Recent figures released by the Philippines health department revealed that over 1,000 people receiving treatment for Covid-19 are severe or critical cases. As with other hospitalised patients, a continuous flow of life-saving Oxygen is crucial for their recovery but can supply be guaranteed when ordering traditional cylinders?

To achieve self-sufficiency with this vital gas a growing number of medical facilities in the Philippines are switching to Oxygen Pressure Swing Adsorption (PSA) technology from Oxair, supplied in the country by distributor and hospital systems specialist Brilliant Metal Craft & Machine Design (BMC).

PSA systems are high quality, robust medical devices designed to last and deliver consistent, high purity oxygen on tap to hospitals and healthcare facilities – even in the remotest locations around the world. BMC has now installed almost 40 Oxair PSA solutions in hospitals across the region, from Isabela to Tagum City, with more in the pipeline.

Australia-based Oxair, a global leader in gas processing systems, offers a simpler, safer alternative to dependence on cylinder-stored medical oxygen. As it extracts its supplies directly from the atmosphere, PSA oxygen provides better patient care with a permanent flow of high-quality oxygen.

This system saves room space, offers output pressure and a flow rate to suit the needs of the hospital and is capable of piping oxygen to every department where it is needed. Many medical centres across Philippine islands now have peace of mind, free from the worries associated with deliveries of cylinders – thanks to the dedicated work from BMC.

Oxair’s system delivers constant oxygen of 94-95 per cent purity through PSA filtration, a unique process that separates oxygen from compressed air. The gas is then conditioned and filtered before being stored in a buffer tank to be used directly by the end user on demand. Oxair has expanded its operations in order to keep up with demand for standalone Oxygen PSA units.

BMC’s Kristine Belle, explained: “PSA systems enable self-generated oxygen so supply for the hospital is secured. No more worries and red tape associated with deliveries of cylinder-stored oxygen. Handling and storage difficulties are also effectively eliminated.”

The cost to a Philippines health facility generating its own oxygen is a fraction of purchased oxygen, meaning fast equipment investment payback and great savings in the long term.

David Cheeseman of Oxair added: “We’ve seen terrible consequences from a lack of life-saving medical oxygen, especially when treating Covid-19 patients. Medical facilities in the Philippines can rely on our technology for their oxygen needs as it is tried and tested over many years and the installations are carried out by BMC to an extremely high standard.”

The covid-19 pandemic is far from over and is continuing to place additional pressure on oxygen supplies. More and more hospitals in the Philippines are recognising that PSA systems provide almost instant access to vital oxygen supplies under significantly safer conditions.

A hospital in the United Kingdom is the first worldwide to insert a brain gadget to repair Parkinson’s symptoms, and the test patient describes it as “wonderful.” A tiny deep brain stimulation (DBS) device is being implanted into the skull by physicians at Southmead Hospital in Bristol, England.

It compensates for Parkinson’s disease’s faulty brain-cell firing patterns. Twenty-five individuals have been considered for inclusion in the North Bristol NHS Trust experiment, which will run until next year. If the experiment is successful, additional Parkinson’s sufferers will be able to get treatment more easily. Tony Howells, who was diagnosed with Parkinson’s disease nine years ago and was the trial’s first patient, described the impact as “wonderful.”

Before the surgery, he went on a walk with his wife on Boxing Day and got 200 yards from the actual car, Howells, who acquired his device in November, said. He had to turn back and return since he couldn’t go much further.

However, a year after the procedure, on Boxing Day, he went for another 2.5-mile stretch, and perhaps he could have gone even farther.

He described it as incredible. 

Parkinson’s disease leads to progressive deterioration of areas of the brain over time and has no cure presently. Unconscious tremors, delayed movement, loss of natural movement, and tight and stiff muscles are some of its symptoms.

The majority of people acquire signs after they are 50, but about 5% of all those who suffer from it do so before they reach 40. Traditional Parkinson’s surgery involves inserting a huge battery in the chest with cables hanging under the skin all the way to the crown of the head. The new DBS system uses a small battery pack for the gadget that is transplanted into the skull, making it the smallest ever constructed.

The device sends electric signals straight to certain parts of the brain. Electric probes are inserted into the subthalamic nuclei, which is an area deep in the centre of the brain that is significant in regulating movement through the skull to accomplish this. The new procedure takes only three hours, which is about half the time it took with the bigger battery.

The trial’s principal investigator, a consultant neurologist at North Bristol NHS Trust, Dr. Alan Whone, said that they are extremely pleased with how this initial case performed in the operating room, as well as how the patient’s condition has improved over the past year. If these findings stay in place, then they will have a significant technical breakthrough by which to enhance Parkinson’s care throughout the world, says the researcher. According to Howells, you won’t realise how aggravating the condition is until it strikes you.

The far harder thing to recognise is the gradual reduction of everyday chores, such as knot tying, which now takes three or four minutes rather than seconds. It has a significant impact on one’s day-to-day life. Howells is now capable of playing golf again, much to his pleasure, and feels DBS is a great way of giving people their lives back.

According to updated information from the US Centers for Disease Control and Prevention, about 60% of adults plus 75% of children have antibodies suggesting that they’ve been exposed to COVID-19.

The information comes from a long-term examination of blood specimens sent out to commercial labs across the United States. At the beginning of December, an estimated 34% of Americans had antibodies suggesting that they had been exposed to the virus that induces Covid-19. After an outpouring of cases caused by the Omicron strain, that number had grown to 58 percent by the end of February. Dr. Kristie Clarke, a paediatrician who headed the study for the CDC, said, the biggest surge in antibody detection was among children and teens.

According to the study, over 75% of kids under the age of 18 had acquired antibodies to COVID-19 by February. Adults 65 and older saw the lowest rise, with the CDC estimating that 33 percent of elders have indeed been affected by the virus. However, it’s unknown what these test results indicate in terms of personal or community resistance to future diseases. Researchers really don’t know how much longer virus-induced immunity lasts, and one can’t tell from the study whether all people who screened positive for SARS-CoV-2 antibodies are still shielded from their previous infection, Clarke said.

As a result, the CDC advises that all Americans keep up to date on their COVID-19 immunizations and receive the required shots and boosters. Clarke says people who have been diagnosed within the last three months may be willing to wait on their second booster shot.

The figures are based on random, anonymous blood tests conducted by commercial laboratories in the United States. The testing detects antibodies to components of the virus that causes COVID-19; as vaccinations do not produce these antibodies, the testing is used to determine how many people have been infected with the SARS-CoV-2 virus. According to the CDC, the antibodies used in the study stay positive for at least 2 years following exposure, indicating that the study should capture infections that have occurred since the start of the pandemic.

According to Clarke, the CDC does not advise anyone to get an antibody test. They don’t encourage this on an individual basis, she explained, since it doesn’t change the advice in terms of what one should do, such as getting the vaccines up to date and addressing other precautionary actions with the doctor.

The research comes as more contagious new strains, BA.2 and BA.2.12.1, are taking control of transmission in the United States, producing more cases and hospitalizations. Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said that the department is closely monitoring COVID-19 instances in the Northeast. They are seeing a larger number of cases in various parts of the country, especially in the Northeast, and they are also beginning to see some hospital admissions go up, she added.

Walensky explained that the numbers had not risen as quickly as they would have previously in the pandemic, thanks to, she believes, a great level of community protection and vaccinations. However, one must keep a close eye on this, she explained.

Medtronic announced the first patient enrollment in the EXPAND TAVR II Pivotal Trial, the first randomized clinical trial evaluating the self-expanding, supra-annular Evolut™ TAVR platform in patients with moderate, symptomatic aortic stenosis (AS), a population outside of current guidelines and indications for transcatheter aortic valve replacement (TAVR). The first patient in the EXPAND TAVR II pivotal trial was enrolled by the team led by Shigeru Saito, M.D. and Tomoki Ochiai, M.D. at Shonan Kamakura General Hospital in Kamakura, Japan.

The EXPAND TAVR II Pivotal Trial is a muti-center, international, prospective trial to be conducted in the U.S., Canada, Japan, EMEA regions, Australia, and New Zealand. Investigational Device Exemption (IDE) approval was received in October 2021 from the U.S. Food and Drug Administration (FDA) and Clinical Trial Approval was received from the Japan Pharmaceutical and Medical Device Agency (PMDA) in February 2022. This global trial will evaluate the safety and effectiveness of the Medtronic Evolut PRO+ TAVR System and guideline-directed management and therapy (GDMT) compared to GDMT alone in the moderate, symptomatic aortic stenosis patient population. The data may be used to support future regulatory submissions to expand the current indications for the Evolut TAVR platform.

“There are many patients living with varying levels of aortic stenosis, including moderate symptomatic, who may benefit from the less invasive TAVR procedure even though they fall outside of the current indications,” said Paul Sorajja, M.D., Headrick family chair, Valve Science Center at the Minneapolis Heart Institute Foundation, and principal investigator in the study. “We are excited to add to the growing body of clinical evidence to support the safety and benefits of TAVR in new patient populations.”

More than two million patients live with moderate aortic stenosis in the U.S., which represents more than two times the population of patients with severe aortic stenosis. Moderate AS remains undertreated due to a lack of clinical evidence informing treatment guidelines. Currently, the recommended management of patients with moderate AS includes periodic monitoring with transthoracic echocardiography every 1-2 years (or with any change in symptoms or findings).

The EXPAND TAVR II pivotal trial will enroll up to 650 patients at up to 100 sites globally and will include two co-primary endpoints to evaluate the safety and efficacy of the Evolut TAVR system with follow up out to ten years. The primary safety endpoint is a composite of all-cause mortality, all-stroke, life threatening or fatal bleeding, acute kidney injury, hospitalization due to device or procedure-related complication, or valve dysfunction (requiring reintervention) at 30 days. The primary effectiveness endpoint is the composite rate of all-cause mortality, heart failure event, or aortic valve replacement or reintervention at two years.

“We are thrilled to have the first patient enrolled in this important trial as we assess the performance of the Evolut TAVR platform in new patient populations,” said Jeffery Popma, M.D., chief medical officer of the Structural Heart and Aortic business, which is part of the Cardiovascular Portfolio at Medtronic. “Demonstrating our leadership in Structural Heart and continued commitment to generating robust clinical evidence, results from this study will support our clinical strategy to pursue a broader indication of the therapy as we work to treat more patients around the world.”

The Evolut TAVR platform is approved for severe symptomatic aortic stenosis patients worldwide.

Medtronic announced new data from the STROKE AF clinical trial, which showed that large and small vessel ischemic stroke patients who receive short-term or intermittent monitoring (i.e., holter monitors and 30-day external monitors) may not be optimally managed for recurrent stroke prevention versus those who received continuous monitoring with insertable cardiac monitors. The data will be presented at the Heart Rhythm Society’s annual Heart Rhythm meeting in San Francisco on Sunday.

In the analysis, which used simulation methods to evaluate 242 patients, the rate of AF incidence (≥2 minutes) was 12.1% at one year in patients with the Reveal LINQ™ Insertable Cardiac Monitor (ICM), while intermittent monitoring showed an AF incidence rate between 0.2 – 2.5% during the same period. Results indicated that even the most aggressive intermittent monitoring strategy would have missed 79% of patients who had ≥2 minutes of AF detected.

“Based on the primary findings from the STROKE AF study we know that detection of AF after stroke is important because it often leads to an evidence-based change in therapy that can prevent secondary stroke from occurring,” said Jonathan P. Piccini, M.D., electrophysiologist and associate professor of medicine at Duke University Medical Center in Durham, N.C. “This analysis using simulation methodologies tells us just how much AF would be missed in these ischemic stroke patients when intermittent monitoring strategies are used instead of continuous monitoring. The majority of patients with AF after stroke would have eluded detection with even the most comprehensive intermittent monitoring strategy; therefore, the absence of AF with intermittent monitoring does not always imply freedom of AF.”

The sub-analysis is part of the STROKE AF, a prospective, multi-site, randomized (1:1) clinical trial comparing ICM monitoring to site specific standard of care (SOC) in patients with stroke attributed to large artery atherosclerosis (LAA) or small vessel occlusion (SVO). Primary results from the STROKE AF trial demonstrated the superiority of the Reveal LINQ™ Insertable Cardiac Monitor (ICM) to detect AF in both large and small vessel stroke patients compared to standard of care. The findings were published in the June 1, 2021 issue of the Journal of the American Medical Association (JAMA).

After years of prescribing aspirin to avoid heart attacks and strokes, researchers now believe it has little benefit for the majority of healthy subjects, and that it may increase the risk of stomach or brain haemorrhage as one gets older.

In most circumstances, the US Preventive Service Task Force’s current guidelines on low-dose aspirin regimens have been finalised, and adults over 60 should not begin taking aspirin for preventive care of heart issues. If one is between the ages of 40 and 59, the USPSTF recommends that the patient and doctor discuss whether he or she should take regular aspirin in certain situations.

Someone will do more damage than good with daily aspirin if the person is extremely healthy, such as a healthy 40-year-old with no key risk factors. The risk of bleeding outweighs any benefits, agrees Dr. Steven Nissen, Cleveland Clinic’s chair of cardiovascular medicine, who has not been involved in the new guidelines. People have to realise that aspirin is not 100% harmless.

If one has had a heart attack, stroke, or even other heart issues or poor circulation and the doctor has prescribed daily aspirin, don’t quit taking it; instead, discuss the updated guidelines with them. Aspirin is important in secondary prevention. It is effective for people who have a stent, have had a myocardial infarction, or have had a stroke. It delivers a small but significant benefit, Nissen remarked.

The USPSTF is an impartial committee of disease prevention and specialist doctors from all over the country that makes recommendations to assist doctors in making better decisions. Their opinions have an influence on insurance companies’ reimbursement decisions. Aspirin works by inhibiting the production of certain natural chemicals that cause pain and swelling in the body. It can help reduce blood clotting, which is why doctors have suggested it for decades to reduce cardiovascular issues such as heart attack and stroke.

If one is in the 40-to-59 age bracket and has a 10% or higher 10-year risk of cardiovascular disease, the doctor may want to explore an aspirin regimen, as per the recommendations. This implies that the chances of having a heart attack or stroke in the next ten years are higher than normal, based on a formula that takes into account characteristics such as age, gender, diabetes status, race, cholesterol levels, blood pressure, medication use, and smoking status. According to the task team, a daily aspirin only offers a minor net benefit for this group.

The task force’s amended recommendations are based on a study of several large randomised trials on low-dose aspirin use, which indicated a link to a lower risk of myocardial infarction as well as stroke but not mortality. Low-dose aspirin was also linked to an increase in bleeding risk. The task committee last updated these recommendations in 2016, when it stated that everyday aspirin could help prevent colorectal cancer. However, the new guidelines state that there is insufficient evidence that it lowers the risk of colorectal cancer or mortality from the disease.

According to the 2016 guidelines, daily aspirin use had some merit for people aged 50 to 59 who had a 10-year risk of cardiovascular issues greater than 10%, were projected to live longer than 10 years, and were not at an elevated risk of bleeding. People aged 60 to 69 who have a 10% or greater cardiovascular risk must make an independent decision about whether or not to take a daily aspirin, as per the 2016 guidelines.

The task force emphasises that bleeding difficulties in adults without high-risk diseases such as peptic ulcer disease, NSAID use, or corticosteroid use are uncommon, although the risk increases with age. Depending on the specific modelling statistics, it may be safe to cease taking aspirin around the age of 75.

According to the US Centers for Disease Control and Prevention, cardiovascular disease is the leading cause of death in the United States, accounting for more than 1 in every 4 deaths. The more the data, the more one can witness that while the risk of coronary disease and heart attack increases with age, the risk of bleeding appears to increase even faster, says medical director of the Harrington Heart & Vascular Institute, Dr. James Cireddu, who was not involved in the guidelines’ development.

Changes to cardiac recommendations that were made previously

These aren’t the sole guidelines for taking aspirin on a daily basis. According to Dr. Roger Blumenthal, who co-chaired the working group that developed the ACC/AHA guidelines, the new USPSTF rules are now more in alignment with the American College of Cardiology/American Heart Association guidelines and standards for the average person who has never had a cardiac event.

When one looks at all of the new trials, it appears that the minor advantage of aspirin in otherwise low-risk individuals is often overshadowed by the increased risk of long-term GI issues and bleeding because of it, Blumenthal stated. While it has been stated that giving aspirin to someone who has not had a heart attack or stroke could be considered, it should likely be the last thing on the priority list.

As per the president of the American Heart Association, Dr. Donald Lloyd-Jones, aspirin may still have a role in heart health. Perhaps the prescription drugs are too expensive or a country’s health system is unable to distribute them, in which case aspirin may continue to make sense, but he believes aspirin now makes a lot less sense in many situations in this country, where individuals have good healthcare access and are managing other risk factors.

Director of wellness at University Hospitals, Ohio Dr. Roy Buchinsky, who was not involved in the creation USPSTF guidelines, noted that one may take additional steps to boost overall heart health with just a little effort.

According to WHO and UNICEF, a rise in cases of measles in January and February 2022 is a significant indication of an elevated risk for the spread of vaccine-preventable diseases and might ignite larger outbreaks, notably of measles, which could affect millions of children in 2022. Pandemic-related interruptions, rising inequities in vaccination access, and shifting resources away from vaccination programs leave far too many children vulnerable to measles as well as other vaccine-preventable illnesses.

As communities loosen social distancing practises and other COVID-19 prevention measures taken during the peak of the epidemic, the danger of massive outbreaks has grown. Furthermore, with millions of citizens dislocated as a result of the conflict and emergencies in Ukraine, Ethiopia, Somalia, as well as Afghanistan, disruptions in routine immunisation and COVID-19 vaccination assistance, a lack of clean water and sanitation, and congestion, all raise the danger of vaccine-preventable disease outbreaks.

In January and February 2022, about 17,338 measles incidents were identified worldwide, compared to 9,665 in the first two months of 2021. Since measles is extremely infectious, cases tend to emerge quickly when vaccination rates drop. The organisations are concerned that measles cases could presage an outbreak of other diseases that spread more slowly.

Apart from its potentially fatal effects on the body, the measles virus damages the immune system and makes a kid more susceptible to other infectious illnesses such as pneumonia and diarrhoea, even months after the measles disease has passed. The majority of cases occur in areas that have experienced social and economic problems as a result of COVID-19, violence, or other crises, as well as health system infrastructure that is chronically poor and insecure.

Measles is more than just a nasty and potentially fatal illness. It is also an early sign that there are vulnerabilities in our global immunisation coverage that underprivileged children simply cannot afford, says UNICEF Executive Director Catherine Russell. It’s heartening to see that people in many places are feeling a bit safe enough outside of COVID-19 to engage in more social activities. However, doing so in areas where children are not routinely immunized creates a perfect storm for a disease like measles to proliferate.

In 2020, 23 million children would have missed out on normal vaccinations, the largest number since 2009 and 3.7 million more than in 2019. As of April 2022, there have been 21 major and disrupting measles infections all around the world in the previous 12 months, according to the agencies. The majority of measles cases are reported in Africa and also the East Mediterranean. Since the pandemic has disturbed surveillance systems around the world, the numbers are likely to be higher, with underreporting a possibility.

Somalia, Nigeria, Yemen, Ethiopia, and Afghanistan have had the highest measles outbreaks over the last year. Poor measles vaccine coverage is the main cause of outbreaks, irrespective of where they occur. The COVID-19 pandemic has disrupted immunisation services, healthcare systems have indeed been overburdened, and fatal illnesses like measles have resurfaced. The consequences of these disruptions in immunisation programmes will be felt for decades for many other illnesses, warned World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus. Now is the time to get essential vaccinations back on track and conduct catch-up programmes to ensure access to such life-saving vaccines.

Since the commencement of the pandemic, 57 vaccine-preventable disease programmes in 43 countries have been postponed, effecting 203 million people, the majority of whom are children. Measles campaigns account for 19 of them, putting 73 million children at risk of contracting the disease owing to missed vaccines. The measles catch-up effort in Ukraine was halted in 2019 due to the COVID-19 outbreak and, later, the war. Routine and catch-up efforts are needed wherever access is available to help prevent outbreaks like the one that occurred in 2017–2019, when the country experienced over 115,000 cases of measles and 41 fatalities, the highest occurrence in Europe.

Children can be protected against measles if they have at least 95% coverage with 2 doses of the effective and safe measles vaccination. However, problems caused by the COVID-19 pandemic have led to the second dosage of the measles vaccination being delayed in many nations. As countries work to respond to measles and other vaccine-preventable diseases flare ups and regain lost ground, UNICEF and WHO, in collaborative partnerships like Gavi, the Vaccine Alliance, the Measles & Rubella Initiative (M&RI), the Bill & Melinda Gates Foundation, and many others, are bolstering immunisation systems by:

• Reinstating facilities and vaccination programmes so that countries can administer routine immunisation in a safe manner to fill the gaps created by backsliding.
• Assisting health care providers and local leaders in actively communicating with caregivers about the need for immunizations.
• Finding communities and individuals who were not vaccinated during the pandemic, as well as identifying the gaps in immunisation coverage.
• Ensuring that the COVID-19 vaccine is self-funded and well-integrated into the overall vaccination strategy so that it does not come at the expense of childhood or other vaccination services.
• As part of COVID-19 recovery efforts, the implementing nation plans to prepare for and respond to incidents of vaccine-preventable diseases, as well as strengthen vaccination infrastructure.