A year and a half has passed since the COVID-19 pandemic swept across the globe. While there seemed no possible cure for the disease and researchers intensified their search for an effective treatment and vaccine, many clinical trials were happening around the world and herbs emerged as a possible alternate treatment. Two of them include Giloy and Ashwagandha.

Giloy is a popular ayurvedic remedy for a number of health conditions including fever, infections and diabetes. However, there have been numerous debates about its benefits. While Ayurvedic doctors have claimed that the herb is not harmful, there have also been some reports claiming that giloy can lead to liver damage. A study published in the Journal of Clinical and Experimental Hepatology claimed the herb is harmful to the liver. On the other hand, the Ministry of AYUSH argued that giloy had been scientifically proven to be an effective remedy for multiple disorders.

To comprehend the facts related to the medicinal herb, we interviewed some eminent personalities from the field of gastroenterology and hepatology. An expert from the field of liver and gastroenterology suggested that alternative medications like giloy can cause some serious liver injuries. Dr. Kaushal Madaan, Head of Hepatology, Max chain of hospitals, said: “When this pandemic came, we realised that there were many patients who came to us with unexplained liver failure and liver injury and some of them had even died. Only after a few months, we realised that they were taking a concoction and the most common ingredient of that concoction in these particular patients was giloy.” He pointed out that people were consuming kadhas or concoctions, twice or thrice a day, for a year, which could have caused serious liver damage.

“Even before the pandemic started, we had been advising our patients, whether or not they have underlying liver disease, to avoid taking herbal medicines of whose ingredients we are not sure about,” Dr. Kaushal added, in the context of herbal and alternative medicines.

Alluding the fact that all medicines- allopathic, homoeopathic or ayurvedic- have their pros and cons, Dr. Sarin, Director, ILBS, said, “I can certainly say that there are certain herbs that can be harmful. There are certain preparation; unless they have published data, or they have data that they are only beneficial, just don’t take them if they have no scientific evidence.”

During the second wave of the COVID-19, in April-May 2021, a number of COVID-19 patients presented with some unusual manifestations. We saw for the first time in last two months unusually large and multiple liver abscesses in fourteen patients after recovery from COVID-19 infection. Liver abscess (Pus formation in Liver) is commonly caused by a parasite known as Entamoeba histolytica (Picture attached) which is transmitted by contaminated food and water.

According to Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, “What we found unusual was that after recovery from Covid within 22 days in patients who were otherwise immunocompetent had large areas of both lobes of liver filled with pus at multiple locations requiring drainage and hospitalization.”

Prof. Anil Arora, further added “These patients were of age group between 28-74 yrs, ten were males and four females. All patients had fever and upper abdominal pain and 3 patients also had associated lower GI bleeding with black coloured stools. Eight of these patients received steroids for the management of COVID-19 symptoms. Six patients had multiple large abscesses in both lobes of liver of which 5 patients had unusually large abscess (>8cm) the largest being 19 cm size (Figures attached). Three patients who had blood in stools showed ulcers in large intestine which were detected by colonoscopy (large intestine were seen through a camera). Median duration between COVID-19 symptoms and diagnosis of liver abscess was 22 days. Thirteen out of Fourteen patients were successfully treated with antibiotics, Metronidazole medications and drainage of pus from the liver. While one patient with large multiple abscesses died due to massive bleeding in abdomen after rupture of abscess in the abdominal cavity. Rest are stable and have been discharged.”

Prof. Anil Arora also said that “In our patients we found multiple and large abscesses which is very unusual for an immunocompetent person. We believe that suppression of immunity by COVID-19 infection along with use of steroids to treat Covid infection per se, low index of suspicion for liver abscess and delay in treatment in patients recuperating from Covid in this pandemic probably led to development of multiple and large abscesses in Liver.”

Entamoeba histolytica is a common parasite in countries with poor sanitation services. This parasite causes amoebiasis, an intestinal infection that is also called amoebic dysentery. After an infection has occurred, the parasite may be carried by the bloodstream from the intestines to the liver and causes liver abscess. Normally these abscesses are single and not very large and picked up early on routine ultrasonography of the abdomen as a part of workup for fever and associated symptoms in immunocompetent patients. Poor nutrition, immunocompromised status (like in HIV and cancer patients) and steroid use predisposes patients to these infections by amoeba causing liver abscesses.

In this present pandemic, a high index of suspicion of such infections in the form of fever and pain in right abdomen merits a timely intervention in the form of an early diagnosis and effective medical therapy can effectively save uncalled misery and avoidable hospitalization in these patients, said Dr. Praveen Sharma, Senior Consultant Gastroenterology, Sir Ganga Ram hospital.

A new study has shown that several common chemicals, including ingredients in consumer products and drinking water contaminants, could increase the risk of breast cancer by causing cells in breast tissue to produce more of the hormones estrogen or progesterone. The findings of the study appeared in the journal ‘Environmental Health Perspectives’. Every day, people are exposed to synthetic chemicals through the products they use. For many of these chemicals, the health effects are unknown.

However, this study has found the adverse effects of these chemicals and how it may increase the risk of breast cancer. “The connection between estrogen and progesterone and breast cancer is well established,” said co-author Ruthann Rudel, a toxicologist and research director at Silent Spring Institute. “So, we should be extremely cautious about chemicals in products that increase levels of these hormones in the body,” added Rudel. For instance, in 2002, when the Women’s Health Initiative study found combination hormone replacement therapy to be associated with an increased risk of breast cancer, women stopped taking the drugs and incidence rates went down.

“Not surprisingly, one of the most common therapies for treating breast cancer is a class of drugs called aromatase inhibitors that lower levels of estrogen in the body, depriving breast cancer cells of the hormones they need to grow,” said Rudel. To identify these chemical risk factors, Rudel and Silent Spring scientist Bethsaida Cardona combed through data on more than 2000 chemicals generated by the US Environmental Protection Agency (EPA)’s ToxCast program.

The goal of ToxCast is to improve the ability of scientists to predict whether a chemical will be harmful or not. The program uses automated chemical screening technologies to expose living cells to chemicals and then examine the different biological changes they cause.

Reporting in the journal Environmental Health Perspectives, Rudel and Cardona identified 296 chemicals that were found to increase estradiol or progesterone in cells in the laboratory. 71 chemicals were found to increase levels of both hormones. The chemicals included ingredients in personal care products, chemical flame retardants in building materials and furnishings, and a number of pesticides.

The researchers don’t yet know how these chemicals are causing cells to produce more hormones. It could be the chemicals are acting as aromatase activators, for instance, which would lead to higher levels of estrogen, said Cardona. “What we do know is that women are exposed to multiple chemicals from multiple sources on a daily basis, and that these exposures add up.” The Silent Spring researchers hope this study will be a wake-up call for regulators and manufacturers in how they test chemicals for safety.

A new study led by researchers at Imperial College London and University of Padua shows antibody levels remain high nine months after SARS-CoV-2 infection, whether symptomatic or asymptomatic. The results of the study were published in the journal Nature Communications. Researchers tested more than 85 per cent of the 3,000 residents of Vo’, Italy, in February/March 2020 for infection with SARS-CoV-2, the virus that causes COVID-19, and tested them again in May and November 2020 for antibodies against the virus.

The team found that 98.8 per cent of people infected in February/March showed detectable levels of antibodies in November, and there was no difference between people who had suffered symptoms of COVID-19 and those that had been symptom-free. Antibody levels were tracked using three ‘assays’ – tests that detect different types of antibodies that respond to different parts of the virus. The results showed that while all antibody types showed some decline between May and November, the rate of decay was different depending on the assay.

The team also found cases of antibody levels increasing in some people, suggesting potential re-infection with the virus, providing a boost to the immune system.

Lead author Dr Ilaria Dorigatti, from the MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA) at Imperial, said: “We found no evidence that antibody levels between symptomatic and asymptomatic infections differ significantly, suggesting that the strength of the immune response does not depend on the symptoms and the severity of the infection. “However, our study does show that antibody levels vary, sometimes markedly, depending on the test used. This means that caution is needed when comparing estimates of infection levels in a population obtained in different parts of the world with different tests and at different times.”

Professor Enrico Lavezzo, from the University of Padua, said: “The May testing demonstrated that 3.5 per cent of the Vo’ population had been exposed to the virus, even though not all of these subjects were aware of their exposure given the large fraction of asymptomatic infections. “However, at the follow-up, which was performed roughly nine months after the outbreak, we found that antibodies were less abundant, so we need to continue to monitor antibody persistence for longer time spans.”

The team also investigated the infection status of household members, to estimate how likely an infected member is to pass on the infection within the household. Their modelling suggests that there was a probability of about 1 in 4 that a person infected with SARS-CoV-2 passes the infection to a family member and that most transmission (79 per cent) is caused by 20 per cent of infections.

This finding confirms that there are large differences in the number of secondary cases generated by infected people, with the majority of infections generating no further infections and a minority of the infections generating a large number of infections.

The large differences in how one infected person may infect others in the population suggest that behavioural factors are key for epidemic control, and physical distancing, as well as limiting the number of contacts and mask-wearing, continue to be important to reduce the risk of transmitting the disease, even in highly vaccinated populations. The team’s dataset, which includes the results of the two mass PCR testing campaigns conducted in February and March and the antibody survey conducted in May and then again in November, also allowed them to tease apart the impact of various control measures.

They showed that, in the absence of case isolation and short lockdowns, manual contact tracing alone would not have been enough to suppress the epidemic.

The second dose of a COVID-19 vaccine induces a powerful boost to a part of the immune system that provides broad antiviral protection, according to a study led by investigators at the Stanford University School of Medicine.

The findings published in the journal Nature strongly supports the view that the second shot should not be skipped. “Despite their outstanding efficacy, little is known about how exactly RNA vaccines work,” said Bali Pulendran, PhD, professor of pathology and of microbiology and immunology. “So we probed the immune response induced by one of them in exquisite detail.”

The study was designed to find out exactly what effects the vaccine, marketed by Pfizer Inc., has on the numerous components of the immune response.

The researchers analyzed blood samples from individuals inoculated with the vaccine. They counted antibodies, measured levels of immune-signalling proteins and characterized the expression of every single gene in the genome of 242,479 separate immune cells’ type and status. “The world’s attention has recently been fixed on COVID-19 vaccines, particularly on the new RNA vaccines,” said Pulendran, the Violetta L. Horton Professor II.

He shares senior authorship of the study with Kari Nadeau, MD, PhD, the Naddisy Foundation Professor of Pediatric Food, Allergy, Immunology, and Asthma and professor of paediatrics, and Purvesh Khatri, PhD, associate professor of biomedical informatics and of biomedical data science. The study’s lead authors are Prabhu Arunachalam, PhD, a senior research scientist in Pulendran’s lab; medical student Madeleine Scott, PhD, a former graduate student in Khatri’s lab; and Thomas Hagan, PhD, a former postdoctoral scholar in Pulendran’s Stanford lab and now an assistant professor at the Yerkes National Primate Research Center in Atlanta. “This is the first time RNA vaccines have ever been given to humans, and we have no clue as to how they do what they do: offer 95% protection against COVID-19,” said Pulendran.

Traditionally, the chief immunological basis for approval of new vaccines has been their ability to induce neutralizing antibodies: individualized proteins, created by immune cells called B cells, that can tack themselves to a virus and block it from infecting cells. “Antibodies are easy to measure,” Pulendran said. “But the immune system is much more complicated than that. Antibodies alone don’t come close to fully reflecting its complexity and potential range of protection.”

Pulendran and his colleagues assessed goings-on among all the immune cell types influenced by the vaccine: their numbers, their activation levels, the genes they express and the proteins and metabolites they manufacture and secrete upon inoculation.

One key immune-system component examined by Pulendran and his colleagues were T cells: search-and-destroy immune cells that don’t attach themselves to viral particles as antibodies do but rather probe the body’s tissues for cells bearing telltale signs of viral infections. On finding them, they tear those cells up.

In addition, the innate immune system, an assortment of first-responder cells, is now understood to be of immense importance.

It’s the body’s sixth sense, Pulendran said, whose constituent cells are the first to become aware of a pathogen’s presence. Although they’re not good at distinguishing among separate pathogens, they secrete “starting gun” signalling proteins that launch the response of the adaptive immune system- the B and T cells that attack specific viral or bacterial species or strains. During the week or so it takes for the adaptive immune system to rev up, innate immune cells perform the mission-critical task of holding incipient infections at bay by gobbling up — or firing noxious substances, albeit somewhat indiscriminately, at — whatever looks like a pathogen to them.

The Pfizer vaccine, like the one made by Moderna Inc., works quite differently from the classic vaccines composed of live or dead pathogens, individual proteins or carbohydrates that train the immune system to zero in on a particular microbe and wipe it out. The Pfizer and Moderna vaccines instead contain genetic recipes for manufacturing the spike protein that SARS-CoV-2, the virus that causes COVID-19, uses to latch on to cells it infects.

In December 2020, Stanford Medicine began inoculating people with the Pfizer vaccine. This spurred Pulendran’s desire to assemble a complete report card on the immune response to it. The team selected 56 healthy volunteers and drew blood samples from them at multiple time points preceding and following the first and second shots. The researchers found that the first shot increases SARS-CoV-2-specific antibody levels, as expected, but not nearly as much as the second shot does. The second shot also does things the first shot doesn’t do, or barely does.

“The second shot has powerful beneficial effects that far exceed those of the first shot,” Pulendran said. “It stimulated a manifold increase in antibody levels, a terrific T-cell response that was absent after the first shot alone, and a strikingly enhanced innate immune response.”

Unexpectedly, Pulendran said, the vaccine — particularly the second dose — caused the massive mobilization of a newly discovered group of first-responder cells that are normally scarce and quiescent. First identified in a recent vaccine study led by Pulendran, these cells- a small subset of generally abundant cells called monocytes that express high levels of antiviral genes — barely budge in response to actual COVID-19 infection. But Pfizer vaccine-induced them.

This special group of monocytes, which are part of the innate museum, constituted only 0.01 per cent of all circulating blood cells prior to vaccination. But after the second Pfizer vaccine shot, their numbers expanded 100-fold to account for a full 1 per cent of all blood cells.

During a recent study, researchers found that among six and seven-year-olds who were born before the 28th week of pregnancy and those who had more than two hours of screen time a day were more likely to have deficits in overall IQ, executive functioning, impulse control, and attention. The findings of the study appeared in the journal ‘JAMA Pediatrics’. According to the study, those who had a television or computer in their bedrooms were more likely to have problems with impulse control and paying attention.

The findings suggested that high amounts of screen time may exacerbate the cognitive deficits and behavioural problems common to children born extremely preterm.

The study was conducted by Betty R. Vohr, M.D., and colleagues. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Heart, Lung, and Blood Institute; and National Center for Advancing Translational Sciences.

Previous studies have linked high amounts of screen time among children born full-term to language and developmental, behavioral and other problems.

In the current study, researchers analysed data from a study of children born at 28 weeks or earlier. Of 414 children, 238 had more than two hours of screen time per day and 266 had a television or computer in their bedrooms. Compared to children with less screen time per day, those with high amounts of screen time scored an average deficit of nearly 8 points on global executive function percentile scores, roughly 0.8 points lower on impulse control (inhibition) and more than 3 points higher on inatten