Wednesday, January 22, 2020

Preventive role of MMR and BCG vaccine against Nobel Coronavirus infection

Forward on many medical groups 👇. Just for your information.

I GOT VACCINACTED AGAINST COVID19 !
Dr Ramesh Gulla, MS

The China born novel Corona virus is devastating the world by killing people in thousands and ruining the the world economies like never before. We still do not have an effective medicine nor do we have a novel vaccine. The medical world was not prepared for such an unprecedented attack on the global health when China announced its arrival on the last day of the last year to the unassuming world. Our own chloroquin unfortunately is far from of any help to stop the deaths. Quite a few new molecules invented by global pharma giants are falling short of expectation and novel corona vaccines are not expected before next year. Actually any new vaccine takes not less than 4 years to hit the market. Doctors are seen sitting helpless, afraid as they are, keeping themselves away from even mundane clinical practice and surgeries. Many large hospitals have shut down to an unimaginable misery of even non covid patients. Unfortunately there seems to be no end to the global pandemic. Amongst all this disheartening facts that we are witnessing there now appears a hope like a ray of light at the end of a tunnel.
The novel Corona virus causes the dreaded disease called Covid19. Out of every hundred infected patients about 7 require hospitalisation for treatment in ICU or to be on oxygen or, even worse, a ventilator. In all, a three of them may die adding to hundreds of deaths nationwide everyday. In this grim situation it appears now that an affordable and quick saviour is already in our hands! Unbelievable but true!

The new Corona virus that escaped from China to haunt the world actually shares its structural resemblance to rubella virus by upto 30% as found in the virology study at Cambridge University (1). The best thing is we already have a means of preventing this rubella disease. And that is the MMR, a combined vaccine for 3 childhood diseases Measles, Mumps and, the more important, Rubella. The antibodies that develop in response to MMR vaccine can also act against the new corona virus preventing a full blown Covid19 fatal stage of the disease. Though the similarity is not more than 30% between the two viruses, rubella and corona, the protective benefit can be near complete. Hence, when exposed to the new Corona virus the body will still get infected no doubt , in the form of a mild cold and fever or nothing at all, but the rubella antibodies prevent its progression into Covid19 disease and its severe complications and death. So the MMR can be a very effective vaccine against the new Covid 19 disease and it's benefits could be impressively lifesaving not less than any expected promises of newer corona vaccines still in pipe line.

Enough evidence is already there to corraborate for this unbelievable finding (2)

1. The death rate in corona pandemic for children is surprisingly very low world over as compared to adults. For, the children do receive MMR vaccine! The rubella antibodies they develop protect them.
2. Covid death rate is very high in older, 50+, people world over. Because, not surprisingly, this age group never received the vaccine. The MMR came into wide spread use only 50 yrs back.
3. Where adults also received the vaccine in their recent past the covid death rates are low in those parts of the world irrespective of any racial difference as seen in Hong Kong, South Korea, Madagascar and US sailors.
4. A country with 2.7 crore population, Madagascar witnessed just 16 covid deaths for having vaccinated about 70 lakh people last year over and above their routine childhood MMR vaccination schedule. This recent MMR dose of vaccine refreshed immune memory and helped battle out the Corona virus and avoided Covid deaths.
5. Hong Kong witnessed just 4 covid deaths as compared to about 30,000 deaths in New York with similar large, denser population. They have an extended MMR immunisation programme including many adults.
6. There are less than 300 covid deaths in South Korea as there is mandatory armed service for adults where they receive 2 MMR vaccines at recruitement.e
7. In American Samoa islands there are very few covid deaths as they recived MMR last year.
8. In the offshore American ship Roosewelt more than a thousamd became corona positive, but only 1 died of covid. For, all of them had received MMR vaccine at recruitment.
9. In contrast, in countries where covid deaths are at top 5, none had MMR programmes for adults in near past.
10. Iran did vaccinate the people with MMR extensively but with only single dose, as against the required two, and could not prevent covid deaths.
11. The novel Corona virus shares its structural similarities by 20% with Measles virus and 30% with Rubella virus.
12. The antibodies produced against novel Corona virus in the body are similar to that produced by MMR vaccine as seen in cross reactions at antibody tests.
13. The pattern of M and G type of antibodies produced in the body in the course of Covid19 disease is similar to that seen in a secondary rubella infection: mild M and very high G.
14. Because of these antibodies, a previous infection from the Corona virus could protect people from rubella, and vice versa.
15. Waning of MMR immunity over years after vaccination occurs because of decreasing levels of antibodies and interferons (3). This immunity needs to be tuned up by fresh vaccination.
16.Covid mortality is very low (0.05%) in children and adolescents because of MMR immunity. But a slightly higher(4.5%) mortality rate in adults below 50 suggests waning status of MMR immunity.
17. Another older vaccine BCG, used against tuberculosis (TB), also confers protection against Covid deaths as seen in countries such as Japan ( compared to other G7 countries), where it is part of universal vaccination (4). BCG is already a part of universal immunization programme in India since decades. This has kept our Covid death rates lower than the Western countries! BCG provides nonspecific but protective immunity against a variety of respiratory diseases.
The above body of corroborative evidence proves fairly convincingly that the good old MMR vaccine has prevented covid deaths in adults and of course in children world over.
After administration of MMR vaccine the body produces antibodies. The antigenicity of rubella virus is committed to the memory of body's immune apparatus. Later when novel Corona virus infects the body, enough antibodies are again produced early on to tame the virus preventing it's complications like respiratory or cardiac failure. There will be, therefore, no need for any scary ICU admissions or requirement of expensive ventilators. This way hundreds of thousands of deaths can be prevented and that too at a very low cost.
This wonderful solution for the dreaded new disease is not drawn from any rat-rabbit or for that matter man-monkey type laboratory research but by just corraborating widely available information to a desperately helpless global shame.
I resorted to injecting the wonder into myself in a show of my enormous confidence in my medical researh as an answer to fix an ultra-modern menacing challenge. I thought, I being a doctor myself, it drives home the point best. I have already vaccinated over a hundred willing adults in my practice at Athani, Karnataka, including many doctor colleagues, their families and their staff, and none, as expected, had any side effects.
MMR is the only scientific preventive tool to prevent Covid deaths apart from face mask, social distancing, hand washing and lock downs. MMR vaccine could be far more effective than other trivials like herbal drinks or homeopath's pills or even the yoga.
The cold chain maintained MMR vaccine is in an injection form of only half ml causing hardly any pain on administration. Two such doses are to be taken a month apart. All Children and adults can have it, dose being the same for both, half ml only.
In all only a quarter of our population needs to be vaccinated to bring down the reproduction rate (R) of the virus to below 1 when the chain of spread gets broken completely. We already have running mandatory MMR vaccination programme for children in India only since last 3 yrs and now it needs to include adults as well to reach one fourth of our total population. This will also prevent second and any later waves of the pandemic in coming years as is warned by the WHO.
The high placed agencies like the ICMR may happen to be misleading the government for being biased heavily towards clinical trials to establish proof. But I am sure this is not the time to be wasted on a very time consuming clinical trials which take months together to complete by which time we might have lost thousands of unimmunised lives. The ICMR may even advise to wait for the arrival of new brand proprietary corona vaccines under the mesmerising infuence of vaccine industrial sharks. I we stay away from such fast tracked inadequately tested for late side effects vaccines however efficacious they may be, from getting into our system before demonstrating absolutely sure of their safety profile over years of clinical observation. The vaccine industry seems to be happily in a hurry abetted by political compulsions. On the other hand MMR is a time tested vaccine in clinical use for over 5 decades and is quite reliable and is bereft of any late serious side effects.
In times of crisis, such as this pandemic, even a small piece of evidence is enough to be proactive and act with full commitment to save ourselves first.
In this endeavour I along with my wife Dr Prabha, a paediatrician herself, along with our 3 children received the MMR vaccine by ourselves in our own hospital in a press meet and thus became the world's first previleged family to ever have got vaccinated against the dreaded Covid19. In doing that I repurposed the MMR vaccine against Covid19 disease, a first in the world.
It is an off the shelf injection and does not even require any governmental or ICMR-like institutional recommendation. MMR is in Indian Pharmacopeia (IP) and can be administered by any registered medical practitioner. Those who have already received MMR, (very very unlikely in India, and not to be confused with DPT !) children including, must also get it now to boost immunity further to fight Covid19.    
 This does not require any fresh clinical trials. We know that during a pandemic a trial is not an absolute necessity. Hydroxychloroquin was advised by ICMR without backing from any clinical trials. Adult MMR vaccine programme is actually being practised in many armed forces like that of South Korea and the US and also in general populations in 25 other countries, from Bhutan to Belarus, to name a few. WHO recommends it for all adult health care workers as also international travellers.
All patients requiring indoor treatment, surgeries, procedures, chemotherapy, radiation therapy and dialyses as well as out door chronic cardiac and respiratory  patients should be manadated a compulsory vaccination.
There is no harm even if Covid positive person also receives it, as it only benefits him by boosting the native immunity. 
Let us kick start the idea with a slogan:
To kick Covid out, get 2 shots MMR.

Dr Ramesh Gulla, MS
2454, Gulla Hospital, Athani
Karnataka 591304
9448424886
ri_gulla@yahoo.com
References:
(1) Homologous protein domain in SARS-CoV-2 and measles, mumps and rubella viruses: preliminary evidence that MMR vaccine might provide protection  COVID-19. A Young, et al Preprint: https//doi.org/10.1101/2020.04.10.20053207
(2) MMR vaccine appears to confer strong protection from COVID-19: Few deaths from SARS-CoV-2 in highly vaccinated population. J E Gold et al : www.world.org  posted on 29.3.2020 v7.3
(3). Characterization of humoral and cellular immunity to rubella vaccine for distinct cohorts. N Lembert et al: Immunol Res 2014; 58(1) 1-8.
(4) Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study. Aaron Miller, Mac Josh Reandelar,  Kimberly Fasciglione, Violeta Roumenova, Yan Li, Gonzalo H Otazu; doi: https://doi.org/10.1101/2020.03.24.20042937
(5) WHO : worldometre; accessed on 26th June, 20

Laser excision of Leukoplakia of the tongue



This case is doing well in follow up. She underwent Laser Excision of the tongue lesion. 
Laser is just a precise cutting tool. Tongue normally bleeds heavily so Laser sometimes creates problem as this alone is insufficient to control the bleeding. Laser is better for smaller lesions and conventional cautery is needed to control the bleeding. 

Saturday, December 21, 2019

Malignant Otitis Externa- Managment Discussion.

Dr. Shakuntala Ghosh: Would be happy if anyone shares a fool-proof
complete treatment schedule for an elderly diabetic with possible
malignant Otitis Externa. He has granulation floor of EAC wth pus,
moderate pain, culture report Pseudomonas sensitive to Pipericillin' tazo?
Cefoperazone- sultamicin.
He has taken the latter combo for 7 days. I have ordered a Ct Mastoids
Duration of symptoms 2 months, treated outside

Dr. Kvss Sastry: Peptaz 10 days
4.5 GM TID 10 days
Please look into fungi also
Aftèr CT temporal bone

Dr. Kiranbir Singh: Ceftazidime 1 gm bd for 10 days. Followed by
Moxifloxacin 400 od for two weeks.
All u need to see response and accordingly change the regime .

Dr. Aru Handa: Most often need to continue antibiotic for weeks or
months even beyond pain and local inflammation  relief.

Dr. Anandabrata Bose: Agree completely and strict control of diabetes

Dr. Madhusudan Rao: My experience Shakunthala,
Inj. Ceftazadime 1gm twice a day
Tab. Ciprofloxacin 500 mg thrice or iv Ciprofloxacin
Topical Ciplox drops hourly for a minimum of 7 days
Followed by
Ciprofloxacin for one month.
As Sastry suggested fungal???
If you can keep ciprofloxacin ointment with dexa as cotton wick will do
wonders twice daily

Dr. Shakuntala Ghosh: Thank u Sir but the aural swab culture showed
Pseudomonas resistant to all
Quinolones.

Dr. Madhusudan Rao: Still it works on long run with higher doses.
Sometimes tge culture test may be
false positive or negative.
Qunalones resistance is a very rare phenomenon. May be false negative

Dr. Amar Singh (Muscat)
Sharing our huge experience of treating Malignant Otitis Externa(MOE) in over
250 patients in diabetic pt successfully in a single institution with  a well defined
Al Nahdha management protocol which is a now a national protocol in Oman followed by all institutions. Hope this helps Dr. Shakunthala and others. Treat this sinister condition in bits and pieces carries high morbidity and morbidity.
Dr.Amar Singh
Senior Consultant 
ENT Al Nahdha Hospital,
Muscat,Oman.

Monday, September 23, 2019

Watering of Eyes in babies (Epiphora)

Doc, Why my newborn has excessive watering from his/ her eyes?  

Ans. Watering of eyes from new born is of serious concern to parents. Usually the passage between eyes and nose for tear drainage is formed by the age of 6 months of fetus. In few cases, this may persist after birth. Most of such cases responds to special massage over lacrimal sac area known by name Criggler hydrostatic massage.

Technique is important. It should be behind the anterior lacrimal crest. search video on youtube. 

Till what age should parents do massage?

Ans.  1 year

When to refer such cases to eye doctor? 

Depends upon severity of symptoms 

Does early probing has any contraindication? 

No

Concerns

How to check vision in babies 🤱 

Can be done with special cards


Infantile glaucoma can also cause epiphora and photophobia













Friday, August 23, 2019

Botox dosages in spasmodic dysphonia

Botox dosages are practioner dependent.

To start with, use low dosage. 1 U for women and 1.5 Unit for man. 

Average dose 3 units per side. 

This maximize benefits (fluency) 
And minimize side effects (breath voice) 

Basal cell carcoma (Atrophic Variant)


Sunday, August 18, 2019

Paediatric auditory brainstem implant



Implant is placed in the lateral recess of the 4tb ventricle close to foramen of Luschka and stimulates dorsal and ventral nuclei. 

The cochlear nucleus has tonotopicity. 




Flocculus of cerebellum is variable in size and hides the entry into lateral recess.

Switch on of cochlear Auditory brainstem implant is done after 3-4 months.

Vestibular dysfunction is seen I. Few patients.
Indication of cochlear implant

(From lecture of Dr. Mohan Kameshwaran)


It take 2-3 year for child to learn after implant and it varies. This is unlike Cochlear implant where it takes less than 1 year.










Dr Ajay Jain's Clinic address and timings

  ENT Clinic (Preet Vihar)   Address :  Shop number 1,2,3 DDA Market-1, G-block, Preet Vihar, Vikas Marg, Delhi-92. Landmark :  Enter G-Bloc...