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SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesIndia has widened its vaccination programme as infections surge and the capital goes into lockdown.All adults over the age of 18 will be offered a coronavirus jab starting from 1 May, the government said on Monday.However, with vaccines in short supply in many states, it is unclear where the additional doses will come from. The government said last week that it only had 27 million doses – or enough jabs for nine days at current rates of vaccination. India is currently vaccinating health workers, front line workers and people over 45 but a number of states – including the worst affected Maharashtra state – have reported insufficient supply. There have been reports of people being turned away from vaccination centres in many areas.How India failed to prevent a deadly second waveVaccine suppliers such as the serum institute have been unable to meet international requirements and have also warned of raw material shortages affecting production, which it attributed to US export bans on specific items needed to make vaccines. image copyrightGetty ImagesSo how will vaccines be ramped up?The process so far has been controlled by the federal government, but the government is changing the rules, a move it says will increase production and availability and attract more domestic and foreign players.Vaccine manufacturers will now have to supply 50% of the doses to the central government and the rest to state governments and the open market at a pre-determined price. Three vaccines were initially approved for use in India – two manufactured by Indian companies Serum Institute and Bharat Biotech, and the third Russia’s Sputnik V. Since then, it has said that vaccines approved for use in other countries could also be used in India. image copyrightGetty ImagesThe government has also approved a $600 million grant for Serum Institute and Bharat Biotech. How bad is the situation in India?India has been reporting around 200,000 cases daily since 15 April – this is well past its peak last year, when it was averaging around 93,000 cases a day. Deaths too have been rising. The government confirmed 1,619 deaths from the virus on Monday. The capital Delhi ordered a six-day lockdown from Monday with city hospitals reporting shortages of beds, oxygen and key medicine.Health officials in UK investigate Indian variantDelhi announces lockdown as Covid cases surgeOver the weekend, Delhi’s Chief Minister Arvind Kejriwal tweeted saying that oxygen has become an emergency in Delhi.”In view of sharply increasing cases, Delhi needs much more than normal supply,” he said. Several major cities have made similar complaints. This has prompted officials to start using the country’s behemoth rail network to start ferrying oxygen around the country in special trains. The first train with seven tankers left from Mumbai in the western state of Maharashtra and is expected to reach Vizag in the southern state of Andhra Pradesh.Many states have diverted industrial oxygen to be used for medical purposes.

Taking multivitamins, omega-3, probiotics or vitamin D supplements may lessen the risk of testing positive for SARS-CoV-2, the virus responsible for COVID-19 infection — at least among women — indicates a large population study, published online in the journal BMJ Nutrition Prevention & Health.
But taking any of vitamin C, zinc, or garlic supplements wasn’t associated with a lower risk of testing positive for the virus, the findings show.
There has been plenty of celebrity endorsement of the use of dietary supplements to both ward off and treat COVID-19 infection since the start of the pandemic, note the researchers.
In the UK alone, market share rose by 19.5% in the period leading up to the first national ‘lockdown’ on March 23 last year, with sales of vitamin C rising by 110% and those of multivits by 93%.
Similarly, zinc supplement sales rose by 415% in the first week of March, at the height of COVID-19 fears in the USA.
Dietary supplements can help to support a healthy immune system, but whether specific supplements might be associated with a lower risk of catching SARS-CoV-2 isn’t known.

The impact on lung cells of Heat not Burn products — a hybrid between traditional cigarettes and electronic vaping devices — may be no less harmful than that of conventional cigarettes, suggest the findings of a small comparative study, published online in the journal Thorax.
Heat not burn products contain nicotine and tobacco, but have been marketed by the tobacco industry as a less harmful alternative to conventional cigarettes on the grounds that they don’t produce specific harmful chemicals that are released when tobacco burns.
Smoking still kills 6 million people every year worldwide. It heightens the risk of coronary heart disease, stroke, peripheral artery disease, and abdominal aortic aneurysm, because it has a role in all stages of artery hardening and blockage.
And it causes emphysema and pulmonary hypertension, because it contributes to the damage of blood vessels in the lungs.
Specifically, it contributes to endothelial dysfunction — whereby the lining of small and large blood vessels becomes abnormal, causing arteries to constrict instead of dilating, or blood vessels to become more inflamed; oxidative stress — an excess of harmful cellular by-products; platelet activation — creation of ‘sticky’ blood; and plaque development that can block arteries.
The researchers wanted to find out if these effects could also be observed in people who used heat not burn products.

For the first time, a study has shown a clear link between the frequency and duration of unconscious wakefulness during night-time sleep and an increased risk of dying from diseases of the heart and blood vessels, and death from any cause, particularly in women.
The study of 8001 men and women, which is published today (Tuesday) in the European Heart Journal, found that women who experienced unconscious wakefulness most often and for longer periods of time had nearly double the risk of dying from cardiovascular disease during an average of between 6 and 11 years’ follow-up, when compared to the risk in general female population. The association was less clear in men, and their risk of cardiovascular death increased by just over a quarter compared to the general male population.
Unconscious wakefulness, also known as cortical arousal, is a normal part of sleep. It occurs spontaneously and is part of the body’s ability to respond to potentially dangerous situations, such as noise or breathing becoming obstructed. Pain, limb movements, trauma, temperature and light can also be triggers.
Dominik Linz, associate professor in the cardiology department at Maastricht University Medical Center (The Netherlands), explained: “A common trigger for nocturnal arousals is obstructive sleep apnoea when breathing stops and the arousal system ensures the activation of our body to change our sleep position and to reopen the upper airway. Another cause of arousals can be ‘noise pollution’ during the night by, for example, night-time aircraft noise. Depending on the strength of the arousal, a person might become consciously aware of the environment, but often that is not the case. Typically, people will feel exhausted and tired in the morning because of their sleep fragmentation but will not be aware of the individual arousals.”
Previous research has shown that sleep duration, either too short or too long, is associated with increased risks of death from cardiovascular or other causes. However, until now, it was unknown whether there was also a link with the arousal burden (a combination of the number of arousals and their duration) during a night’s sleep and the risk of death.
In a collaboration between a team led by associate professor Mathias Baumert from the School of Electrical and Electronic Engineering at the University of Adelaide (Australia) and Prof. Linz, researchers looked at data from sleep monitors worn overnight by men and women taking part in one of three studies: 2782 men in the Osteoporotic Fractures in Men Sleep Study (MrOS), 424 women in the Study of Osteoporotic Fractures (SOF), and 2221 men and 2574 women in the Sleep Heart Health Study (SHHS). The average ages in the studies were 77, 83 or 64 years, respectively. The participants were followed up over a period of several years, which ranged from an average of six years (SOF) to 11 years (MrOS).

Black women are more likely than white women to experience common mental health problems, such as anxiety and depression, according to government figures. Sectioning powers under the Mental Health Act also disproportionately affect black people.BBC journalist Abdirahim Saeed reflects on the case of a close relative and speaks to black women about their experiences.If you’ve been affected by issues raised in this story, sources of support are available at the BBC Action Line.Video Journalist: Tobias ChappleSenior Producer: Tammi WalkerAdditional Filming: Abdirahim Saeed

A group of scientists have just made a key discovery that could prevent and eradicate immune responses that lead to treatment failure in about one-third of people with severe hemophilia A.
Hemophilia is the most common severe inherited bleeding disorder in men. The disease affects 1 in 10,000 males worldwide and results from deficiency of blood clotting factor VIII (FVIII). Both children and adults with hemophilia A (80 percent of all hemophilia) receive treatment that involves infusing FVIII protein into the bloodstream. However, about 30 percent of them develop an immune response in the form of antibodies to FVIII (inhibitors), rendering treatment ineffective and increasing risk of mortality.
For inhibitor-positive patients, immune tolerance induction (ITI) options are scarce, costly and invasive. Investigators at Indiana University School of Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania joined efforts to explore immune responses to FVIII under an NIH-funded U54 initiative.
The study, led by IU School of Medicine’s Moanaro Biswas, PhD, and Valder R. Arruda, MD, PhD, from Children’s Hospital of Philadelphia and the University of Pennsylvania, is titled “B cell activating factor modulates the factor VIII immune response in hemophilia,” and was published in the Journal of Clinical Investigation earlier this month. Bhavya Doshi, MD, from Children’s Hospital of Philadelphia, as is the first author.
In it, the group used plasma samples from pediatric and adult hemophilia A patients and animal models to determine whether BAFF plays a role in the generation and maintenance of FVIII inhibitors.
They also looked at combining antibody to BAFF in an ITI approach with a CD20 antibody (rituximab). Rituximab alone has shown mixed results in eradicating inhibitors when used alone in previous studies for hemophilia A.
Major findings from the study include: BAFF levels in plasma are higher in both pediatric and adult hemophilia A patients with persistent FVIII inhibitors, and correlate with FVIII antibody titers, suggesting that BAFF could be a potential harbinger for an ongoing humoral immune response to FVIII An increase in BAFF levels after rituximab-based therapy precludes tolerance to FVIII. Blocking BAFF is effective in the prevention of FVIII inhibitors in an animal model of hemophilia A. Combination CD20/BAFF monoclonal antibody therapy induces tolerance in a hemophilia A animal model with established FVIII inhibitors. This is due to a concerted effect of the combination therapy on memory B cells and plasma cells.Next, the group will perform in-depth mechanistic studies to identify additional BAFF modifiers, which may provide additional insight into the pathways that lead to BAFF elevation and inhibitor formation.
These data also have important translational potential for inhibitor in hemophilia A, since there is an FDA-approved anti-BAFF antibody currently used as part of immunosuppressive regimens for autoimmune diseases.
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Materials provided by Indiana University School of Medicine. Note: Content may be edited for style and length.

Ensuring COVID-19 vaccine access for refugee and displaced populations, and addressing health inequities, is vital for an effective pandemic response. Yet, vaccine allocation and distribution has been neither equitable nor inclusive, despite that global leaders have stressed this as a critical aspect to globally overcoming the pandemic, according to a paper published by Columbia University Mailman School of Public Health. Read “Leave No-one Behind: Ensuring Access to COVID-19 vaccines for Refugee and Displaced Populations” in the journal Nature Medicine.
As of April 1st, high and upper-middle-income countries received 86 percent of the vaccine doses delivered worldwide, while only 0.1 percent of doses have been delivered in low-income countries. Worldwide, over 80 percent of refugees and nearly all internally displaced persons are hosted by low and middle-income countries — nations at the end of the line for COVID-19 vaccine doses.
“As the world grapples with supply challenges and inequitable vaccine access on local and global scales, marginalized groups, particularly refugees, internally displaced persons and stateless persons, face a double burden of access, even within countries that are themselves marginalized on the global stage,” said Monette Zard, MA, Allan Rosenfield Associate Professor of Forced Migration and Health and director of the forced migration and health program at Columbia Mailman School. “Legal status should have no place in decisions about vaccine access, and relying on regularization as a route to vaccination will unacceptably delay the protective effects for migrants and refugees, particularly in higher risk groups.”
In fragile settings with weak governance, competition for scarce COVID-19 vaccines may heighten tensions and exacerbate conflict, while unequal access raises the prospect of populations moving in an effort to access vaccines that are not available in their country or region, according to the authors.
The COVAX facility allocates around 5 percent of total available vaccine doses for humanitarian use, including vaccinating refugees, yet the total 2 billion vaccine doses targeted by the end of 2021 will only cover 20 percent of participating countries’ populations, at most. Poorer countries may not be able to widely vaccinate their populations until 2023.
To create an equitable and inclusive COVID-19 vaccination strategy, Zard and co-authors believe lessons can also be drawn from experience managing conditions such as HIV and TB among mobile populations, as well as previous large-scale vaccination campaigns in humanitarian settings. They point out how the global community approaches COVID-19 vaccinations may further entrench the inequities and distrust experienced by refugees and displaced populations around the world or is a chance to build stronger, fairer health systems that are better prepared to respond to COVID-19 and future health emergencies. “Engage, listen, and mobilize trusted community and religious leaders — involving the community, including displaced populations, in vaccine activities is vital,”noted Zard.
“Policy makers need to seize the opportunity of the pandemic to strengthen health systems more broadly and sustainably, to better respond to the challenges of COVID-19, while addressing the comprehensive health needs of refugees and host populations,” observes one of the authors S. Patrick Kachur, MD, professor of population and family health at Columbia Mailman School. “As the world confronts one of the most formidable public health challenges in recent history, how we respond today will not only determine the course of this pandemic, but also who benefits from public health advances for years to come.”
Co-authors are: Ling San Lau, Goleen Samari, Rachel Moresky, Mhd Nour Audi, and Claire Greene, Program on Forced and Migration and Health, Columbia Mailman School; Diana M. Bowser and Donald Shepard, Brandeis University; Fouad M. Fouad, American University of Beirut; Diego Lucumí and Arturo Harker, Universidad de los Andes; and Wu Zeng, Georgetown University.

At the end of 2020, experts led by allergists at Massachusetts General Hospital (MGH) examined all information related to possible allergic reactions to COVID-19 vaccinations. Now the team has published updated insights based on their experience overseeing more than 65,000 employees who have become fully vaccinated since that time. The group’s latest findings are published in the Journal of Allergy and Clinical Immunology: In Practice.
“Our main goal is to enable as many individuals as possible to receive a COVID-19 vaccine safely and avoid unnecessary vaccine hesitancy due to a lack of knowledge around allergic reactions to vaccines,” says lead author Aleena Banerji, MD, clinical director of the Allergy and Clinical Immunology Unit at MGH.
In addition to updated guidance on the Pfizer-BioNTech and Moderna COVID-19 vaccines, this guidance also includes the Janssen COVID-19 vaccine, which had not yet been authorized for emergency use at the end of 2020.
With additional clinical data and authorization of the third COVID-19 vaccine in the United States, the investigators propose modified approaches to the evaluation of patients with a history of allergies. This includes clear and simple initial questions to identify individuals who are eligible for all COVID-19 vaccines without needing an allergist evaluation.
“With more time and experience, we have been able to significantly narrow the group of patients with prior allergies who require an allergist assessment before COVID-19 vaccination,” says senior author Kimberly G. Blumenthal, MD, MSc, co-director of the Clinical Epidemiology Program within MGH’s Division of Rheumatology, Allergy and Immunology. “We now advise that only the rare individuals who have had a recent severe allergic reaction to polyethylene glycol, an ingredient in the vaccines, see an allergist or immunologist for evaluation, which may include skin testing.” Individuals with severe allergies to foods, oral drugs, latex, bee stings or venom can safely receive the COVID-19 vaccines.
The team noted that severe allergic reactions to the vaccines remain exceedingly rare. Vaccine clinics should continue to observe higher-risk individuals for 30 minutes after vaccination, and they should have staff trained in recognizing and managing allergic reactions that may occur.
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Materials provided by Massachusetts General Hospital. Note: Content may be edited for style and length.

Researchers at Albert Einstein College of Medicine have developed a topical drug that regenerates and restores the function of erectile nerves damaged by radical prostatectomy, the most common treatment for localized prostate cancer. The drug was tested in rats, and the findings were published online today in JCI Insight.
“Erectile dysfunction (ED) after radical prostatectomy has a major impact on the lives of many patients and their partners,” said study co-leader David J. Sharp, Ph.D., professor of physiology & biophysics and of ophthalmology and visual sciences and professor in the Dominick P. Purpura Department of Neuroscience at Einstein. “Since rats are reliable animal models in urologic research, our drug offers real hope of normal sexual function for the tens of thousands of men who undergo this surgery each year.”
Radical prostatectomy — surgery to remove the prostate gland — is considered the definitive treatment for localized prostate cancer. “Despite the advent of so-called nerve-sparing procedures, the surgery can damage the cavernous nerves, which control erectile function by regulating blood flow to the penis,” said study co-leader Kelvin P. Davies, Ph.D., professor of urology and of physiology & biophysics at Einstein. He notes that about 60% of patients report having ED 18 months after surgery, and fewer than 30% have erections firm enough for intercourse after five years. Viagra and similar ED treatments are rarely effective in these patients, he said.
A decade ago, Dr. Sharp and colleagues discovered that the enzyme fidgetin-like 2 (FL2) puts the brakes on skin cells as they migrate towards wounds to heal them. To speed wound healing, the researchers developed an “anti-FL2” drug: small interfering RNA molecules (siRNAs) that inhibit the gene that codes for FL2. Packaged in gel nanoparticles and sprayed on mice, the siRNAs not only healed wounds twice as fast as untreated wounds but also regenerated damaged tissue. A February 2021 study in rats found that the siRNAs also aided the healing of corneal alkaline burns.
Dr. Sharp, Dr. Davies, and their teams realized that injured nerves might be especially amenable to this gene-silencing drug: For unknown reasons, the FL2 gene becomes over-active after injury to nerve cells, causing the cells to produce copious amounts of FL2 enzyme.
The Einstein team evaluated the drug using rat models of peripheral nerve injury in which the cavernous nerves were either crushed or severed, mimicking the nerve damage associated with radical prostatectomy. The siRNA gel was applied to the nerves immediately after injury.

Having an epidural during childbirth is not associated with a greater risk of autism in the child, according to a study led by researchers at the Stanford University School of Medicine and the University of Manitoba.
The study, which will publish online April 19 in JAMA Pediatrics, helps resolve questions raised by an earlier, widely criticized report on the topic.
“We did not find evidence for any genuine link between having an epidural and putting your baby at increased risk of autism spectrum disorder,” said the study’s senior author, Alexander Butwick, MD, associate professor of anesthesiology, perioperative and pain medicine at Stanford. The study should help reassure both physicians and pregnant women about the favorable safety profile of epidurals, he added.
Epidurals are the most common form of pain relief for childbirth, used by about three-quarters of women in labor in the United States. Autism is a developmental disorder that affects one in every 54 children nationwide.
“The epidural is the gold standard in labor pain management,” said the study’s lead author, Elizabeth Wall-Wieler, PhD, assistant professor at the University of Manitoba. “The vast majority of evidence around epidurals, including that from our new study, shows that they are the most effective means of providing pain relief to women during labor and that serious complications are rare.”
Questions raised by prior study
During an epidural, anesthetic is given by catheter into the space around the woman’s spinal cord. Epidurals relieve pain from labor contractions while allowing women to stay alert and push during birth. They also have other important, yet underappreciated, advantages. For example, epidurals can provide anesthesia to laboring women who require unplanned, and often urgent, cesarean sections. They also pose a lower risk to the mother and baby than general anesthesia, which may be necessary if a woman who has not already had an epidural needs an emergency C-section.