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Monthly Archives: July 2021
Novartis, GBT sickle cell drugs face coverage hurdles as gene therapy threats loom: survey – FiercePharma
Posted: July 6, 2021 at 2:13 am
Novartis Adakveo and Global Blood Therapeutics Oxbryta started their commercial life in 2019 as novel drugs for sickle cell disease. While physicians like their efficacy and safety profiles, formulary coverage is a hurdle, doctors told analysts in a survey. That's not to mention potential gene therapy threats.
For both Adakveo and Oxbryta, 64% of physicians said the drugs have unfavorable cost and coverage dynamics compared with traditional hydroxyurea therapies, analysts at JPMorgan wrote in summarizing survey responses from 25 U.S. physicians. Each of the doctors sees at least 25 sickle cell disease patients.
The unfavorable coverage profiles suggest the companies still have work to do to increase access, the JPMorgan team said in a recent note to investors. Currently, many payers are requiring patients try other meds before covering the newer drugs, the analysts wrote.
RELATED:New sickle cell drugs from Novartis, GBT need big discounts: ICER draft
The access problem comes in contrast to the fact that most doctors view the drugs as having a better or similar clinical profile compared with hydroxyurea.
Nevertheless, about half of physicians said their overall clinical experience with Oxbryta has been worse than that with hydroxyurea. Thatrate was 36% for Adakveo incomparison with the older drug. The JPMorgan team labeled the results as no surprise, given the Novartis and GBT drugs are relatively new.
Adakveo vs. Oxbryta
Between the two new offerings, doctors generally rated Adakveo higher in terms of itsability to reduce vaso-occlusive pain episodes,which is the most important product characteristic the doctors said they look for when making therapy choices. Oxbryta scored better with respect to hemoglobulin improvement or impact on anemia.
Adakveo is an antibody drug given by infusion once a month, whereas Oxbryta is a daily oral drug. Despite their difference, dosing and convenience dont weigh much on prescription behavior, the doctors said.
RELATED:Bluebird's Zynteglo trials set to resume, putting gene therapy back on flight path to FDA filing
Currently, physicians treat60% of sickle cell patients with single-agent drugs, the survey showed. Among those patients, only 6% are on Adakveo monotherapy, whileanother 6% take Oxbryta. Looking forward, the outlook appears to favor the Novartis drug. Over the next three years, the physicians expectsingle-agent use to rise to 18% for Adakveo but only 11% for Oxbryta, while combination utilization of the drugs with other therapies will remain relatively stable.
Butthe potential entry of gene therapies could become a key barrier to Oxbryta and Adakveo growth over the longer term. The surveyed doctors expect single-agent use of gene therapy to reach 24% of patients by 2028.
Overall, the physicians surveyed believe that a third of their sickle cell disease patients on average would be suitable for a gene therapy. Most physicians had a favorable view of the two clinical candidates, bluebird bios LentiGlobin and CRISPR Therapeutics and Vertexs CTX-001.
The physicians feedback highlights the potentialsqueeze fromfuture competition, the JPMorgan analysts said. All told, the team expects Adakveo to reach about $700 million in peak sales and Oxbryta to hit $950 million from the U.S. and EU.
COVID-19 slows launch
Like other drug launches in recent years, the pandemic has wreaked havoc on the sickle cell disease rollouts. A quarter of surveyed doctors said they'd seen a decrease in patient visits during the pandemic.In the first quarter, sales of Oxbryta reached $39 million in the U.S., compared with$37 million for Advakeo from the U.S. and EU.
RELATED:GBT chief blames COVID-19 for 'clear' slowdown in Oxbryta launch, but analysts are still impressed
Telemedicine has helped ease the negative effects from COVID-19, but doctors are less comfortable starting a new therapy without an in-person visit, GBTs chief commercial officer, David Johnson, said during an investors call in May.
As two doctors observed in their response to the JPMorgan survey, they have adopted telemedicine for very stable patients, or mostly for follow-ups and discussing side effects. Looking ahead, the physicians expect to increasingly shift back to on-site visits over the next six to 12 months.
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Novartis, GBT sickle cell drugs face coverage hurdles as gene therapy threats loom: survey - FiercePharma
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Gene Therapy in Oncology Thematic Research Report 2021 – ResearchAndMarkets.com – Business Wire
Posted: July 6, 2021 at 2:13 am
DUBLIN--(BUSINESS WIRE)--The "Gene Therapy in Oncology - Thematic Research" report has been added to ResearchAndMarkets.com's offering.
Gene therapy describes the treatment of various cancers with the use of in vivo treatments: viral and non-viral gene therapy products, therapeutic oligonucleotides, oncolytic viruses and genome editing therapies.
There are currently just 3 gene therapies marketed for oncology indications in the eight major pharmaceutical markets (8MM) (US, France, Germany, Italy, Spain, UK, Japan, and China). Oncolytic viruses lead the category with 2 products, followed by viral vector gene therapies with 1 approved drug.
Gene therapies are in development for melanoma and other various solid tumors. As of April 2021, there are 252 clinical trials investigating in vivo gene therapies across the 8MM with 81 drugs in development.
Sales of products that comprise the categories of in vivo gene therapy are forecast to reach over $7B by 2027. The therapeutic oligonucleotide market, which will be galvanized by the success of COVID-19 messenger ribonucleic acid (mRNA) vaccines, is forecast to reach $4.5B by 2027 globally.
Key Highlights
Key Questions Answered
Scope
Key Topics Covered:
1. Preface
2. Executive Summary
2.1. Key Findings
3. Gene Therapy Overview
3.1. What is Gene Therapy?
3.2. History of Gene Therapy Development in Cancer in the 8MM
3.3. Key Twitter Chat
4. Trends
4.1. Industry Trends - Gene Therapy Vectors
4.2. Industry Trends - Therapeutic Oligonucleotides
4.3. Industry Trends - Genome Editing
4.4. Industry Trends - Oncolytic Viruses
4.5. Regulatory Trends
5. Value Chain
5.1. Gene Therapy Value Chain
5.2. Gene Therapy Vectors
5.3. Therapeutic Oligonucleotides
5.4. Genome Editing
5.5. Oncolytic Viruses
5.6. Gene Therapy in Oncology Clinical Trials
6. Marketed Products
6.1. Marketed Gene Therapy Products for Cancer in the 8MM
6.2. Leading Gene Therapy Treatments in The 8MM
7. Pipeline Products
7.1. Gene Therapy Pipeline Products in the 8MM
7.2. Gene Therapy Pipeline Candidates
7.3. Late Stage Gene Therapy Candidates, 8MM
8. Market Analysis and Deals
8.1. Gene Therapy Market Analysis and Forecast by Class of Therapy
8.2. Top 10 Transaction Deals by Size during 2012-2021 in the Oncology Gene Therapy Space
8.3. Latest Transaction Deals in the Oncology Gene Therapy Space
8.4. Mergers and Acquisitions That Include Oncology Gene Therapy Assets: 2019 - 2021
8.5. Mergers and Acquisitions That Include Oncology Gene Therapy Assets: 2014 - 2018
9. Regulatory and Market Access
9.1. Gene Therapy in Clinical Trials
9.2. Regulatory - US
9.3. Market Access - US
9.4. Regulatory - Europe
9.5. Market Access - Europe
9.6. Regulation of Gene Therapy in the US and Europe
9.7. Regulatory and Market Access - Japan
9.8. Comparison of Early Access Schemes in the US, EU, and Japan
9.9. Regulatory and Market Access - China
10. Opportunities, Challenges, and Unmet Needs
10.1. Gene Therapy Vectors, Viral - Opportunities & Challenges
10.2. Gene Therapy Vectors, Non-viral - Opportunities & Challenges
10.3. Therapeutic Oligonucleotides - Opportunities & Challenges
10.4. Genome Editing - Opportunities & Challenges
10.5. Oncolytic Viruses - Opportunities & Challenges
10.6. Clinical Unmet Needs in Gene Therapy - Gap Analysis
10.7. Commercial Unmet Needs in Gene Therapy - Gap Analysis
10.8. Unmet Needs - KOLs Perspective
11. Companies
11.1. Drug Development Scorecard - Regenerative Medicine
11.2. Current Major Players
11.2.1. Amgen
11.2.2. SiBiono
11.2.3. Sunway Biotech
11.3. Future Players Based on Pipeline Strength
11.3.1. Candel
11.3.2. CG Oncology
11.3.3. Checkmate
11.3.4. Daiichi Sankyo
11.3.5. Ferring
11.3.6. FKD
11.3.7. Geron
11.3.8. Idera
11.3.9. Istari
11.3.10. VBL
12. Appendix
For more information about this report visit https://www.researchandmarkets.com/r/v0ma92
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Gene Therapy in Oncology Thematic Research Report 2021 - ResearchAndMarkets.com - Business Wire
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Gene therapy breakthrough could cure rare and fatal brain disease – Health Europa
Posted: July 6, 2021 at 2:13 am
A team of scientists and doctors from University College London Great Ormond Street Institute of Child Health (UCL GOS ICH) and Great Ormond Street Hospital (GOSH) have recreated and cured the condition using state-of-the-art laboratory and mouse models of the disease. They will soon apply for a clinical trial of the therapy.
The findings from the study have been published in Science Translational Medicine.
DTDS is a rare neurological condition that causes progressive dystoniaandparkinsonism, so called because of similarities to Parkinsons disease. It usually begins in infancy; however, some people may not develop symptoms until childhood or later. Infants with DTDS are rarely able to learn to walk or speak. Symptoms include slow movements, involuntary twisting postures of the arms and legs, and whole-body stiffness.
Currently, there are no effective treatments or a cure for the disorder and most children with DTDS sadly die before reaching adulthood, often from respiratory infections or other complications. Although the condition is rare, with around 50 children worldwide currently known to doctors, it has previously been mistaken for cerebral palsy and may continue to be undiagnosed.
Professor Manju Kurian discovered the faulty gene causing DTDS in 2009 and was subsequently granted seed funding worth just over 86,500 from Great Ormond Street Hospital Childrens Charity (GOSH Charity) to begin developing the treatment. Professor Kurians team and her collaborators at UCL have also spent the last decade working to better understand the mechanisms that underpin this disease, and this has enabled them to develop a new, precision gene therapy with the potential to treat this devastating disorder.
When developing the gene therapy, scientists took skin cells from children with DTDS and turned them into stem cells, which can grow into any type of cell to build or repair different parts of the body. Professor Kurians team, with work led by Dr Serena Barral, converted these stem cells into the exact brain cells (dopaminergic neurons) that carry the genetic fault responsible for DTDS.
Using this laboratory model made directly from the cells of children with this rare condition, scientists were able to test the experimental gene therapy for DTDS and show that it could relieve the disease-related defects in DTDS brain cells.
The team used fluorescence microscopy to see what was happening in the laboratory model. A seemingly random pattern of colours in the untreated cells demonstrated how the neurons and their communicating arms called neurites had not formed properly in cells with DTDS. The gene therapy treated cells formed a much more obvious cluster pattern for the neuron, with its red neurites, essentially showing the DTDS is cured in a laboratory model.
A further collaboration with UCLs Professor Simon Waddington and Dr Joanne Ng enabled the researchers to build on these results, studying DTDS in mice and testing gene therapy as a cure. The gene therapy injects a modified, harmless virus containing the healthy gene into the area of the brain where this gene is missing. The mice were successfully cured of their symptoms including involuntary and disordered movements, progressive parkinsonism, and weight loss. Based on the promising results of the laboratory tests, the next phase is to develop a clinical trial which would involve children diagnosed with DTDS.
Professor Manju Kurian, Consultant Paediatric Neurologist at GOSH and NIHR Research Professor at UCL Great Ormond Street Hospital Institute of Child Health, co-lead author on this study and the scientist behind the discovery of this disease, said: Our study provides real hope of an effective treatment for children who are living with this devastating, life-limiting brain disease, and it is hugely exciting to be at the stage of planning a clinical trial just ten years after discovering the gene that causes the condition.
We hope this pioneering gene therapy will prevent the progression of this rare but cruel disease with a single procedure, giving children the improved quality and length of life that they deserve. If we can use gene therapy to treat children with this condition early enough, there is great potential for improvement in their health.
Professor Simon Waddington, Professor of Gene Therapy at UCL, co-lead author on this study, said: Our whole working process has been guided by one principle: we want to find the answers for these children and how we can treat them.
The mice received the same carefully selected vector and delivery route that we plan to use in treating the children. This careful selection has allowed us to progress rapidly to design a protocol so we can start the clinical trial next year.
While DTDS is rare, we know that there are many other conditions we can model in this way, opening the door for a standardised approach to finding cures for these rare conditions.
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Gene therapy breakthrough could cure rare and fatal brain disease - Health Europa
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Cobra flags successful production of gene therapy plasmids – BioPharma-Reporter.com
Posted: July 6, 2021 at 2:13 am
CG01 is CombiGene's gene therapy for the treatment of drug-resistant focal epilepsy.
The newly released GMP plasmids were produced by Cobra in the early part of this year. It said the material had to be quality assured through a variety of analyses, a process that is now finalized.
The plasmid production itself was very successful and generated so much material that, according to current estimates, it will be enough for more productions of CG01 than originally planned, according to the parties.
The release of the plasmids produced by Cobra means that we will be able to start GMP production of CG01 later this year. In doing so, we are taking another important step towards the first in human study that we plan to start in 2022, saidJan Nilsson,CEO of CombiGene.
When asked why this production of plasmids is considered a landmark moment, and whether it was thought that the process was going to be more challenging than it turned out to be, Tony Hitchcock, technical director, Cobra, told BioPharma-Reporter:
This is a critical milestone for CombiGene as it provides the starting materials for the production of their clinical CGO1 therapy for the treatment of epilepsy. Cobra Biologics has been producing plasmid DNA for its customers for over 20 years, however the production of key plasmids for the production of AAV vectors such as CG01 can produce some challenges due to sequence elements and the size of the plasmids. There was a requirement to optimize processes to overcome these issues to generate plasmids of the required quality, and quantity, to support CombiGenes planned manufacturing campaigns.
Unlike many gene therapies, which are developed for the treatment of rare diseases, CG01 caters to a large population of patients, said CombiGene.
Epilepsy is a major global problem. Every year, approximately 47,000 drug-resistant patients with focal epilepsy are estimated to be added in the US, EU4, UK, Japan and China.CombiGene believes that it is realistic that 10-20% of these patients could be treated with the drug candidate, CG01.
Assuming, for example, that the therapy cost per patient is somewhere between $134,000 and $200,000, it provides sales between $750-$1,500 million annually, it added.
Cobra anticipates that there will be a long-term requirement to supply plasmid DNA to support the production of viral vectors, including AAV and Lenti viral vectors, for advanced therapy products, he added.
Whilst some manufacturers may adopt the use of stable cell lines for the production of certain vectors such as Lenti, it is likely that transfection approaches will be retained for some vectors such as AAV, where the generation of stable cell lines is more challenging, remarked Hitchcock.
What is next in terms of goals, both short term and long term, for Cobra Biologics?
Like many plasmid suppliers, Cobra is working to expand is plasmid production capabilities, both in terms of throughput and the numbers of High Quality (HQ) and GMP grade plasmid batches it can produce, whilst also scaling up its production processes to meet the needs for products entering later phase and commercial supply.
Furthermore, with Cobra Biologics becoming a Charles River company, alongside Cognate BioServices, and Vigene BioSciences, the goal is to continue to grow and develop our offering in the cell and gene therapy space, offering supply chain simplification and an end-to-end service offering for development, testing, and manufacturing, providing clients with an integrated solution from basic research and discovery through GMP production.
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BioMarin resubmits haemophilia A gene therapy to the EMA – PharmaTimes
Posted: July 6, 2021 at 2:13 am
BioMarin has resubmitted a marketing authorisation application (MAA) for its haemophilia A gene therapy valoctocogene roxaparvovec to the European Medicines Agency (EMA), the company announced yesterday.
BioMarin initially withdrew the EU marketing application for the gene therapy also known as Roctavian last year, after stating that it was unable to provide the data needed to resolve a major objection raised by the EMAs Committee for Advanced Therapies.
The first EMA filing contained interim results from 32 adults with severe haemophilia A in a Phase III trial.
According to BioMarin, the EMA had requested the full 52-week results from all 134 patients enrolled in the study.
Now, BioMarin has that data in hand included in the new MAA is safety and efficacy data from the 134 patients enrolled in the study, all of whom have been followed for at least one year post-treatment with valoctocogene roxaparvovec.
"This is an important step to deliver the potential first gene therapy for people with haemophilia A.The data package for this submission includes the largest Phase III study in any gene therapy for haemophilia A supported by up to four years of observation in a Phase I/II study," said Hank Fuchs, president, worldwide research and development at BioMarin.
"We look forward to the EMA reviewing the robust data set. We believe that valoctocogene roxaparvovec represents a scientific innovation that may become an important treatment choice for those people who have unmet medical needs," he added.
BioMarin also announced that it is planning to submit two-year follow-up safety and efficacy data on all participants from the Phase III trial to support the benefit/risk profile of the gene therapy, which was previously requested by the US Food and Drug Administration (FDA).
Last August, BioMarin received a complete response letter from the FDA for valoctocogene roxaparvovec.
At the time, the FDA recommended that BioMarin complete the Phase III study and submit two-year follow-up safety and efficacy data on all study participants.
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The controversy being created about the origins of the virus that causes COVID-19 – Frontline
Posted: July 6, 2021 at 2:07 am
The famous question about whether the world as we know it arose from evolution or creation was settled long ago in favour of evolution and against religious bigotry. But the old debate resurfaced, only in a different garb, during the pandemic. The question is posed thus: did the SARS-CoV-2 virus, which causes COVID-19, naturally evolve from bats through an intermediary to humans or was it engineered in a laboratory in Wuhan, the capital of Hubei Province, and leaked accidentally or intentionally?
COVID-19, perhaps one of the most virulent pandemics in the past 100 years, has exposed the frailties of public health systems in many countries, as evidenced by the massive loss of lives and livelihoods across the world. But it has also shown the power of science and technology, especially the open and quick sharing of data and results. Obversely, the ensuing infodemic has brought with it a tide of misinformation, chiefly the manufactured controversies on whether the SARS-CoV-2 virus evolved naturally or was deliberately or artificially created by Chinese scientists who then caused its spread intentionally or otherwise.
Here, we argue that the virus, which appears so perfect and complexly suited to infecting humans and for transmission amongst them, is most likely of natural evolutionary origin. Various statements and articles speculating that the virus was created by design and released through laboratory leaks appear to lack scientific credibility and border on conspiracy theories. The push by some scientists and governments for investigations, in the name of biosafety monitoring, into a possible laboratory leak from the Wuhan Institute of Virology (WIV) appear to be driven by paranoia or a Chinaphobia.
Nearly two centuries ago, Charles Darwin said in his Origin of Species: To suppose that the eye with all its inimitable contrivances .could have been formed by natural selection, seems, I freely confess, absurd in the highest degree. When it was first said that the sun stood still and the world turned round, the common sense of mankind declared the doctrine false .Reason tells me, that if numerous gradations from a simple and imperfect eye to one complex and perfect can be shown to exist, ...then the difficulty of believing that a perfect and complex eye could be formed by natural selection, though insuperable by our imagination, should not be considered as subversive of the theory.
Also read: On the political economy of pandemics
Viruses are opportunistic and take advantage of unusual situations and the weaknesses of their hosts. In most cases, humans invite viral pathogens upon themselves by invading and occupying biological spaces to the detriment of other animals, thereby also presenting viruses with greater opportunities to infect them. The precise path that leads a particular virus jumping from its reservoir population to humans is mostly fortuitous, difficult to determine and, in some instances, has remained inconclusive.
The influenza pandemic that started in 1918, which was popularly called the Spanish flu though the origin was not in Spain but in Haskell County, Kansas, United States, infected about 500 million people and resulted in the death of possibly 50 million. It is now known to have been caused by the virus H1N1 with genes of avian origin, although the exact origin has still not been conclusively established. It is thought to be of zoonotic origin from birds because since then there have been several similar influenza virus pandemics: in 1958 (H2N2), 1968 (H3N2) and 2009 (H1N1 pdm09). Interestingly, H1N1 pdm09 was also called swine flu because it contained a sequence segment similar to the Eurasian swine influenza virus from 1992. It is estimated that 0.001 per cent to 0.007 per cent of the worlds population died of respiratory complications associated with the H1N1 pdm09 virus infection in the first 12 months of the virus circulation. Where did that virus jump from? No intermediate host has been identified. Thankfully, there was no laboratory leak conspiracy theory for that episode.
A highly pathogenic avian influenza (HPAI), A(H5N1) was first detected in humans in 1997 during an outbreak among poultry in Hong Kong. H5N1 has continued to circulate and been detected at various times, for instance in 2003 and 2014. It has been found that low pathogenicity avian influenza viruses (LPAIVs) are generally asymptomatic in their natural avian hosts. LPAIVs can evolve into highly pathogenic forms, which can affect avian and human populations with devastating consequences. The acquisition of multiple amino acids with positively chargeable side chains such as lysine (K) and arginine (R) in the haemagglutinin cleavage site creates what is called a polybasic motif because of the presence of exchangeable hydrogens in the side chains. Thus, for example, the polybasic motif (RERRRKKR) can be cleaved by proteases such as furin in the human host. This leads to the switch to a HPAI virus from LPAIV precursors facilitating viral entry into cells. Proteolytic cleavage regulates numerous processes in health and disease.
Also read: COVID-19: No endgame in sight
The ubiquitously expressed protease furin cleaves a plethora of proteins at polybasic recognition motifs. Mammalian substrates of furin include cytokines, hormones, growth factors and receptors. A viral pathogen generally needs to bind to a receptor in human cells in order to make its entry. The receptor binding decides the type of cells the virus infects. Receptor binding is often enhanced by proteolytic cleavage of the viral protein that binds. Since the virus can reproduce and make the proteins it needs only after entry into cells, it makes use of the proteases in the host. So, not surprisingly, numerous viral pathogens exploit the ubiquitous nature of furin to enhance their virulence and spread. A furin cleavage site occurs in SARS-CoV-2, and its occurrence is the centrepiece of the conspiracy theories, the so-called smoking gun if you will.
Acquired immune deficiency syndrome (AIDS), which was first reported in 1981 from New York City, has killed about 35 million plus people so far. A retrovirus, now termed human immunodeficiency virus type 1 (HIV-1), was subsequently identified as the causative agent of what has since become one of the most devastating infectious diseases to have emerged in recent history. The zoonotic origin of HIV-1 was unclear for more than a decade and was discovered by pure luck and some hard work.
The HIV-1 is similar in sequence and genomic organisation to viruses found in chimpanzees (simian immunodeficiency virus, or SIVcpz). However, there was a low prevalence of SIVcpz infection in wild-living animals. Moreover, chimpanzees were present in geographic regions of Africa, but AIDS was not initially seen there. This along with the differences between HIV-1 and SIVcpz cast doubts on chimpanzees as a natural host and reservoir for HIV-1. It was then suggested that another, as yet unidentified, primate species could be the natural host for SIVcpz and HIV-1. The link was finally established in 1999. A chimpanzee (named Marilyn) of the subspecies Pan troglodytes troglodytes had been caught in the wild in Africa and then exported as an infant to the U.S. for research. She had not received any blood contaminated with HIV. But, during a sero-survey in 1985 amongst 98 chimpanzees, Marilyn showed a high level of antibodies to HIV-1. She died shortly afterwards giving birth to stillborn twins. A polymerase chain reaction analysis in 1999 of the spleen and lymph node tissues retrieved from frozen samples showed the presence of the virus now called SIVchzptt, which is the closest relation to HIV-1, and confirmed its zoonotic origin.
Also read: India's vaccination policy: A U-turn and a spin
Interestingly, the HIV-1 envelope protein initiates infection by mediating the fusion of the viral envelope with the cell membrane. For this to occur, the envelope protein has to be cleaved by host proteases such as furin at a polybasic motif in a loop connecting two regions. In fact, in an attempt to bolster the conspiracy theory that SARS-CoV-2 was man-made, claims have been made that Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), holds patents of an HIV component used to create COVID-19.
The severe acute respiratory syndrome (SARS) pandemic of November 2002 to July 2003, which was caused by a coronavirus now called SARS-CoV, affected about 8,000 people in more than 30 countries. In May 2003, sampling of 25 animals in a wet market in Hong Kong showed the presence of a coronavirus in three masked palm civets, one racoon dog and two Chinese ferret badgers with 99.8 per cent of its sequence identical to the human SARS-CoV. Subsequently, serological and epidemiological surveys pointed to traders of palm civets having been infected with SARS-like viruses earlier. Studies in 2004 suggested that a small proportion of healthy individuals in Hong Kong had been exposed to SARS-CoV-related viruses at least two years before the SARS outbreak reached Hong Kong in mid February 2003.
In 2005, two groups of researchers demonstrated that bats were natural reservoirs of SARS-like viruses. There is now evidence to suggest that there are four possible routes of transmission of SARS-CoV: animal-to-human, animal-to-animal, human-to-human and human-to-animal. Studies with animals showing infectivity to SARS-CoV have shown that inter-species contact and cross-species virus transmission (i.e. spillover) are essential and sufficient to cause epidemic emergence. Sustained transmission and virus adaptation within the spillover species determine the magnitude and scope of subsequent disease outbreaks. For example, SARS-CoV uses the angiotensin-converting enzyme (ACE2) as a receptor for its spike protein to bind to and gain entry into human cells. The spike protein also gets cleaved by a host protease (not furin), which enables the binding and fusion of the viral envelope with the cell membrane. It was found that the spike protein in the virus isolated from human patients in the 2002-03 outbreak bound more efficiently to the ACE2 receptor than the virus isolated from palm civets or from humans with mild cases in 2004. It took about three years after the outbreak of SARS-CoV to establish all this.
Also read: COVID-19: Perils of vacuous claims
However, a study in 2012 isolated a SARS-like coronavirus that was able to utilise ACE2 in humans, civets and in Chinese horseshoe bats for cell entry. This virus (bat SL-CoV-WIV1) offers strong evidence that SARS-CoV originated from a bat reservoir and suggests that an intermediate host may not have been required to facilitate adaptation to human ACE2. Curiously, in 2009 an article in the journal Proceedings of National Academy of Sciences of the United States of America revealed that a group at Cornell University engineered SARS-CoV to introduce a furin cleavage polybasic site to study the proteolytic activation of SARS-CoV.
In November 2012 came the first case of the disease that since May 2013 has been called the Middle East respiratory syndromes (MERS), which is caused by the MERS coronavirus (MERS-CoV). The outbreak started in the Middle East and has now spread to about 24 countries, affecting people and causing deaths, albeit in comparatively smaller numbers than COVID-19. In June 2014, it was found that the sequence of the virus from a man who became sick with MERS and that isolated from the camel he was tending were nearly identical. It was concluded that the camel was the intermediate host from which the virus could have jumped to humans. But a 2015 study showed that transmission from camels to humans is rare. This raises questions about whether the camel was really the intermediate animal for transmission. MERS-CoV does not use ACE2 as the receptor but binds to dipeptidyl peptidase 4 (DPP4). However, it has a furin cleavage site similar to that in SARS-CoV-2, which helps in its infection.
In China, on December 29, 2019, local hospitals in Wuhan using the surveillance mechanism for a pneumonia of an unknown aetiology that was established in the wake of the 2003 SARS outbreak identified the first four cases of COVID-19, which were all associated with the seafood wholesale market in Wuhan. On December 31, the Chinese Centre for Disease Control and Prevention dispatched a rapid response team to Wuhan to accompany the Hubei provincial and Wuhan city health authorities who were conducting an epidemiological and aetiological investigation. Scientists of the WIV made the sequence of the virus available to the international community through a manuscript that was submitted to the journal Nature on January 20, 2020. The paper was published online on February 3. It showed that the sequence of the virus from human patients was 94.4 per cent identical to SARS-CoV and 96.2 per cent identical to the virus from bat samples (RaTG13) collected previously from caves in Yunan.
Also read: COVID and other diseases: An Animal Farm perspective
On February 11, the International Committee on Taxonomy of Viruses named the virus SARS-CoV-2 because of its close relationship to SARS-CoV. The World Health Organisation (WHO) called the disease COVID-19 to distinguish it from the earlier SARS. The disease rapidly spread to many countries, and the WHO declared it a pandemic on March 11. The virus was shown to use the ACE2 receptor for binding and cell entry and was aided by cleavage by protease transmembrane serine protease 2 (TMPRSS2). A furin protease cleavage site not seen in SARS-CoV was found in this virus, and the cleavage at this site enables the entry of the virus into the cell.
To date, the disease has caused 177.5 million cases and 3.8 million deaths worldwide, and 1.99 million sequences from infected cases have been made publicly available. These sequences have shown the evolutionary changes that are happening in the virus. No other virus or disease in history has been subject to such close scrutiny and public discussion, thanks to the sharing of data and findings facilitated by modern communication, including social media channels. The first reports of the virus and disease were from China, which is becoming a major player in the world economy and is threatening to surpass existing powerhouses. The fact that the WIV specialises in coronaviruses, and has allegedly been engaged in collaborative work with U.S. institutions on gain of function research because of the prevalence of these viruses in the region, gave rise to conspiracy theories spread by right-wing governments and scientists.
At the beginning of 2020, several scientists/virologists were of the opinion that the question of whether the virus was the result of natural evolution should be answered in the affirmative. But because of the elections in the U.S., President Donald Trump needed an enemy to blame and attack in order to distract attention from his poor handling of the pandemic despite prior warnings from the U.S. Centres for Disease Control and Prevention. When the horrifying images of people being buried in New York were splashed in the media, he chose to call the virus a China virus. He even declared that he had found the cure in the form of hydroxychloroquine. But in the beginning, a few reputed scientists even declared the disease an ordinary influenza. Later, the vicious nature of the pandemic became clear, and the whole world had to look for solutions that would work in the temporary short term as well as the permanent long term.
Once the U.S. elections were over, the new President brought in measures to help the vulnerable sections and to ramp up vaccinations. Now the question about the origin of the virus, which scientists were working on anyhow, became politicised to align with the new policy to challenge the emerging force of China. The discredited conspiracy theory that the virus was a bioweapon engineered at a laboratory in Wuhan is now brought out as new wine in old bottles with the claim it leaked from that same laboratory.
Also read: COVID-19: Vaccine follies
So what evidence has been marshalled in support of the contending conjectures and what should be done now? Coronaviruses are not new. They have been around for at least a few decades. Jemma Geoghegan, the well-known virologist from New Zealand who was prominent in her countrys prompt COVID-19 response, said: SARS-CoV-2, the virus that causes the COVID-19, is closely related to other viruses that exist in nature. This virus is likely to have taken a path similar to SARS in 2003, viz., from animals to humans. Jemma Geoghegan explores the role that size, structure and mode of transmission of viruses play in the prediction of whether a virus will infect humans and cause a pandemic. She explained that prediction was difficult because of the vast number of viruses and said it was simply impossible to predict... whether a newly discovered animal virus could jump into humans and cause a pandemic. She also mentioned that five coronaviruses have emerged in the past and the intermediary animal responsible for COVID-19 remains unclear. Farm animals such as rabbits could be a possible intermediary for many viruses, but more studies are required to establish this conclusively. Ninety-six per cent of the genome sequence of SARS-CoV-2 is common to that found in bat coronaviruses. That the spike protein of SARS-CoV-2 can bind effectively to human cells is most likely a result of natural selection rather than manipulation in a laboratory. The backbone of the virus seems to be linked to bats and pangolins and is quite different from anything available in laboratories.
The genome of SARS-CoV-2 shows thousands of differences from its closest relative, according to Jonathan Stoye, group leader of the Retrovirus-Host Interactions Laboratory at the Francis Crick Institute in the United Kingdom. Now the changes that have been observed in the nucleotide sequence of the SARS-CoV-2 genomes sequenced so far clearly indicate that it is highly improbable for modifications that span such a large evolutionary distance to have taken place in a laboratory. This therefore suggests that the variations happened in animals, either bats, which form the reservoir for coronaviruses, or an intermediary animal in the wild, which is yet to be discovered.
The most important supposed villain in this is said to be the spike glycoprotein, which helps the virus bind to the specific ACE2 receptor. A cleavage of the spike protein by the host proteases, one of which is furin, helps facilitate the entry. This was the smoking gun the science correspondent Nicholas Wade attributed to the Noble laureate David Baltimore. While Wade used this information and spun stories beyond what is known, Baltimore himself withdrew from Wades surmises. In an article in Current Science (June 10, 2021), Prof. P. Balaram developed Wades arguments and gave further impetus to the improbable thesis that the virus was manipulated/engineered in the WIV and leaked. This scenario was also the favourite among the conspiracy theorists initially. However, U.S. scientists immediately responded that nature was responsible for the virus reaching humans through an intermediary via slow evolutionary processes. Moreover, many viruses use the furin cleavage site, and it is not unique to SARS-CoV-2. An analysis of all coronavirus sequences published in the journal Stem Cell Research in December 2020 showed that furin cleavage sites in spike proteins naturally occurred independently multiple times in coronaviruses.
Also read: Misplaced optimism as COVID numbers go down
A recent report in the journal Cell showed the great diversity of viruses in least horseshoe bats, or Rhinolophus pusillus (https://doi.org/10.1016/j.cell.2021.06.008 ). It showed that apart from the previously reported coronavirus sample, RaTG13, two others, RpYN06 and RmYN02, had similarities over the whole genome. A bioRxiv reprint in March 2021 used the available 1,58,118 public seasonal genome sequences of hCoV, SARS-CoV-1, SARS-CoV-2 and MERS-CoV and noted that the current sampled diversity of seasonal coronaviruses had emerged over a 70-year-period, punctuated by the emergence of new lineages at intervals ranging from 5 to 20 years.
Interestingly, in July 2020, a group published an analysis of the more than 45,000 SARS-CoV-2 sequences from infected people then available, which showed the mutations and deletions that happened in the furin cleavage site, and concluded that the furin cleavage site might not be essential for SARS-CoV-2 to enter human cells in vivo. This shows that the virus in its passage through human cells is capable of losing the furin cleavage site. So it is not a site that is essential to virus infection, and this makes the case for the artificial insertion of this sequence to create a new virus much less appealing. A study published in PLOS Biology in March 2021 showed that the bat virus closest to SARS-CoV-2, RmYN02 (sharing an ancestor from about 1976), arose from a recombination within coronaviruses in bats and shares genetic features similar to SARS-CoV-2. This suggests the possibility that SARS-CoV-2 could have evolved in bats and directly jumped to humans without the need for an intermediate animal.
Although it is possible to conclude that there may be an undiscovered facilitating intermediate species, the results support the premise that the progenitor of SARS-CoV-2 was capable of efficient human-to-human transmission as a consequence of its adaptive evolutionary history in bats, not humans, that created a relatively generalist virus capable of infecting many hosts. Thus, finding the closest relative to SARS-CoV-2 could then be a matter of screening diverse bat populations. This really warns us against jumping the gun, whether it is smoking or not, and concluding that SARS-CoV-2 does not have a natural origin. A letter published in Science on May 14 said: We must take hypotheses about both natural and laboratory spillovers seriously until we have sufficient data. A proper investigation should be transparent, objective, data-driven, inclusive of broad expertise, subject to independent oversight, and responsibly managed to minimise the impact of conflicts of interest.
Also read: India needs to spread its bets on vaccines: Dr Satyajit Rath
But a couple of months earlier, The Lancet published a letter emphatically dismissing conspiracy theories and saying that sharing of data is being threatened by disinformation and rumours. This issue of sharing data and information has become more about political sloganeering, in which some scientists too have joined in, than about science. Scientists from various countries have analysed the genomes of SARS-CoV-2 and come to the conclusion that this virus originated in the wild as did many other pathogens. The presidents of the U.S. national academies of sciences, engineering and medicine have backed this and warned that conspiracy theories create only fear, rumours and prejudice and jeopardise the global fight against the virus. They said they supported the call from the WHO Director General to promote scientific evidence and unity over misinformation and conjecture.
The problem with conspiracy theories is that they usually provide one point of speculative evidence that forms the basis for further speculative theorising. Essentially, they all turn to one final definitive source to rest their case. In this case, Nicholas Wades publication of his speculative thesis in Bulletin of the Atomic Scientists has been used to spread the canard that the pandemic was caused by negligence or deliberate action in Wuhan.
Incidentally, Wades book A Troublesome Inheritance: Genes, Race and Human History (2014) drew sharp criticism from 130 scientists for its racist overtones. They said in a letter to The New York Times: Wade juxtaposes an incomplete and inaccurate account of our research on human genetic differences with speculation that recent natural selection has led to worldwide differences in I.Q. test results, political institutions and economic development. We reject Wades implication that our findings substantiate his guesswork. They do not. We are in full agreement that there is no support from the field of population genetics for Wades conjectures. In the past, many people have criticised him for misreporting their remarks in his articles.
No doubt more data is needed on the nature of studies at the WIV. The institute is one of international standing where research work is carried out in collaboration with scientists from the U.S., Europe, Australia, Japan and India (the National Centre for Biological Sciences, or NCBS) with funding from these countries. It is one of the two laboratories in China to have a biosafety level of 4 (the highest level). Even the U.S. Department of Defence has funded programmes at the institute. It is only natural that researchers from these countries would demand a high degree of transparency about safety procedures at the WIV, including the recording of accidents and the corrections undertaken. The WIV has a high level safety procedures that is not matched even by the Indian Department of Atomic Energyfunded NCBS. There has even been a collaboration on the bat viruses from Nagaland involving scientists from the NCBS. A needless controversy has now been created about whether proper approvals were obtained from the Indian Council of Medical Research, the Ministry of External Affairs, and so on, for such studies. This is because the issue has deliberately been politicised with the intention of derailing international scientific collaborations with entities based in China.
Also read: The B.1.617 variant of COVID-19 that emerged in India is spreading to South Asia and beyond
To this end, conspiracy theorists have attempted to link Dr Fauci, the face of the COVID-19 response in the U.S., to the laboratory leak theory. His office provided a research grant of $6,00,000 for five years (which the NIH eventually halted) to an American organisation, EcoHealth Alliance, working with the WIV. Dr Fauci received an email on April 18, 2020, from the zoologist Peter Daszak thanking him on behalf of the staff of EcoHealth Alliance for rejecting the laboratory leak theory. Actually, Dr Fauci did not reject it but only claimed it was less likely compared with the zoonotic origins theory. Republican senators in the U.S. introduced a Bill to remove Dr Fauci, who has advised several Presidents across parties, from his post.
Harping on conspiracies vitiates the atmosphere to the point where research involving international collaboration, particularly on virus mutations and the required responses, becomes increasingly difficult. In an article in Forbes magazine, Ethan Siegel lists out the strident remarks that have been made about the virus, which cannot, in the language of the scientific method, even be termed hypotheses: 1. It was a bioweapon developed in Wuhan. 2. Dr Fauci was directly involved in funding the programme in the laboratory that created the virus 3. Dr Shi Zhengli, the bat woman, was the brains behind the research to unleash the virus 4. Some kind of banned/unregulated research in gain of function was being done to modify a coronavirus, which resulted in the virus that causes COVID-19. All these are extraordinarily improbable compared with the hypothesis that the disease has zoonotic origins.
But the international collaboration the pandemic has brought about among scientists, virologists, medical professionals and public health administrators is extraordinary. They will eventually agree that Darwin still rules the world of cell biology.
S. Krishnaswamy is a retired professor of biotechnology earlier from Madurai Kamaraj University, Tamil Nadu. T.R. Govindarajan is a retired professor of physics from the Institute of Mathematical Sciences, Chennai.
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In Conversation: What everyone should know about menopause – Medical News Today
Posted: July 6, 2021 at 2:06 am
Menopause specialist Dr. Louise Newson and broadcaster Rachel New talk about what everyone should know about perimenopause and menopause.
Hot flashes, sleep problems, and mood swings these are the symptoms that many people may be familiar with when it comes to menopause.
Yet there is so much more to this biological transition that anyone who has periods goes through. When a person has stopped having periods for 12 months, they have officially gone through menopause.
The time leading up to this point is called perimenopause, and many experience a range of symptoms during this time. How long people will spend in perimenopause varies greatly from person to person.
To find out what everyone should know about menopause and why, as a society, we find conversations around womens health so difficult, I spoke to broadcaster Rachel New, who recently wrote a Through My Eyes piece about her experience of menopause for Medical News Today.
Joining us in conversation was Dr. Louise Newson, a general practitioner (GP) in the United Kingdom and menopause specialist. Louise is the founder of the free balance app, which allows users to track symptoms and changes in their periods. The app also provides information about menopause.
To hear more about menopause, including the latest on hormone replacement therapy (HRT), listen to the accompanying podcast:
This podcast is also available on Spotify, Apple Podcasts, and other platforms.
We started our conversation with Louise taking us through what happens during menopause.
Most of us go through the menopause as a natural process. Our hormones deplete because our eggs run out in our ovaries. And when they run out, [the] hormones associated with them go down, she explained.
Some women have their menopause forced on them, Louise continued.
For some, menopause happens as a result of a medical procedure, such as the surgical removal of the ovaries, or certain drugs or treatments.
The average age in the U.K. is 51, but around 1 in 100 women under the age of 40 have an early menopause. My youngest patient is 14, [and] my oldest is 92, so it can affect all women [of] all ages, Louise said.
And what about perimenopause? Louise told us that perimenopause can last several years, a decade, or even more.
[The] symptoms can start sometimes just for a few days before each period, and then it can be a week or 2 weeks, and then all the time. Its quite a transient process that often worsens with time, she said.
She listed the range of symptoms that a person can experience:
The list can go on and on and on, actually, and symptoms can vary between women and actually sometimes vary between the days and months.
Dr. Louise Newson
For some people, menopause means the end of their symptoms. But this is not the case for all.
Once a person has gone through menopause, their hormone levels will be low for the rest of their life. In some, this is accompanied by ongoing symptoms.
The average length of time for symptoms is about 7 years, but I certainly have seen and spoken to many women who have symptoms for decades, Louise explained. But symptoms change.
A lot of women find that their hot flashes and sweats improve. And then when you talk to them, theyll say, Now Ive gone through my menopause, I dont have any symptoms. But then they will say, Oh yes, but my sleeps rubbish or I have some joint pains, and I cant exercise the same way or Im just a bit more irritable, so these symptoms often do linger, she continued.
Rachel told us that she can trace back the beginning of her menopause to when she was 51. But prior to that, she had experienced problems with her sleep throughout her 40s.
I was having vaginal problems, but I kept thinking I had thrush. I was getting urinary tract infections. But it was only when I was 51 that those problems started to really bother me. I kept going to the doctor [and] being put on antibiotics for urinary tract infections, Rachel said.
Sex was becoming painful at the same time. My periods were getting closer together and heavier. Id always had quite heavy periods, but now, I wake up [and] Id flood the bed [] But I didnt know this was the perimenopause. Id never heard of perimenopause.
Rachel New
Other symptoms that Rachel experienced included itchy skin all over her body. Her GP did not mention menopause or perimenopause to her at the time.
It was only when I went and had a Mirena coil fitted for my really heavy periods [that] the gynecologists talked to me about perimenopause, Rachel told us.
Her experiences led her to set up her own podcast about menopause, called On My Last Eggs. Rachel told us that she feels her experience mirrors that of many others. Faced with perimenopause, she sought out Louises YouTube videos.
I [thought], Oh my gosh, this is whats wrong with me. I felt like I had finally found someone that I could trust the advice of, Rachel explained.
I asked Rachel why it is so challenging for women to find information about menopause. Women of menopausal age are very different from women of menopausal age in the past, she said.
Often, a woman may be in her perimenopause, [and] she may only have a 5-year-old child. She doesnt equate herself with a menopausal woman she may be at the peak of her career. She doesnt look like our menopausal mothers or grandmothers looked like, and so I think often we just dont understand, Rachel continued.
Few women are equipped with the knowledge about the breadth of symptoms that can accompany perimenopause. Add busy lives to the mix, and it can be easy to miss the fact that these symptoms must have a cause.
Louise added that there is a gap in menopause education among doctors.
I feel very embarrassed that I have probably missed thousands of women whove come to see me as a GP, telling me they have headaches, or they feel low, or theyre tearful, or theyve had palpitations, and Ive never thought about their hormones, because I didnt really know, she shared with us.
Louise missed the signs of her own perimenopause. I was busy developing and writing the content for Menopause Doctor, and I was also lecturing other healthcare professionals, saying, You must not miss the other symptoms of the menopause, she told us.
Yet I had them all but thought it was because I was working hard trying to split my time with three children, being a GP, being a medical writer, and now developing a website and trying to get a job as a menopause specialist in the [National Health Service (NHS)].
Dr. Louise Newson
So I had a lot of reason to be tired, irritable, and low mood, poor sleep, back-to-back migraines, etc. Not once did I think about my own hormones, Louise explained.
We need to be so much more open about womens health, Rachel advocated. She called for conversations about reproductive health, including periods, fertility, and endometriosis.
Louise pointed to the lack of menopause research and suggested a change in narrative.
If were not going to listen to women talking about symptoms, then we need to think about the health risks, and we need to think about the risks to the economy, she said.
Louise explained that around 20% of women either consider leaving their job or do so due to menopause. In addition, poor memory, anxiety, and fatigue are very common symptoms and can impact workplace productivity.
Its affecting the health economy, because 1 in 3 women will have an osteoporotic hip fracture, which costs the NHS 3 billion a year, she added.
Rachel encouraged everyone to arm themselves with information about menopause. She was also keen to bring vaginal health into the spotlight.
I would say to women, You deserve to have a healthy, happy, comfortable vagina [] and dont take any kind of fob off for an answer. Everyone deserves to have a lovely, happy, useful vagina that they can carry on having sex with and enjoying, and so dont be battered away from that.
Rachel New
To Louise, menopause should be on everyones radar. A lot of the work that needs to be done about awareness is [that] not just middle-aged women need to be aware, she said.
We all need to be aware: men, women, children, adults, everyone. Because we all know women, [and] recognizing [menopause] within our friends or family or work colleagues can be really important, she added.
Were new to audio on MNT and want to make sure were doing it right. Let us know what you thought of our In Conversation podcast by emailing us at mnt_editors@medicalnewstoday.com.
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Premenstrual dysphoric disorder is associated with the longer length from clitoris to urethra – BMC Blogs Network
Posted: July 6, 2021 at 2:06 am
The PMDD is triggered at times of hormonal fluctuations, in particular exposure to progesterone [1], and does not occur in the women during pregnancy and after menopause (without hormone replacement). The suppression of ovulation and suppression of the cyclical hormonal changes by the hormone therapy is the most effective treatment for PMDD [1, 18]. These evidences highlight that the direct activating effect of hormones plays an essential role in the pathogenesis of PMDD, at least sexual steroid hormones, such as progesterone, may precipitate the presentation of PMDD. Moreover, the very early organizational effect of prenatal sex hormones that may contribute to the PMDD has recently got attentions. The previous work using the 2D:4D ratios as a marker of prenatal sex hormones exposure, indicated that the prenatal sex hormones exposure might influence individual differences in the severity of premenstrual symptoms [9], and could be a factor in the development of PMDD. A recent preclinical animal study clearly showed that prenatal androgenization induced anxiety-like behavior in adult female rats, implying that prenatal exposure to high concentration of testosterone might influence the development of neural networks and impose the risk of anxiety-like behavior later in life [19]. We measured the 2D:4D ratios, AGD-AC, AGD-AF, and CUMD of the subjects, and found that the left/right 2D:4D ratios, AGD-AC and AGD-AF did not show any difference between PMDD patients and controls, but a significant longer CUMD was seen in the patients with PMDD. The CUMD, as well as the 2D:4D ratios, AGD-AC and AGD-AF, is supposed to be positive association with prenatal androgen levels, therefore, our results supported that atypical high prenatal androgen exposure might predispose individuals to be susceptible to PMDD.
We did not detect the current level of androgens in the patients with PMDD. An early research reported that serum levels of androgens were higher in women with premenstrual irritability and dysphoria than in controls [20], but other studies had shown that plasma testosterone in women with premenstrual symptoms was not different from that in non-symptomatic controls [21, 22]. A recent study which carefully investigated the level of androgens in women with cyclical mood changes and premenstrual syndrome demonstrated that plasma testosterone was significantly lower in women with luteal phase symptoms compared with those with additional follicular phase symptoms [23]. The PCOS is a hyperandrogenic, oligomenorrhea/amenorrhea, fertility problems and metabolic disorder found in 67% of reproductive-aged women [24]. Therefore, the clinical features and pathophysiological processes of the PMDD should be totally different from ones of the PCOS. Recently, several studies demonstrated that AGD in adult patients with PCOS was longer than that in control, implying that extreme prenatal androgen exposure might contribute to PCOS [16, 25, 26]. Whereas, our PMDD patients showed elongated CUMD, rather than extended AGD. It seems that both of PMDD and PCOS are probably involved in the higher prenatal androgen exposures. But, why did PMDD patients have a longer CUMD and PCOS patents have a longer AGD? Future studies are awaited to help delineate the difference. At present, it can be inferred that there are other factors led to discrepant perineum appearances, in addition to prenatal androgen hormones.
Several reports demonstrated that the presence of premenstrual symptoms correlated negatively with sexual satisfaction [23, 27,28,29]. Sexual pleasure and orgasm during copulation in women depends on many factors, such as past experience, stimulation of one or all of these triggering zones, autonomic arousal, and partner- and contextual-related cues, etc. [30]. The clitoral complex in relation to the urethra, vulva, and vagina is the essential sensory triggering zone [29]. A longer CUMD in a woman decrease her likelihood of experiencing orgasm in sexual intercourse, as the longer CUMD may decrease penile-clitoral contact during sexual intercourse or decrease penile stimulation of internal aspects of the clitoris [12]. Therefore, the longer CUMD might contribute to the sexual difficulties of women with premenstrual symptoms, according to our results.
There are some major defects in the present studies. This is a preliminary study with limited samples that were not chosen randomly, the way of collecting cases could lead the bias to some extent. Moreover, we did not study the association of individual differences in the severity of premenstrual symptoms with the left/right 2D:4D ratios, AGD-AC, AGD-AF and CUMD, and did not collect data about the sexual function/satisfaction of subjects, at same time.
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People come together to fund hair removal of Gaurang aka Prakriti, so that she feels complete in her identified gender – OpIndia
Posted: July 6, 2021 at 2:06 am
Fundraising platforms in India have helped people in need of medical treatment or other financial needs, and now this spectrum of public help appears to be widening. One particular call for public help caught the attention of many on social media earlier today was where a person started a fundraiser for hair removal.
The fundraiser was started by a Bangalore based person Prakriti Soni, who needed funds for hair removal as the financial condition of the family was not stable.
While hair removal might sound too mundane a thing for which a fundraiser should be started, Prakriti explained that it was nothing less than a life altering procedure for her, who is 21-years-old and identifies as trans-woman.
She explained that she must get rid of the hair on her body to remove the mismatch between her biological sex and her gender identity. This mismatch was majorly affecting the mental health of Prakriti, giving her distress and discomfort something that is known as gender dysphoria as Prakriti explained in her fundraising page.
She said that the Covid-19 induced lockdowns were making her gender dysphoria worse and thus she has decided to completely remove the body hair via laser treatment. Since her own or her familys financial condition is not stable, she decided to seek public help, and it appears to have worked for Prakriti Soni, who was earlier Gaurang Soni.
To support her claims, Prakriti uploaded a doctors letter from Ramaiah Memorial Hospital of Bangalore. The letter stated that the client refers to themselves in the feminine gender and to respect their feelings I will be using female pronouns throughout this report.
Doctors letter identifies Prakriti as a male to female transgender person who had described a desire to be and to be treated like a member of the opposite sex since early childhood. It also states that her family is supportive of this and so is her social network, which reflected in the fact that Prakriti was able to raise more than half of her targeted fundraise.
An anonymous person who helped with 5000 rupees, the maximum individual contribution at the time of this report being published, left a message that read Hi Prakriti! Wish you all the very best. I wish you are able to meet your target and get your hair treatment done and feel better!! You are an amazing person and deserve the best!!
Another contributor, who identified himself as Adil, said, I am a friend of Nikita whose friends with mridula. And I cant tell you how happy I am for you and hope that everything works out fine (sic.)
The doctors letter dated 28 October 2020 report said that Prakriti reported gender congruent experience of living like a woman for the past two years. It further revealed that Gaurang alias Prakriti liked being with and playing with girls in the school, and also acted like them.
She wants to get rid of both primary and secondary sexual characteristics because of the marked incongruence she experiences. She seeks hormone replacement therapy to feminize her body to suit her gender identity, the doctors letter declared.
It is not clear if Prakriti has already undertaken hormone replacement therapy or she might need another fundraiser for that. However, the hair removal fundraiser was on track.
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People come together to fund hair removal of Gaurang aka Prakriti, so that she feels complete in her identified gender - OpIndia
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You could be going through the menopause for YEARS without getting help these are the signs… – The Sun
Posted: July 6, 2021 at 2:06 am
WOMEN are going through the menopause for years before receiving the help they need, a shocking survey has revealed.
Symptoms of hot flushes, fatigue and depression can be managed. But many women are not getting access to drugs.
3
Some women said they had visited their GP several times without any progress.
The menopause is when a woman stops having periods and is no longer able to get pregnant naturally due to depleting levels of oestrogen.
But the hormone rollercoaster that comes with it leaves women with debilitating symptoms for up to several years.
These can start years before periods stop, known as the perimenopause, meaning some women may not even realise it's due to the menopause.
On top of this, campaigners say GPs are not trained sufficiently to spot the signs or treat women appropriately.
Menopause is a natural part of ageing, which usually happens when a woman is between the age of 45 and 55.
In the UK, the average age for a woman to go through menopause is 51, but it can start as early as the 30s.
The severity of menopausal symptoms can vary depending on the individual.
They can range from mild to significantly interrupting your daily routine.
Menopausal symptoms can start months or years before your periods stop, and can last until four years or longer after your last period.
Symptoms include:
The new survey, carried out for menopause medic Dr Louise Newson, who runs the not-for-profit Newson Health Research And Education, highlights the delays women face.
Of the 5,187 women surveyed, the majority (74 per cent) had been experiencing menopausal symptoms for more than a year, while 15 per cent said this had been the case for more than six years.
Some 79 per cent of women had visited a GP with their symptoms.
A shocking seven per cent attended more than 10 times before receiving adequate help or advice.
Some 27 per cent of women said they had also seen more than three doctors in hospital about their symptoms, even though in most cases, they can be managed by a GP.
Of those who did undergo treatment (33 per cent of all the women surveyed), 44 per cent had waited at least one year, and 12 per cent had waited more than five years.
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Of those given treatment, 37 per cent of women received hormone replacement therapy (HRT) and 23 per cent were given antidepressants.
Guidance from the National Institute for Health and Care Excellence (Nice) saying women should not be prescribed antidepressants for symptoms such as hot flushes and night sweats.
Dr Newson said: This is a huge waste of NHS resources, including increasing the strain and workload to primary care not to mention womens time.
Since May of this year, we are seeing a greater appetite from medical professionals, especially in primary care, to learn more about managing the menopause. This cant come soon enough for women who are struggling.
A separate survey of 1,096 women by Mumsnet and Gransnet found that 14 per cent have found it difficult to get their GP to prescribe HRT.
Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists (RCOG), said: It is saddening to see the ongoing challenges that women are experiencing in the diagnosis and treatment of the menopause.
There is no one size that fits all when it comes to the menopause. This is why it is crucial that women have access to reliable, accurate education and information so they are made aware of the options available and can make informed choices about their health.
While access may vary, we want to reassure women that most GPs are very experienced in offering menopause care, and can refer women to specialist menopause services where necessary.
Originally posted here:
You could be going through the menopause for YEARS without getting help these are the signs... - The Sun
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