breath, bloody vomits, and altered mental status.
- According to the advisory, infection with mucormycetes should be suspected when there is:
- Sinusitis: nasal blockade or congestion, nasal discharge (blackish/bloody);
- Local pain on the cheek bone, one-sided facial pain, numbness or swelling;
- Blackish discoloration over bridge of nose/palate;
- Loosening of teeth, jaw involvement;
- Blurred or double vision with pain;
- Thrombosis, necrosis, skin lesion;
- Chest pain, pleural effusion, worsening of respiratory symptoms.
- The experts advise that one should not count all cases of blocked nose as cases of bacterial sinusitis, particularly in the context of immunosuppression and/or Covid-19 patients on immunomodulators.
Treatment of Black Fungus disease
- It is treated with antifungals and mucormycosis may eventually require surgery.
- The doctors have said that it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs.
- The treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.
Types of mucormycosis
- Rhinocerebral (sinus and brain) mucormycosis is an infection in the sinuses that can spread to the brain.
- This form of mucormycosis is most common in people with uncontrolled diabetes and in people who have had a kidney transplant.
- Pulmonary (lung) mucormycosis is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.
- Gastrointestinal mucormycosis is more common among young children than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness.
- Cutaneous (skin) mucormycosis occurs after the fungi enter the body through a break in the skin (for example, after surgery, a burn, or other type of skin trauma).
- This is the most common form of mucormycosis among people who do not have weakened immune systems.
- Disseminated mucormycosis occurs when the infection spreads through the bloodstream to affect another part of the body.
- The infection most commonly affects the brain, but also can affect other organs such as the spleen, heart, and skin.
C-reactive protein (CRP) Test
Recently, a large number of doctors are recommending the C-reactive protein (CRP) testto those Covid positive patients who are in home isolation with moderate to mild symptoms.
C-reactive protein (CRP) Test
- It is a blood test mainly conducted for patients who are hospitalised for Covid virus treatment.
- It is not a diagnostic test but it has prognostic value.
- It tells about inflammation level in the body during any ailment and indicates about the infection level.
- The higher value of CRP level than the normal level indicates that the infection is increasing.
- It is a marker which shows the level of C-reactive protein, which is made by the liver, in the blood.
Recommendation of C-reactive protein (CRP) Test
- The doctors are conducting it mandatorily for the patients with critical conditions who are in hospital care, because it is one of the indicators showing the body’s reaction to the ongoing treatment.
- If the CRP is normal then the patient’s body is reacting to the treatment positively.
- If the CRP is higher than the required, then doctors need to check the infection levelin the body through other tests like CT scan.
Why C-reactive protein (CRP) Test is recommended for mild covid patients?
- The CRP is not necessary unless and until the patient is suffering with the same symptoms even after passing of 5 days of his/her contracting the virus.
- The doctors recommend it for at least twice on an interval of 4-5 days just to check the inflammation so as to judge about the further complication level.
Significance of C-reactive protein (CRP) Test
- The conduction of CRP test twice on an interval of 4-5 days reveals the CRP level in the patients on the basis of which doctors can decide the next course of action.
- A CRP test measures the amount of CRP in the blood to detect inflammation due to acute conditions or to monitor the severity of disease in chronic conditions.
- It is a non-specific indicator of inflammation and one of the most sensitive acute phase reactants.
What is CRP test used for?
- A CRP test may be used to find or monitor conditions that cause inflammation which include:
- Bacterial infections, such as sepsis, a severe and sometimes life-threatening condition
- A fungal infection
- Inflammatory bowel disease, a disorder that causes swelling and bleeding in the intestines
- An autoimmune disorder such as lupus or rheumatoid arthritis
- An infection of the bone called osteomyelitis.
Sinopharm COVID-19 Vaccine
Recently, the WHO has implied that the Sinopharm COVID-19 vaccine can now be used in immunisation drives worldwide for emergency use.
Sinopharm COVID-19 Vaccine
- It is an inactivated coronavirus vaccine developed by China.
- It is the first non-Western vaccine to get WHO backing.
- It will possibly be used for the COVAX programme, under which vaccines are supplied to low and middle-income countries.
- Sinopharm, Covaxin and Sinovac (also developed by China) are the only ones that useinactivated virus.
- The others such as Pfizer-BioNTech and Moderna are mRNA vaccines, whereas Oxford-AstraZeneca, Sputnik and Johnson and Johnson’s single-dose vaccines use a viral vector.
Working of Sinopharm COVID-19 Vaccine
- The inactivated vaccines take the disease-carrying virus (in this case SARS-CoV-2) and kill it using heat, chemicals or radiation.
- The WHO notes that these vaccines take longer to make and might need two or three doses to be administered.
Sinopharm’s Protection from COVID-19
- As per WHO, Sinopharm has an efficacy of about 79 percent for symptomatic and hospitalised disease for all age groups.
- The WHO notes that since few adults over the age of 60 years were enrolled, the efficacy in the age group is not clear.
- The WHO has not recommended an upper age limit on the use of this vaccine because the immunogenicity data suggest the vaccine is likely to have a protective effect in older persons.
- The WHO has recommended that the vaccine be administered to adults of the age of 18 and above in a two-dose schedule with a gap of three to four weeks.
Significance of WHO’s emergency use approval
- The WHO’s emergency use listing (EUL) assesses the suitability of novel health products during public health emergencies.
- The Pfizer-BioNTech coronavirus vaccine was given the EUL approval on December 31, 2020 and the Oxford-AstraZeneca vaccine was approved by the WHO on February 15 2021.
- The objective is to make medicines, vaccines and diagnostics available as rapidly as possible to address the emergency, while adhering to stringent criteria of safety, efficacy and quality.
- The assessment weighs the threat posed by the emergency as well as the benefitthat would accrue from the use of the product against any potential risks.
- The approval is given after assessment of late phase II and phase III clinical trial dataand data related to safety, efficacy, quality and risk management.
INS Vikramaditya
Recently, the Ministry of Defence has announced that there was a minor fire on board India’s aircraft carrier INS Vikramaditya.
- It is a modified Kiev-class aircraft carrier purchased by India from Russia in 2013.
- It was originally built as Baku and commissioned in 1987.
- It served with the Soviet (until the dissolution of the Soviet Union) and Russian Navies before being decommissioned in 1996.
INS Vikramaditya
- It was renamed in honour of Vikramaditya, the legendary emperor.
- It is a floating airfield which has an overall length of 284 metres and a maximum beam of 60 metres, stretching as much as three football fields put together.
- It is the Indian Navy’s largest short take-off but assisted recovery (STOBAR) aircraft carrier.
- It can carry more than 30 long-range multi-role fighters with anti-ship missiles, air-to-air missiles, guided bombs, and rockets.
- The naval variant of the indigenous LCA Tejas fighter aircraft made its first landing on the INS Vikramaditya in January 2020.
Regulatory Review Authority (RRA 2.0)
Recently, the Reserve Bank of India (RBI) has said that an advisory group has been constituted to assist the second Regulatory Review Authority (RRA 2.0).
- In 1999, the RBI had set up a Regulations Review Authority (RRA) for reviewing the regulations, circulars, reporting systems, based on the feedback from the public, banks, and financial institutions.
- The recommendations of the RRA enabled streamlining and increasing the effectiveness of several procedures and simplifying regulatory prescriptions.
- It also paved the way for issuance of master circulars and reduced reporting burden.
Regulatory Review Authority (RRA 2.0)
- It was constituted by the central bank of India to streamline regulations and reduce the compliance burden of regulated entities.
- The RBI has set up the second Regulatory Review Authority (RRA 2.0), initially for a period of one year from May 01, 2021.
- The Reserve Bank of India Deputy Governor M Rajeshwar Rao has been appointed as the head of the RRA 2.0.
Objectives of Regulatory Review Authority (RRA 2.0)
- It aims to review the regulatory prescriptions internally as well as by seeking suggestions from regulated entities and other stakeholders on their simplification and ease of implementation.
- It will focus on streamlining regulatory instructions and reducing the compliance burden of regulated entities by simplifying procedures and reducing reporting requirements.
- It shall intend to make regulatory and supervisory instructions more effective by removing redundancies and duplication.
- It will look to reduce the compliance burden on regulated entities by streamlining the reporting mechanism, revoking obsolete instructions if necessary and obviating paper-based submission of returns wherever possible.
- It will also be tasked with obtaining feedback from regulated entities on simplification of procedures and enhancement of ease of compliance.
- It will examine and suggest the changes required in the dissemination process of RBI circulars and instructions.
Advisory Group for RRA 2.0
- It is headed by SBI Managing Director S Janakiraman.
- It will assist the RRA by identifying regulations, guidelines, and returns that can be rationalised.
- The advisory group represents the members from regulated entities, including compliance officers, to support the RRA in achieving the objective set forth in the terms of reference of RRA 2.0.
DCGI approves anti-COVID drug
Recently, the Drugs Controller General of India (DCGI) has approved the DRDO’s anti-COVID oral drug as an adjunct therapy in moderate to severe coronavirus patients.
- In April 2020, during the first wave of the pandemic, INMAS-DRDO scientists conducted laboratory experiments with the help of Centre for Cellular and Molecular Biology.
- The DCGI’s Central Drugs Standard Control Organisation (CDSCO) permitted Phase-II clinical trial of 2-DG in COVID-19 patients in May 2020.
- In Phase-II trials conducted during May to October 2020, the drug was found to be safe in COVID-19 patients and showed significant improvement in their recovery.
- In 2-DG arm, a significantly higher proportion of patients improved symptomatically and became free from supplemental oxygen dependence by Day-3 in comparison to SoC.
Anti-COVID drug by DRDO
- The clinical trials of the drug 2-deoxy-D-glucose (2-DG) showed that it helps in faster recovery of hospitalised patients and reduces supplemental oxygen dependence.
- The anti-COVID-19 therapeutic application of 2-DG drug has been developed by the Institute of Nuclear Medicine and Allied Sciences (INMAS).
- The drug comes in powder form in a sachet and is taken orally by dissolving it in water.
- It accumulates in the virus-infected cells and prevents virus growth by stopping viral synthesis and energy production.
- The patients treated with 2-DG showed faster symptomatic cure than the standard of care (SoC) on various endpoints.
Paediatric Task Force
Recently, the Maharashtra government has constituted a nine-member committee called Paediatric Task Force.
- The experts have said that while there is a vaccination programme for those aged more than 18 years, children and teenagers are still vulnerable to the infection.
- Of 48.93 lakh Covid-19 cases in Maharashtra, 10 per cent cases have been reported from those aged less than 20 years.
- Of that 1.49 lakh are children aged less than 10 years.
- The children suffer diarrhoea, loss of appetite and fever as common signs of Covid-19, unlike adults who suffer weakness, body pain, fever, loss of smell and taste.
Paediatric Task Force
- The task force has been set up under the chairmanship of Dr Suhas Prabhu in an attempt to brace for the next wave.
- The special paediatric task force will be responsible for procuring medicines for children, paediatric ventilators and building Covid-19 care centres for children.
Objectives of Paediatric Task Force
- It aims to develop a comprehensive plan for treating children affected with Covid-19.
- It will set up more sick new born care units (SNCUs), more ventilators suited for infants and prepare a separate line of medication for them.
- It has recommended setting up fever clinics with paediatricians or trained staff to screen children with Covid symptoms.
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