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ALL YOU NEED TO KNOW ABOUT BLACK FUNGUS

What is black fungus? How does it spread in the body? Is there any link between mucormycosis and Covid-19? Top doctors and health experts answer these queries and more.

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Black Fungus

CASE STUDY

Mucormycosis has increasingly been seen in Covid positive and recovered patients, among others, of late. Recovered patients are advised to stay in contact with doctors and immediately inform them in case of black fungus-related symptoms, asserts top doctors and health experts. Early detection will aid prompt treatment of this fungal disease.

TREATMENT Antifungals Amphotericin B and surgical debridement. Steroids and globulins can also help tackle the infection.

A rare fungal infection affecting 1 in 10 lakh people, mucormycosis or black fungus is gradually taking the country into its grip. What is this black fungus? How does it spread in the body? Is there any link between mucormycosis and Covid-19? Top doctors and health experts answer common queries ranging from signs and symptoms to causes to prevention and treatment. 

There is no official number of mucormycosis cases in India; however, estimation of fungal burden in India using computational models by international health experts predicts around 1,750 to 2,500 cases of mucormycosis daily in India. This is just a predictive model so the actual number may be higher.

Dr Atul Mittal, Director & HoD, Department of ENT, Head & Neck Surgery, Fortis Memorial Research Institute, Gurugram; Dr Manjunath Malige, Chief Endocrinologist and Diabetologist, Aster RV Hospital, Bengaluru; Dr Behram Pardiwala – Internal Medicine, Wockhardt Hospital Mumbai Central; Dr Deepak Jaiswal, Consultant Physician and Incharge Covid Care, Shri Balaji Hospital, Raipur; Dr Santosh Sivaswamy, Consultant – ENT, Columbia Asia Hospital Hebbal (A unit of Manipal Hospitals), Bengaluru; Dr ChandraVeer Singh, Consultant, Otorhinolaryngologist and Head & Neck Onco Surgeon, Wockhardt Hospital Mira Road, Mumbai; Dr Sanjay Dhawan, Director & Head – Ophthalmology, Max Super Speciality Hospital, Delhi and Gurugram; Dr Amitabh Malik, Chief, ENT Department, Paras Hospitals, Gurugram; Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo TeleHealth; and Dr Bhavika Verma Bhatt, Consultant ENT Surgeon and Medical Consultant- ENTOD International share all that they know about black fungus. 

Q. What is black fungus? What causes it? How is it linked with Covid-19?

Dr Atul Mittal: Mucormycosis or Black Fungus is a rare fungal infection that affects the sinuses, the brain, and the lungs. It can be life-threatening in diabetic or severely immune-compromised individuals such as cancer patients or people with HIV/AIDS.

In the current scenario, the infection is especially affecting Covid patients with weakened immunity due to comorbidities like diabetes, cancer, and kidney or heart failure. Steroids are the cornerstone of Covid treatment, helping to reduce inflammation in the lungs and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive, referred to as cytokine storm, to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid patients. It’s thought that this drop in immunity could be triggering these cases of mucormycosis.

Q. What are the warning signs and symptoms of this fungal infection? Which organs can it infect?

Dr Manjunath Malige: During the second wave of the Covid-19 pandemic, it has been found that there is a sudden increase in the cases of mucormycosis across the country. Some of the early symptoms are obstruction in the nose, unexplainable headache even after post-Covid recovery, pain in the teeth, numbness in the face, vision difficulties or loss of vision, local pain in ear, nose or orbital region, nose blocks experienced more towards one side, etc. In case a Covid positive patient experiences any of these symptoms, he/she must inform the treating doctor so that intervention measures can be introduced at the earliest. This infection mainly affects the sinus cavity and lungs and can spread to the brain. In some cases, if left untreated, it can affect the digestive system, heart, skin, or other organs in the body. Once you overcome the disease and are Covid-free, please do stay in touch with your endocrinologist to ensure that your health is well-monitored and there is no risk of developing severe mucormycosis.

Q. What is the possible reason behind the increasing number of mucormycosis cases in the country? What can be done to curb its spread?

Dr Behram Pardiwala: In Covid-19 we use steroids as part of therapy and it worsens preexisting diabetes. This is a very good nidus for the black fungus to grow. The only way that you can prevent the black fungus from growing is to control the patient’s diabetes very strictly. Further, one must have a high degree of suspicion for the existence of the fungus and look out for it in almost all diabetics. And when the black fungus is diagnosed it is imperative that you hit it very hard with appropriate drugs before it is allowed to spread.

Q. How can the possibility of black fungus be stalled amongst Covid-19 patients—both who are being treated and those who have recovered?

Dr Deepak Jaiswal: The chances of this fungus infection have increased in patients with weak immune systems, on long term immunosuppressive drugs and steroids, Covid-19 positive and diabetic. Such patients can get affected by mucormycosis. There is nothing like all Covid positive patients will be affected. In case you get infected by it, proper diagnosis and treatment are crucial. If any Covid patient experiences any black fungus-related symptoms, then they should consult the doctor immediately. Mucormycosis is a medical emergency with high morbidity and mortality. A team approach is required with specialist microbiologist, histopathologist, intensivist, neurologist, ENT specialist, ophthalmologist, dentist, surgeon and radiologist.

Q. Can you tell us about the people who are more prone to developing mucormycosis? Can they take any precautions?

Dr Santosh Sivaswamy: Mucormycosis is a deadly fungal disease. With increasing Covid-19 cases, we are witnessing a lot of patients coming to us with mucormycosis condition post-Covid-19 infection. We had seen quite a few cases during the first Covid wave as well. This infection can develop when there is an increase in the usage of steroids and uncontrolled diabetes. Not only do these two factors contribute to the occurrence of the mucormycosis, but other factors like age, high ferritin levels in the blood, usage of unrationalised antibiotics, and the rate of overall immunosuppression of the patients can also lead to this infection. The incidence of mucormycosis is most commonly seen in the coastal belts and people with uncontrolled diabetes. A hot and humid climate is one of the reasons to develop this infection. To prevent patients from developing this infection, it is advised to avoid high steroid dosages, blood sugar control, Covid-appropriate behaviour, and rationalised use of antibiotics.

Q. What is the treatment for this fungal disease?

Dr ChandraVeer Singh: Antifungals Amphotericin B and surgical debridement wherein surgery is done to remove all fungus debris help treat the black fungus. Steroids and globulins can also help tackle the infection. However, the treatment may vary from person to person. 

Q. Is mucormycosis also affecting young people?

Dr Bhavika Verma Bhatt: No, mucormycosis is rare, but it’s more common among people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Black fungus generally affects Covid-19 recovered patients who have other comorbidities like diabetes, kidney or heart failure, cancer as well as patients who are on steroids or have had a transplant, irrespective of their age. However, it is most common in diabetic patients, as per the Centers for Disease Control and Prevention (CDC) of the United States.

Dr Mubasheer Ali: There is no specific age group who are more susceptible but mainly it affects people with diabetes mellitus and other immunodeficiency disorders. Though there is no official number of mucormycosis cases in India, estimation of fungal burden in India using computational models by international health experts predicts around 1,750 to 2,500 cases of mucormycosis daily in India. This is just a predictive model so the actual number may be higher.

Dr Amitabh Malik: It is affecting young people also with all age groups, who have recovered from Covid-19. Vulnerable groups include people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. These include those with diabetes, cancer, or people who have had organ transplants.

Q. What can be the repercussions if this fungal disease spreads to the lungs?

Dr Sanjay Dhawan: In the cases that I have come across and treated so far, it hasn’t reached the lungs. The Black fungus is an opportunistic pathogen that affects and invades the body only when its defences are low, otherwise, it will not as this fungus is always there in the environment at all times. It starts spreading from the nasal sinus and move upwards to the eyes and then the brain. The fungus forms a layer on the surface of paranasal sinus walls (hollow air spaces), it doesn’t go into the tissues directly. It first grows in the walls of the sinuses and from there it starts taking nutrition from the walls of sinuses and begins invading the blood vessels, causing blockage in blood vessels and thereby deriving nutrition for itself. It doesn’t go into the tissues directly. This is also the reason why the drugs given or even injected intravenously do not reach the body of the fungus and thus, surgical debridement is needed. We are using a new technique at our hospital whereby we are able to save the eyeball and structures around the eye to some extent, we introduce a special device into the orbit and directly deliver the drug into the orbit. But it is possible only in early cases and not in advanced ones. After surgical debridement, we treat the patients with an intravenous high dose of antifungal drugs that are quite toxic. 

Q. In what scenario do you have to surgically remove the eye or the jaw bone to stop the spread of the black fungus?

Dr Ali: Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proves successful in most of the cases of mucormycosis. Appropriate surgical intervention prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. In the present scenario where mucormycosis has a high mortality rate, anti-fungal therapy should be used secondarily or as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

Rhinocerebral or rhino-orbito cerebral (mucormycosis) usually occurs among patients with poorly controlled diabetes mellitus (especially those with ketoacidosis), in patients undergoing treatment with glucocorticosteroid agents, or in post-Covid patients who were on immune modulators and long term oxygen therapy. The fungus may spread to invade the palate, sphenoid sinus, cavernous sinus, orbits, or cranially to invade the brain. Pain and swelling precede oral ulceration and the resulting tissue necrosis can result in palatal perforation. Infection can sometimes extend from the sinuses into the mouth and produce painful, necrotic ulceration of the hard palate. If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in the loss of extraocular muscle function and proptosis. Surgical treatment includes the resection of involved tissues of the face, including skin and muscle, any skin of the nose that is involved, maxillary and ethmoid sinuses, necrotic tissue of the temporal area and infratemporal fossa, and orbital exenteration along with the mandibular part. The keys to successful therapy include early diagnosis and early recognition of the signs and symptoms and complications, correction of underlying medical disorders and quick surgical intervention. An aggressive surgical approach has appeared to enhance survival in many scientific studies conducted.

Dr Bhatt: While it is treated with antifungal drugs, mucormycosis may eventually require surgery. This disease affects the tooth, eye, and sinus. Involvement of the eye is an advanced stage that starts affecting the nervous system, thus the removal of the eye takes place.

So, it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes an infusion of normal saline (IV) before the infusion of amphotericin B and antifungal therapy, for at least four to six weeks.

Dr Malik: The eye is cosmetically preserved but the dead tissue is removed around the eyeball in the Endoscopic Endonasal approach which is currently being practised. Removal of Jawbone is done if the disease spread involves the bone.

Q. What are your views on the severity and the frequency of this disease?

Dr Malik: Mucormycosis, has an overall mortality rate of 50%, maybe triggered by the use of steroids, a life-saving treatment is done in case of severe and critically ill Covid-19 patients with this disease. Steroids reduce inflammation in the lungs for Covid-19 patients and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive to fight off the virus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. The drop in immunity could be triggering these cases of mucormycosis.

 Dr Ali: Complications of mucormycosis can be dire: blindness, organ dysfunction, loss of body tissue due to infection and debridement, and death. Its prognosis (outcomes) range from fair to poor. So the early detection of the signs and symptoms and early intervention will have a better outcome.

Dr Bhatt: Eight out of 200 patients treated so far in various parts of Maharashtra have died due to black fungus. They survived Covid-19 but the fungal infection attacked their weak immune system which proved fatal.

Also, Delhi’s Sir Ganga Ram Hospital has reported a rise in the number of Covid-induced mucormycosis cases. Sir Ganga Ram Hospital in New Delhi reported over 15 cases of mucormycosis amongst patients on the path to recovery who had been admitted to the Covid-19 ward.

In Gujarat, more than 100 cases of black fungus have been notified across state government hospitals and Gujarat Medical Education Research Society (GMERS) hospitals. Currently, Ahmedabad’s Zydus Hospital has around 40 such patients while Vadodara’s SSG hospital is treating 35 patients.

We had a Covid-19 patient who was a diabetic and on admission, his fasting sugar was around 200 and post-lunch it was 300 and HbA1c 9.6. He had temperature also and we started giving him remdesivir immediately and also started giving him rapid-acting insulin. The saturation on admission was about 97-98 with two litres of oxygen on the first day. By the second day, oxygen came down further and the patient still had a high temperature. Under these circumstances, we decided to shift him to ICU overnight as he was deteriorating rapidly. We gave him a high flow of nasal oxygen. With the high flow of nasal oxygen, gradually the patient started improving, we continued with the insulin and brought the sugar under control. After 72 hrs in ICU, we shifted him to a ward where we maintained nasal prong oxygen and his saturation was about 96-97% with two litres of oxygen. Gradually it improved until the three-minute walk showed a saturation of 97%. At the time of discharge, he had a headache. But after the discharge, he started complaining about pain in the head and behind the eye, which was alarming. We called him in immediately. His eye was red. We did a CT Scan immediately, we discovered that he had mucormycosis. His sugar at that time was a little high and we got him admitted and started giving him intravenous amphotericin for 15 days and he recovered rapidly. A repeat scan showed almost complete resolution, shares Dr Behram Pardiwala – Internal Medicine, Wockhardt Hospital Mumbai Central.

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Medically Speaking

Punjab populace more hypertensive than the nation: NFHS Survey

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When the national average is 25.3% in terms of hypertension prevalence, Punjab is shooting up at 35.7%. As per National Family Health Survey that was conducted in 2020-2021, it is clear that Punjab is the only state where the populace is more prone to hypertension than any other state in India. All thanks to trans fat and the lifestyle of Punjabis makes them easy victims of cardiovascular diseases.

The Daily Guardian spoke to the Community Medicine Professor Dr Sonu Goel on this. Dr Goel exhorted that it has been concluded in many surveys including the NFHS survey that trans fat is an invariable component of industrial fat and one of the major dietary factors associated with cardiovascular disease mortality, increasing the risk of heart disease by 21% and deaths by 28%. Many in the early age group of 35 to 50 years in Punjab have become victims of uncontrolled high blood pressure, says Dr Goel.

“It’s being seen in people with a family history of premature chronic heart disease or stroke and a raised triglyceride level. Besides this, modifiable risk factors include unhealthy diets, excessive salt consumption, a diet high in saturated fats and trans fats, and low intake of fruits and vegetables,” says Dr Goel.

“Non-communicable diseases (NCDs) are the most found cause of disease burden. In recent years, the rising burden of cardiovascular diseases and high disease severity has been one of the significant threats in low-income and middle-income countries compared with high-income countries. People who are young believe in the myth that heart attacks can occur only in old age. They should wake up and adopt a healthy lifestyle at the earliest. One should give at least one hour to physical activity and make sure not to ignore the body’s signals,” he adds.

There has been an increase in the rate of coronary artery disease (CAD) in India in the last three decades.

A study published by the Journal of Clinical and Diagnostic Research in 2016 states that Indians have three, six, and twenty times greater risk of hypertension than Americans, Chinese, and Japanese populations respectively. “It is a matter of concern and there is a requirement to identify the factors responsible for its increasing prevalence, concludes Dr Goel.

Punjab is the only state where the populace is more prone to hypertension than any other state in India.

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Medically Speaking

HOW TO KEEP CHILDREN SAFE AMID RISING TEMPERATURE AND HEAT WAVE

Here are some tips to beat the heat that parents can try to ensure their child’s health and well being.

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The country is experiencing a heatwave with temperatures in many parts of India above 46 degrees Celsius, resulting in states issuing orange alerts. High temperatures and extreme heat can cause children to become sick very quickly.

What is heat-related illness?

Heat-related illness occurs when the body severely overheats. This can occur when a child is exposed to high temperatures for a long period of time and the body’s ability to cope with the heat wears out. The health impacts of Heat Waves typically involve dehydration, heat cramps, heat exhaustion and/or heat stroke. The signs and symptoms are as follows:

Heat Cramps: Edema (swelling) and Syncope (Fainting) generally accompanied by fever below 39°C i.e.102°F.

Heat Exhaustion: Fatigue, weakness, dizziness, headache, nausea, vomiting, muscle cramps and sweating.

Heat Stoke: Body temperatures of 40°C i.e. 104°F or more along with delirium, seizures or coma. This is a potential fatal condition. Heat stroke can lead to damage of a child’s brain, heart, kidneys, and muscles.

During summer months, research shows that children may be more likely to visit the emergency department not only for heat-related illness, but also for bacterial intestinal infections, ear infections, nervous system diseases, or for any reason.

Exposure to extreme heat may also make it more difficult for students to do well in school.

Children at increased risk of heat- related illnesses

Anyone can develop heat-related illness, but some children may be at higher risk than others. Infants and young children, especially with chronic medical conditions like asthma and diabetes; Obese children; children on medications that can make it harder to cope with heat and Children living in urban slums.

Useful tips

Some useful tips to protect the children from heat-related illness and hazards are:

• Encourage children to drink water frequently and have it readily available—even before they ask for it.

• Dress children in clothing that is light-coloured, lightweight, and limited to one layer of absorbent material that will maximise the evaporation of sweat.

• Provide extra rest time to children.

• Keep the surroundings cool and when child is feeling hot, give him or her a bath or sponge the body with water to cool down.

• Never leave child in a car: The inside of a car can become dangerously hot in just a short amount of time, even with the windows open.

Government response

 Ministry of Health & Family Welfare, Govt. of India has asked all states and union territories to review their health facility preparedness for the availability of all essential medicines and equipment amid the rising temperature and heatwave in several parts of the country. States have been advised to continue efforts on sensitisation and capacity building of medical officers, health staff and grassroots level workers on heat illness, its early recognition and management.

National Disaster Management Authority (NDMA), Government of India advises following measures to minimise the impact during the heat wave and to prevent serious ailment or death because of heat stroke:

§ Avoid going out in the sun, especially between 12.00 noon and 3.00 p.m.

§ Drink sufficient water and as often as possible, even if not thirsty

§ Wear lightweight, light-coloured, loose, and porous cotton clothes. Use protective goggles, umbrella/hat, shoes or chappals while going out in sun.

§ Avoid strenuous activities when the outside temperature is high. Avoid working outside between 12 noon and 3 p.m.

§ While travelling, carry water with you.

§ Avoid alcohol, tea, coffee and carbonated soft drinks, which dehydrates the body.

§ Avoid high-protein food and do not eat stale food.

§ If you work outside, use a hat or an umbrella and also use a damp cloth on your head, neck, face and limbs

§ Do not leave children or pets in parked vehicles

§ If you feel faint or ill, see a doctor immediately.

§ Use ORS, homemade drinks like lassi, torani (rice water), lemon water, buttermilk, etc. which helps to re-hydrate the body.

§ Keep animals in shade and give them plenty of water to drink.

§ Keep your home cool, use curtains, shutters or sunshade and open windows at night.

§ Use fans, damp clothing and take bath in cold water frequently.

Parents are advised to be vigilant and aware on protective measures during heat wave. They should immediately seek medical care if child develops symptoms like extreme tiredness, feeling faint, intense thirst, vomiting, headache, fever, fast breathing, muscle aches or spasms.

The writer is a Senior Consultant Health, Save the Children.

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Medically Speaking

Better mobility in frail older people linked to regular exercise with dietary advice

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A programme of regular exercise along with expert dietary advice is linked to a reduction in mobility problems among frail older people living in the community, finds a trial.

The findings were published in The BMJ. The combination of aerobic (walking), strength, flexibility, and balance exercises alongside personalised nutritional counselling reduced mobility disability by 22 per cent over three years.

US and EU data indicate that about 13 per cent of adults aged 70 years and older living in the community have mobility disability, which is linked to poor quality of life, admission to hospital or residential care, and death, as well as greater healthcare costs.

It is therefore important to find safe and effective ways to preserve mobility in older people at risk of further decline.

So researchers designed the SPRINTT trial to find out whether a combined intervention of physical activity with technological support and nutritional counselling prevents mobility disability in frail older adults compared with education on healthy ageing.

Their findings are based on 1,519 men and women (average age 79 years) with physical frailty and sarcopenia (a combination of reduced physical function and low muscle mass) recruited from 16 clinical sites across 11 European countries between 2016 and 2019.

Physical frailty and sarcopenia was defined as having a physical performance battery (SPPB) score of 3 to 9 points (score range 0 to 12, with lower scores indicating poorer physical function) and low levels of muscle mass, but able to independently walk 400 metres in 15 minutes.

In all, 760 participants were randomised to the intervention, 759 received education on healthy ageing (controls), and all were monitored for up to 36 months.

The intervention group received twice weekly moderate intensity physical activity sessions at a centre and up to four times weekly at home alongside personalised nutritional counselling. Activity was measured by an actimeter worn on the thigh.

Controls received education on healthy ageing once a month and a brief instructor led programme of upper body stretching exercises or relaxation techniques.

Among participants with SPPB scores of 3-7 at the start of the trial, mobility disability occurred in 47 per cent assigned to the intervention and 53 per cent controls.

Persistent mobility disability (inability to walk 400 m on two consecutive occasions) occurred in 21 per cent of intervention participants compared with 25 per cent of controls. SPPB scores increased more in the intervention group than in controls at both 24 months and 36 months (average differences of 0.8 and 1 point, respectively).

Women in the intervention group lost less muscle strength (0.9 kg at 24 months) and less muscle mass (0.24 kg and 0.49 kg at 24 months and 36 months, respectively) than control women, but no significant group differences were seen in men.

The risk of adverse events was, however, greater among intervention participants (56 per cent) than controls (50 per cent).

In a separate analysis of participants with better mobility (SPPB scores of 8 or 9 at the start of the trial), the intervention did not affect the risk of developing mobility disability and had marginal effects on physical performance.

The researchers acknowledge some limitations. For example, older adults with important cognitive deficits were not included, and almost all participants were white, so findings may not apply to other ethnic groups.

However, retention and adherence to interventions were high compared with other similar trials, and their use of validated tests in a geographically and culturally diverse group of frail older people across Europe, suggests that results are solid.

As such, they conclude that such an intervention “may be proposed as a strategy to preserve mobility in older people at risk of disability.”

This fresh evidence confirms the benefits of structured physical activity in community living older adults, says Thomas Gill at Yale School of Medicine in a linked editorial.

He acknowledges that translating even the best designed trial findings into clinical practice can be challenging, but says these findings, along with those from another large US trial (the LIFE Study), “provide compelling evidence that mobility in the community can be preserved among vulnerable older people through structured physical activity, with walking as the primary modality.”

He notes that the cost effectiveness of the LIFE programme “was found to be comparable to that of many commonly recommended medical treatments.”

Confirming these findings in SPRINTT “would further strengthen the case for developing, implementing, and supporting community based physical activity programmes to preserve independent mobility among vulnerable older people,” he concludes. (ANI)

US and EU data indicate that about 13 per cent of adults aged 70 years and older living in the community have mobility disability, which is linked to poor quality of life, admission to hospital or residential care, and death, as well as greater healthcare costs.

It is therefore important to find safe and effective ways to preserve mobility in older people at risk of further decline.

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Medically Speaking

50% of brain’s cells execute new functions

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In a new study at Tufts University, researchers came across a previously unknown function performed by a cell type that contains almost half of all cells in the brain.

The findings of the research were published in the journal ‘Nature Neuroscience’. The scientists say this discovery in mice of a new function by cells known as astrocytes opens a whole new direction for neuroscience research that might one day lead to treatments for many disorders ranging from epilepsy to Alzheimer’s to traumatic brain injury.

It comes down to how astrocytes interact with neurons, which are fundamental cells of the brain and nervous system that receive input from the outside world. Through a complex set of electrical and chemical signaling, neurons transmit information between different areas of the brain and between the brain and the rest of the nervous system.

Until now, scientists believed astrocytes were important, but lesser cast members in this activity. Astrocytes guide the growth of axons, the long, slender projection of a neuron that conducts electrical impulses. They also control neurotransmitters, chemicals that enable the transfer of electrical signals throughout the brain and nervous system.

In addition, astrocytes build the blood-brain barrier and react to an injury. But they did not seem to be electrically active like the all-important neurons–until now. “The electrical activity of astrocytes changes how neurons function,” said Chris Dulla, associate professor of neuroscience at the School of Medicine and Graduate School of Biomedical Sciences.

“We have discovered a new way that two of the most important cells in the brain talk to each other. Because there is so much unknown about how the brain works, discovering new fundamental processes that control brain function is key to developing novel treatments for neurological diseases.”

In addition to Dulla and lead author Moritz Armbruster, the study’s other authors include Saptarnab Naskar, Mary Sommer, Elliot Kim, and Philip G. Haydon from Tufts University School of Medicine; Jacqueline P. Garcia from the Cell, Molecular and Developmental Biology program at Tufts Graduate School of Biomedical Sciences; and researchers from other institutions.

To make the discovery, the team used brand new technology to devise a technique that enables them to see and study the electrical properties of brain cell interactions, which could not be observed previously.

“With these new tools, we’ve essentially uncovered completely novel aspects of biology,” said Armbruster, research assistant professor of neuroscience at the School of Medicine.

“As better tools come along–for example, new fluorescent sensors are being developed constantly–we’ll get a better understanding of things we didn’t even think about before.”

“The new technology images electrical activity with light,” Dulla explained. “Neurons are very electrically active, and the new technology allows us to see that astrocytes are electrically active, as well.”

Dulla describes astrocytes as “making sure everything is copacetic in the brain, and if something goes wrong, if there’s an injury or viral infection, they detect it, try to respond, and then try to protect the brain from insult. What we want to do next is determine how astrocytes change when these insults happen.”

Neuron-to-neuron communication occurs through the release of packets of chemicals called neurotransmitters.

Scientists knew that Neuron-to-neuron communication helps to make sure that neurons stay healthy and active.

But the new study reveals that neurons also release potassium ions.

which change the electrical activity of the astrocyte and how it controls the neurotransmitters.

“So the neuron is controlling what the astrocyte is doing, and they are communicating back and forth.

Through a complex set of electrical and chemical signalling, neurons transmit information between different areas of the brain.

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Medically Speaking

HOW SLEEP HELPS IN PROCESSING EMOTIONS

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Researchers at the Department of Neurology of the University of Bern and University Hospital Bern identified how the brain triages emotions during dream sleep to consolidate the storage of positive emotions while dampening the consolidation of negative ones.

The work expands the importance of sleep in mental health and opens new ways of therapeutic strategies. Their findings were published in the journal Science. Rapid eye movement (REM or paradoxical) sleep is a unique and mysterious sleep state during which most of the dreams occur together with intense emotional content. How and why these emotions are reactivated is unclear. The prefrontal cortex integrates many of these emotions during wakefulness but appears paradoxically quiescent during REM sleep. “Our goal was to understand the underlying mechanism and the functions of such a surprising phenomenon”, says Prof. Antoine Adamantidis from the Department of Biomedical Research (DBMR) at the University of Bern and the Department of Neurology at the Inselspital, University Hospital of Bern.

Processing emotions, particularly distinguishing between danger and safety, is critical for the survival of animals. In humans, excessively negative emotions, such as fear reactions and states of anxiety, lead to pathological states like Post-Traumatic Stress Disorders (PTSD). In Europe, roughly 15 percent of the population is affected by persistent anxiety and severe mental illness. The research group headed by Antoine Adamantidis is now providing insights into how the brain helps to reinforce positive emotions and weaken strongly negative or traumatic emotions during REM sleep. This study was published in the journal Science.

A DUAL MECHANISM

The researchers first conditioned mice to recognize auditory stimuli associated with safety and others associated with danger (aversive stimuli). The activity of neurons in the brain of mice was then recorded during sleep-wake cycles. In this way, the researchers were able to map different areas of a cell and determine how emotional memories are transformed during REM sleep.

Neurons are composed of a cell body (soma) that integrates information coming from the dendrites (inputs) and send signals to other neurons via their axons (outputs). The results obtained showed that cell somas are kept silent while their dendrites are activated. “This means a decoupling of the two cellular compartments, in other words, soma wide asleep and dendrites wide awake”, explains Adamantidis. This decoupling is important because the strong activity of the dendrites allows the encoding of both danger and safety emotions, while the inhibitions of the soma completely block the output of the circuit during REM sleep. In other words, the brain favours the discrimination of safety versus danger in the dendrites, but blocks the over-reaction to emotion, in particular danger.

A SURVIVAL ADVANTAGE

According to the researchers, the coexistence of both mechanisms is beneficial to the stability and survival of the organisms: “This bi-directional mechanism is essential to optimize the discrimination between dangerous and safe signals”, says Mattia Aime from the DBMR, first author of the study. If this discrimination is missing in humans and excessive fear reactions are generated, this can lead to anxiety disorders. The findings are particularly relevant to pathological conditions such as post-traumatic stress disorders, in which trauma is over-consolidated in the prefrontal cortex, day after day during sleep.

BREAKTHROUGH FOR SLEEP MEDICINE

These findings pave the way to a better understanding of the processing of emotions during sleep in humans and open new perspectives for therapeutic targets to treat maladaptive processing of traumatic memories, such as Post Traumatic Stress Disorders (PTSD) and their early sleep-dependent consolidation. Additional acute or chronic mental health issues that may implicate this somatodendritic decoupling during sleep include acute and chronic stress, anxiety, depression, panic, or even anhedonia, the inability to feel pleasure. Sleep research and sleep medicine have long been a research focus of the University of Bern and the Inselspital, Bern University Hospital. “We hope that our findings will not only be of interest to the patients but also to the broad public”, says Adamantidis.

The work expands the importance of sleep in mental health and opens new ways of therapeutic strategies.

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Health & Wellness

ABHA WILL ENHANCE DIGITAL HEALTHCARE SYSTEM IN THE COUNTRY

The health insurance sector in India is expecting a growth at a rate of 10.1% in the years between 2021 and 2027. Distribution and affordability are two keywords to get a large number of people insured, said experts.

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Introducing the challenges and the need for new policies in health insurance in India, a conference on ‘Health Insurance 2042- Let us Plan for Ambitious Target for 2042’ was organised in Vigyan Bhawan, New Delhi. The conference organised by the PHD Chamber of Commerce and Industry (PHDCCI) highlighted the need to boost the digital healthcare system in the country.

Speaking about the Ayushman Bharat Digital Mission (ABDM), Dr. Malti Jaswal, a Senior Consultant, World Bank and Advisor with the National Health Authority, said, “ABDM plans to create a healthcare infrastructure that will bridge the existing gap amongst different stakeholders in the healthcare ecosystem through digital highways.” A health id for all Indian citizens-ABHA (Ayushman Bharat Health Account) will help maintain personal health records digitally and easily accessible.

The Ayushman Bharat scheme has also been able to cover the bottom 50% and several voluntary schemes cover almost 20%. The government must focus on the remaining 30%. Pradeep Multani, President, PHDCCI, said, “The health insurance sector has undergone a lot of change in the last two years of the pandemic, with people realising its importance.” He also focussed on the need for customising products as per the customers.

Also, while discussing the growth of digital healthcare, Dr. Harsh Mahajan, Chair, Hospital & Diagnostics Committee, PHDCCI and Founder & Chief Radiologist, said, “The digital healthcare market, valued at $116 billion in the year 2018 is expected to touch $485 billion by the year 2024, a growth of 3.5 times. The spurt in growth is primarily due to the pandemic, which accelerated the diagnostics sector to grow at a rate of 20.5 percent. It is valued at $32 billion now, up from just $5 billion in the year 2012.”

Mr. S K Sethi, Co-Chair, Banking, Financial Services and Insurance (BFSI) Committee, PHDCCI & Founder & CEO, Insurance Foundation of India, stated that from Rs 690 crore in 2001 to Rs 73,300 crores in 2022, the sector has grown approximately 106 times. He stated that blockchain technology would help in eliminating the fraud taking place in the insurance sector

Although the pandemic taught us the significance of mental health, health insurance policies exclude the challenges of mental health. According to Deepak Singh, CEO and Co-founder of Tatsam, insurance companies have developed plans but, except for psychiatrists, have yet to recognise counselors and therapists. Most people have often faced a treatment gap while claiming their insurance. Dr. Steward Doss, Professor, National Insurance Academy, Pune, stated that there is a significant treatment gap in India. A lot of these issues can be resolved with insurance cover.

The knowledge paper on Health Insurance 2042 was also released at the event. Other members who participated in the event were Kanya Saraswathy C, Head Commercial and Reinsurance Practice, Insurance Advisory Group & Lead – US West Accounts, BFSI, Tata Consultancy Services Limited, Ashish Agrawal, Co-Chair, BFSI Committee, PHDCCI, Ravi Bhati During the seminar, Teena Jain Kaushal, Senior Editor of Business Today, and so on.

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