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FUTUREMEDICINEINDIA.COM
'LONG COVID'
MEDICAL WORLD BAFFLED BY MYSTERIOUS,
UNPREDICTABLE SYMPTOMS AMONG COVID-19 SURVIVORS
POLICY SPECIAL REPORT GENETICS FM COVID-19 UPDATES
IMA OPPOSES
'AYUR SURGERY'
HIV/AIDS:
BEYOND CURE
NON-SARCOMERIC
HCM FLAGGED
IN INDIA
INDIGENOUS
VACCINE GOES
PHASE III

editor’s note
December 2020 / Vol. 7 / Issue 8
Founder & Managing Editor
CH Unnikrishnan
Executive September Editor 2020 / Vol. 7 / Issue 5
S Harachand
Founder & Managing Editor
Associate CH August Unnikrishnan Editor 2020 / Vol. 7 / Issue 4
N S
Executive
Arunkumar
Founder
AUGUST
&
Editor
2018
Managing / Vol:
Editor
Science S 5 / Issue: 4
CH
Harachand Editor
Unnikrishnan
Dr
Science
Rajanikant
Executive Editor
Vangala
Editor
Consulting Dr S Rajanikant Harachand
Editors Vangala
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Science Editor Editors
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CH Unnikrishnan
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editor’s note
editor’s note
Dear Doctor,
editor’s Over the past note weeks, I’m sure you have come across several patients
who Dear have Doctor, complained about prolonged health issues after making a
‘complete
Dear Doctor,
My daughter,
recovery’
like every
from
other
COVID-19.
urban, school-going
You may or
child,
may
had
not
hardly
have
any
noted
time to
down
sit Perhaps unengaged.
their against name
Besides most or diagnosis
endless of our expectations, academic
in your practice
chores, we still including find diary. ourselves But,
the
going
hectic the homework
by middle of
early a and raging soft indications, pandemic. skill projects it Like might and everyone presentations, be worth else, your she too while also are found exhausted to make time with for a note her all the painting of options such and
patients for dancing disease classes. going management foward In between and laid all out share these before with edu-arta-thons, you. the However, world your she the fact would experiences is that also symptom invariably with
such relievers
squeeze Dear cases, and
in Doctor her particularly proven
favourite
and unproven
sports if and and how immunity
workouts you’ve boosters
with been school able are the
and to only help building
options them buddies,
in front
overcome of
of
the
whom
infected,
she such has
and problems. many.
that the
But,
pandemic It COVID-19 is now remains officially has put
as
a known stop
untamed
to that all
as
that.
ever. COVID-19 The
All
lack
hope is of
now
the
leaving rests
usual
on
We opportunities know a trail potential
you of pain vaccine.
are for busy. action, and But
It suffering is with
how
always classes
close in reassuring some are
confined
we of to
that its that
to patients the
panacea
trust internet and that really?
and, faith stretches Not
most
very,
of of all,
for to be frank, but not very far either.
the months
hundreds relentless after
of confinement patients
a confirmed
in at your home, recovery.
healing often touch leaves keeps her moody you busy and in glum—a this noble typical
Indeed, the latest WHO survey has a list of 165 SAR-CoV-2 vaccine candidates
psychological The
profession.
medical syndrome In
world
the hectic
has that no
practice, affects clue the yet
it’s ‘normal’ on
quite
what
natural people underlies
that exposed you
this
might to depleting ‘abnormal’ miss
condition
under development across the world. At least 23 of them are clinical trials and
situations. and
six are out in on This
final some pandemic who are most
stages, of the including latest and developments the at prolonged risk. Described
phase-3 human in lockdown in varying
studies. emerging is nothing terms
Eight medicine. less
vaccine candidates In than such
this era a very
as ‘abnormal “post-COVID
are in of various innovation,
situation’ syndrome”,
stages medical
for not
of development science
just “chronic her,
is
but COVID-19” getting
millions
India too. redefined
of children and “long
Of these, almost
and COVID”,
two by
adults
are the already day.
across it
in Old
the
exhibits world. widely differing manifestations from patient to patient. While
phase-1 technologies human trials. are being The Oxford-AstraZeneca replaced by the new vaccine, the which blink is of presumably an eye. Robots the
continued The repercussions physical and fatigue manifestations and mental of depression this prolonged are abnormality some of the in our
front-runner and artificial among intelligence the four global are taking candidates over a in good the part most of advanced the procedures, stages, has
common
now
social
while been
life vary symptoms,
genomics allowed
from
to
person there
and be tested
to are person. other
molecular in India.
These issues
science The unveil Indian
include which
the manufacturing
anxiety vary and from depression patient
mysteries of partner life further. of
as
to
the
well patient,
We British
as biological
are vaccine
affecting effects
fortunate project—Serum
everything like disturbed
to have such Institute
from sleep, breathing,
breakthroughs of India
appetite
— as will
the disturbances
they conduct
brain, the
help specialists the
and
observerblind,
heart other
and
like
emotional the
you
randomised cardiovascular difficulties.
rise above
controlled
The system severity
the expectations
study to may
to
of
determine the even kidneys. extend
today’s informed
the Some safety
to mental
patient.
and have immunogenicity
illness been and found even
to of substance have the vaccine problems misuse. candidate The with young in the about gut, and 1600 the old, healthy liver pregnant and human the women, skin, volunteers while family in others
members country. of
reported However, the infected this issues and only those with the their who second have eyes phase died or a of due loss human to of the ability trials, infection and to smell they and will even and move the taste. to lonely
WHO Phase-3 are Similarly, all has vulnerable only already it
when
is also to the acknowledged mental a
company
time health when
is successful issues India patient is caused witnessing
in groups’ submitting by the concerns revolutionary pandemic safety data, that and growth this evaluated society’s in
condition by reaction the healthcare Data to needs it. Safety industry, recognition, Monitoring especially Board guidelines in (DSMB), the private and to the sector, research, CDSCO—the wherein and Indian the increasing global drugs
agency regulator. One number of is the now of most doctors looking crucial are forward areas taking we up to must multiple more focus patient roles on is of inputs the clinician, psychological and researcher narratives impact and that
to this These shape entrepreneur. has on promising its the response first This advancements response requires to this teams expansion debilitating by like the you scientific of and your post your community focus COVID colleagues. to condition. a wider worldwide The canvas. long So, are you In hours
and certainly spent this your working context, commendable. colleagues in it potentially becomes have But, important dangerous what a key we role seem how and to play to a unpleasant busy be here losing professional in sight situations, collecting like all such you as this much as can are testing the
as very labs, information keep real hospital challenges pace wards with from these and your risks COVID latest patients involved ICUs, developments makes in and vaccine taking frontline development. a part quick health in and this workers The easy collective development
way. prone to such
research. of mental a safe health vaccine We issues. have typically brought In this a edition, long, to you complex we a wanted compilation process to highlight and of often the the lasts world ground 10-15 view realities years on
this and on this
At serious involves Future
front multiple issue and
Medicine,
the in elements paramount this which edition’s is of conceived
importance research cover and and story of development providing
crafted in order by
additional
a to and team support various of
mental
senior you levels health in
this of support public and information private participation. to both the Therefore, care-seeker this rapid as well race as and the the caregiver. shortened
journalists, task. scientists and doctors, our aim is to help you do just that. We
process Along
Another is certainly highlight not of the this desirable edition is way a report to go on forward, a genetic but study we do on need the a NCD-hit solution
are equipped with in-depth to bring COVID-19 you the latest coverage from the of developments science of care from across
the
urgently. South Asian That, population—uncovering however, doesn’t answer the the story question behind of whether first-ever such Genome-wide
a rapidly
developed Polygenic
the world, world we
Risk solution
in have
Score
an
will
interesting also included
for be coronary 100%
and
safe artery
convenient a look back
and disease efficacious.
way, at
on the
supplemented the global efforts
In this South edition, Asian we
by
population. delve
the to best end
HIV/AIDS
Dr
deep V Ramprasad, of into views on
the and the
high-wire CEO analyses occasion
of MedGenome, acrobatics from of the that masters 32nd World
which is COVID-19 initiated each Aids
vaccine the field. Day.
CAD We development.
PRS present study, you also this talks
Wishing about Also specialised the in an this greater insightful edition knowledge impact is a reading, special that vehicle it feature can that make plugs on the in India, you latest into scientific Straight the emerging advancements Talk of world this edition. of
a most care promising seamlessly. cardiovascular Come, let’s treatment join hands involving this information one-time gene journey. editing. Our
Wishing you an insightful reading,
guest on Straight Talk this month is Sameer Sheriff of iPC Health who explains why
we need CH Unnikrishnan
to get a grip on India’s high levels of medical error deaths urgently.
Wishing editor@futuremedicineindia.com
you an insightful reading,
C H Unnikrishnan
editor@futuremedicineindia.com
C H Unnikrishnan
editor@futuremedicineindia.com
C H Unnikrishnan
editor@futuremedicineindia.com
www.futuremedicineindia.com futuremedicineindia FutureMedIndia
AUGUST 2018/ FUTURE MEDICINE / 3

POLICY SPECIAL REPORT GENETICS FM COVID-19 UPDATES
Vol 7 Issue 8
December 2020
₹ 250.00
VOL 7 | ISSUE 8
PAGES 100
DEcEmbEr 2020
FUTUrEmEDIcINEINDIA.COM
LONG COVID
IMA OPPOSES
'AYUR SURGERY'
cLINIcIANS ArE GrAPPLING WITH
THE LONG-LASTING, ILL-DEFINED ILLNESS IN cOVID-19 SUrVIVOrS
HIV/AIDS:
ELUDING A CURE
NON-SARCOMERIC
HCM FLAGGED
IN INDIA
INDIGENOUS
VACCINE GOES
PHASE III
12
POLICY
CENTRE MOVES
TO INTEGRATE
ALLOPATHY
WITH AYUSH
CCIM decision to allow ayur doctors
practice surgery draws flak
REGULAR FEATURES
06 Letters
08 News updates
40 Drug approvals
50 Research
52 Research snippets
61 Hospital news
64 Genetics
70 Devices&gadgets
74 Gynecology &
paediatrics
76 Diseases
78 Guidelines
96 Calendar
98 Holy grail
Columns
29 TRIALOMICS
Dr Arun Bhatt
62 THE CELLVIEW
Dr Rajani Kanth Vangala
62
GENETICS
INDIAN STUDY FLAGS
PRKAG2-LINKED
HCM IN SOUTH ASIA
Study finds clinical and genetic
features of cardiomyopathy reported
from multiple large familial cases in
India
46
STRAIGHT TALK
“FEAR, ANGER
AND COMFORT
DRIVE PATIENTS
TO SOCIAL MEDIA”
Dr Renjit Nair
Founder & Chief Executive Officer
Germin8 Solutions Pvt Ltd (Germin8)

18
FM COVID-19 UPDATES
COVID-19
VACCINE
ARRIVES,
FINALLY!
56
SPECIAL REPORT
A WORLD
WITHOUT AIDS:
STILL A
DISTANT DREAM
Nearly four decades later, HIV
continues to elude a cure and
defies all efforts to wipe it out
A negative swab
for COVID-19
is not necessarily
a signal of
well-being.
Dr Aashish
Contractor
Director of
Rehabilitation and
Sports Medicine
Sir HN Reliance
Foundation Hospital
Mumbai.
28
COVER STORY
LATE
SEQUELAE OF
COVID-19
The world sees an increasing
number of COVID-19 'long haulers'
— survivors experiencing lasting
virus symptoms

RESEARCH POLICY SPECIAL FEATURE FM COVID-19 UPDATES
letters to the editor
of
KERALA
SPECIAL
FEATUrE
T-CELL DRIVEN
VACCINE STRATEGY
HErD ImmUNITY A DISTANT DrEAm FOr INDIA,
SUGGEST SErO-SUrVEYS
IMMUNE
NDHM: IMA
UP IN ARMS
@
COVID-19:
MOUNTING
HUMAN COST
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FUTUrEmEDICINEINDIA.COM
'HUMAN CHALLENGE'
TRIALS BEGIN IN UK
Don't throw the
gauntlet away!
Hi
With the new encouraging
results from vaccine trials
and the likelihood of early
emergency use authorisation,
the voluntary caution has
begun to weaken, and
people have started yielding
to pandemic fatigue. The
decreasing number of
cases in many states have
lead several institutions to
resume functioning. However,
certain states like Punjab
and Himachal Pradesh have
started seeing a new spurt in
the number of new cases. The
changing climatic condition in
India may also be contributing
to the spread of infections
as the citizens become less
concerned. Hence, the health
authorities must reinforce
the message that low-cost
interventions such as masks,
good ventilation and distancing
norms cannot be abandoned.
Following the rise in cases,
Delhi has started to bring
in strict measures to control
the spread. The restrictions
were made stricter as the
people were showed less
concern about the growing
cases. A recent multinational
study in The Lancet has
highlighted that the benefits
of restricting group gatherings
to 10 people, and reducing
physical attendance at
workplaces could bring down
the infection spread rate to
38% in one month. Evidently,
the entire economy stands
to benefit from such painless
interventions to which the
people must adjust and make
it the new normal.
Dr Farzana G
Banglore
Patient access to
digital medical care
Dear Editor
Amid the infectious outbreak
and ensuing panic of this
public health crisis, there is an
immediate need to restructure
health care delivery. Globally,
telemedicine has emerged as
an option to protect frontline
health care providers, and
assist vulnerable patients with
chronic conditions. However
effective deployment and use
of telemedicine is still trying
to pick up its way in low and
middle income countries.
Health literacy is an often
neglected but critical element
for the implementation of
telemedicine in all countries.
It is required to help people
obtain, read, understand,
and use health information
to make health decisions.
It is, therefore, critical for
countries worldwide to
improve health literacy to
optimize patient access and
engagement in this expanding
world of digital medical care
delivery.
Dr Shehna Fatima
Kolkata
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news updates
India reserves MBBS seats for
‘Wards of COVID Warriors’
The Indian government
has decided to introduce
a new category called
‘Wards of COVID Warriors’
in the guidelines for
selection and nomination of
candidates against Central
Pool MBBS seats for the
academic year 2020-21.
This move aims to
dignify and honour the
noble contribution made
by COVID Warriors in the
treatment and management
of COVID patients, the
union health minister Harsh
Vardhan said, announcing
the decision.
“This will honour the
solemn sacrifice of all
COVID warriors who served
with selfless dedication
for the cause of duty and
humanity”, he stated.
Central Pool MBBS seats
may be allocated for the
selection and nomination
of candidates from the
wards of “COVID Warriors”
who have lost their lives
due to COVID-19; or died
accidentally on account of
COVID-19 related duty.
The term COVID Warrior
has been defined by the
government of India while
announcing an insurance
package of Rs.50 lakhs
for them. It involves all
public healthcare providers,
including community health
workers who may have
to be in direct contact of
COVID-19 patients and who
may be at the risk of being
impacted by this.
Included in the list are
private hospital staff and
retired/volunteer/local urban
bodies/ contracted/ daily
wage/ ad-hoc/outsourced
staff requisitioned by
states/ central hospitals/
autonomous hospitals of
central/states/UTs, AIIMS
and Institutes of National
Importance (INIs)/ hospitals
of central ministries drafted
for COVID-19 related
responsibilities.
The state/UT
government will certify the
eligibility for this category.
Five (05) Central Pool
MBBS seats have been
reserved for this category
for the year 2020-21.
The selection of
candidates will be made
by the Medical Council
Committee (MCC) through
online application on the
basis of rank obtained
in the NEET-2020
conducted by the National
Testing Agency.
Sale of ulipristal
5 mg pills
banned in India
The Drugs Controller
General of India (DCGI)
has directed state licensing
authorities (SLAs) to direct
manufacturers to suspend
the manufacturing, sale
and distribution of ulipristal
acetate tablets 5 mg based
on the reports of liver failure
associated with the use of the
drug.
Ulipristal acetate (5 mg
tablets) has been widely used
for the treatment of moderate
to severe signs and symptoms
of uterine fibroids in adult
women of reproductive age
who are eligible for surgery.
The European Medicines
Agency (EMA) has reported
several liver failure cases
associated with the use of
ulipristal acetate tablets 5 mg.
The drug regulator has
directed all SLAs to recall the
stock in respect of the subject
product from the market. The
action taken in the matter
may be communicated to this
directorate at the earliest.
In May 2018,
Pharmacovigilance Risk
Assessment Committee
(PRAC) in EMA finalised a
review of the benefit-risk
balance of ulipristal tablets
5 mg initiated due to three
cases of liver injury leading to
8 / FUTURE MEDICINE / December 2020

liver transplantation.
The drug was approved
by DCGI on March 14, 2018
for pre-operative treatment of
moderate to severe symptoms
of uterine fibroids in adult
women of reproductive age
and intermittent treatment of
moderate to severe symptoms
of uterine fibroids in adult
women of reproductive age.
The PRAC reviewed
the new cases of serious
liver injury leading to liver
transplantation reported with
ulipristal acetate 5 mg and
concluded a probable causal
association with the drug.
WHO speeds up
global strategy
to end cervical
cancer
The World Health
Organization (WHO)
launched the Global Strategy
to Accelerate the Elimination
of Cervical Cancer. The global
public health agency is also
releasing the first estimates of
Worldwide measles deaths climb 50%
from 2016 to 2019: WHO, US CDC data
Measles cases worldwide
increased to 869,770
in 2019, the highest
number reported since
1996 with increases in all
WHO regions, according to
a publication by the World
Health Organization (WHO)
and the United States
Centers for Disease Control
and Prevention (CDC).
Global measles deaths
climbed nearly 50 percent
since 2016, claiming an
estimated 207,500 lives in
2019 alone.
After steady global
progress in elimination from
2010 to 2016, the number
of reported measles cases
climbed progressively to
2019. Comparing 2019
data with the historic low in
reported measles cases in
2016, authors cite a failure
to vaccinate children on time
with two doses of measlescontaining
vaccines (MCV1
and MCV2) as the main
driver of these increases in
cases and deaths.
“We know how to
prevent measles outbreaks
and deaths,” said Dr Tedros
Adhanom Ghebreyesus,
WHO Director-General.
“These data send a clear
message that we are failing
to protect children from
measles in every region
of the world. We must
collectively work to support
countries and engage
communities to reach
everyone, everywhere with
measles vaccine and stop
this deadly virus.”
Measles outbreaks
occur when people
who are not
protected from the
virus are infected and
spread the disease
to unvaccinated or
under-vaccinated
populations. To control
measles and prevent
outbreaks and deaths,
vaccination coverage rates
with the required MCV1
and MCV2 must reach 95
percent and be maintained
at national and sub-national
levels. MCV1 coverage has
been stagnant globally for
more than a decade at
between 84 and 85 percent.
MCV2 coverage has been
steadily increasing but is
only now at 71 percent.
Vaccination coverage against
measles remains well below
the 95 percent or higher
needed with both doses to
control measles and prevent
outbreaks and deaths.
Although reported
cases of measles are lower
in 2020, necessary efforts
to control COVID-19 have
resulted in disruptions in
vaccination and crippled
efforts to prevent and
minimize measles outbreaks.
As of November, more than
94 million people were at
risk of missing vaccines
due to paused measles
campaigns in 26 countries.
Many of these countries
are experiencing ongoing
outbreaks. Of countries with
postponed planned 2020
campaigns, only eight (Brazil,
Central African Republic,
Democratic Republic of
Congo, Ethiopia, Nepal,
Nigeria, Philippines and
Somalia) resumed their
campaigns after initial
delays.
The Measles & Rubella
Initiative (M&RI), which
includes American Red
Cross, the United Nations
Foundation, the US CDC,
UNICEF and WHO, and global
immunization partners like
Gavi, the Vaccine Alliance,
the Bill and Melinda Gates
Foundation and others,
are working to address
the current measles crisis
and ensure that resources
are positioned to address
immunization delays – for
measles and all vaccines – in
every region of the world. A
bold strategy released
by M&RI, Measles & Rubella
Strategic Framework
2021 – 2030, will help
to address reversals in
global progress toward
measles elimination by
bolstering strong, national
immunization systems.
December 2020 / FUTURE MEDICINE / 9