Medically Speaking

To combat Covid-19, the Ministry of Health and Family Welfare (MoHFW) encouraged all states on Thursday to maintain concentrating on the 5-pronged approach of Test-Track-Treat-Vaccination and Covid Appropriate Behavior. According to the letter,  “We will do another mock drill to see the COVID-19 preparations. Mock drills will be done soon in all the states/UTs.”

According to a Health Ministry notice, more than 220.65 crore total doses of vaccinations have been provided across the country. “There has been no evidence of an increase in hospitalization. Precaution doses should be increased. Enhanced lab surveillance and testing of all severe acute respiratory Illness (Sari) cases needs to be done”, reads the statement.

The Ministry has also ordered states to guarantee that necessary medications and supplies for Influenza and Covid 19 are available in health institutions. Apart from that, states have been requested to guarantee that there are enough dedicated beds and health personnel.

While listening to music is a well-known mood booster, researchers at Michigan State University discovered that music-listening therapy can also increase drug effectiveness. “Music-listening interventions are like over-the-counter medications,” said Jason Kiernan, an assistant professor in the College of Nursing, adding, “You don’t need a doctor to prescribe them.”

Before, music-listening treatments were used to treat pain and anxiety, but Kiernan took a different approach by evaluating the benefits of music-listening interventions on chemotherapy-induced nausea. “Pain and anxiety are both neurological phenomena and are interpreted in the brain as a state,” Kiernan said, adding, “Chemotherapy-induced nausea is not a stomach condition; it is a neurological one.”

The short pilot trial comprised 12 chemotherapy patients who consented to listen to their favorite music for 30 minutes each time they needed to take their anti-nausea medicine as needed. They repeated the music intervention whenever nausea struck over the five days following their chemotherapy treatment. The patients in the research reported 64 incidents in total.

“When we listen to music, our brains fire all kinds of neurons,” Kiernan said. While Kiernan saw a reduction in patients’ nausea intensity and distress (how much it hurt them to be queasy), he adds that it is impossible to determine whether this was due to the medication’s slow release or the increased effect of the music. Kiernan is drawing inspiration for future research from another previously published study that examined the amount of serotonin, a neurotransmitter, produced by platelets in the blood after listening to painful and pleasurable music.

“Serotonin is the major neurotransmitter that causes chemotherapy-induced nausea,” Kiernan said, adding, “Cancer patients take medications to block serotonin’s effects.” Researchers discovered that patients who listened to pleasant music had the lowest amounts of serotonin release, indicating that the serotonin remained in the blood platelets and did not circulate throughout the body. Patients had higher stress and serotonin release after listening to music they felt unpleasant, according to the findings.

“This was intriguing because it provides a neurochemical explanation and a possible way to measure serotonin and the blood platelet release of serotonin in my study,” Kiernan said, adding, “In 10 to 20 years, wouldn’t it be neat if you could use a nonpharmacological intervention like listening to 10 minutes of your favorite music to complement a medicine?” The findings were reported in Clinical Nursing Research.

According to a new study published in Clinical Nutrition and funded by the Institute for Scientific Information on Coffee, coffee drinking can help reduce the occurrence of type 2 diabetes (T2D) (ISIC). This is mediated by differences in inflammatory indicators in the body. The study investigated the underlying mechanisms by which coffee consumption may help to reduce T2D risk and discovered that lower subclinical inflammation may explain a portion of the link.

The study intended to investigate the underlying processes correlating increased coffee intake with a decreased risk of T2D3-9 by examining coffee’s influence on inflammation biomarkers like C-reactive protein (CRP), which increases when there is inflammation in the body.

Utilizing data from the UK Biobank (n=145,368) and the Rotterdam Study (n=7,111), researchers verified that increasing coffee consumption by one cup per day was related to a 4-6% decreased risk of T2D. It is also anticipated that cohort participants will have lower insulin resistance, lower CRP, lower leptin, and greater adiponectin concentrations. Adiponectin is a hormone that regulates glucose and lipid metabolism and has been proven to have anti-inflammatory and insulin-sensitizing properties, whereas leptin regulates food intake and energy balance.

Rather than a fixed baseline, a one-cup-per-day increase was tested against individuals’ variable daily intake. The research cohort’s daily coffee intake varied from 0 to 6 cups per day, with data indicating advantages from an additional cup per day regardless of whether participants fell at the lower or upper end of that range.

Research from the UK Biobank cohort also revealed that the way coffee is brewed may have an influence on its health benefits. Filtered or espresso coffee, along with not smoking, exhibited the highest favorable correlation with decreased T2D risk and CRP concentrations. Dr. Trudy Voortman, Ph.D., Associate Professor in Nutritional Epidemiology at Erasmus University Medical Centre Rotterdam, and Dr. Carolina Ochoa-Rosales, Ph.D., Postdoctoral Scientist at the same university, co-authored the study.

Dr. Voortman said, “Coffee is one of the most frequently consumed beverages worldwide and its potential health effects trigger significant scientific research. Previous studies have linked higher coffee consumption to a lower risk of developing T2D but underlying mechanisms remained unclear. Our research shows that coffee is associated with differences in the levels of inflammation biomarkers in the body, and as we know that T2D is partly an inflammatory disease, this could be one of the mechanisms at play. These findings could also support future research into the effects of coffee on other inflammation-related chronic diseases.”

The study adds to the current body of data linking coffee drinking to a decreased risk of T2D, which might aid in the creation of guidelines on how diet and lifestyle modifications can assist noncommunicable disease reduction efforts like T2D.

According to a new study, those who suffer from epilepsy are more likely to die early. The elevated risk varies according to the individual’s location, the number of drugs they take, and any other ailments they may have. The findings were published online in Neurology, the official journal of the American Academy of Neurology.

“Our research found an increased risk even among those who do not have other health problems and are taking only one medication to control their seizures,” said study author Seo-Young Lee, MD, Ph.D., of Kangwon National University in Chuncheon, Republic of Korea.

The researchers identified 138,998 persons newly treated for epilepsy using a national health database. The researchers next analysed the national death record and discovered that 20,095 study participants died throughout the 10-year study period. At the commencement of the trial, the average age of the participants was 49.

Researchers recorded the reasons for death for all subjects. They also recorded information such as a person’s age, gender, where they resided, and the number of prescriptions they had been prescribed. The researchers then computed the total fatality rates for study participants. The mortality rate is a measure of the total number of deaths in a given population. The mortality rates of study participants were compared to the general population’s death rates.

There were roughly 660,000 person-years among research participants, which indicate both the number of persons in the study and the amount of time each person spends in the study. There were 20,095 fatalities in research participants for that number of person-years, compared to an estimated 8,929 deaths in the general population.

Using person-years to quantify risk, researchers discovered that patients with epilepsy had a risk of mortality that was more than double that of the general population. The elevated risk was significantly greater in the study’s younger participants. Furthermore, those with epilepsy residing in rural locations had a 247 percent higher risk of mortality than the general population, while those living in urban areas had a 203% higher risk.

Participants in the study who used just one anti-seizure medicine had a 156% increased risk of mortality compared to the general population, while those who took four or more anti-seizure medications had a nearly fivefold increased risk.

When compared to the general population, people with epilepsy who had no other illnesses or health issues had a 161% greater chance of mortality. Those with epilepsy who had never or only once been hospitalised showed no higher risk of dying prematurely.

Among study participants who died, 19% died of cerebrovascular disease, which had a 4.5 times higher risk of death than the general population, 16% died of cancers outside the central nervous system, which had a 137% higher risk, and 7% died of cancers in the central nervous system, which had a 46 times higher risk.

According to Lee, such malignancies and cerebrovascular disease are commonly thought to be underlying causes of epilepsy. In addition, 6 percent died of pneumonia, 7 percent died of external causes such as falls, accidents, and drowning and 2 percent died of suicide, all of which had a two times greater risk. Epilepsy and status epilepticus were responsible for 2% of all fatalities.

“Our study demonstrated a wide range of mortality risks in people with epilepsy, depending on age, disease duration, disease severity, and other health conditions,” said Lee. “We also identified disparities for people living in rural areas and urge public health efforts to improve access to care. Active control of seizures, education about injury prevention, monitoring for suicidal thoughts, and efforts to improve accessibility to epilepsy care all contribute to reducing mortality.”

Many people who want to cut back on meat are turning to legumes, which are high in protein, vitamins, and fiber. Allergies to legumes, such as soy and peanuts, are common and fatal. Are meat-free proteins made of legumes dangerous to patients who are allergic to specific legumes, even if the legumes are different? Dr. Mark Smits and his colleagues at Utrecht University Medical Center set out to investigate.

“Both protein consumption and the world’s population are increasing which leads to an urgent demand for sustainable protein sources,” said Dr. Thuy-My Le, senior author of the study published in Frontiers in Allergy. “An increase in the consumption of legumes may increase the number of allergies to these foods. Furthermore, these new legumes may elicit allergic complaints in already legume-allergic patients. Therefore, we investigated how often sensitization and allergy to different legumes occur in these patients.”

Any other name for an allergy, Food allergies occur when the immune system misidentifies food proteins as a threat and produces Immunoglobulin E (IgE) antibodies. Individuals who have been sensitised to food may develop allergy symptoms if exposed to it again. Patients who are allergic to one food may also be allergic to another: this is known as co-allergy. Co-allergies are often accompanied by co-sensitization, which occurs when patients produce IgE antibodies against multiple foods. Cross-reactivity, in which IgE antibodies bind to proteins from different foods because their structures are similar, may cause co-sensitization.

Co-sensitization can lead to a diagnosed co-allergy, but it does not always: it is possible to be co-sensitized to a food and not have a reaction when eating it. So, do patients who are allergic to specific legumes react to other legumes?

Smits and colleagues recruited legume-allergic patients from the University Medical Center Utrecht’s Allergology Clinic and divided them into six groups based on allergies: peanuts, soybeans, green peas, lupines, lentils, and beans. Allergies were validated in all patients through an oral food challenge or a positive IgE test combined with a history of reactions. IgE antibodies against the other legumes were tested in each group separately.

“We showed that a large number of patients produced antibodies against more than one legume,” said Dr. Kitty Verhoeckx, second author of the study. “However, clinical data showed that only a small part of these patients had actual symptoms.”

Co-sensitization is common among legumes, but not always co-allergy.
Co-sensitization to additional legumes was observed in all six patient groups, with nearly a quarter of patients sensitised to all legumes. Almost all of the patients in the bean allergy group developed sensitivities to other legumes. Patients who were allergic to green peas, lupines, or lentils were more likely to be sensitised to other legumes, whereas patients who had peanut or soybean allergies were not.

The researchers also investigated which of these patients had documented co-allergies to various legumes. Only a small number of patients had clinical symptoms as a result of the high co-sensitization rate. Co-allergies to green peas, lupine, lentil, and bean were uncommon in peanut and soybean-allergic patients, but patients who were allergic to this second group of legumes were more likely to be allergic to peanuts or soybeans.

Patients who were allergic to peanuts were frequently also allergic to soybeans, and vice versa. Peanut sensitization was linked to clinically significant co-allergy in almost all other legume groups. However, the researchers cautioned that the study should be expanded to a larger group and co-allergies confirmed with oral food challenges before determining how clinically relevant this co-sensitization is in practise.

“Legumes are an attractive sustainable protein source, but allergic reactions in the already legume-allergic population cannot be excluded as antibodies in the blood of legume-allergic patients frequently react to different legumes,” said Le.

“However, this reaction does not always lead to a clinically relevant food allergy. Introduction of novel foods into the market should be accompanied by an appropriate assessment of the risk of developing (new) food allergies.”

Is there a risk from meat-free proteins derived from legumes, even if the legumes are different? Dr. Mark Smits and his colleagues at Utrecht University Medical Center set out to investigate.

According to research published in the European Heart Journal – Open, an ESC journal, sleeping less than five hours per night is associated with a 74% increased risk of developing the peripheral arterial disease (PAD) compared to sleeping seven to eight hours.

“Our study suggests that sleeping for seven to eight hours a night is a good habit for lowering the risk of PAD,” said study author Dr. Shuai Yuan of the Karolinska Institute, Stockholm, Sweden. More than 200 million people globally have peripheral artery disease (PAD),2 where arteries in the legs are clogged, restricting blood flow and increasing the risk of stroke and heart attack. Dr. Yuan said: “Insufficient night-time sleep and daytime napping have previously been associated with a raised risk of coronary artery disease which, like PAD, is caused by clogged arteries. In addition, sleeping problems are among the top-ranked complaints in PAD patients. There are limited data on the impact of sleep habits on PAD and vice versa, and our study aimed to fill that gap.”

The study had over 650,000 participants and was divided into two parts. 3 First, the researchers looked at the links between sleep duration and daytime napping, and the risk of PAD. In the second part, the researchers used genetic data to conduct naturally randomised controlled trials, also known as Mendelian randomisation, to investigate the causality of the associations.

Dr. Yuan said: “Observational analyses are limited by reverse causality – meaning that if an association between sleep habits and PAD is found, we cannot be certain if sleep habits caused PAD or having PAD caused the sleep habits. Mendelian randomisation is a robust method for evaluating causality and provides more certainty about the results.”

Taken together, the strongest evidence was for insufficient sleep, where the relationship with PAD was bidirectional. In a study of 53,416 adults, sleeping less than five hours per night was linked to a nearly doubled risk of PAD compared to sleeping seven to eight hours (hazard ratio [HR] 1.74; 95 percent confidence interval [CI] 1.31-2.31). This finding was supported by additional analyses of 156,582 and 452,028 people, respectively. Short sleep was linked to an increased risk of PAD in the causal studies, and PAD was linked to an increased likelihood of short sleep.

Dr. Yuan said: “The results indicate that brief night-time sleep can raise the chance of developing PAD and that having PAD increases the risk of getting insufficient sleep.”

In an observational study of 53,416 adults, sleeping eight hours or more per night was associated with a 24% increased risk of PAD compared to seven to eight hours (HR 1.24; 95 percent CI 1.08-1.43). Analyses in two larger populations of 156,582 and 452,028 people supported this finding. However, no causal relationships between long sleep and PAD were discovered. Similar findings were reported for napping, with daytime nappers having a 32% higher risk of PAD than those who did not nap (HR 1.32; 95% CI 1.18-1.49) but no causal links were found.

“More studies are needed on the relationships between lengthy night-time sleep, daytime napping, and PAD,” said Dr. Yuan. “Although we found associations in the observational studies, we could not confirm causality.”
He concluded: “More research is needed on how to interrupt the bidirectional link between short sleep and PAD. Lifestyle changes that help people get more sleep, such as being physically active, may lower the risk of developing PAD. For patients with PAD, optimising pain management could enable them to have a good night’s sleep.”

A diet high in vitamin A or its analogues may help adolescents and young adults with acute lymphoblastic leukaemia (ALL) reduce their risk of painful pancreatic inflammation during chemotherapy, according to a study.
Details about this potential dietary solution to prevent a potentially fatal adverse event were published in Science Translational Medicine on March 15, 2023.

Sohail Husain, MD, chief of Pediatric Gastroenterology, Hepatology, and Nutrition at Stanford University, and Anil Goud Jegga, DVM, MRes, a computational biologist at Cincinnati Children’s Hospital Medical Center, led the research team. Treatment with the enzyme asparaginase helps starve cancer cells by lowering the amount of asparagine circulating in the blood, which cancer cells require but cannot produce.

The medication, which is frequently used in conjunction with other chemotherapies, is administered by injection into a vein, muscle, or under the skin. However, an estimated 2% to 10% of asparaginase users develop pancreatic inflammation as a result of asparaginase treatment. The symptoms can be severe for one-third of these people.

Jegga and colleagues used over 100 million data points from gene expression data, small-molecule data, and electronic health records to better understand the mechanisms underlying asparaginase-associated pancreatitis (AAP) and to identify potential interventions to prevent or mitigate AAP.

First, they analysed massive amounts of gene expression data to discover that retinoids could reverse gene activity associated with asparaginase or pancreatitis (vitamin A and its analogs). More evidence was discovered by “mining” millions of electronic health records from the TriNetX database and the US Food and Drug Administration Adverse Event Reporting System.

The AERSMine software developed at Cincinnati Children’s by Mayur Sarangdhar, PhD, MRes, and colleagues was used in this number crunching and predictive analytics work. The researchers also analysed data from mouse experiments and compared plasma samples from ALL patients who developed pancreatitis to those who did not.

Finally, the team came up with two sets of human “real-world” experiences. They discovered that when asparaginase was combined with vitamin A, only 1.4% of patients developed pancreatitis, compared to 3.4% of patients who did not. Concurrent vitamin A use was associated with a 60% reduction in the risk of AAP. Lower dietary vitamin A levels were linked to an increased risk and severity of AAP.

“This study demonstrates the potential of mining ‘real-world’ data to identify therapy modifiers for improving patient outcomes. In cases where a primary drug induces toxicity but is critical to therapy, such as asparaginase, therapy modifiers, such as vitamin A and its analogs, may be of immediate relevance to patients on asparaginase and ‘at-risk’ for AAP,” says Sarangdhar, a co-first author of the study.

Says Jegga: “Our study highlights the power of heterogeneous data integration and analysis in translational research. By leveraging existing ‘omics and patient-centric data and a systems approach, we were able to identify new insights into the development of AAP and potential interventions to prevent or mitigate this side effect.”

Next steps

In some ways, the findings of this study could be immediately applied to patient care. More clinical research is needed, however, to determine how much vitamin A is required to protect ALL patients from pancreatitis, and whether a protective level can be achieved through diet or supplements. In fact, target vitamin levels may need to vary based on individual metabolic differences.

28th February 2023, New Delhi: An 8-year-old boy from Saudi Arabia with weight 84 kg, height 4 feet and BMI (57.2kg/m2) was suffering from MORBID OBESITY with OSA (OBSTRUCTIVE SLEEP APNOEA). OSA was so severe that he could not sleep in night and has to be awake whole night. Obstructive Sleep Apnoea (OSA) is a life-threatening condition which is associated with morbid obesity. Patient have apnea sleep (Air hunger) in night and feel sleepy throughout day and can be life threatening. It requires BiPAP machine to sleep overnight. It can be treated by losing weight with bariatric surgery and BiPAP machine can be removed in most patients as early as first week following surgery.

He was very much addicted to chocolates and fast food. He came to INDIA for help. He was advised psychological and pediatric Endocrinologist counseling but his family after meeting them wanted some definitive, fast result procedure to save his life. They wanted him to undergo BARIATRIC SURGERY and met Dr Rajat Goel at Rosewalk Hospital for same. Bariatric (Metabolic or Life style modification) SURGERY is like laparoscopic Surgery, like gall bladder or hernia or appendix surgery requiring 4 to 5 key holes to perform it.

Dr Rajat Goel refused surgery due to age of child and was not sure whether child will be able to understand post-operative dietary protocol. Because the youngest age for Bariatric surgery usually advised at the age of 14 and it is normal for the patients above 18 years. His family was counselled about the procedure and all its pros and cons for 1 month but since Child was having severe OSA (breathing is interrupted during sleep, for longer than 10 seconds at least 5 times per hour throughout your sleep period), and was advised BiPAP machine to breath which he could not tolerate, patient was taken for Laparoscopic Sleeve Gastrectomy after anesthesia and other clearances and informed consent.

The child lost 10 kg of weight in 1week time and could sleep easily without need of BiPAP machine. Due to hormonal changes after surgery he stopped eating chocolates and was counseled by dietician along with his family for healthy lifestyle like 40 minutes activity daily and healthy food intake. BARIATRIC SURGERY done on right patient at right time can be like saving with long lasting results. Life after surgery is like patient becoming a new born baby with new taste and control over eating which lasts for 6 months and all eating habits can be reformed due to hormonal changes in bariatric surgery.

It not only improves physical health and treats/ controls all diseases associated with obesity like type 2 DM, HT, OSA, PCOS, FATTY LIVER and lot more but also improves mental (depression, inferiority complex, anxiety, eating disorders associated with obesity) and social life. To summarize surgery gives you a second chance to live life in a healthy way.

A more mystical and insightful psychedelic drug experience, according to a new study, may be linked to a long-term reduction in anxiety and depression symptoms. The study was recently published online in the Journal of Affective Disorders. The data from nearly 1,000 survey respondents about their previous non-clinical experiences with psychedelic drugs was analysed using machine learning. People who scored the highest on questionnaires assessing the mystical and insightful nature of their experiences reported consistent improvements in their anxiety and depression symptoms, according to the findings.

The analysis also suggests that a difficult experience while using these substances, one that feels frightening or destabilising, can be beneficial, particularly in the context of mystical and insightful experiences. This could be useful for practitioners as they guide patients through clinical trials testing the therapeutic potential of psychedelics.

“Sometimes the challenge arises because it’s an intensely mystical and insightful experience that can, in and of itself, be challenging,” said senior author Alan Davis, assistant professor and director of the Center for Psychedelic Drug Research and Education in The Ohio State University College of Social Work.

“In the clinical research setting, folks are doing everything they can to create a safe and supportive environment. But when challenges do come up, it’s important to better understand that challenging experiences can actually be related to positive outcomes.”

The study is the first to identify and link subtypes of subjective psychedelic experiences to mental health outcomes. The data came from previous research Davis led, which included an anonymous internet-based survey of people who reported having a moderate to strong psychedelic experience in the past and the resulting changes in their anxiety and depression symptoms – regardless of the level of those symptoms prior to the psychedelic experience.

The 985 participants whose responses were analysed in this study described substances they had used and filled out questionnaires assessing how mystical (evoking a sense of pure awareness, positive mood, and/or transcendence of time and space that is difficult to describe in words), psychologically insightful (eliciting acute insight into memories, emotions, relationships, behaviours, or beliefs) or challenging their psychedelic experience was. The survey measured depression and anxiety symptom levels, as well as ratings of life satisfaction and psychological flexibility – one’s ability to act in ways that are consistent with their values regardless of any internal or external experience – before and after using the psychedelic.

Users of psilocybin (magic mushrooms), LSD, Ayahuasca, mescaline, peyote cactus, and 5-MeO-DMT, the natural psychedelic substance found in the venom of the Colorado River toad, were included in the study, along with the estimated dose level of the single drug use they recalled.

The data analysis revealed three distinct psychedelic experience subtypes:

• High score, combining high mystical and insightful assessment scores with moderate challenging assessment scores.
• Low to moderate scores on mystical and insightful experiences, as well as low scores on the challenging scale.
• Positive evaluation, with high marks for mystical and insightful experiences and low marks for the difficult assessment.

“The group that had the highest insightful and mystical experiences and low challenging experiences showed the most benefit in terms of remission of anxiety and depression symptoms and other longer lasting benefits to their life,” said first author Aki Nikolaidis, an affiliate of Ohio State’s Center for Psychedelic Drug Research and Education (CPDRE) and a research scientist in the Center for the Developing Brain at the Child Mind Institute.

When the researchers analysed only data from participants who had used psilocybin and LSD, the same patterns emerged: three distinct subtypes that were associated with the same outcomes, including mental health benefits even after a difficult experience. According to Nikolaidis, this replication demonstrates the importance of subjective experience for psychedelic users.

“Identifying subtypes that exist regardless of which psychedelic you take answers an interesting question,” he said. “But the fact that we found that they’re associated with specific outcomes, and replicated that finding, really shows why it’s important to understand the powerful nature of what is happening subjectively and its potential to yield a beneficial outcome.”

A few other trends stood out: Participants in the positive scoring group, whose experience could be considered optimal (high scores on mysticism and insight and low scores on challenges), were younger than those in the other groups. There was a higher proportion of people who had taken large doses of psychedelic drugs among those who scored highest on challenging experiences. Furthermore, the low-scoring subtype had lower psychological flexibility, anxiety, and depression scores prior to the psychedelic experience, as well as lower improvements in those symptoms and life satisfaction than the other two subtypes.

Davis said he’ll be interested to see if these subtypes of experiences are applicable in the clinical setting, where psilocybin-assisted therapy is being studied at Ohio State for the treatment of post-traumatic stress disorder in military veterans.

“Finding the variety of other outcomes that these subtypes might be related to is an interesting next step,” he said. “These could include adaptive or functional outcomes in people’s quality of life or well-being, or a better understanding of their life’s purpose or relationships.”