Manila:

The Philippines has confirmed two more mpox virus infections of the milder clade 2 variety, its health ministry said Monday, bringing the number of active cases to three.

“We continue to see local transmission of mpox clade II here in the Philippines, in Metro Manila in particular,” Health Minister Teodoro Herbosa said in a statement.

The newly confirmed cases were a 37-year-old male in Metro Manila who had rash on his body last week and was brought to a government hospital, and a 32-year-old male from the capital who had skin lesions on his body.

The Philippines announced last week it had detected a case of the mpox virus’ milder variant in a 33-year-old male who had no travel history outside the Philippines.

The three cases this year means the Philippines has had 12 laboratory-confirmed case since July 2022.

The World Health Organization earlier this month declared mpox a global public health emergency, its highest form of alert, for the second time in two years, because of an outbreak in the Democratic Republic of Congo that had spread to neighbouring countries.

A new form of the virus has triggered global concern as it seems to spread easily though routine close contact.

The disease, caused by the monkeypox virus, leads to flu-like symptoms and pus-filled lesions. It is usually mild but can kill, with children, pregnant women and people with weakened immune systems, such as those with HIV, all at higher risk of complications.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

Come with me to a busy outpatient clinic at a public hospital in rural Andhra Pradesh. There is a sea of waiting patients. Some are on chairs, most on the floor, waiting to be called in by the doctor. People on the floor talk, eat, and some even nap as they wait. Oppressive heat, along with the smell and feel of sweat, pervade the atmosphere.

In a small consultation room two doctors attend to a patient. In the corner, another doctor treats a patient. Outside the door stand a multitude of patients. Every now and then someone peeks in and asks, “Doctor, when will my turn come?”

Looking around, we notice there are no windows. An old fan rattles overhead, recirculating the same overheated air. While the doctors can take breaks in their air-conditioned duty room, patients have no such respite.

A similar stifling environment is replicated in many places across the country, as Mr. Joseph can testify.

“I accompanied my relative to his appointment at the B. Baruah cancer centre in Guwahati,” says Mr Joseph (name changed). “The hospital waiting room was overcrowded and extremely humid because everybody there was sweating. Soon enough, I started having a headache and muscle cramps. My temperature rose too. I had to go out to a different clinic to consult a doctor and they diagnosed me with heat exhaustion. I was admitted and given paracetamol along with saline injections. Only after some time did I feel better,” he adds.  

Failing infastructure

India’s public health infrastructure is crumbling under the sheer volume of sick people and this might have unintended consequences for people in the current heatwave India is experiencing. 

This year, India is experiencing its longest and deadliest heatwave in the past 15 years with some parts of North India hitting record-high temperatures. This heat wave disproportionately affects the poor and marginalised communities who have no access to cooling devices. While several forms of inequalities have been exposed by the current heatwave – such as occupational inequality and gender inequality, it is also important to talk about how economically-weaker sections of the community who seek healthcare from the public sector are exposed to heat-related illnesses within the premises of these clinics and hospitals. 

“My father was admitted to the general ward of a hospital because he had a fever and stomach pain sometime back,” says Muniamma, a daily wage labourer from Vellore, South India. “The doctors told me that he had a kidney infection and they were treating it with injections with which he was getting better. Suddenly his fever returned and he started speaking incoherently. Initially, the doctors did a lot of tests but then they realised that it was heat related as it was peak summer.”

Muniamma’s father, though he was admitted with a different ailment, developed a heat-related illness as he lay in the hospital bed in the overcrowded and poorly ventilated hospital ward. “The doctors tried their best,” says Muniamma who had to then sit with her father day and night spraying cold water from a spray bottle onto every bit of exposed skin. “They gave him saline injections which were cooled in a refrigerator. They asked us to bring a few table fans which we placed around him. We also kept trying to cool him by placing ice cubes in his armpits and such. But he did not get better. His kidneys failed due to the heat and he died,” she recounts sadly. 

Killer heat

Just like Muniamma, Kumari from Vellore too has lost an uncle to heat illness in a poorly-ventilated general ward. “He had some mental illness and would always be sad or crying, so we showed him to a psychiatrist and got him some medicines. However, after a suicide attempt, we rushed him to a hospital where they put a tube in his nose and gave him injections and medications. He started gaining consciousness and was getting better when he started having a fever. Considering that he was in a hospital, the doctors initially said that he might have caught an infection from one of the other patients. But all the tests came back negative. That is when we realised that it might have been the heat, as it was scorching. He was treated for heat-related illness but he did not recover,” she says, “I am truly sad that my uncle died of something that was not even his initial problem. But what can we do? We can only afford to come to a government hospital and we know how overcrowded and hot it can get,” she adds. 

While the news of heat-related deaths is making it to the headlines daily, there is reason to believe that the numbers may be underreported due to several logistical reasons. Known reasons include decreased knowledge among healthcare professionals about when to report and inadequate autopsy services to conclusively prove heat-related deaths, patients developing heat-related illness after admission to a hospital for a different illness are lesser-known reasons for the underreporting. For instance, in the past two examples, the causes of death may be mentioned as urinary tract infection and suicidal poisoning despite the actual reason being heat. 

According to Anand Zachariah, consultant physician, CMC Vellore, people who come to hospitals for certain illnesses are more vulnerable to heat-related illnesses. “Especially when someone has a fever due to any infection, it is very important for them to dissipate heat from their bodies via sweating. However, if the ambient heat in the hospital ward is high, they will not be able to do so. This puts them at a very high risk for developing heat exhaustion or heat stroke,” he says. Alongside this, older individuals, individuals with any longstanding illnesses and skin conditions which cause issues with sweating may also be at risk of developing heat-related illnesses in the hospital according to a paper co-authored by Dr. Zachariah. 

According to Aditi Dandawate, a paediatrician working at Cooper Hospital, Mumbai, such issues can be very common in newborns and children admitted for other reasons as well. “Considering the high temperatures in Mumbai in summer, we always keep our eyes peeled for dehydration in children. In the ward, we advise mothers to dress their children in the bare minimum clothing required to prevent issues. We also ensure adequate hydration in our patients as a priority, providing them with IV fluids, ORS or even coconut water to proactively ensure that heat does not worsen the child’s health,” she adds. 

Improving amenities

While these are individual measures taken at the level of the treating doctors, it is not enough to combat the systemic failings of poor infrastructure of the healthcare system and the ever-looming problem of climate change at large. Hospitals, for one, need to have a strategy in place every year as to how they would deal with such occurrences. This year some hospitals including Tirunelveli Medical College, RML Hospital Delhi, GRH Madurai etc. have started air-conditioned wards to admit and treat heat stroke patients, but these measures fall short on the prevention front. CMC Vellore has prepared a protocol for its doctors which disseminates information about how heat stroke can develop while in hospital. The document shows the signs the doctors must look out for and cautions them as to which kinds of patients are at risk for the same. 

“On top of this, it is important to ensure further changes at the level of the hospital like providing shady areas for patients to wait, keeping pots of water or water dispensers in outpatient areas, measures to cut the time patients must stand in queues etc,” says Dr. Zachariah. “Hospitals must also ensure adequate spacing between beds and ensure every patient has a fan, but in resource-limited settings, one can ask the patient bystanders to bring table fans for the patient. It is also important to store saline and some other IV fluids in the refrigerator as a precaution as administering cold saline can help bring down the body temperature of a person about to go into a heat-related illness soon,” he adds. 

The other solutions that can be considered are conducting outpatient clinics during cooler hours of the day such as early mornings and evenings, creating awareness among patients regarding the development of heat-related illnesses in hospitals and advising patients who come for just general check ups or regular check ups for their diabetes or hypertension to not to do so in the summer months and to come only if they have any troubling symptoms. 

In the current scenario of climate change as we all adapt to “the new normal” it is time that healthcare providers, clinics and hospitals also adapt to ensure that people seeking treatment from them are not subjected to heat-related ailments due to poor planning and infrastructural concerns. 

(Assistance for overcoming suicidal thoughts is available on the State’s health helpline 104, Tele-MANAS 14416 and Sneha’s suicide prevention helpline 044-24640050. Helplines across the country can be accessed here.)

(Dr. Christianez Ratna Kiruba is an internal medicine doctor with a passion for patient rights advocacy. christianezdennis@gmail.com)

Sperm donated in the UK is being exported to other countries and can be used to create large numbers of children across the world, violating a strict 10-family limit that applies in the UK, experts warned. According to The Guardian, while a single donor can be used to create no more than 10 families in UK fertility clinics, there are no restrictions on sperm or eggs from the country being sent abroad. This legal loophole is being exploited in what appears to be an industrial-level practice. It also raises the prospect of some donor-conceived children navigating relationships with dozens of biological half-siblings across Europe and beyond. 

Amidst this, experts are calling on the Human Fertilisation and Embryology Authority (HFEA) to tighten restrictions. “If you believe that it’s necessary to enforce the 10-family limit in the modern world then logically that should apply wherever the sperm are from,” said Prof Jackson Kirkman-Brown, chair of the Association for Reproductive and Clinical Scientists (ARCS), per The Guardian. “There is data showing that some of the children who find the really big families struggle with that,” he added. 

Separately, speaking to the outlet, Prof Lucy Frith, of the University of Manchester, who is researching donor-conceived experiences, said that making contact with biological half-siblings is often viewed positively. However, she added that “when numbers of siblings began to grow [it] felt unmanageable to have contact and relationships with a growing and indeterminate number of people.” 

“There are no hard and fast figures of when the number becomes ‘too much’ and this depends on individuals, but generally over 10 was felt to be a large group,” she said. 

“Once you’ve frozen sperm it doesn’t get any older,” said Mr Kirkman-Brown. This means that a donor sperm could continue to be used for years or decades. “You can end up with donor siblings older than your parents, which is not somewhere we’ve been yet,” he added.

Donations are “presented to donors as a beautiful gift to help someone create a family, not as, ‘We’re going to maximise the number of births from your gametes and make as much money as we can from that,'” said Prof Nicky Hudson, a medical sociologist at De Montford University. 

The rule for enforcing the 10-family limit across licensed clinics is controlled by HEFA. According to the regulatory body, 10 is the number people feel comfortable with in terms of the number of potential donor-conceived children, half-siblings and families that might be created. 

“As the HFEA has no remit over donation outside of HFEA licensed clinics, there would be no monitoring of how many times a donor is used in these circumstances,” said Rachel Cutting, director of compliance and information at the HFEA.

Also Read | Humans Experience Fastest Aging At These Two Ages, Reveals Study

Experts are now asking HEFA to crack down. “The HFEA is limited by its statutory duties, but it could stipulate that it will only import gametes that meet the UK limit (10 families), outside the UK,” said Lucy Frith. 

“The HFEA’s position that this is outside its remit is not good enough,” said Sarah Norcross, director of the fertility charity Progress Educational Trust. “I’m not against there being more than 10 families if some are outside the UK, but 75, which some of these banks have alighted on, is a heck of a lot of relatives. Even if they say we can’t control the number of families abroad, they could insist that the number is made available to the recipient,” she added. 

Notably, according to The Guardian, the United Kingdom was an importer of sperm till five years ago, mainly from the US and Denmark. But between 2019 and 2021, the UK exported 7,542 straws of sperm. Additionally, the world’s largest sperm and egg bank Cryos opened a unit in Manchester this April.

“The European Sperm Bank, which accounted for 90% of exports, applies a worldwide limit of 75 families a donor and estimates that its donors help on average 25 families,” the report said. 

“The idea of a dad to loads of children already exists in our cultural imagination. We don’t have that for women,” noted Prof Nicky Hudson, adding that it’s not an idea encouraged by women. One of them told her it “felt like human trafficking”. 

In the last few decades, scientists have finally learned to harness the immune system to successfully treat cancer. Image for Representation.
| Photo Credit: Freepik

In the last few decades, scientists have finally learned to harness the immune system to successfully treat cancer. Although doctors often use immunotherapy drugs, another type of treatment uses patient’s cells to treat their own cancers.

Car-T therapy, short for “chimeric antigen receptor T-cell”, is a cutting-edge treatment that reprogrammes a patient’s immune cells to fight their cancer. This innovative approach involves taking T-cells, a type of white blood cell that plays a crucial role in the immune system, from a patient and modifying them in a laboratory to better recognise and attack cancer cells.

These enhanced T-cells are then multiplied and infused back into the patient, where they seek out and destroy cancer cells. Lots of data shows that in difficult-to-treat lymphomas, a type of cancer, patients can do so well.

In November 2023, the US Food and Drug Administration (FDA) announced an investigation into this celebrated cancer treatment. They were looking into whether Car-T therapy might be causing new cancers in some patients who had undergone the treatment. This was a significant concern given the therapy’s reputation as a revolutionary cancer-fighting strategy.

Initially, the FDA mentioned that it had observed 20 cases where patients developed new immune-cell cancers, such as lymphomas or leukaemias, which are types of blood cell cancer, after receiving Car-T therapy. This prompted questions about who these patients were, how many such cases existed and what other treatments they might have received before Car-T therapy.

By March 2024, the FDA had documented 33 such cases among around 30,000 treated patients. Consequently, all Car-T therapies now carry a boxed warning about the potential risk of developing secondary cancers. The European Medicines Agency also started its own investigation into the matter.

Despite these concerns, it is still unclear whether the new cancers are directly caused by the Car-T cells or whether other factors are involved. It is also important to note that these cancers are very rare – as data published this month shows.

Many cancer treatments come with a risk of secondary malignancies and, of course, the cancer returning. And patients receiving Car-T therapy often have had several other treatments that could also contribute to the risk. Researchers are now working to determine if Car-T therapy is a contributing factor or the primary cause of these new cancers.

Car-T therapy was initially used for patients with no other treatment options, but it has since been approved as a second-line treatment for certain types of blood cancers, like lymphoma and multiple myeloma. Scientists are also exploring its potential for treating solid tumours including hard to treat brain cancers, autoimmune diseases, ageing, HIV and other conditions.

The process of creating Car-T cells involves using viruses to insert new genetic material into T-cells. These viruses, called retroviruses, are engineered to carry the gene for a chimeric antigen receptor (Car) into the T-cells.

Massive benefits

While these retroviruses are modified to be safe, there is always a risk that the new genetic material could disrupt other important genes and potentially lead to cancer – a phenomenon known as “insertional mutagenesis”. This means new genetic material is added to a cell.

This risk isn’t new. About 20 years ago, gene therapy treatments for severe combined immunodeficiency syndrome using similar retroviruses led to leukaemia in some patients. As a result, scientists have worked to improve the safety of these viral vectors. The FDA now requires thorough testing to ensure that the viruses used in Car-T therapy cannot replicate and cause harm.

Despite these findings, the most important thing to emphasise is that secondary cancers remain rare and these cell therapies can have massive benefits in very sick people.

The new review of patients treated with Car-T therapies at various centres found that only a small percentage developed secondary cancers, and most were not the type directly linked to the Car-T treatment. This suggests that while there is a risk, it is relatively low compared to the immediate threat posed by the patient’s existing cancer.

Medical professionals now inform patients about the potential but rare risk of secondary cancers when discussing Car-T therapy. For most patients, especially those with advanced cancers, the potential benefits of Car-T therapy far outweigh these risks.

As mentioned, Car-T therapy is also being investigated for other applications beyond cancer. For instance, it has shown promise in treating autoimmune diseases such as lupus and even in preventing organ transplant rejection. The potential uses for Car-T cells are continually expanding, offering hope for treating a wide range of diseases.

Ultimately, while the risk of secondary cancers from Car-T therapy is a serious consideration, the benefits for many patients are significant and far outweigh this small risk. Research will continue to refine these treatments and improve their safety.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Reeni Tharakan power lifting at Ulaanbaataar
| Photo Credit: SPECIAL ARRANGEMENT

When Reeni Tharakan hit the gym 10 years ago, at 53, it was driven by a desire to lose weight and stay healthy. The last thing on her mind was powerlifting, let alone winning gold medals at international powerlifting competitions. She won four gold medals in her category at the recently concluded International Powerlifting Federation (IPF) World Classic & Equipped Masters Powerlifting Championships at Ulaanbaatar, Mongolia. 

Gymming was a new experience for Reeni who confesses to not having seen the inside of a gym until then: “I did not know what a dumbbell was or a kettlebell.” Once she began training, her trainer saw potential in her and egged her on to lift weights.  

“My trainer, Jagan KG, encouraged me to lift weights right from the start. He saw my interest and understood my capability, and encouraged me to lift [weights],” says Reeni over the phone from Thycattusserry, near Cherthala. This achievement would not have been possible without her trainer’s support and that of her immediate family which includes her husband and two daughters, she confesses. Despite the backing of her family, the ride has been anything but smooth. “It is not approved of in traditional, conventional families. Questions include ‘why are you doing this at this age?’”  

Reeni Tharakan with her haul at Ulaanbaatar
| Photo Credit:
SPECIAL ARRANGEMENT

The IPF Championship had her compete with around 145 weightlifters from 44 countries. The Masters’ competition is held in four categories — M1, M2, M3, and M4 — for the age groups of 40 years and above, 50, 60, and 70 plus years old. Reeni participated in the M3 category. She is all praise for participants in the championships, “A Japanese man, in his 80s, walked in with a walking stick and ‘out-lifted’ the others. There were more women than men, which was an eyeopener about the number of women who powerlift,” says the homemaker. The fitness levels of participants have left her impressed. The Indian contingent had 25 members, of which around 15 were women. 

Reeni travels three times a week to Kochi, travelling 37-odd kilometres one way, to work out at Mr Standard Gym at Vyttilla. “My husband drives me down, and this is one way of showing support.” She works out for close to two hours, the other three days she works out at home and takes one day off from training. Strict about maintaining her weight [at 69 kilograms for her category] she follows a keto diet, which she says works well for her.

With team mates
| Photo Credit:
SPECIAL ARRANGEMENT

“I keep my weight between 66-67 kilograms. When you compete in an international competition, being overweight by even something as seemingly insignificant as five grams can get you disqualified!” For an idea of how much she can lift — she deadlifted 112.5 kilograms.

She also won a medal at the Asian Women’s Equipped Powerlifting Championships held earlier this year at Alappuzha. She has won medals at district level competitions as well; she began competing in 2021. She credits Jagan and Jerry Lopez, owner of Mr Standard Gym for encouraging her and creating an atmosphere of support for her. “It is not easy for someone my age to do this. And the support I get when I train goes a long way.” Jagan credits her for getting more women interested in lifting weights.  

Reeni is excited about her experience and her advice for others is — “Everybody should lift weights. It is critical… do it for your bones, body and general health.”  

Indonesian researchers have tested a cheaper way of monitoring antimicrobial resistance that could be a key tool for developing countries. Image for Representation.
| Photo Credit: Getty Images/iStockphoto

Indonesian researchers have tested a cheaper way of monitoring antimicrobial resistance that could be a key tool for developing countries.

Indonesian researchers have tested a cost-effective, relatively quick method of measuring changes in antimicrobial resistance that could help developing countries fight a problem seen as a global threat.

Instead of sticking to an approach that emphasises the need for intensive laboratory testing that might not be practical in many countries, they assessed lot quality assurance sampling — a system where a population’s antimicrobial resistance can be assessed using smaller sample sizes.

That’s good news for the G20 after health ministers committed to tackling the threat comprehensively at their meeting last month. Antimicrobial resistance is the ability of microbes to block the effect of drugs that are meant to kill them. This makes infections harder to treat and can lead to longer hospital stays, more expensive care and increased risk of death.

The high level of antimicrobial resistance in Indonesia is now becoming a silent pandemic.

Explained | Is air pollution driving the rise of antibiotic resistance? 

The United Nations has warned the rise of ‘superbugs’ could kill 10 million people a year globally by 2050 and be a drain on the world economy. Like in many other countries, the improper use of antimicrobial drugs and other factors that trigger resistance, such as poor sanitation and air pollution, are prevalent in Indonesia. In 2015, the 68th World Health Assembly adopted the Global Action Plan on antimicrobial resistance.

It emphasises the importance of enhanced global surveillance, particularly in low- and middle-income countries where it is a major concern. One of the key pillars of the Global Action Plan is the support for national strategies through improved global surveillance.

The proposed global surveillance system aims to estimate the prevalence of resistance by using laboratory testing of clinical samples. However, this approach is not always practical in developing countries because of their limited access to quality microbiology diagnostics.

Population-based surveillance is a preferred strategy, but it is also time-consuming, labour-intensive and costly. That means many regions need a rapid, feasible and affordable surveillance strategy.

Explained | The challenge of antimicrobial resistance

Indonesian researchers found an alternative approach: they tried lot quality assurance sampling. This method, which was originally developed in the manufacturing industry to assess batch quality, involves classifying a population as having a high or low prevalence of antimicrobial resistance based on a small sample size.

It has proved to be more practical and cost-effective than conventional population-based surveillance. The Indonesian research applied the lot-based approach to assess the prevalence of antimicrobial resistance in patients with suspected urinary tract infections.

The researchers wanted to estimate the test characteristics for identifying populations with a high prevalence of resistance in urinary tract pathogens, provide lot-sampling classifications for 15 antibiotics in 11 different settings and estimate the cost of implementing lot sampling in a single health facility.

The testing was done in the Indonesian cities of Medan and Bandung, and the exercise was repeated 1,000 times for each of the 13 lots.

Also Read | Putting minds and funds together to find ways of tackling drug resistance 

They found lot testing was 98 percent effective in correctly identifying populations with a high prevalence of antimicrobial resistance.

Overall, the researchers were able to show that lot quality assurance sampling is a promising approach to efficiently estimate antimicrobial resistance prevalence and guide treatment decisions, especially in resource-limited settings.

By significantly reducing sample size requirements and increasing efficiency, lot-based surveillance could significantly contribute to public health efforts to combat antimicrobial resistance worldwide. The findings are particularly significant in the context of the growing importance of surveillance as a crucial tool for antimicrobial stewardship.

Previous studies on drug resistance have shown lot-based surveys are effective in identifying local variations in drug-resistant tuberculosis and assessing the prevalence of transmitted drug resistance in HIV.

This style of survey could be implemented at sentinel sites, enabling regular assessments of changing trends, intervention impacts, or early detection of resistance development after introducing new drugs. This utility is particularly beneficial in settings with limited microbiology capacity or where empirical treatment is common, such as primary care settings globally.

The cost of the lot-based surveys, including 15 antibiotics, ranged between US USD 403 and USD 514 in the 11 sites studied — relatively cheaper than conventional testing regimes. Despite some limitations, including the need for careful site selection and ensuring proper laboratory accreditation and quality control, lot quality assurance sampling shows promise in providing valuable information on antimicrobial resistance for both clinicians and policymakers.