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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INDIAN RESUSCITATION COUNCIL
The motto of Indian Resuscitation council is to make Every Citizen a Life saver. We postulated the technic of Compression only Life Support (COLS) where a layperson can perform Cardiopulmonary resuscitation with his two hands outside the hospital and even useful for the Army personal.
Sudden Cardiac Arrest is the most leading cause of preventable deaths in India. It can occur to any person rich or poor, anywhere, even without any pre-existing cardiac diseases. Many important dignitaries of the Nation have succumbed sudden Cardiac Arrest. The incidence is more than covid-19.
Less than 2% of the population in India are aware of CPR. Most of the victims unattended or treated by local methods of superstitions. About 4280 people per one lakh population are prone to Sudden Cardiac Arrest every year and nearly 90% succumbed to death. The Sudden Cardiac Arrest the cause for 59,064,000 preventable deaths in a year in India. And 161,819 per day, ie 6742people get Sudden Cardiac Arrest in an hour. India is a poor country with very meager per capita income and can’t afford an expensive training.
1.38 billion population in India. A sort of Indian guidelines and trainings is a must. Indian Resuscitation Guidelines will give confidence in all medical fraternity and among people, will save life’s, bring unity among organization. They need training in the local languages.
Indian Society of Anaesthesiologists has convened a meeting on 16th April 2017 at Hyderabad inviting many people involved in CPR in India. Indian Society of Anaesthesiologists, Indian society to study pain, Research society of Anaesthesiology and clinical pharmacology, Indian association of Cardiothoracic Anaesthesiologists, Indian Medical Association, Dr. NTR University of Heath Sciences, Indian Society of Critical Care Medicine, Association of Obstetric Anesthesia, UP Rural Institute of Medical University, Indian Association of Pediatric anesthesia , GVK EMRI, 108, Indian society of perinatology and reproductive biology, Indian College of Anaesthesiologists, and some members of Emergency medicine from different cities. It is resolved that India should have its own guidelines of resuscitation, as we do not have proper emergency medical system, equipped Ambulances, AEDs. We have different cultures, languages, customs, religions, inaccessible areas and superstitions. We studied the available literature available on similar circumstances around the world, less effluent countries and brought out the guidelines, and published in a PubMed Indexed journal after peer reviewing. Thus, a MAKE IN INDIA guidelines prepared to serve Indians.
- Ahmed SM, Garg R, Divatia JV, Rao SC, Mishra BB, Kalandoor M V, Kapoor MC, Singh B. Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:867-73. Available from: https://www.ijaweb.org/text.asp?2017/61/11/867/218099
- Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SC, Kalandoor M V, Divatia JV, Singh B. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:874-82. Available from: https://www.ijaweb.org/text.asp?2017/61/11/874/218100
- Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, Kalandoor M V, Singh B, Divatia JV. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:883-94. Available from: https://www.ijaweb.org/text.asp?2017/61/11/883/218102
- Singh B, Garg R, Chakra Rao S S, Ahmed SM, Divatia J V, Ramakrishnan T V, Mehdiratta L, Joshi M, Malhotra N, Bajwa SJ. Indian resuscitation council (IRC) suggested guidelines for comprehensive cardiopulmonary life support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient. Indian J Anaesth [serial online] 2020 [cited 2021 Jul 12];64, Suppl S2:91-6. Available from: https://www.ijaweb.org/text.asp?2020/64/14/91/284914
The motto of Indian Resuscitation council is to make Every Citizen a Lifesaver
Train your neighbors and save yourself
Your two hands can save lives
We postulated the technic of Compression only Life Support (COLS) where a layperson can perform Cardiopulmonary resuscitation with his two hands outside the hospital and even useful for the Army personal.
We have many challenges ahead, to make Every Citizen A LifeSaver
13 million school children every year need to training Basic cardiopulmonary life support (BCLS)
83,000 medical students need mandatory certificate in Basic Cardiopulmonary life support and Comprehensive cardiac life support (CCLS)
200,000 nurses need of certify every year in BCLS and CCLS across nation
Only 1 % out of cardiac arrest attempt was done in India vs 40% in western countries.
We Indian Resuscitation Council established in 2017 participated in WRAH Day and trained school children and laymen.
Over 675,000 lay people trained in
worldwide — The “World Restart a Heart
(WRAH)” initiative 2018
Available online at www.sciencedirect.com
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
The Indian Resuscitation Council, members of the Indian Society of Anaesthesiologists, and other professional, societies performed nationwide CPR training of laypeople in high schools, colleges, bus stations, railway stations, police stations, company offices, and other public places. At least 30 federal states of India participated and many
Chief Ministers and Health Ministers were actively involved. Overall, 225,000 people were trained in India for WRAH 2018.
Up to 206 million People Reached and Over 5.4 million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative
INDIA IRC/ ISA : No trained in COLS are 500,268 , in 2019,
Vice President of India Sri Venkaiah Naidu released in BCLS manual in November 2018.
Vice President of India Sri Venkaiah Naidu released the CCLS manual in July 2019.
2020 March Covid19 has slowed down our progress.
Since 2018, IRC is attending all the bimonthly meetings of WRAH Day. Demonstrated CPR in Heritage sites, prepared songs, skits on CPR, in different languages including Urdu and Kashmiri.
Released 1st day envelop and stamp on the occasion of WEAH Day on 16th October 2020, by the Andhra Pradesh State Minister, Member of the Parliament and the Member of Legislative Assembly, in the virtual presence of WRAH Day, AAPI and ISA dignitaries.
COLS basic CPR guidelines are included in 12th grade nationwide school’s syllabus in July 2021
-Mandatory Certification of Basic cardiopulmonary life support before graduation in state of Andhra Pradesh by Dr NTR University of Health Sciences, Andhra Pradesh of 50 million population,6000 medical student graduated,
National Medical commission has introduced a foundation course for the newly admitted students of MBBS and they have incorporated BCLS for them
Establishing IRC Resuscitation Training centers in medical colleges across country
Training of trainers (TOT) across country is going on every two months. A separate dedicated training started for all the hospital staff with National Accreditation Board for Hospitals and Health care providers (NABH) (like joint council of hospitals). NABH certifying body of 30,000 private and thousands of govt hospital, who has mandatory certification for BCLS to all Doctors, nurse and paramedics working from front office to the high dependency areas
Providing affordable courses through IRC part of ILCOR will have more support and on an international platform as health is global.
Learn CPR and Save Life- Must for every citizen
We must have heard or seen situations like “A 50-year-old man jogging in the park. He suddenly collapses and people in the park surround him” Or “Oh ! he was well last night, I have talked to him, but expired suddenly in the early morning” And we keep wondering what could be the reason!!
Every year, about 4,280 out of one lakh victims of sudden cardiac arrest (SCA) die in India. Sudden cardiac arrest is a condition where the heart stops its function of pumping blood to the whole body leading to the cessation of heartbeat and breathing. The terms cardiac arrest and heart attack are often used interchangeably, but these are two different conditions. A heart attack occurs when an artery is blocked due to fat and cholesterol deposition and prevents blood from reaching the heart muscle causing severe chest pain and breathing difficulty. Whereas cardiac arrest often occurs suddenly without any warning due to disturbance in the electrical activity of the heart that causes an irregular heartbeat (arrhythmia) which disrupts the heart’s ability to pump blood to the brain, lungs, and other vital organs. Disturbance in the electrical activity of the heart leading to cardiac arrest can be due to any of the following reasons: diabetes, hypertension, lungs, liver and kidneys diseases, etc. However, it can happen to anybody at any point in time. Within few minutes of cardiac arrest, the victim becomes unconscious and death occurs within minutes if the victim didn’t receive treatment. It has been observed that “ Every minute’s delay in the resuscitation of the cardiac arrest victim reduces the chance of survival by 7-10%”. So a prompt action can save the person’s life with cardiac arrest.
India is a vast country with lots of diversity, differences in culture, language, religions, customs, atmosphere, socio-economic issues, and differences in terrain. The environment and the infrastructure for resuscitation of a person with sudden cardiac arrest vary from place to place. So there was a need for a structured guideline to be followed for resuscitation of cardiac arrested victims. Moreover, the approach should be such that it is applicable at all scenarios and remains scientifically valid. There is a large body of evidence to show that it is possible to save the victims of SCA with immediate high-quality bystander hands-only cardiopulmonary resuscitation (CPR) – Compression only life support (COLS)
Compression only life support (COLS) are the guidelines developed by the Indian Resuscitation Council for providing only chest compressions in a stepwise algorithmic approach by a layperson for the cardiac arrest victims till the time medical help arrives
The timely management of the victim with cardiopulmonary arrest is paramount. It may not be possible to provide immediate medical care by the trained person when the victim is outside the hospital. The inclusion of common man after their proper training would be beneficial to improve the outcome of the victim. However, the medical steps to be taught to a layperson should be kept simple and easy to follow, and yet evidence-based.
Learning the skill of saving one’s life is may not be easy. But it is equally not easy to ignore someone dying unattended. Let us all try and make a world where no one dies from cardiac arrest. The Compression only Life Support (COLS) provides an easy, algorithmic stepwise approach for resuscitation of the victim with cardiopulmonary arrest by the lay person. To save one’s life, you should know various steps of COLS-Compression Only Life Support.
- Ensure Scene safety
- Victim’s response check
- Call for help and emergency medical system
- Early and effective chest compression
- Transfer to the health facility
The main activity of Compression-Only Life Support (COLS) is effective chest compression which should be performed continuously till help arrives. The chest compressions are performed at the rate of 120 per minute and the depth of each chest compressions should be around 5-6 cms.
To enhance the outcomes in cardiac arrests we need high-quality adult resuscitation education and Hands-on Training to maximum citizens. To achieve this, we first need to create the awareness and creating confidence among laypersons, that their contribution is equally important for the survival of a sudden cardiac arrested victim outside the hospital.
The main motto of any project related to layperson training in CPR is to bring out wide popularity for resuscitation, impart training to as many laymen including school children so that every citizen becomes a lifesaver. The IRC aims to train at least one person in the family to save the life from sudden cardiac arrest.
So, remember, Each of one us can save a life. Your two hands can save a life. Your timely help with compression-only CPR (COLS), in this emergency, may save somebody’s life. This victim could be your family member, friend, or a stranger on the street! Let us take a pledge on this National CPR day to learn CPR.
About the authors:
- Mr Aditya Kumar is an Honorary Director Public Relations at Indian Resuscitation Council.
- Dr Rakesh Garg is an Honorary Scientific Director at Indian Resuscitation Council.
The “well wishing” Aunties and Uncles of breastfeeding
Aunty 1: The baby looks so thin, Baby needs cow’s milk, my dear. Me: Cow’s milk is for cow’s baby, my baby needs my milk.
Aunty 2: Oh God, such small breasts you have, how will your milk be enough? Me: My body has the capacity to create however much milk needed for my baby and you know it is the best food for her
Aunty 3: Don’t feed your baby so long, you are pampering him, he will never leave you. Me: How can you pamper your baby by nourishing him?
Aunty 4: Look at you, with the baby all the time, in our times we used to do all the household work and brought up so many kids as well. Me: bringing up a baby with love, care, and breastmilk is our choice as parents and we need all your help and support to successfully do it
Let’s ponder, how many of us have been the Aunty or ME in the above conversations in our lives? Almost all, right? Being a first-time mother at the age of 33 was not easy for me, to have a baby late was not a choice as well. Being a pediatrician was a privilege and personal life took a backseat in the pursuit of higher studies. I thought I knew the solutions to all the challenges of breastfeeding, but reality was far from different. As the saying goes “It takes a village to bring up a baby”, in the modern times “it takes an entire family to breastfeed a baby”. Urbanization, nuclear families and career goals have made the art of breastfeeding less familiar to many of the millennial to-be mothers. We want the best for our baby and we know that breastfeeding is the best path. However, many of us land up being a bundle of nerves when our babies arrive, not sure where to start and how to go about. Agreed that breastfeeding is natural both for mother and the baby, but we forget to warn the to-be mothers that it is a helluva painful, stressful and exhilarating ride. To top it all, mothers also have to deal with the benevolent, free-advice churning Aunties and Uncles in the midst of this roller-coaster. Many a time, the well-wisher could be our own father, mother or even husband. Equipped with knowledge and confidence, I could defend and retort to many of them. However, the dream is to equip every mother of our land with enough knowledge to be the ME in the above situations.
Adequate breastfeeding is a single practice that can prevent lakhs of children from dying, worldwide. World health organization and UNICEF recommends that breastfeeding is initiated within 1st hour of birth, baby be given nothing but mother’s milk till 6 months and breastfeeding to be continued till 2 years of age and beyond. The global rates for breastfeeding are 43%, 41%, and 45% at 1st hour, 6 months, and 2 years, respectively. So, it is not as universal as it has to be. Survey by POSHAN reported that in India, exclusive breastfeeding rate is 54.9%. Mothers face many a challenge like feeling of inadequate milk, household chores, expectations from workplace, pressure to supplement with formula etc. She needs the support of her near and dear ones as well as the community to overcome these hurdles. Currently, mothers can get guidance from ASHA/ anganawadi worker, and gain knowledge through materials circulated by Government of India via Radio and TV. She can also access various peer groups in social media as well as consult trained lactation counsellors. World Breastfeeding week celebration is celebrated every year in the 1st week of August and this year the theme is “Protect breastfeeding- a shared responsibility”. Breastfeeding no longer can be left as “ladies’ matter”. Confident, and knowledgeable mothers are the foundation of future generation. Hence, lets come together to support our mothers and become the true “well-wishing” Aunties and Uncles for our younger ones.
REMOTELY SUPERVISED EXERCISE CLASSES ARE BEST OPTION DURING COVID
The findings of a new study suggest that remotely supervised workout sessions are more effective than face-to-face exercise classes during the COVID-19 pandemic. The findings of the study appeared in the journal ‘Psychiatry Research’. Researchers at the University of Sao Paulo (USP) in Brazil investigated the effects of regular exercise on the physical and mental health of 344 volunteers during the pandemic.
The study compared the effectiveness of three techniques: sessions led in person by a fitness instructor, sessions featuring an online instructor but no supervision, and sessions supervised remotely by an instructor via video call. The two kinds of sessions with professional supervision had the strongest effects on physical and mental health. According to the researchers, this was due to the possibility of increasing the intensity of the exercises over time.
To their surprise, remotely supervised sessions were more effective than face-to-face sessions. Sedentary subjects served as controls. “The findings underscore the benefits of either approach, with the instructor online or physically present, compared with being sedentary. However, the physical and mental benefits have much to do with a secure and progressive increase in the intensity of the exercises, which occurred only when they were supervised by a professional. What’s interesting is that remote supervision by video call was more efficient. The difference was small but statistically significant,” Carla da Silva Batista, last author of the study, told Agencia FAPESP.
Batista is a researcher at the University of Sao Paulo’s School of Physical Education and Sports (EEFE-USP). The study was supported by FAPESP. Volunteers were selected from different age and income groups and came from different parts of Brazil. Some had symptoms of depression. The remotely supervised participants, who worked out using Pilates, Crossfit, yoga, dance and aerobics, exercised more intensely than those who lacked supervision.
“Increasing intensity in supervised online sessions was of paramount importance during the pandemic,” Batista said. “Around half the participants, or 55 per cent, performed high-intensity exercises before the pandemic, but the proportion fell to 30 per cent once lockdown began.” Other research shows intense exercise increases longevity, reduces the risk of developing Parkinson’s disease, and is associated with a reduced risk of 26 types of cancer.
“We don’t know exactly why working out with remote supervision by video call gets better results than when the instructor is physically present,” Batista said. “It’s probably that the participants felt the discomfort of wearing a mask hindered their performance during the pandemic.”
Other reasons could include the possibility that remotely supervised participants were more motivated. “They were doing exercises in safety and at home, but with supervision and without having to wear a mask. They didn’t have to worry about spreading the virus, so the instructor may have felt free to increase the intensity of the exercises safely, without risking injury or discomfort,” Batista said.To evaluate the participants’ physical and mental health, in July-August 2020 the researchers applied validated online questionnaires known as the International Physical Activity Questionnaire – Short Form (IPAQ-SF) and the Montgomery-Asberg Depression Rating Scale – Self-Rated (MADRS-S).
Chemotherapy can induce mutations that lead to pediatric leukemia relapse
A new study has found that a group of chemotherapy drugs can result in mutations that may trigger the relapse of blood cancer in children.Chemotherapy has helped make acute lymphoblastic leukemia (ALL) one of the most survivable childhood cancers. Now, researchers working in the US, Germany and China have shown how chemotherapy drugs called thiopurines can lead to mutations that set patients up for relapse. The findings of the study were published in the journal ‘Nature Cancer’.
The research provided the first direct genomic and experimental evidence in pediatric cancer that drug-resistant mutations can be induced by chemotherapy and are not always present at diagnosis. “The findings offer a paradigm shift in understanding how drug resistance develops,” said Jinghui Zhang, PhD, Department of Computational Biology chair at St. Jude Children’s Research Hospital.
“The results also suggest possible treatment strategies for ALL patients who relapse, including screening to identify those who should avoid additional thiopurine treatment,” added Zhang. Zhang is co-corresponding author of the study with Bin-Bing Zhou, Ph.D., of Shanghai Children’s Medical Center; and Renate Kirschner-Schwabe, M.D., of Charite-Universitaetsmedizin Berlin.
THE ROOTS OF RELAPSE
While 94 per cent of St. Jude patients with ALL become five-year survivors, relapse remains the leading cause of death worldwide for children and adolescents with ALL. This study involved ALL samples collected from relapsed pediatric ALL patients in the US, China and Germany. Researchers analysed more than 1,000 samples collected from the patients at different times in treatment, including samples from 181 patients collected at diagnosis, remission and relapse.Co-first author Samuel Brady, PhD, of St. Jude Computational Biology, identified a mutational signature that helped decipher the process. Mutational signatures reflect the history of genetic changes in cells.
Brady and his colleagues linked increased thiopurine-induced mutations to genes such as MSH2 that become mutated in leukemia. The mutations inactivated a DNA repair process called mismatch repair and rendered ALL resistant to thiopurines. The combination fueled a 10-fold increase in ALL mutations, including an alteration in the tumour suppressor gene TP53. The mutation, TP53 R248Q, promoted resistance to multiple chemotherapy drugs, including vincristine, daunorubicin and cytarabine.
STUDY SUGGESTS EXCESS COFFEE CONSUMPTION COULD INCREASE RISK OF DEMENTIA
It’s a favourite first-order for the day, but while a quick coffee may perk us up, new research from University of South Australia showed that too much could be dragging us down, especially when it comes to brain health.In the largest study of its kind, researchers have found that high coffee consumption is associated with smaller total brain volumes and an increased risk of dementia. The findings were published in the journal ‘Nutritional Neuroscience’.
Conducted at UniSA’s Australian Centre for Precision Health at SAHMRI and a team of researchers, the study assessed the effects of coffee on the brain among 17,702 UK Biobank participants, finding that those who drank more than six cups of coffee a day had a 53 per cent increased risk of dementia. Lead researcher and UniSA PhD candidate, Kitty Pham, said the research delivers important insights for public health. “Coffee is among the most popular drinks in the world. Yet with global consumption being more than nine billion kilograms a year, it’s critical that we understand any potential health implications,” Pham said.
“This is the most extensive investigation into the connections between coffee, brain volume measurements, the risks of dementia, and the risks of stroke – it’s also the largest study to consider volumetric brain imaging data and a wide range of confounding factors,” Pham added.
“Accounting for all possible permutations, we consistently found that higher coffee consumption was significantly associated with reduced brain volume – essentially, drinking more than six cups of coffee a day may be putting you at risk of brain diseases such as dementia and stroke,” Pham further said.Dementia is a degenerative brain condition that affects memory, thinking, behaviour and the ability to perform everyday tasks. About 50 million people are diagnosed with the syndrome worldwide. In Australia, dementia is the second leading cause of death, with an estimated 250 people diagnosed each day.
Stroke is a condition where the blood supply to the brain is disrupted, resulting in oxygen starvation, brain damage and loss of function. Globally, one in four adults over the age of 25 will have a stroke in their lifetime. Data suggests that 13.7 million people will have a stroke this year with 5.5 million dying as a result.Senior investigator and Director of UniSA’s Australian Centre for Precision Health, Professor Elina Hypponen, said while the news may be a bitter brew for coffee lovers, it’s all about finding a balance between what you drink and what’s good for your health.
“This research provides vital insights about heavy coffee consumption and brain health, but as with many things in life, moderation is the key,” Professor Hypponen said. “Together with other genetic evidence and a randomised controlled trial, these data strongly suggest that high coffee consumption can adversely affect brain health. While the exact mechanisms are not known, one simple thing we can do is to keep hydrated and remember to drink a bit of water alongside that cup of coffee,” Professor Hypponen added.
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