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Medically Speaking


Neeraj Nischal



Covid-19. The name strikes a special chord with each one of us. It has been a scientific enigma, a medical crisis, an economic meltdown, and now, a way of life. I now see the past year as a series of stages (not unlike the stages of grief). This is my story of Covid-19, having treated and been treated.

Phase one: Apprehension. Though this pandemic has been one to remember, this is not our first. We’ve tackled many, from the plague in the 1350s to SARS in 2003. One would hope that we would be better prepared this time, however, it wasn’t the case. It is our tendency to be fearful of the new, the unknown, and Covid-19 was no exception.

After the WHO declared the pandemic on 11 March 2020, governments across the globe enforced complete lockdowns. Scientists and epidemiologists got to work on the different aspects of the disease, from the pathophysiology and epidemiology, to treatments and vaccines. Families in lockdown did their bit by watching the movie Contagion on Netflix. The healthcare workers, however, braced for the worst; A disaster of magnitudes we had not seen, nor trained for.

The pandemic was a wrench in the perfect clockwork of our practice. However, this was an exciting time. A time to make a real difference. A time to finally be proud of this profession that has become dangerously aristocratic in its development.

Phase two: Preparation and action. The work began, the trenches were dug, and the soldiers were enlisted. Make-shift hospitals were built from scratch. Systems for patient testing, contact tracing, and the Covid-19 isolation pathway were defined. Healthcare workers irrespective of their current medical background were recruited and trained. We trained in infection control practices, usage of personal protective equipment, and disease management. The art and science of medicine was now replaced with military precision. Egos and hierarchy aside, everyone pitched in at their capacity. It now made sense, similar to the camaraderie of soldiers.

We as healthcare providers, grew alongside with this disease. We learned to identify the different patterns of the disease and how to manage it. Literature on the disease expanded manifold each day. Our ‘eminence-based’ use of seemingly random medication were replaced by scientifically sound, evidence-based medicine. The system was getting better every day. Not only did we have to manage Covid-19 patients, but also other patients with chronic illnesses. Soon, we were able to expand our practice to the digital platform.

Words are powerful. While information helped tailor our practice, mis-information was rampantly spreading through the social media. The unknown that was feared, was now slowly being stigmatised. Stigma has changed the face of diseases like HIV/AIDS in the past. Stigma segregates, penalises and prevents responsible dialogue. It had to be nipped in the bud. The only way to do so was through public education and awareness. We engaged with the public through the radio, news, and social media. Campaigns were launched to bust myths and tackle misinformation. We tried to educate the public on the prevention and transmission of the disease, and the appropriate ways to show support for the affected. On some level, we were definitely successful.

Phase three: Fatigue. Well, Phase two definitely looked good, right? But how long can someone sustain this? (Hats off to the military, I must say). The pandemic took its toll too, chipping off our capacity—mentally, and physically. I think it was expected. With bruised noses, working in a highly contaminated area, with a constant worry about exposing loved ones at home—I cannot think of anyone who would adapt well to this. By the end of the year, we were burned out.

Phase four: Realisation. It was only when I had to fight my own battle with Covid-19 at home that I realised some things are easier said than done. My whole family tested positive, which made it just a little easier to monitor each other. We washed our hands off the virus, and our minds off the anxiety. We kept each other in good spirits while taking the necessary medication and a healthy diet, all in complete isolation. I can only imagine the plight of people who have to isolate themselves alone for the entire duration.

I have seen both sides of the coin. I have been a Covid-19 warrior and a patient. I discovered that a positive frame of mind is as essential as the medication and a healthy diet for speedy recovery. The anxiety cannot be avoided, but a positive attitude goes a long way.

The writer is Associate Professor of Medicine, AIIMS.

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Medically Speaking

Bowel cancer patients at higher risk of clinical depression



According to a new study, the prevalence of depression in bowel cancer patients is up to five years after surgery to treat their cancer.

The findings have been published in the ‘Colorectal Disease Journal’. A research team, led by the University of Southampton and funded by Macmillan Cancer Support, surveyed 872 adult patients with non-metastatic colorectal cancer before surgery and conducted follow-up surveys at regular intervals until 60 months post-surgery.

Lead author Dr Lynn Calman, Associate Professor in Nursing at the University of Southampton, said, “Depression in people living with colorectal cancer is an important clinical problem. Our study shows that the level of depression exceeds that of the general population over time. The research has also helped us to identify important time points where certain patients are at a high risk of depression which can inform strategies for recognition and referral for appropriate support.”

The results of the survey showed that before surgery over a fifth of participants (21 percent) reported clinically significant levels of depression, which reduced to 14 percent at 5 years. Risk factors identified before surgery that predicted subsequent depression were pre-existing clinically significant depression and anxiety, previous mental health service use, low confidence to manage illness-related problems, poor health, and low social support.

Further analysis of the findings suggested that people with bowel cancer who had reduced levels of social support are nearly 2.5 times more likely to also have depression. Among participants with the highest levels of social support at diagnosis, 16 percent developed clinical levels of depression within five years of their cancer treatment, compared with 37 percent of those with lower levels of social support.

While the above results are based on people’s experiences pre-Covid, evidence suggested the social isolation linked to the pandemic could be further worsening the mental health of people with cancer. The research team are currently carrying out another study into the impact of Covid-19, also funded by Macmillan Cancer Support; interim results from this have found that four in five (81 percent) cancer patients surveyed remained at home at all times in the pandemic, and nearly half (45 percent) of these have experienced at least two serious psychological impacts from the pandemic, such as feeling afraid, depressed or helpless.

Dany Bell, Strategic Advisor for Treatment, Medicines and Genomics at Macmillan Cancer Support said, “We know that for many people, being diagnosed with cancer and going through treatment is one of the scariest things they have ever faced, and this can often have a serious impact on people’s mental health.”

“Cancer affects people differently and at Macmillan, we’re here to ensure everyone living with cancer gets the support that’s right for them. We’re urging anyone in need of help – or simply someone to talk to – to get in touch with the trained nurses and advisors on our Support Line who are available at the end of the phone, seven days a week,” Bell added.

The new findings also showed that people with bowel cancer who had undergone neoadjuvant chemotherapy were also more likely to experience depression, perhaps explained by the fact these patients usually face more complex treatment, side effects and increased treatment time.

Dr Calman continued, “in this study, we investigated risk factors of depression at two key time points: close to diagnosis before surgery and two years after surgery, when routine oncological check-ups end.”

“Depression in people living with cancer can lead to poor health and wellbeing and this has an impact on long-term outcomes. Recognising those colorectal cancer patients who are at a higher risk and referring them to the right support services could therefore lead to overall improved outcomes for patients,” Calman concluded.

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Medically Speaking


Dr Gunita Singh



Diabetes is the most common lifestyle disease in today’s world both in India and abroad in children and adults in men and women.

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy. The most common types of diabetes are type 1, type 2, and gestational diabetes.

Too much glucose, also called sugar, in your blood from diabetes can cause pain, infection, and other problems in your mouth. Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow.

These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.

Gum disease can be more severe and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control.


Tooth decay (cavities): Your mouth naturally contains many types of bacteria. When starches and sugars in foods and beverages interact with these bacteria, a sticky film known as plaque forms on your teeth. The acids in plaque attack the surfaces of your teeth (enamel and dentin). This can lead to cavities and gum disease. The higher your blood sugar level, the greater the supply of sugars and starches — and the more acid wears away at your teeth.

Early gum disease (gingivitis): Diabetes reduces your ability to fight bacteria. If you don’t remove plaque with regular brushing and flossing, it’ll harden under your gum line into a substance called tartar (dental calculus). The longer plaque and tartar remain on your teeth, the more they irritate the part of your gums around the base of your teeth, called the gingiva. In time, your gums become swollen and bleed easily. This is known as gingivitis.

Advanced gum disease (periodontitis): Left untreated, gingivitis can lead to a more serious infection called periodontitis, which destroys the soft tissue and bone that support your teeth. Eventually, periodontitis causes your gums and jawbone to pull away from your teeth, which in turn causes your teeth to loosen and possibly fall out. Periodontitis tends to be more severe among people who have diabetes because diabetes lowers the ability to resist infection and slows healing.

Thrush: People with diabetes may be more likely to develop thrush, which is a fungal infection caused by the yeast Candida albicans. Signs of thrush include painful white or red patches inside your mouth. Practicing good oral hygiene can help you avoid thrush.

Dry mouth (xerostomia): Some people with diabetes also experience a lack of saliva, a condition known as dry mouth. Without saliva to keep your mouth moist and bathe your teeth, you could be at risk of tooth decay, gum disease, and thrush.

It is important to take proper dental care to help prevent damage to your teeth and gums, and its very important to take diabetes and dental care seriously and there are some ways by following which you can take care of yourselves.

Make a commitment to manage your diabetes. Monitor your blood sugar level, and follow your doctor’s instructions for keeping your blood sugar level within your target range. The better you control your blood sugars, the less likely you are to develop gingivitis and other dental problems.

Brush your teeth at least twice a day. Brush in the morning, at night, and, ideally, after meals and snacks. Use a soft-bristled toothbrush and toothpaste that contains fluoride. Avoid vigorous or harsh scrubbing, which can irritate your gums.

Schedule regular dental visits. Visit your dentist at least twice a year for professional cleanings, X-rays, and checkups. Look for early signs of gum disease. Report any signs of gum disease — including redness, swelling, and bleeding gums — to your dentist. Also mention any other signs and symptoms, such as dry mouth, loose teeth, or mouth pain.

Smoking increases the risk of serious diabetes complications, including gum disease and ultimately, loss of your teeth. If you smoke, ask your doctor about options to help you quit.

The author is practising Cosmetic and Laser dental surgeon for 20 years. BDS MD Dental Lasers, Director Dentem & Associate Consultant Sir Ganga Ram Hospital.

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Medically Speaking


The global reach and spillover of the virus has given researchers a unique opportunity to investigate the viral evolution of SARS-CoV-2.



The findings of a new study suggest that when animals catch Covid-19 from humans, new SARS-CoV-2 variants can arise.

To evaluate this phenomenon, an interdisciplinary team at the College of Veterinary Medicine and Biomedical Sciences systematically analysed mutation types occurring in the virus after infection of cats, dogs, ferrets, and hamsters. The study was recently published in ‘PNAS’, the official journal of the National Academy of Sciences. Confirmed Covid-19 cases in a variety of wild, zoo, and household animals demonstrate cross-species transmission, which is a rare occurrence for most viruses.

“SARS-CoV-2, in the realm of coronaviruses, has a very broad species range,” said Laura Bashor, one of the first authors and a doctoral student in the Department of Microbiology, Immunology and Pathology. “Generally speaking, many types of viruses can’t infect other species of animals, they evolved to be very specific.”

“Humans have so much exposure to many different animals which permitted this virus to have the opportunity to expose a variety of different species,” said Erick Gagne, a first author and now an assistant professor of wildlife disease ecology at the University of Pennsylvania.

The global reach and spillover of the virus have given researchers a unique opportunity to investigate the viral evolution of SARS-CoV-2, including in University Distinguished Professor Sue VandeWoude’s laboratory at Colorado State University.

These specialists in disease transmission in wild and domestic cats applied their experience in sequence analysis and studying a collection of genomes to SARS-CoV-2. Researchers in the VandeWoude lab worked with Assistant Professor Angela Bosco-Lauth and Professor Dick Bowen in the Department of Biomedical Sciences, who used their animal modelling expertise to develop a test for SARS-CoV-2 susceptibility of animal species.

Also, the key to the findings was a newer sequencing technique of the virus at different stages of the study, now common to detect variants in the human population. Mark Stenglein, associate professor in the Department of Microbiology, Immunology, and Pathology, provided computational skills in analysing biological molecule sequences, known as bioinformatics, to the study.

“We found there was evolution, we saw the selection on the virus, and we saw a lot of variants emerge in the genome sequence of the virus,” said Bashor.

To provide ample viral material for the study, Bosco-Lauth and Bowen cultivated a SARS-CoV-2 human sample in cells grown in the lab. Bashor and Gagne determined that multiple mutations developed, and became a greater percentage of the genetic population, at each step of this process.

Then the virus was introduced to the four household species, and samples of the virus were collected from their nasal passages after infection. “In the animals, the cell culture variants reverted back to the initial human type, which indicates that likely there is adaption occurring in that cell culture and environment that was selected for those variants,” said Gagne.

Not all these mutations within the cell culture SARS-CoV-2 variant transferred in the new hosts. Instead, different mutations emerged within the virus shed by the live animals. The initial viral sample in the study was isolated in early 2020. The team observed mutations that have since formed widespread SARS-CoV-2 strains in the human population at an accelerated rate throughout the study.

“Among those were a number that we’ve since seen in humans in the alpha, beta, delta variants,” said Dr Sue VandeWoude, senior author. “There were specific genetic code changes that mimicked what other scientists have reported in people.”

Contact exposure between two cats demonstrated the SARS-CoV-2 variant can be transmitted with the possibility of producing a new strain within the species. “That’s what we’re seeing in people too,” said Bosco-Lauth. “Hosts that are really well adapted to support SARS-CoV-2 infection are also very good at allowing these mutations to stick and to be passed on.”

Bashor did not anticipate studying SARS-CoV-2 when she came to CSU to begin her doctoral studies during the pandemic. However, it provided a unique opportunity to hit the ground running as a graduate student on a “really cool and viable project” in disease ecology and evolution.

Gagne was completing his postdoctoral research on the cross-species transmission of feline retroviruses in the VandeWoude lab when the team launched the SARS-CoV-2 study. Now an assistant professor, he has continued to investigate SARS-CoV-2 spillover with the Wildlife Futures Program at the University of Pennsylvania.

Graduate students and early-career scientists like Bashor and Gagne, have made meaningful contributions to SARS-CoV-2 research, said Vande Woude. The team has continued their investigations to focus on cats, as they have shown higher susceptibility for Covid-19 spillover from humans and can produce variants of the virus and spread to other cats.

Bashor began analysing SARS-CoV-2 genome sequences from a large pool of cat species all over the world, including tigers, lions and snow leopards. The publicly available data of infected cats could provide additional insights on the adaptability and mutability of Covid-19 within and among cat species. There is no evidence of transmission from cats to humans. But cats continue to be susceptible to all variants of Covid-19 in the human population. By understanding viral evolution within cats, the research team may find answers to the question: what is the future of SARS-CoV-2 for humans and animals.

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Medically Speaking

Study finds cardiovascular disease, high cholesterol linked to plastics



A new study has found that phthalate—a chemical used to make plastics more durable—has led to increased plasma cholesterol levels.

The findings of the study were published in the journal ‘Environmental Health Perspectives’. “We found dicyclohexyl phthalate, or DCHP, strongly binds to a receptor called pregnane X receptor, or PXR,” said Changcheng Zhou, who is a professor in the UCR School of Medicine.

“DCHP ‘turns on’ PXR in the gut, inducing the expression of key proteins required for cholesterol absorption and transport. Our experiments show that DCHP elicits high cholesterol by targeting intestinal PXR signalling,” added Zhou.

DCHP, a widely used phthalate plasticiser, has recently been proposed by the Environmental Protection Agency as a high-priority substance for risk evaluation. Not much is known yet about DCHP’s adverse effects on humans.

“To our knowledge, our study is the first to show the effects of DCHP exposure on high cholesterol and cardiovascular disease risk in mouse models. Our results provide insights and new understandings of the impact of plastic-associated chemicals on high cholesterol—or dyslipidemia—and cardiovascular disease risk,” Zhou said.

Zhou’s team also found that mice exposed to DCHP had in their intestines higher circulating “ceramides”—a class of waxy lipid molecules associated with increased cardiovascular disease risk in humans—in a way that was PXR-dependent.

“This, too, points to the potentially important role of PXR in contributing to the harmful effects of plastic-associated chemicals on cardiovascular health in humans,” Zhou said.

Zhou was joined in the research by Zhaojie Meng, Jinwei Liu, Rebecca Hernandez, and Miko Gonzales of UCR; and Yipeng Sui, Taesik Gwag, and Andrew J. Morris of the University of Kentucky.

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Medically Speaking




Listening to the spoken word in noisy environments is challenging for everyone. Acoustic studies show people with mild dementia struggle to understand speech in both noisy and quiet environments, highlighting the need for everyone to communicate clearly.

During the 181st Meeting of the Acoustical Society of America, Kate McClannahan, from Washington University School of Medicine, discussed how background noise impacts have spoken word recognition in people with mild dementia. The talk, “The effect of mild dementia on speech perception in quiet and noise,” took place on Wednesday, December 1, at the Hyatt Regency Seattle.

Difficulty in understanding speech, especially in background noise, is a common concern for older adults. Using a word identification task in quiet and noisy conditions, researchers examined the impact of mild dementia on speech perception. They tested individuals with and without mild dementia.

The scientists found word identification scores of those without dementia were significantly better in all conditions, meaning people with mild dementia symptoms recalled fewer words in both quiet and noisy situations.

In the quiet condition, the group with mild dementia missed around 20 per cent of the words, while the control group missed approximately 5 per cent. The findings indicate individuals with mild dementia struggle with understanding speech, even without background noise.

“What is important to take away from this study is that people who are experiencing mild dementia symptoms may have difficulty understanding speech in both quiet and acoustically challenging situations,” said McClannahan.

McClannahan added, “Therefore, when conversing with someone who may be experiencing cognitive difficulties, considerations such as speaking more clearly and slowly, reducing background noise and distractions, making sure the listener can see the speaker’s face and providing ample contextual information, may help to improve the listener’s speech understanding.”

“If you or a loved one notice difficulty with your communication, seeking the advice and care of an audiologist is a great place to start!” McClannahan said taking these measures will aid effective communication for all listeners.

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Medically Speaking

Study provides model for treating HIV/AIDS, depression



For people with HIV who are also struggling with depression, remaining healthy is often an insurmountable challenge, especially in South Africa, home to the highest number of cases in the world and a significant shortage of mental health professionals.

However, a new study has provided local and global implications for successfully treating both mental health and HIV/AIDS in settings like South Africa—or even Miami, the epicentre of new cases in the United States. The findings of the study were published in the ‘Journal of the International AIDS Society’.

In the study, an international team of researchers—led by the University of Miami’s Steven Safren and two colleagues—demonstrated the effectiveness of training nurses in public HIV clinics to deliver a specially adapted cognitive behaviour therapy (CBT) to help people with depression and uncontrolled HIV adhere to their prescribed medication regiment. CBT is a proven approach for changing faulty or unhelpful thinking or behavioural patterns.

“We know that treating HIV-positive people who are clinically depressed with antidepressants alone does not affect their viral loads. Their depression may improve, but their adherence does not,” said Safren, professor of psychology and director of the University’s Center for HIV/AIDS Research and Mental Health.

“So, given the global shortage of mental health professionals, we showed it is possible to train nurses to deliver cognitive-behavioural therapy for adherence and depression (CBT-AD), an intervention that successfully addresses both clinical depression and uncontrolled HIV,” added Safren.

Safren, who joined the University in 2015 from Harvard Medical School, conducted the study in a poor township just outside of Cape Town, South Africa, with fellow researchers John A Joska, director of the HIV Mental Health Research Unit and professor of psychiatry at the University of Cape Town, and Conall O’Cleirigh, associate professor of psychology at Harvard and director of Behavioral Medicine at Massachusetts General Hospital.

For their study, the researchers recruited 161 patients with uncontrolled HIV/AIDS and clinical depression from four public health clinics in the township of Khayelitsha. Although a medical officer could prescribe antidepressants to the patients, the clinics have limited psychological services—as does the country in general. According to the study, South Africa only has 0.28 psychiatrists and 0.32 psychologists per 100,000 people.

At the onset of the study, all participants received the usual enhanced care for clinically depressed HIV-AIDS patients who did not achieve viral suppression after receiving the first month of their antiretroviral medication. That customary treatment included another prescription and follow-up meetings with an adherence counsellor.

But half the patients were also randomly assigned to attend eight CBT-AD sessions, where specially trained nurses integrated strategies for treating depression with adherence counselling that included modules on life skills, depression, relaxation, mood monitoring, and problem-solving.

The idea, Safren said, was to help patients “turn down the volume” of their mental health symptoms, so they would be more open to counselling on the benefit of taking their medication. To track their adherence, the patients also received an electronic pillbox that, every time it was opened, transmitted a real-time signal to a web server.

And, researchers found, the task-shared approach delivered by nurses proved effective. Patients who completed the CBT-AD sessions were more than 2.5 times more likely to achieve undetectable viral loads than those who underwent the usual care.

Now, Safren noted, the next step will be for the research team to evaluate how to sustainably implement the CBT-AD approach in South Africa or even South Florida. He said the task-shared approach could be viable in Miami, where there are fewer services to help people achieve viral suppression than in other US cities with large populations of people living with the virus.

“South Africa has the most cases of HIV/AIDS in the world and Miami is the city with the highest incidence of new cases in the US—so there is a parallel,” Safren pointed out.

“And unlike places like New York or Massachusetts, where people are more likely to be virally suppressed, Florida doesn’t have the same public health resources. If, for example, you’re an HIV patient at Massachusetts General or Fenway Health, where I used to work, and you miss your visit, or your viral load becomes uncontrolled, social workers will swoop in and provide assistance. That doesn’t happen as often in Florida and other places in the US with less public health HIV/AIDS funding,” Safren added.

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