Medically Speaking Team

Union Health Minister Mansukh Mandaviya on Friday said that India sent medicines to 150 countries during covid crisis without increasing the price and compromising on the quality of the medicines.

Minister was speaking at the inauguration of the International Symposium on Health Technology Assessment in Delhi on Friday. “During the Covid crisis, India sent medicines to 150 countries without increasing price and compromising on the quality,” Union Health Minister said.

India offered support to more than 150 affected countries in the form of vaccines, medical equipment and medicines during the pandemic, Deputy Chairman of Rajya Sabha Harivansh said in a Keynote address at the 26th Conference of Speakers and Presiding Officers of the Commonwealth (CSPOC) in Canberra, Australia in January.

The Deputy Chairman had said that India facilitated the evacuation of stranded foreign nationals from different parts of India to around 123 countries.

Mandaviya said that India fulfils 65% of the world’s vaccine requirement.
“Today, if there is any country in the world which is providing affordable medicines, then it’s India,” he informed.
Harivansh further added that India took an exclusive initiative “Vaccine Maitri” to supply COVID-19 Made-in-India vaccines to various countries across the world.

Under this initiative, as of the first week of December 2022, India has supplied more than 282 million vaccine doses of COVID-19 to 101 countries and two UN entities.

“Since the outbreak of the COVID pandemic in India, we followed a ‘whole of Government’ and ‘whole of society approach’. We took several measures for containing the spread of the virus, addressing major gaps in the availability of life-saving healthcare facilities, shoring up livelihoods and restoring normalcy in the areas such as education and employment,” he had added.

On the steps taken by the Indian government during the COVID-19 pandemic, he had said, “As regards enacting relevant legislations, the Epidemic Diseases Act, 1897 was amended by Parliament to provide for adequate safety and protection of healthcare personnel handling patients and the epidemic. The Essential Commodities Act, of 1955 was amended to ensure that there are no shortages of foodgrains and also to keep the commodity prices under check during a pandemic. These changes helped to ensure food security to vulnerable sections of the country through the Public Distribution System.”

According to a study published in The BMJ, the general population’s mental health has not changed significantly throughout the covid-19 pandemic compared to pre-pandemic levels.

According to the researchers, some specific groups, particularly women, appear to have been more negatively affected, but the changes have been limited to minor. Numerous studies and media accounts claim that covid-19 has caused widespread mental health declines, although variations in study quality and misreading of cross-sectional data may have contributed to misleading results.

To address this, researchers compared general mental health, anxiety, and depression symptoms in populations during the covid-19 pandemic (from 1 January 2020 or later) to pre-covid evaluations (1 January 2018 to 31 December 2019).

Studies had to report data from groups comprising at least 90% of the same participants between pre-pandemic and pandemic periods or to use statistical methods to account for missing data. Most of the eligible studies were from high or upper middle income countries and were thoroughly assessed for bias before being included in the analysis.

Differences between groups were expressed as standardised mean differences (SMD). Generally, an SMD of less than 0.2 indicates a minimal effect, 0.2-0.5 a small effect, 0.5-0.8 a moderate effect, and 0.8 or more a large effect.

Among general population studies, no changes were found for general mental health or anxiety symptoms, but depression symptoms worsened minimally (SMD change 0.12).

Among specific groups, women or female participants were the only group that experienced a worsening of symptoms across all outcomes; all by small amounts (SMD changes 0.20 to 0.22). This is consistent with evidence that women and female members of society have experienced a disproportionately greater burden from the pandemic, note the researchers.

Depression symptoms worsened by minimal to small amounts for older adults, university students, and people who self-identified as belonging to a sexual or gender minority group, but not for other groups.

General mental health and anxiety symptoms were shown to worsen for parents, although the researchers stress that these results were based on small numbers of studies and participants.

In contrast, general mental health and depression symptoms were shown to improve for people with pre-existing mental health conditions. But, again, the researchers stress that these results were based on only two studies and improvement was negligible (SMD change 0.05).

No other subgroup experienced significant changes across all outcomes, including young people.
This was a well designed review based on a thorough literature search, but the researchers acknowledge that differences in study design, a high risk of bias in many studies, and a lack of evidence from lower income countries and children may have had an influence, and they suggest caution is needed in interpreting their results.

“Across population groups, results suggest that, rather than a mental health crisis, at a population level there has been a high level of resilience during covid-19, and changes in general mental health, anxiety symptoms, and depression symptoms have been minimal to small with no changes detected in most analyses,” they write.

Nevertheless, they say the pandemic has affected the lives of many people, and urge governments to “continue to ensure that mental health supports are available and respond to population needs.”

While this study clearly shows that we need not be overly concerned about the general population’s mental health in relation to the covid-19 pandemic, reported prevalence rates of mental health symptoms, especially among adolescents, are still concerningly high, say researchers from Denmark in a linked editorial.

This review does not tell us why any deteriorations occurred, or whether these deteriorations might have occurred even without the pandemic, signifying an underlying, but not covid-19 related, pan-societal problem, they write. Further research is required to help answer these important questions.

“Pandemic or not, there is a strong need to provide preventive mental health interventions for those most at risk of poor mental health outcomes,” they conclude.

Dr. Bharati Pravin Pawar, Minister of State for Health and Family Welfare, stated on Monday that the need of the hour is to shift gears and adopt a focused approach to imparting the best pharmacy education while keeping our curriculum in line with the latest developments in the field, as well as providing extensive education of specialised drugs to benefit the reach of pharmacists in the country.

On the occasion of National Pharmacy Education Day, Dr. Bharati Pravin Pawar launched Pharma Anveshan-2023. The day commemorates Prof. ML Shroff’s birth anniversary as the father of Pharmacy Education in India.

The event was organised with the goal of providing a platform for sharing academic research with industry and exchanging the benefits of research outcomes. This can aid in the exploration of commercial applications based on the interlinking of academia and industry.

Bharati Pravin Pawar congratulated the Pharmacy Council of India (PCI) on organising “Pharma Anveshan 2023” to promote research and innovation and to strengthen industry-academia collaboration.

She discussed the contributions of “Prof ML Schroff” in this field, stating “A pharmacist is just as important as doctors and nurses in helping patients get treated for diseases and other health concerns. Pharmacists know the science of medicine in and out. They ensure that the patients get the right dose of life-saving prescriptions. By educating a patient and making sure their prescription is safe to take with their other health conditions and medications, pharmacists improve their quality of life and possibly even save a life. During the COVID pandemic, Pharmacists played a vital role in maintaining the supply chain of essential medicines.”

Reiterating Prime Minister Narendra Modi’s words – “innovation should not only be the goal of our science, but innovation should also drive the scientific process forward”, she urged everyone to work on need-based medicine manufacturing and emphasized the crucial role of Pharmacists in the battle against AMR (Antimicrobial Resistance).

She also suggested PCI and pharmacy institutes create awareness about drugs and their usage, the importance of hygiene, community disease prevention, survey and data collection.

Dr Pawar further highlighted that under the visionary leadership of PM Modi, the Government of India has successfully laid the foundation to tackle the challenges related to the health system of the country. The government of India has prioritized developing its human resources towards developing a resilient, efficient and adaptive healthcare system.

Accentuating the future healthcare landscape need, Dr Pawar accentuated the pivotal role of pharmacists in the future of healthcare, evolving beyond dispensing medicines and becoming an essential part of your healthcare team.
She said, “Patient counselling and maintaining patient medical history can also be our focus area for better utilization of medicines and reducing adverse events. Doing so will help reduce the cost of treatment.”

The MoS emphasized that it is necessary for PCI not only to keep pace with global changes but also to lead research in this area so that the Indian pharmacy sector leads the world in innovation.

She also launched a ‘One Stop-Non Stop’ digital job portal of the Pharmacy Council of India, which will be useful for pharma professionals as well as recruiters from the industry. This will prove to be a game changer for the students coming from small towns and villages.

At the event, PCI also signed a Memorandum of Understanding with the Karnataka Drugs and Pharmaceuticals Manufacturer’s Association (KDPMA), Life Sciences Sector Skill Development Council, Ministry of Skill Development and Entrepreneurship (LSSSDC), Indian Pharma Alliance (IPA) and Federation of Pharma Entrepreneurs (FOPE) to reduce the gap of industry and academia, strengthen faculty and student training and promote entrepreneurship and infrastructure development.

Noting an increase in cases of the H3N2 virus, which has become a source of concern, Dr. Randeep Guleria, Chairman of the Institute of Internal Medicine, Respiratory and Sleep Medicine, and Director of Medical Education, stated that this virus mutates every year during this time and spreads through droplets.

“So, currently we are seeing an increase in the number of cases of influenza, which is basically presenting fever, sore throat cough, body aches and runny nose history and is a type of influenza virus, which we see every year during this time of the year. But it is a virus with changes over time, it mutates over time and what we call an antigenic drift,” said Randeep Guleria. “We had a pandemic many years ago of H1N1. That circulating strain of that virus is now H3N2 and therefore it is a normal influenza strain. But we are seeing more cases because as the virus mutates a little bit, the immunity that we had against the virus becomes a little less and therefore people who are susceptible tend to get infection more easily,” Dr Guleria explained.

“It spreads through droplets. However, I think there is not that much of a cause of concern because although the number of cases increased hospitalisation has not gone up to a very large extent,” he said.

Dr Guleria also said that this virus changes slightly every year, so the virus which is H3N2, comes from the family of influenza viruses and influenza viruses, based upon its various subtypes, and it mutates or it goes changes slightly every year what is known as antigenic drift.

“We also see that during this time of the year when the weather changes, there is a higher chance of getting influenza and also because of the fact that we have now come back to a non-COVID state where we are not wearing masks, we’re having a lot of crowding. This is also allowing the virus to spread more easily. And therefore if we need to really prevent yourselves from getting influenza. We need to wear a mask if we’re going to crowded places. We also need to wash our hands frequently and also have physical distancing, if we are a more susceptible population, for influenza also there is a vaccine for the high-risk group and the elderly,” he said

“So in the festive season and we are only just around the corner. I would really say that people should celebrate Holi but they should be careful especially the elderly and those who have underlying comorbid conditions like chronic respiratory diseases, heart problems, patients have kidney problems or dialysis, they need to be careful about going into a crowded place and getting exposure,” Dr Guleria said alerting the elderly and people with comorbidities.

According to WHO, Globally, nearly 2.5 billion people worldwide ─ or 1 in 4 people ─ will be living with some degree of hearing loss by 2050, warns the World Health Organization’s (WHO) first World Report on Hearing.

On the steps of Prime Minister Sh. Narendra Modi ji for “Make in India” Prof. Dr. J.M. Hans, Padmashree Awardee with experience of over 40 years in ENT, 25 years in Cochlear Implant and with over 3500 counts of Cochlear Implant Surgeries did the first indigenous Cochlear Implant of Neubio Bold in India. Making efforts to promote hearing health on this “World’s Hearing Day” on 3rd March 2023, Dr Hans has organized community outreach programs, providing free hearing screenings and education to underserved communities and helping them with the “Gift of Hearing”. He believes that everyone, regardless of their background or socioeconomic status, deserves access to quality hearing healthcare as “Hearing care for all”.

Dr. J.M. Hans has done over 3500 such procedures and as a veteran he has even been tirelessly working to promote hearing health and raise awareness about the impact of hearing loss on individuals and society as a whole.

Dr JM Hans treated more than 30 children and families who were given “Gift of Hearing” and were implanted with “Neubio Bold”, first and only made in India Cochlear Implant in which there is no electronic inside making it safe for users. Dr JM Hans took an initiative to treat poor people who have hearing loss and couldn’t afford the expensive cochlear implant surgery.

Neubio BOLD being an indigenous implant, the recurring cost for patients is reduced drastically which is a major challenge with other manufacturers. This makes the implant affordable and accessible for lot of patients who are advised for cochlear implant as a hearing solution. With Neubio BOLD patients can listen close to natural sound appreciating music and tonal languages as this implant provides electric analogue signals-said Dr. J M Hans.

Every family had heart-warming stories to share after the implant was activated. The happiest moment in a parent’s life is when they hear their child say ‘papa’ & ‘mama’. Our child has been using Neubio’s implant for about 6 months and she is developing speech very well” said Himani’s father.

Shivika’s mother pointed out that her daughter now has a newly discovered hobby, dancing to music. ‘No matter how loud the music was before the surgery, she would not respond. Her favourite thing to do now after using the implant every morning is to turn on music & joyfully dance to it’.
Nikhil’s mother said he could now identify different fruits, vegetables, animals, vehicles & much more by just listening to their associated words. He is now following her mother’s verbal commands and enjoys learning mathematics at school.

A cochlear implant can be an expensive device to maintain. Considering Neubio’s implant is made in India, a question about the cost of maintenance was asked to many families. Parents pointed out that no family had bought or spent anything extra for the device’s maintenance over the course of a year.

Dr Hans was the first surgeon to do Neubio’s Implant in India and has done over 30 surgeries with this “New Make in India Neubio Cochlear Implant ” with all the patients showing very good outcomes. His Aim in the last 25 years, has been to improve & improvise, both Technique and Technology in the field of Cochlear Implant in the world.

The Minimal Invasive Technique reduced the time taken for surgery from 3 hours to 40 mts, which becomes even more Important when Bilateral Implantation is being done on an 8 months old child. Bilateral Implantation will take 6 to 7 hours as compared to 2.5 hours in this Technique

Dr. Hans Pioneered the Minimal Invasive Technique for Cochlear Implant in India, he was also involved in making of indigenous implants which was a project with the DRDO. In 2021, Neubio started making indigenous cochlear implants in India after being approved by CDSCO. These implants were made under the technology transfer program.

According to Prime Minister Narendra Modi, over 260 new medical colleges have opened in the last few years, doubling the number of seats in graduate and postgraduate medical courses.

He made the remarks addressing a post-Budget webinar on the subject of ‘Health and Medical Research’.
This was the ninth in a series of 12 webinars hosted by the government. The webinars are being held to solicit ideas and suggestions for the effective implementation of the initiatives announced in the Union Budget 2023.

During the webinar, PM Modi emphasised the importance of nursing in this year’s budget.

“Opening 157 nursing colleges in the vicinity of the medical colleges is a huge step in the direction of medical human resources. This may be useful in fulfilling global demand, not just the domestic need,” he added.

On India’s pharma sector during the Covid-19 pandemic, he said the trust it has gained the world over was unprecedented.

“The way India’s pharma sector has gained trust the world over during the Covid-19 pandemic was unprecedented. We have to capitalize on this”, the Prime Minister said.

Notably, India not only catered to its own population with life-saving vaccines but also supplied vaccines worldwide. Under Vaccine Maitri, India supplied vaccines to 100 countries and provided drugs to around 150 countries during the pandemic.

PM Modi also put a thrust on how his government is focused on using more technology in the health sector.

“We wish to provide timely healthcare to all citizens through digital health ID system. 10 crore teleconsultations have been made through government’s eSanjeevani telemedicine service,” PM Modi said.

Further, PM Modi also said one of the main focuses of the government is that people should get testing facilities and better primary health care near their homes.
“Critical health infrastructures are being set up in small cities and townships under PM Ayushman Bharat Health Infrastructure Mission. Not only small cities are getting hospitals, ecosystem related to the health sector has also been developed,” he added.

According to a significant US study, giving patients too much oxygen during surgery increases the risk of later kidney, heart, and lung damage.

The results of the investigation were released in The BMJ. According to specialists in a related editorial, this study implies it may be time to reevaluate the liberal use of oxygen during general anaesthesia, even though the absolute risk is still modest.

Nearly all patients undergoing surgery under general anaesthesia get oxygen frequently to assist prevent hypoxia (dangerously low oxygen levels), and the World Health Organization suggests using oxygen liberally to lower the risk of infection.

During surgery, arterial blood haemoglobin oxygen saturation (SpO2) is continuously measured, enabling doctors to adjust the dose of oxygen to a target level. A normal SpO2 is 94-95 per cent. Giving oxygen in excess of that required to saturate haemoglobin – known as supraphysiological oxygen – is common.

Supraphysiological oxygen can harm the body’s cells and tissues, but the clinical relevance of these effects during surgery remains uncertain, and previous trials have not been able to detect any meaningful effects on organs.

To address this knowledge gap, a team of US researchers examined whether supraphysiological oxygen administration during surgery is associated with lower or higher postoperative kidney, heart, and lung injury.

Their findings are based on data for over 350,000 patients (average age 59; 52 per cent women; 70 per cent white) undergoing surgery with general anaesthesia and endotracheal intubation (a breathing tube placed into the windpipe) at 42 medical centres across the United States between January 2016 and November 2018.

Background information on factors such as age, sex, race, weight (BMI), and medical history was collected, and patients were screened for kidney, heart, and lung injury before and after their surgery.

The researchers then used an algorithm to calculate the amount of oxygen given above air level (21 per cent) against the time spent with oxygen saturation at or above 92 per cent throughout surgery.

Medical records were used to track cases of acute kidney, myocardial, and lung injury as well as 30 day mortality, hospital length of stay, and stroke.

The average duration of surgery was 205 minutes. Acute kidney injury was diagnosed in 6.5 per cent of patients, myocardial injury in 2.8 per cent, and lung injury in 4.4 per cent.

After accounting for baseline factors and other potentially influential variables, increased oxygen exposure during surgery was associated with a higher risk of organ injury.

For example, patients at the upper end (75th centile) of oxygen levels had 26 per cent greater odds of acute kidney injury, 12 per cent greater odds of myocardial injury, and 14 per cent greater odds of lung injury compared with patients at the lower end (25th centile).

Patients at the 75th centile of oxygen levels also had 9 per cent greater odds of stroke and 6 per cent greater odds of 30-day mortality than patients at the 25th centile.

However, patients at the 75th centile had a slightly shorter length of stay compared with patients at the 25th centile, an effect unchanged after excluding patients who died before discharge.

These are observational findings, so can’t establish cause, and the researchers acknowledge that not all patients were screened for kidney and heart injury after their surgery, nor were they able to consider factors such as diet, lifestyle, and medication use, which can influence susceptibility to organ injury.

Nevertheless, this was a large study, drawn from geographically diverse populations, ensuring precision and generalisability of the results. And findings were similar after additional analyses, providing greater confidence in their conclusions.

Based on their findings, the researchers say: “A large clinical trial to detect small but clinically significant effects on organ injury and patient-centred outcomes is needed to guide oxygen administration during surgery.”

This, and previous research, shows that oxygen can be a double-edged sword, point out experts in a linked editorial.
They suggest that future research on this topic could deal with some of the study’s acknowledged limitations and could also measure cognitive impairment because experimental evidence suggests that brain tissue is particularly vulnerable to redox imbalance.

Research collaborations between biochemists and anaesthesiologists should be encouraged, they add, “especially to identify cause-effect relationships between supraphysiological oxygen administration and organ injury.”

According to a large study published in The BMJ, most symptoms or diseases that occur after a mild Covid-19 infection last several months but return to normal within a year.

When compared to unvaccinated people, vaccinated people were at a lower risk of developing breathing difficulties, the most common side effect of mild infection. According to the researchers, while the long covid phenomenon has been feared and discussed since the beginning of the pandemic, the vast majority of mild disease cases do not suffer from serious or chronic long term illness.

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Study reveals most long covid symptoms resolve within a year after mild infection

ANI | Updated: Jan 12, 2023 23:54 IST

Washington [US], January 12 (ANI): According to a comprehensive study published in The BMJ, most symptoms or diseases that occur after mild Covid-19 infection last for several months but recover to normal within a year.

In particular, vaccinated people were at lower risk of breathing difficulties – the most common effect to develop after mild infection – compared with unvaccinated people. These findings suggest that, although the long covid phenomenon has been feared and discussed since the beginning of the pandemic, the vast majority of mild disease cases do not suffer serious or chronic long term illness, say the researchers.

Long covid is defined as symptoms persisting or new symptoms appearing more than four weeks after initial infection. In March 2022, an estimated 1.5 million people in the UK (2.4 pc of the population) reported long covid symptoms, mainly fatigue, shortness of breath, loss of smell, loss of taste, and difficulty concentrating.

But the clinical effects of long covid one year after mild infection and their association with age, sex, covid-19 variants, and vaccination status are still unclear.

To address this, researchers compared the health of uninfected individuals with those who had recovered from mild covid-19 for a year after infection.

They used electronic records of a large public healthcare organisation in Israel, in which almost 2 million members were tested for covid-19 between 1 March 2020 and 1 October 2021. Over 70 long covid conditions were analysed in a group of infected and matched uninfected members (average age 25 years; 51% female).

They compared conditions in unvaccinated people, with and without covid-19 infection, controlling for age, sex and covid-19 variants, during early (30-180 days) and late (180-360 days) time periods after infection. Conditions in vaccinated versus unvaccinated people with covid-19 were also compared over the same time periods.

To ensure only mild disease was assessed, they excluded patients admitted to hospital with more serious illness. Other potentially influential factors, such as alcohol intake, smoking status, socioeconomic level, and a range of pre-existing chronic conditions were also taken into account.

Covid-19 infection was significantly associated with increased risks of several conditions including loss of smell and taste, concentration and memory impairment, breathing difficulties, weakness, palpitations, streptococcal tonsillitis and dizziness in both early and late time periods, while hair loss, chest pain, cough, muscle aches and pains and respiratory disorders resolved in the late period.

For example, compared with non-infected people, mild covid-19 infection was associated with a 4.5-fold higher risk of smell and taste loss (an additional 20 people per 10,000) in the early period and an almost 3-fold higher risk (11 per 10,000 people) in the late period.

The overall burden of conditions after infection across the 12-month study period was highest for weakness (an additional 136 people per 10,000) and breathing difficulties (107 per 10,000).

When conditions were assessed by age, breathing difficulties were the most common, appearing in five of the six age groups but remaining persistent throughout the first year post-infection in the 19-40, 41-60, and over 60 years age groups.

Weakness appeared in four of the six age groups and remained persistent in the late phase only in the 19-40 and 41-60 age groups.

Male and female patients showed minor differences, and children had fewer outcomes than adults during the early phase of covid-19, which mostly resolved in the late period. Findings were similar across the wild-type, Alpha and Delta covid-19 variants.

Vaccinated people who became infected had a lower risk of breathing difficulties and similar risk for other conditions compared with unvaccinated infected patients.

The researchers point to some limitations, such as incomplete measurement within medical records, so data might not fully reflect diagnoses and outcomes reported. And they can’t rule out the possibility that covid-19 patients may use healthcare services more frequently, resulting in higher reporting and increased screening for potential covid-related outcomes in these patients.

Nevertheless, this was a large detailed analysis of health records across a diverse population, representing one of the longest follow-up studies in patients with mild covid-19 to date. And findings should apply to similar western populations worldwide.

“Our study suggests that mild covid-19 patients are at risk for a small number of health outcomes and most of them are resolved within a year from diagnosis,” say the researchers.

• “Importantly, the risk for lingering dyspnoea was reduced in vaccinated patients with breakthrough infection compared with unvaccinated people, while risks of all other outcomes were comparable,” they add.

Strokes are a major source of morbidity and mortality in the United States and around the world. A number of environmental and biological factors have been identified as influencing stroke risk and outcome.

A new study sponsored by Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, examined the cerebral blood flow (CBF) modulation of stroke patients. The researchers discovered that cerebral autoregulation (CA), one of the fundamental processes for maintaining adequate blood flow to the brain, had a daily rhythm in stroke patients, with more deteriorated regulation during the night and morning hours compared to the afternoon hours.

Their results, which are published in the Journal of Cerebral Blood Flow and Metabolism, are relevant for health care planning during stroke recovery.

“The care and course of actions done after a stroke are essential for optimal rehabilitation. Our study suggests that the daily rhythm of CBF regulation in stroke patients may be highly relevant to managing an individual’s activity and stroke recovery,” said senior author, Kun Hu, PhD, of the Medical Biodynamics Program in the Brigham’s Division of Sleep and Circadian Disorders.

Kun added, “Exercise and surgery post-stroke could be more optimal when scheduled during afternoon hours, as this is when dynamic CA functions more effectively. These results may improve our understanding of a vulnerable time window for the cerebrovascular system and help guide daily activity and personal care during stroke recovery, which could improve health outcomes for patients who have had a stroke.”

Stable CBF is a necessary component for normal brain function. Dramatic changes in CBF can cause increased cranial pressure and brain tissue damage. Thus, a process like CA, which helps maintain relatively stable CBF through constriction and dilation of blood vessels in the brain, particularly during changes in an individual’s blood pressure (BP), is crucial.

Currently, there is a gap in knowledge concerning the daily variance of CA in stroke patients. Generally, the daily rhythms of physiological functions can be controlled by external behaviors like food intake, sleep, and exercise, as well as the internal circadian clock. This study is among the first to examine the potential variation of CA in the stroke population.

The research team observationally studied 28 participants being treated in a hospital in Sao Paulo, Brazil after experiencing a stroke. They received thrombolysis within 5 hours of the onset of their symptoms. After undergoing this procedure, the participants’ CA was assessed over the course of 48 hours at various time points by examining the relationship between temporal changes in blood pressure and cerebral blood flow velocity of the middle cerebral artery.

Analysis of the results showed evidence of differing cerebral blood flow regulation during various times of the day, especially when cerebral blood flow and pressure fluctuated at large time scales or low frequencies < 0.05 Hz. In particular, a more degraded regulation motif was seen during the nighttime and morning hours when compared to the afternoon. This dysregulation interval coincides with the increased prevalence of recurrent and first-ever stroke events during morning times.

While these results are promising, the researchers identified future avenues to assist in creating a greater understanding of the regulation mechanism.

“Interestingly, the daily rhythm of CA was present in both stroke and non-stroke sides of the brain, suggesting the factor(s) driving the rhythm should affect CBF regulation globally,” said first author Daniel Abadjiev, of the Medical Biodynamics Program in the Brigham’s Division of Sleep and Circadian Disorders. “To better understand underlying mechanisms, future studies should consider more frequent assessments across the 24-hour cycle, an increase in patient sample size, the inclusion of non-stroke controls, and monitoring of the daily activity rhythms like sleep and exercise as well as intrinsic circadian rhythm among the participants.”

“This study demonstrates that a daily rhythm does exist for stroke patients,” said Hu. “Rehab plans should look to identify the daily rhythm and design a strategy that makes use of optimal CA. The long-term goal is to see if we can further control the rhythm of CA by manipulating an individual’s daily behavioral cycles or endogenous circadian clock in order to deliver more personalized medicine and improve their recovery.”