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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

Difficult conversation about death with children: The dos and don’ts

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‘A child asked her grandmother when her mother would return. The grieving grandmother told her that her mother had gone to heaven and became a star. She will watch her from there.’ All of us at some point in our childhood would have been told a story such as this. The intention of the grandmother is none else than to comfort the child. Won’t it be easier to look up at the sky and remember her mother? or believe she is safe with God.

But what really happens when you use euphemisms like ‘gone to a better place’ or ‘gone to heaven’. Usage of such terms can be very confusing for children and sometimes scary too! They may struggle to understand how heaven might be better than being with them, why did their loved one leave, how do you become a star?

As such children may experience intense feelings of anxiety, sadness, guilt, anger etc. on losing a loved one. They themselves may be struggling with their feelings and more often than not they look to the other caregivers for guidance and support. In these moments, not openly sharing about the loss or telling them how they should be strong and try to move on can prove to be very damaging for the child. Unaddressed feelings of grief can lead to development of anxiety, depression and even cause post-traumatic disorder in children.

How we talk about death and conversations around it, can therefore go a long way in determining how our children cope with their grief. The words you choose will have to depend on the emotional maturity and development of your child. But there are some basic guidelines that medical experts outline which should be applied when having a conversation with a child about loss.

To begin with, there is no right time to inform a child about the loss. Children should be informed sooner than later lest they find out on their own which can throw them into an emotional spiral. The person who talks to the child about the loss should be someone who they are close to, like the primary caregiver or if the person is grieving and not in a position to talk, then the next person the child is attached to. Talking about loss can be a difficult conversation and requires all the love and attention of the person breaking the news.

When talking about loss, first assess their understanding of loss. Different age groups perceive death and loss, differently. For a toddler it may be a temporary loss with the expectation of seeing the caregiver after sometime. For a younger child, death may mean something more permanent and can therefore generate a strong sense of loss and sadness.

Avoid using euphemisims like ‘passed away’ or ‘gone to sleep’ when talking about loss. Children tend to focus on words literally and using unreal words and telling stories about what happened to their loved one, can leave them wondering, confused and anxious. They might also feel that death is not permanent and their loved one may come back. It is therefore important to use real words like ‘death’, and ‘dying’ and state exactly what happened in order to prepare them for real life situation and help them cope better with their feelings.

Talk to your child in age-appropriate language while talking about the loss. As per medical experts, younger children within the age range of 2-5 years, can be explained about death in simple words. For instance, you can let them know that when a person dies, their body stops working- that means the heart does not beat and they do not breathe. For older children in the age range of 6-9 years, a caregiver can add more information and explain with what they might relate. For instance ‘every organism has a life cycle. Humans also have a life cycle. You are born, you die and in between you live.’

Children may get curious and ask questions repeatedly. Respond to the questions honestly, openly and with patience. Share with them, what you think is relevant for their age and do not overwhelm the child with facts and description. It can make the loss scary, and result in feelings of anxiety.

Children may struggle with their emotions as you talk about the loss. Encourage them to express their feelings and let them know it’s ok for them to cry. Avoid telling them how they should or should not feel. There are no rules to grieving. Acknowledging their feelings and letting them express is the first step to healing.

Some children may also carry the guilt, if they believed they were in any way responsible for the death of their loved one. For instance, if they said something hurtful to their grandmother after which she died. Let them know it’s not their fault.

More importantly, as you have this most difficult conversation, mindfully listen to your child’s responses and reactions and be available to support them. Be open about your feelings and reassure the child that you are taking care of yourself and that you are going to be with them and keep them safe.

As adults, when we lose a loved one, we struggle with our emotions. For a child it’s even harder as they are still in the process of developing their emotional and cognitive skills and are therefore not as equipped to navigate through the torrent of emotions they may experience on losing a loved one. Having an open conversation about the loss can support your child to cope better with the loss and prevent it from turning into a traumatic experience.

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PROMISING OVARIAN CANCER TREATMENT PROVES BOTH EFFECTIVE, EFFICIENT

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Preclinical trials of a new radiopharmaceutical to treat ovarian cancer have produced successful results, dramatically limiting tumour growth and decreasing tumour mass. Designed specifically for ovarian cancers that are resistant to traditional therapies, the new radiopharmaceutical can be produced in 25 minutes at a low cost, which leads to better efficiency compared with alternative methods.

This research was presented at the Society of Nuclear Medicine and Molecular Imaging 2021 Annual Meeting. According to the American Cancer Society, more than 20,000 women are diagnosed with ovarian cancer each year and nearly 14,000 will die from the disease. Ovarian cancer patients have a five-year survival rate of 49.1 per cent. It is the fifth leading cause of cancer-related death among women.

In the study, researchers utilized a new generator system to develop the targeted alpha-therapy Pb-214-TCMC-trastuzumab to treat HER2-positive ovarian cancer. Ovarian cancer cells and mice bearing ovarian cancer tumours were split into three groups: those treated with Pb-214-TCMC-trastuzumab, those treated with Pb-214-TCMC-IgG and an untreated control group. All groups were imaged over time to determine the effectiveness of the treatment. Compared to the Pb-214-TCMC-IgG and control groups, the tumour signal for mice and cells treated with Pb-214-TCMC-trastuzumab decreased dramatically over the course of the study, signalling the efficacy of the therapy. There were no adverse side effects from the treatment as determined by the weight loss of all animals surviving.

“The short 27-minute half-life of Pb-214 is ideal for fractioned alpha particle therapeutic applications,” stated Mike Zamiara, study author and president of Niowave Inc. in East Lansing, Michigan. “The generator system can provide Pb-214 every hour, potentially providing a new source of alpha-particle therapy to patients at a lower cost. In the future, the generator system will be available for many therapeutic products in a turn-key system under development, providing reliable doses for improved patient care.”

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Study examines the effects of corona on human kidney cells

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Researchers have studied human kidney cells in the lab to examine the effects of COVID-19 on kidney health. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Many individuals who develop COVID-19 also experience kidney damage, but it’s unclear if this is a direct result of viral infection or a consequence of another condition or the body’s response to the infection. To investigate, a team led by Benjamin Dekel, MD, PhD (Sheba Medical Center, in Israel) cultivated human kidney cells in lab dishes and infected them with the virus that causes COVID-19. The researchers found that although the virus that causes COVID-19 could enter, infect, and replicate in human adult kidney cells, this did not typically lead to cell death.

Prior to infection, the cells contained high levels of interferon signalling molecules, and the infection stimulated an inflammatory response that increased these molecules. In contrast, infection of kidney cells deficient in such molecules resulted in cell death, suggesting a protective effect. The cells in these experiments were grown as a three-dimensional spheroid that imitates the healthy kidney or as a two-dimensional layer that mimics the cells of an acutely injured kidney. Cells that mimicked an acutely injured kidney were more prone to infection and additional injury but not cell death.

“The data indicate that it is unlikely that the virus is a primary cause of acute kidney injury seen in COVID-19 patients. It implies that if such injury takes place in the kidney by any cause, the virus might jump on the wagon to intensify it. Therefore, if we’re able to limit the common scenario of acute kidney injury in the first place, then there might be the possibility to minimize the potential damage caused by the virus,” Dr Dekel explained.

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Radiotracer effective for detection and assessment of lung fibrosis

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Positron emission tomography (PET) using a 68Ga-labeled fibroblast activation protein inhibitor (FAPI) can noninvasively identify and monitor pulmonary fibrosis, according to research presented at the Society of Nuclear Medicine and Molecular Imaging 2021 Annual Meeting.

By binding to activated fibroblasts present in affected lungs, FAPI-PET allows for direct imaging of the disease process. Idiopathic pulmonary fibrosis (IPF) causes substantial scarring to the lungs, making it difficult for those impacted to breathe. It is a significant cause of morbidity and mortality in the United States, with more than 40,000 deaths annually.A major challenge in the diagnosis and treatment of IPF is the lack of a specific diagnostic tool that can noninvasively diagnose and assess disease activity, which is crucial for the management of pulmonary fibrosis patients.“CT scans can provide physicians with information on anatomic features and other effects of IPF but not its current state of activity. We sought to identify and image a direct noninvasive biomarker for early detection, disease monitoring and accurate assessment of treatment response,” said Carolina de Aguiar Ferreira, PhD, a research associate at the University of Wisconsin-Madison in Madison, Wisconsin.

In the study, researchers targeted the fibroblast activation protein (FAP) that is overexpressed in IPF as a potential biomarker. Two groups of mice–one group with induced pulmonary fibrosis and one control group–were scanned with the FAPI-based PET/CT radiotracer 68Ga-FAPI-46 at multiple time points. Compared to the control group, the mice with induced pulmonary fibrosis had much higher uptake of the radiotracer, allowing researchers to successfully identify and evaluate areas of IPF. “Further validation of 68Ga-FAPI-46 for the detection and monitoring of pulmonary fibrosis would make this molecular imaging tool the first technique for early, direct, and noninvasive detection of disease. It would also provide an opportunity for molecular imaging to reduce the frequency of lung biopsies, which carry their own inherent risks,” noted Ferreira. “This development will demonstrate that functional imaging can play an invaluable role in the evaluation of the disease process.”Abstract 10.

“Targeting Activated Fibroblasts for Non-invasive Detection of Lung Fibrosis,” Carolina Ferreira, Zachary Rosenkrans, Ksenija Bernau, Jeanine Batterton, Christopher Massey, Alan McMillan, Nathan Sandbo, Ali Pirasteh and Reinier Hernandez, University of Wisconsin – Madison, Madison, Wisconsin; and Melissa Moore, Frank Valla and Christopher Drake, Sofie Biosciences, Dulles, Virginia.

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COVID-19 LINKED TO ALZHEIMER’S DISEASE-LIKE COGNITIVE IMPAIRMENT

Reports of neurological complications in Covid-19 patients and ‘long haulier’ patients whose symptoms persist after the infection clears are becoming more common, suggesting that SARS-CoV-2 may have lasting effects on brain function.

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A new Cleveland clinic-led study has identified mechanisms by which COVID-19 can lead to Alzheimer’s disease-like dementia.The findings, published in Alzheimer’s Research and Therapy, indicate an overlap between COVID-19 and brain changes common in Alzheimer’s and may help inform risk management and therapeutic strategies for COVID-19-associated cognitive impairment. Reports of neurological complications in COVID-19 patients and ‘long haulier’ patients whose symptoms persist after the infection clears are becoming more common, suggesting that SARS-CoV-2 (the virus that causes COVID-19) may have lasting effects on brain function.

However, it is not yet well understood how the virus leads to neurological issues. “While some studies suggest that SARS-CoV-2 infects brain cells directly, others found no evidence of the virus in the brain,” says Feixiong Cheng, PhD, assistant staff in Cleveland Clinic’s Genomic Medicine Institute and lead author on the study. “Identifying how COVID-19 and neurological problems are linked will be critical for developing effective preventive and therapeutic strategies to address the surge in neurocognitive impairments that we expect to see in the near future.” In the study, the researchers harnessed artificial intelligence using existing datasets of patients with Alzheimer’s and COVID-19. They measured the proximity between SARS-CoV-2 host genes/proteins and those associated with several neurological diseases where closer proximity suggests related or shared disease pathways. The researchers also analyzed the genetic factors that enabled SARS-COV-2 to infect brain tissues and cells.

While researchers found little evidence that the virus targets the brain directly, they discovered close network relationships between the virus and genes/proteins associated with several neurological diseases, most notably Alzheimer’s, pointing to pathways by which COVID-19 could lead to Alzheimer’s disease-like dementia. To explore this further, they investigated potential associations between COVID-19 and neuroinflammation and brain microvascular injury, which are both hallmarks of Alzheimer’s.“We discovered that SARS-CoV-2 infection significantly altered Alzheimer’s markers implicated in brain inflammation and that certain viral entry factors are highly expressed in cells in the blood-brain barrier,” explained Dr Cheng. “These findings indicate that the virus may impact several genes or pathways involved in neuroinflammation and brain microvascular injury, which could lead to Alzheimer’s disease-like cognitive impairment.”

The researchers also found that individuals with the allele APOE E4/E4, the greatest genetic risk factor for Alzheimer’s, had decreased expression of antiviral defence genes, which could make these patients more susceptible to COVID-19. “Ultimately, we hope to have paved the way for research that leads to testable and measurable biomarkers that can identify patients at the highest risk for neurological complications with COVID-19,” said Dr Cheng. Dr Cheng and his team are now working to identify actionable biomarkers and new therapeutic targets for COVID-19-associated neurological issues in COVID long-hauliers using cutting-edge network medicine and artificial intelligence technologies.

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No health worries for children born to mothers given seasonal flu vaccine in pregnancy

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Correspondent,Ottawa

A population-based study, published in the Journal of the American Medical Association (JAMA), has found flu vaccination during pregnancy does not lead to an increased risk of adverse early childhood health outcomes.

Although pregnant people are not more susceptible to acquiring influenza infection, they are at an increased risk of severe illness and complications if they get the flu during pregnancy. For this reason, all pregnant people are advised to receive a flu shot each year, yet only 36% received it according to a study monitoring four flu seasons in Nova Scotia. Safety concerns are reportedly a leading reason women may not receive influenza vaccination in pregnancy.

Dr Deshayne Fell, an Associate Professor of Epidemiology in the Faculty of Medicine at the University of Ottawa and a Scientist at the CHEO Research Institute, a pediatric healthcare and research centre, led the study along with researchers in Ontario and at Dalhousie University in Nova Scotia. The study followed over 28,000 children from birth up to an average age of 3.5 years, with the results suggesting that maternal influenza vaccination during pregnancy was not associated with:

– Immune-related health conditions, such as asthma, ear infections or other types of infection.

– Non-immune-related health problems like neoplasms, sensory impairment.

– Nonspecific health needs such as Emergency Department visits and hospitalisations did not increase.

“This study adds to what we know from other recent studies showing no harmful effects of flu vaccination during pregnancy on the long-term health of children,” says Dr Fell, whose other recent work includes studying the effectiveness and safety of Covid-19 vaccines during pregnancy.

She added, “This is important because we know that getting the flu shot during pregnancy not only protects the pregnant person but has the added bonus of protecting newborn babies from getting the flu during their first few months of life, which is when they are most susceptible to respiratory infections but still too young to get the flu shot themselves.”

The study, Association of Maternal Influenza Vaccination During Pregnancy with Early Childhood Health Outcomes, is published in JAMA.

With ANI inputs

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