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Rajeev Jayadevan Profile picture
Rajeev Jayadevan
@RajeevJayadevan
Medical doctor/specialist 🇮🇳🇺🇸🇬🇧🇮🇪🇳🇱 Author, Co-Chairman National IMA COVID Task Force & Past President, Indian Medical Association, Cochin
8 subscribers
Dec 18 • 8 tweets • 2 min read
AIIMS study on sudden deaths, autopsy-based, IJMR

Main points (thread)

Analysed as 2 groups: Young (18-45) & old (46-65)

Young (94 cases):
🔹1/5 due to heart rhythm problem (many are silent until event)
🔹36% had CAD (>70% occl), 59% of these were chronic smokers, 44% alcohol Image 🔹29% of young CAD: both chronic tobacco + alcohol use
🔹HCM deaths occurred 10 years earlier than CAD deaths
🔹Lung disease: aspiration in alcoholics, TB, pneumonia
🔹Mean age of “sudden unexplained deaths”= 30.5 (negative autopsy
Apr 30 • 8 tweets • 2 min read
Need to add “category 4” for severe dog bites @WHO

Children get bitten on their face, head & neck by rabid dogs due to their small size. As wounds are close to brain, there is higher risk of rabies than bites elsewhere.

This category requires special attention, see thread👇 Image
Image Rabies is ~100% fatal. Once the virus enters the brain or spinal cord no medication can stop it. Areas of the body like fingertips and face are rich in nerve supply, and wounds in these parts enable more viruses to enter the nerves to travel upstream towards the CNS.

2/
Jul 16, 2024 • 5 tweets • 2 min read
Defects in immune system at 10 months following COVID: research from Medical University Vienna

🔹Innate immunity diminished: ⬇️Natural Killer cells, neutrophils
🔹T cells, B cells diminished: ?Bone marrow effect
🔹TH1 to Th2 switch (shift towards allergic type of response)

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Image They compared people who were initially infected (before vaccines) versus uninfected controls. See paper for profile at 10 weeks and 10 months

Anti N declined slower than Anti Spike (also noted by Sarah Beale from London recently among people with Long COVID)

2/
Apr 17, 2024 • 7 tweets • 2 min read
Tuesday meeting highlights 17 April

COVID returns sooner than expected.

This week, 6.7 - 7.3% of COVID tests turned positive, compared to nil the month prior.

Cases mild or asymptomatic (screening), severe disease not yet reported

(The last wave collapsed December 21)

1/6 While the return of COVID is only expected (cyclical), the short duration (3 months) of case-free gap is surprising.

This coincides with Bangalore waste water surveillance @TIGS_India showing viral load in all samples tested.

This means COVID is in circulation.

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Mar 6, 2024 • 5 tweets • 2 min read
Even among sedentary people, as little as ~4000 steps per day can reduce death / heart disease risk. Maximum benefit at ~9000.

There are many studies on step count, see thread. This paper also looked at how step count helped in a sedentary lifestyle.

1/5
 bjsm.bmj.com/content/early/… There is no such thing as a 10,000 steps requirement for health.

Benefits start at much lower levels.

This study received wide attention, attaching my earlier tweet

2/
Mar 2, 2024 • 5 tweets • 2 min read
“Bed Rest” leads to loss of muscle

In healthy people over 60, just ten days of bed rest led to 1 kg muscle loss from the lower limbs.

Worse in people with illnesses.

In fact, there are very few real indications for “bed rest” now.
Exercise and early mobilisation is key.

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Image Also called sarcopenia, this is a serious problem especially in the elderly, who might suffer an abrupt decline in their health as a result. Frailty creeps in, and once they lose their muscle/bone strength, falls and other complications occur.

Also affects younger people.

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Feb 17, 2024 • 4 tweets • 3 min read
Long COVID study from Japan, published in Nature answers many questions

🔹At 1 year, 20.7% had it, higher in adults.

🔹Most initial infections (89%) were mild, 60% had Omicron

🔹Vaccine has no preventive effect

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Link

nature.com/articles/s4159…
Jan 29, 2024 • 5 tweets • 2 min read
Lung 🫁 function declines long term - even after *mild* COVID.

Major Denmark study measured PFT before, 6 months after and 2 years later. They compared with uninfected people.

The speed of decline leveled off at 6 months, but failed to improve back to baseline. See graph.

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Image The accelerated decline among patients slowed at the 6 month mark, and eventually followed the expected “normal” age related decline. But it did not return to baseline.

DL co increased past the 6 month mark, but the was no corresponding improvement in breathing difficulty.

2/
Jan 1, 2024 • 9 tweets • 4 min read
Spent a week in Singapore, did not get COVID despite JN.1 surge. Sharing some travel tips to stay safe.

Masks, worn according to situation, keep viruses away. Here is what we did.

1. Airports are high risk, hence kept them on all the time

2. High risk while boarding

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Image 3. Airplane jet bridges are tiny tunnels that are crowded, kept masks on.

4. Until the plane takes off and is cruising, cabin isn’t well ventilated. People were coughing throughout, a common problem nowadays. Masks stayed on.

5. At meal times (cruising), masks came off.

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Nov 26, 2023 • 7 tweets • 3 min read
Research from Harvard shows SARS-CoV2 virus doesn’t necessarily require the ACE2 receptor to enter cells.

Antibodies generated against RBD of the virus naturally attach to FcγR1 receptors on immune cells.

This complex can serve as a receptor for virus to attach, and enter.

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Image FcγR1 receptors are found on the surface of immune cells like macrophages and monocytes. When a floating antibody attaches on these “landing pads”, these cells get activated.

Authors find that this antibody-receptor complex can also serve as a substitute of sorts for ACE2.

2/
Nov 15, 2023 • 5 tweets • 3 min read
Hybrid immunity not protective, may worsen risk of infection

48-fold increased risk of getting a repeat Omicron infection among those who had prior Omicron infection

Large study from McMaster University Canada on vaccinated older adults, includes immune response details👇

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Image Study was done from July to September 2022, when Canada was going through a 2nd Omicron wave. They wanted to find out who was at greater risk of getting a 2nd omicron infection. Surprisingly, authors found that those who had prior omicron infection where are FAR GREATER risk.

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Oct 20, 2023 • 10 tweets • 3 min read
Dengue virus infects lab cells more easily in the presence of antibodies generated after COVID-19

2 types of cells K562 & U937 were used, findings compared with control serum.

Evidence of ADE (antibody dependent enhancement) of Dengue, facilitated by SARS-CoV2 antibodies.

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Image ADE is well-known in dengue👇

Dengue virus has 4 serotypes.

Instead of being protective, antibodies generated against one serotype paradoxically worsens the next bout of dengue by another serotype.

It has also been implicated in a few other viruses such as RSV, HIV.

2/
Jun 9, 2023 • 8 tweets • 4 min read
Enjoyed being invited to this fun podcast mainly about immunology related to COVID vaccination without jargon, adding some of the latest research summaries.

With @alexmeshkin @TakeWeightOffMD @julesannenphd

Immunology discussion starts at 10 min

podcasts.apple.com/in/podcast/har… Image Linking a few relevant studies in the context of the podcast

1. The Columbia University Study on Bivalent vaccines
Jun 7, 2023 • 5 tweets • 2 min read
Abnormal brain function found in Long COVID patients with cognitive impairment

Italy study compared multiple parameters with healthy controls

TLDR: Brain has delicately balanced excitatory and inhibitory circuitry. This was disrupted in Long COVID, but not in controls.

1/4 ImageImageImageImage Link to paper

sciencedirect.com/science/articl…

Thanks @THAILANDMEDICA1 for noticing this study

See thread below

2/
Jun 4, 2023 • 5 tweets • 3 min read
Omicron can reinfect in 16 days.

Thrice-vaccinated healthy 52 year-old man gets two separate infections by BA.1.1 and BA.2.

Symptoms lasted 6 and 7 days.

Reinfection used to be considered impossible/unlikely if anyone tested positive within 90 days.

Times have changed.

1/3 ImageImageImage Report from Belgium, April 2022

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May 19, 2023 • 15 tweets • 4 min read
Role of genes in critical COVID

Article headline can be misleading however, suggesting that “being born with bad genes is the reason for COVID deaths”

The problem is that genes are assumed to be like “fingerprints” by most people.

That’s not true. See detailed thread.

1/15 ImageImageImage This study was done on people who had critical Covid, predominantly in the pre-vaccine era.

Using GWAS, authors found that the expression of certain genes was greater in people who had more severe disease.

nature.com/articles/s4158…

2/
May 18, 2023 • 6 tweets • 3 min read
XBB was born in summer 2022 by recombination

This is a landmark event in the pandemic

Until now, variants used individual mutations

But XBB was born from “marriage” of two different viruses, getting a massive advantage at one shot

It is now replacing earlier Omicrons

1/5 ImageImageImageImage This graph shows the relative growth difference between XBB and other Covid variants. See annotations.

These are lab studies, and need not represent human disease.

However, indications are that XBB.1 has the same disease severity as BA.2.75.

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May 4, 2023 • 12 tweets • 5 min read
Detailed study of immune response to Omicron-based boosters and natural infection

Several points (see thread)

🔹mRNA vaccination leads to worse immune imprinting*

(*In plain English: ‘fixed old memory that cannot be updated’)

🔹Longer gap = Better

1/9 ImageImage For those who are unfamiliar with Dr Cao’s work: relentless research by @yunlong_cao and colleagues from China has kept us updated on the latest Omicron versions, and deserve appreciation. See his timeline for prior works, which many of us have retweeted over the years.

2/
May 2, 2023 • 4 tweets • 3 min read
COVID-19 increases the risk for heart attacks and other outcomes in the future

This interview with Dr Soumya Swaminathan @doctorsoumya by @MKadampad was published in @ManoramaDaily

Attaching her recent interview by @ANI quoted by @EconomicTimes

See thread for links

1/4 twitter.com/i/web/status/1… Image Dr Swaminathan’s video interview link here

2/
 m.economictimes.com/news/india/ind…
Apr 27, 2023 • 9 tweets • 4 min read
Arteries became stiffer after even mild COVID - among young healthy volunteers

Study compared stiffness levels measured just prior to pandemic vs. well after COVID symptoms fully resolved

The parameters only worsened with time, and did not improve.

See long thread 👇 ImageImageImageImage There are several measures of arterial stiffness, for example cfPWV (carotid-femoral pulse wave velocity).

Arterial stiffness refers to the reduced ability of arteries to expand & contract in response to changes in blood pressure, and is linked with cardiovascular disease.

2/
Apr 26, 2023 • 5 tweets • 3 min read
Monkeypox detected in Pakistan. The first case was a 25 year-old man who recently returned from Saudi Arabia.

See thread for news report from @AlJazeera and for the first case report in India of fatal encephalitis, Monkeypox in a man who returned from UAE in July 2022.

1/4 Report of fatal encephalitis, Monkeypox. Thanks @hellopragya22 @Aravind22729416

Very few cases were eventually found in India, where it did not spread in the general population despite early concerns by a few experts. In fact, it died down quickly as we had predicted.

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