Dr. Shumaila Tanveer

Dr. Shumaila Tanveer


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Ultrasound Specialist and Gynecologist
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General surgeon

Operating as usual


An 8-year-old girl who was infected with SARS-CoV-2 died after developing an extremely rare condition known as acute fulminant cerebral edema (AFCE), according to pediatric neurologists who are urging colleagues to watch out for similar cases.
At least one other child in the United States has died after becoming infected with the virus and developing cerebral edema. "The rapid and devastating clinical course in both of these cases highlights the need for early recognition of a cerebral edema and AFCE as potential complications of COVID-19 in pediatric patients," the neurologists wrote.
The case was highlighted in a poster presented at the annual meeting of the Child Neurology Society and in a report published earlier this year in Child Neurology Open.
According to pediatric neurologist Timothy Gershon, MD, PhD, of the University of North Carolina at Chapel Hill, the child appeared in clinic in July 2020. She had been healthy but was suffering from 1 day of fever, seizure-like activity (generalized convulsions and drooling), anorexia, and lethargy.
The girl, who was subsequently diagnosed with COVID-19, deteriorated in the hospital. "She received IV dexamethasone in attempts to reduce cerebral edema," the neurologists wrote. "Regarding immunomodulatory therapy, she received intravenous immunoglobulin (2 g/kg), anakinra, and hydrocortisone; despite approval for remdesivir and COVID-19 convalescent plasma, these were ultimately withheld due to poor prognosis."
Brain death examinations at 24 and 48 hours after cardiac arrest were consistent with brain death, they reported.
Neurologists believe the patient suffered from AFCE, "an often fatal pediatric clinical entity consisting of fever, encephalopathy, and new-onset seizures followed by rapid, diffuse, and medically-refractory cerebral edema." They add that "AFCE occurs as a rare complication of a variety of common pediatric infections, and a CNS [central nervous system] pathogen is identified in only a minority of cases, suggesting a para-infectious mechanism of edema."
Neurologists offered a case definition of the "recently recognized" AFCE earlier this year.
"This was an extremely rare rapid progression to cerebral edema. I think it was related to the patient's COVID infection, but why this patient got it and others don't is unknown," Gershon said in an interview. "The full spectrum of neurological complications of COVID were not yet known [at the time]. We didn't know, and still don't know, what the causative links are between COVID and suddenly having seizures and brain swelling."
He said he'd treat a similar patient differently now and give dexamethasone earlier in the clinical course, although "there is no data to tell us if any therapy could have reversed it." Specifically, he said, "I'd give dexamethasone at the first sign of brain involvement, using the dosing recommended for cerebral edema, and try to get the MRI earlier in the course."
Gershon and colleagues noted another case of fatal cerebral edema in a child, a 7-year-old boy who was treated in New York state. That case "shows that fatal cerebral edema may complicate pediatric multisystem inflammatory syndrome," they wrote.

CVST After COVID-19 Vaccine: New Data Confirm High Mortality Rate 03/10/2021

CVST After COVID-19 Vaccine: New Data Confirm High Mortality Rate

A new series of cases of cerebral venous sinus thrombosis (CVST) linked to the adenoviral vector COVID-19 vaccines has been reported, confirming the severity of the reaction and the associated high mortality rate.
The new series comes from an international registry of consecutive patients who experienced CVST within 28 days of COVID-19 vaccination between March 29 and June 18, 2021, from 81 hospitals in 19 countries.
The cases are described in an article published online in JAMA Neurology on September 28.
"This is a reliable description on the clinical condition of these patients with CVST associated with COVID-19 vaccination. It is striking that this a much worse condition than CVST not associated with COVID-19 vaccination, with a much higher rate of intracerebral hemorrhage and coma and a much higher mortality rate," senior author Jonathan M. Coutinho, MD, Amsterdam University Medical Centers, Amsterdam, the Netherlands, told Medscape Medical News.
These data confirm the observations from an earlier UK cohort in which cases of cerebral venous thrombosis linked to COVID-19 vaccination occurred.
"This is the biggest series, and as an international series, it gives a broader perspective from a larger range of countries," Coutinho said. "All the data together show that although this side effect is rare, the consequences are very severe," he added.
In the current study, the researchers regarded CVST as being linked to the vaccine if it was accompanied by thrombosis with thrombocytopenia syndrome (TTS), as evidenced by thrombosis and new-onset thrombocytopenia.
In the cohort of 116 patients with CVST after COVID-19 vaccination, 78 (67.2%) had thrombosis with TTS and were thus classified as having had a vaccine-related adverse event. These patients were frequently comatose at presentation (24%) and often had intracerebral hemorrhage (68%) and concomitant thromboembolism (36%); 47% died during hospitalization.
These patients were compared with the 38 patients in the same cohort who had CVST but in whom there was no indication of concomitant thrombosis and thrombocytopenia. The case patients were also compared with a control group of 207 patients with CVST who were included in a separate international registry before the COVID-19 pandemic.
Mortality rates were much higher among the patients deemed to have had a vaccine-related CVST. The in-hospital mortality rate was 47%, compared with 5% among the patients in the same cohort who did not have TTS and 3.9% among the prepandemic control group.
The mortality rate was even higher (61%) among patients in the TTS group for whom the diagnosis was made before the condition garnered attention in the scientific community. The mortality rate was 42% among patients diagnosed later.
Of the 78 patients in whom CVST and TTS occurred after COVID-19 vaccination in this cohort, 76 had received the AstraZeneca vaccine (in 75 patients, CVST and TTS occurred after the first vaccination; in one patient, they occurred after the second vaccination). One patient had received the Johnson & Johnson vaccine, and one had received the Pfizer vaccine.
"After more analysis, the case after the Pfizer vaccination is not believed to be caused by the vaccine," Coutinho said. "In that case, the patient had a platelet count just below the lower limit and was taking an immunomodulator drug that is known to be associated with thrombocytopenia."
For two patients who received the AstraZeneca vaccine, there was also an alternative explanation for the thrombocytopenia.
Coutinho also pointed out that the Johnson & Johnson vaccine has been used mainly in the United States, and these data were largely from other countries.
The median time from vaccination to CVST symptom onset was 9 days in the TTS group. The median platelet count at hospital admission among patients with post-vaccination CVST-TTS was 45. Three patients presented with a normal platelet count and developed thrombocytopenia during admission; two patients presented with mild thrombocytopenia, 30 presented with moderate thrombocytopenia, and 43 presented with severe thrombocytopenia.
Antibodies against platelet factor 4 (PF4) were measured in 69 patients with TTS, of whom 63 (91%) tested positive (the one patient in which TTS occurred after the patient received the Pfizer vaccine did not test positive). However, the researchers note that sensitivity varies among different PF4 ELISA tests. Findings of platelet activation assays were positive in all 36 tested patients.
In the TTS group, 52 patients (67%) received immunomodulation therapy, most often intravenous Immunoglobulins (IVIG). Among patients treated with IVIG, the mortality rate was lower (28%).
Different From CVST Linked to Natural COVID-19 Infection

Coutinho noted that CVST can occur in natural SARS-CoV-2 infection but that vaccine-associated CVST is very different.
"In natural COVID-19 infection, there is an increased risk of thrombosis, and some patients can get CVST as a part of this, but in these cases, this is not accompanied by thrombocytopenia. While the CVST in natural COVID-19 infection is also associated with a bad prognosis, this is more to do with the underlying disease. It is normally the very sick COVID patients who develop CVST, and these patients usually die from the underlying disease rather than the CVST itself," he explained.
"Clinicians need to be aware of vaccine-related CVST, as it requires very specific and rapid treatment," Coutinho stressed.
"Patient presenting with an extremely severe headache (unlike any headache they've had before) or with seizures or a focal deficit (weakness in arm or problems with speaking or vison) within 4 weeks of an adenovirus COVID-19 vaccination should ring alarm bells. It is important to do diagnostics quickly, with a platelet count the most important first step, and a rapid CT/MRI scan," he said.
Other tests that should be conducted are D-dimer for thrombosis and the PF4 antibody test. But results for the PF4 antibody test can take days to come back, and clinicians shouldn't wait for that, Coutinho notes.
"Specific treatment needs to be given immediately ― with anticoagulation (preferably non-heparin) and immunomodulation with IVIG to stop the immune reaction. Platelets should not be given ― that may seem counterintuitive in patient with a low platelet count, but giving platelets makes it worse," he said.
Is There a Geographic Difference?

Coutinho pointed out that fewer cases of this vaccine-related CVST are being reported at the current time.
"We are not sure why this is the case. These adenovirus vaccines are not being used much now in Western countries, but our collaboration covers many less developed countries in South America and Asia, which are relying heavily on these vaccines. We are now shifting focus to these countries, but so far we have only seen a handful of cases from these areas," he said.
He suggested that this may be because these countries started their vaccination programs later and are vaccinating their elderly (who are not so susceptible to this side effect) first, or it may be due to some environmental or genetic factor that has not yet been discovered.
"This is now an important research question ― is the risk of vaccine-induced CVST the same in different countries or ethnicities? This could influence decisions on future vaccine strategies," Coutinho said.
"So far, female sex is the strongest risk factor for vaccine-induced CVST. In our cohort, 81% of cases were in women. In addition, 95% were White, but that doesn’t allow us to conclude that this is a risk factor, as the majority of people who have been vaccinated are White. So, we have no clear insight into that yet," he said.
Commenting for Medscape Medical News, the lead author of the previous UK report of a series of 70 cases of cerebral venous thrombosis linked to COVID-19 vaccination, Richard Perry, PhD, University College Hospital, London, United Kingdom, described this new report as "an excellent study, with many of the same strengths and weaknesses as our study and has very similar results."
Perry noted that the two studies used slightly different definitions of vaccine-induced thrombotic thrombocytopenia, but the cases reported appear to be very similar overall. "It is reassuring and gratifying to see that they have made such similar observations," he said.

"And as they have drawn their cases from a broad range of countries whereas ours were all from the UK, this provides evidence that the observations from both studies are reasonably generalizable," he added.
Perry pointed out that this new report states that TTS occurred in one patient after the patient had received a second dose of the AstraZeneca vaccine. "I would like to know more about this case, because we didn't see any cases after a second dose in our cohort," he said.
Coutinho responded that he didn't believe this was the first reported case after the second dose.
The study did not receive any specific funding. Coutinho has received grants paid to his institution from Boehringer Ingelheim and Bayer and payments paid to his institution for data safety monitoring board participation by Bayer.
JAMA Neurol. Published online September 28. Full text

CVST After COVID-19 Vaccine: New Data Confirm High Mortality Rate

Dr. Shumaila Tanveer updated their business hours. 23/09/2021

Dr. Shumaila Tanveer updated their business hours.

Dr. Shumaila Tanveer updated their business hours.

Should Deferrals Be Lifted for Gay Blood Donors? 07/08/2021

Should Deferrals Be Lifted for Gay Blood Donors?

For years, men who have sex with men have faced extra restrictions if they tried to donate blood. The latest FDA guidance requires a 3-month sexual abstinence period before donating for all men who have sex with men. That applies even to men married to other men or two men in a monogamous relationship.

Should Deferrals Be Lifted for Gay Blood Donors? Researchers are trying to determine if assessing personal risk for gay men -- instead of ordering a blanket deferral -- would keep the blood supply just as safe.

Covid: China's Sinovac vaccine gets WHO emergency approval 01/06/2021

Covid: China's Sinovac vaccine gets WHO emergency approval

Covid: China's Sinovac vaccine gets WHO emergency approval It is the second Chinese vaccine to get the green light from the global health body.

Photos from Dr. Shumaila Tanveer's post 28/05/2021

Kindly vaccinate your loved ones,don’t delay and get them vaccinated so we can return to normal activities as before
Stay safe


Vegetarians have more favorable levels of a number of biomarkers including cardiovascular-linked ones — total cholesterol, low-density lipoprotein (LDL) cholesterol, and apolipoprotein A and B — than meat-eaters, shows the largest study of its kind to date.

Results of the cross-sectional, observational study of 178,000 participants were presented as an electronic poster at this year's online European Congress on Obesity (ECO), by Jirapitcha Boonpor of the Institute of Cardiovascular & Medical Sciences, University of Glasgow, UK.


Eid Mubaraka to everyone


The Pfizer and Moderna COVID-19 vaccines appear to be safe in pregnant patients,according to preliminary findings published in the New England Journal of Medicine.
The CDC and Prevention have said pregnant people have an increased risk of being severely ill from COVID-19.

COVID Vaccine and New Virus Strains 17/03/2021

COVID Vaccine and New Virus Strains

Summary of webinar on Current Vaccines and Newer Strains of Corona Virus

Salient points.

1.All appoorved vaccines including Pfizer, Moderna, Covishield and Covaxin have ~100% efficacy in preventing Death due to Covid, And
-Very High efficacy against Severe Covid
-High to moderate efficacy (60%-95%) against symptomatic Covid but
-poor efficacy only against asymptomatic covid
*so people should not run after efficacy data while choosing a vaccine*

2. Because all vaccines prevent severe covid and death. Vaccination of large cohort of population is important if we want to save the humanity from I'll effects of the current pandemic.
Every one should get vaccinated and encourage others to get vaccinated.

3. *Nasal vaccines might be able to prevent even asymptomatic covid* because it generates local IgA antibodies cutting chain of transmission and bringing an end to this pandemic

4. Vaccination of 10000 pregnant ladies has been done in USA without any additional side effects seen upto 3 months of follow up. Hence, *Pregnant ladies can be safely vaccinated*.

5. *People with allergy to food, drugs, latex, venomous previous non covid vaccine can safely take covid vaccine*.

6.Only *People with severe anaphylaxis to previous covid or non covid vaccine should avoid covid vaccine*.

7. *People who have had Covid in past must go for Covid Vaccination four to six weeks after recovery*
Data is emerging that they might need just one shot of vaccine as Robust Neutralising antibody titres and Strong T cell responses have been found in them even after single shot of vaccination.

8. *People who have received Plasma therapy should wait at least four weeks before taking a vaccine* . Because during these four weeks the preformed antibodies transfused in external plasma will wane off and this will avoid the neutralization of virus(protein) produced by covid vaccine

9. *People with Severe disease who are admitted should wait at least 4 to 10 weeks after recovery* before taking any vaccine .

10. *People with Diabetes should go for vaccination after taking food/breakfast*

11. *People who are on Corticosteroids should decrease dose to less than 7.5 mg per day if possible for six weeks* when taking the vaccine because higher doses act as immunosuppressive and may decease immunity development.

12. *Inhaled steroids may not be tapered* when taking covid vaccine because systemic bioavailability of inhaled corticosteroid is low.

13. *People with nasal allergy, Bronchial asthma skin allergy can be safely vaccinated*

14. *People on immunosuppressive agents like methotrexate should stop the drug two weeks before and two weeks after the vaccine*

15. Rituximab given for Non- Hodgkin's Lymphoma, Rheumatoid arthritis should be avoided for at least 4 weeks {drug acts by attaching to B cells}

16. Those being treated for Blood cancer and who have been given Bone marrow transplant should wait at least 3 months

17. Those being given Monoclonal antibodies can be given vaccine safely as it is not aive vaccine.

18. Those with out bone marrow transplant/Cell therapy should wait for vaccine till Absolute Neutrophils Count returns to normal.

19. *Those who are planning to undergo surgery should to take vaccine at least 2 weeks in advance for protection*

20. *For patients with Autoimmune diseases like SLE Sjogrens Syndrome, no disease specific data exists but theoretically covishield and m RNA vaccination is unlikely to increase auto immunity*. Vaccination should be encouraged though extra caution be taken

21. *Older people should be encouraged to take vaccine as risk of covid mortality is high among them*.

22. *People with Dementia, paralysis etc Neurological disorders should take vaccine* as their covid appropriate behaviour is likely to be compromised.

22. *Stable CKD, Cardiac failure, Liver failure can take Vaccine but their immune response may be poor*;

23. Immunocompromised people should preferably be given Covishield vaccine as it has a non replicating viral vector coding for spike protein.

24. *People talking Aspirin and Clopidogrel need not stop* these drugs before vaccination

25. *People on anticoagulants can be given vaccine safely*.

COVID Vaccine and New Virus Strains COVID vaccines are still our most powerful tool to fight all the strains of the virus. Learn more about new COVID variants and the vaccines.





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