More en Thu Jan 27 14:42:48 IST 2022 john-naish-on-how-to-bolster-your-brain <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>If you worry about suffering senior moments in midlife, new research suggests that you can forget about it for now. Our brains are so resilient that they may maintain their full youthful spritz into our sixties, German scientists say. Their study of 1.2 million people, aged between 10 and 80, claims to dispel the belief that our brainpower peaks at 20, after which it’s all downhill into a treacle-headed world of forgotten names, misplaced door keys and anecdotes everyone’s heard 50 times.</p> <p>&nbsp;</p> <p>The report in the journal Nature Human Behaviour studied the participants’ speed at answering online tests. It found that average levels in mental speed seem to be quite stable until the age of 60. Furthermore, it adds that if midlifers’ brains may sometimes appear a little ponderous, it’s because they have shed the impetuosity of youth and instead cautiously consider their options before acting. The results suggest that people in their twenties are quicker on the draw not because of more efficient brain processes, but because they are more likely to prioritise speed over accuracy.</p> <p>&nbsp;</p> <p>Does that mean our brains are so resilient that we can ditch the brain-saving exercise regimens, stop trying to learn new skills and instead order up a squadron of junk food-laden mopeds? Despite the good cognitive-ageing news, the flat answer is no.</p> <p>&nbsp;</p> <p>Indeed, a different study published this week shows that people who are physically fit in middle and older age can cut their risk of developing Alzheimer’s by up to a third. You may only need to walk briskly for two and a half hours a week to maintain sufficient fitness, says information released by the American Academy of Neurology.</p> <p>&nbsp;</p> <p>One reason that we should all work to protect our neurons is that not all brains age the same, says Dr Mischa von Krause, the psychologist at Heidelberg University who co-authored the German study. The results, he adds, found “great variability in mental speed within all age groups. There were young, middle-aged, but also old people that showed high levels in mental speed.”</p> <p>&nbsp;</p> <p>Healthy lifestyles may well be helping here, he says, but his study didn’t examine possible links. “We do not want to imply that exercise, diet, education etc do not matter,” he emphasises.</p> <p>&nbsp;</p> <p>Von Krause would not be drawn on whether his research showed that age brings wisdom. “Rather than ‘wise’ we prefer the term ‘cautious’,” he says. “We do not want to judge whether collecting more information before making a choice is a ‘better’ strategy. It probably greatly depends on content and context which decision style suits best.”</p> <p>&nbsp;</p> <p>Nevertheless, international research in the same journal last year suggests that, in fact, wisdom does come with age. The study of more than 700 participants between the ages of 58 and 98 found that while mental alertness declines, our key cognitive abilities to focus on new information and one’s situation actually get stronger.</p> <p>&nbsp;</p> <p>Although that’s good news, emerging evidence shows that such positives may be imperilled by Covid.</p> <p>&nbsp;</p> <p>First there’s the virus’s direct impact: an Imperial College London study of 81,000 infected people found that those who had suffered even mild symptoms showed impaired memory, attention, problem-solving and emotional processing. The brains of those who had been put on ventilators had aged more than a decade on average, reports the Lancet journal eClinicalMedicine.</p> <p>&nbsp;</p> <p>There may also be a more widespread effect, warns Dr Alastair Noyce, the clinical senior lecturer in preventive neurology at Queen Mary University of London, and a consultant neurology registrar at Barts Health NHS Trust. This is because the pandemic lastingly changed our lifestyles, he says.</p> <p>&nbsp;</p> <p>“A lot of the risk factors for poor brain health will have increased over the past two years, such as lack of exercise, social isolation and stress. We must work to reduce the effect that this has had.”</p> <p>&nbsp;</p> <p>Fully reviving our networks post-lockdown seems particularly important. Numerous studies have shown how feeling isolated socially can accelerate age-related cognitive decline. But it’s not just about being lonely: a study last August, in the journal JAMA Network Open, showed that being sociable actually has brain-protecting benefits.</p> <p>&nbsp;</p> <p>It found that in people aged 40-plus, simply having someone available whom you can count on to listen is associated with greater cognitive resilience—which is a measure of your brain’s ability to function better than would be expected for its physical age.</p> <p>&nbsp;</p> <p>Indeed, the study of more than 2,000 people found that those in their forties and fifties with low “listener availability” had a cognitive age four years older than those with sympathetic ears around.</p> <p>&nbsp;</p> <p>Joel Salinas, the professor of neurology at New York University who led the study, says it “adds to growing evidence that people can take steps, either for themselves or the people they care about most, to increase the odds they’ll slow down cognitive ageing”.</p> <p>&nbsp;</p> <p>Meanwhile, Noyce adds that improvements in cardiovascular health, particularly through exercise as well as weight control and not smoking, seem already to be helping to keep our brains young. “We have seen evidence from epidemiological studies that there has been a reduction overall in the incidence of dementia, once age is taken out. The most likely candidate for causing this improvement is work done to improve the population’s cardiovascular health,” he says.</p> <p>&nbsp;</p> <p>Dag Aarsland, the professor of old age psychiatry at King’s College London, agrees. “Everything that is good for your heart is good for your brain,” he says. “Keeping your blood pressure and cholesterol levels under control has benefits inside the brain as well as outside it.”</p> <p>&nbsp;</p> <p>While we might feel bombarded by exhortations to maintain an extensive list of brain-healthy habits, Aarsland maintains that exercise is the most important of all. “The best research we have, which covers more than 50 countries, shows that to make the most difference you have to do several things: eat healthily, exercise, stimulate your brain, control your blood pressure and cholesterol, and have social interactions. But if you only focus on one thing, it should be exercise, not least because it encourages all the other things,” he says.</p> <p>&nbsp;</p> <p>As this week’s study from the American Academy of Neurology shows, you don’t have to do much, Aarsland adds: “The biggest beneficial difference we see is between those who do nothing and those who do something once or twice a week, which may only be brisk walking. However, both aerobic exercise—getting your heart beating faster—and strength training are now shown to have significant benefits as we grow through midlife into older age.”</p> <p>&nbsp;</p> <p>A recent report in Neurology Today explored how researchers have identified a key brain-protecting benefit that we can all get from exercise: physical exertion releases cognitively beneficial proteins and hormones. One chemical, in particular, is exciting interest: clusterin. The protein is high in the blood of lab mice that do lots of exercise. It is low in sedentary mice, which also have faster-ageing brains.</p> <p>&nbsp;</p> <p>When researchers at Stanford University, California, took blood serum high in clusterin from exercising mice and gave it to the lazy mice, their brains showed significant benefits, in particular a significant reduction in brain inflammation associated with the development of Alzheimer’s. But if the researchers removed clusterin from the exercising mice’s blood serum before giving it to the lazy mice, their brain-inflammation levels remained high.</p> <p>&nbsp;</p> <p>Dr Ashok Jansari, the senior lecturer in cognitive neuropsychology at Goldsmiths, University of London, is another big fan of exercise—but more importantly of playing a fast-moving physical game. “One of the best to play is table tennis. It is really good for the brain to get numerous areas involved and networking on a task,” he explains. “The game, obviously, requires plenty of exertion, but also coordination and fast movement, which stimulates numerous regions across the brain: areas at the back are involved in the physical stuff, the front brain makes rapid decisions, and the parietal areas—left and right at the rear—process actions. Then there’s the motor-control area, which is like an Alice band on your brain. You also have to use social areas of the brain to guess what your opponent’s about to do next.”</p> <p>&nbsp;</p> <p>But it’s not all about rushing about competitively. Jansari also recommends mindfulness meditation. “It exercises the brain’s frontal decision-making areas and also the limbic system. When the limbic system is underactive it lets negative thoughts spiral around—there’s a loss of emotional control.<br> Research shows that mindfulness strengthens this control,” he says.</p> <p>&nbsp;</p> <p>“If you compare long-term meditators with people of the same age, IQ and socioeconomic status, you find that they have better developed areas of the brain that are associated with the perception and control of emotions, so they are more resilient to life’s challenges and keep their moods buoyant,” he says. “This is important in later life, when there are strong associations between depression and dementia.”</p> <p>&nbsp;</p> <p>So there you have it, the new recipe for nurturing your naturally resilient midlife brain: just bolster it with brief, brisk bits of exercise and some sociable fun and games. You even get to sit down and do almost nothing.</p> Sun May 29 12:02:36 IST 2022 dr-alok-kulkarni-on-factors-causing-borderline-personality-disorder <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p><b>RAMONA, 36,</b> visited me at the peak of the pandemic with anger outbursts, frequent threats of self-harm, problems with her spouse, family members and friends, and intense crying spells lasting hours. Her attempts at ‘deliberate self-harm’ were a frequent occurrence following a tiff with her spouse. Ramona would lock herself in a room, and violently bang on the door threatening suicide.</p> <p>&nbsp;</p> <p>During my session that followed, it was evident that Ramona’s worldview fit into the classical “all good’’ or “all bad’’ phenomenon. Some people were perfect, according to her, while a few others were extremely bad. At times, she worshipped the same people who she otherwise criticised.</p> <p>&nbsp;</p> <p>Ramona had a string of failed relationships, and she feared being cut off from people she loved. Her values and ideas about people changed dramatically and quickly. After a comprehensive and holistic clinical assessment, it was deemed that Ramona could possibly have borderline personality disorder.</p> <p>&nbsp;</p> <p>What is borderline personality disorder?</p> <p>&nbsp;</p> <p>It is characterised by an ongoing pattern of varying moods, unstable self-image and rapidly changing behaviour. Impulsive actions are at the core of the disorder. People experience intense episodes of anger, depression and anxiety, which can last from a few hours to days. They make frantic efforts to avoid real or imagined abandonment, which may take the form of rapid initiation of intimate (either physical or emotional) relationships or blocking communication with someone in anticipation of being abandoned. Impulsive behaviour—such as spending sprees, unsafe sex, substance abuse, binge eating and reckless driving—may be seen in such people.</p> <p>&nbsp;</p> <p>A person having this disorder may also have chronic feelings of emptiness. They may experience a deep sense of mistrust, which is termed as “paranoia’’. This may be accompanied by an irrational fear regarding other people’s intentions.</p> <p>&nbsp;</p> <p>Ongoing research in neuroscience suggests the role of a number of factors behind borderline personality disorder. A positive family history, brain factors, environmental, social and cultural factors modulate the risks associated in developing the disorder. Most people report having experienced painful events, traumatic childhood, abuse, abandonment or other adversities.</p> <p>&nbsp;</p> <p>I conducted a comprehensive clinical interview that involved many sessions with Ramona and her family. Following this, a thorough physical examination was performed and a few laboratory tests were run to rule out other possible organic causes. Special attention was paid to Ramona’s use of alcohol and nicotine.</p> <p>&nbsp;</p> <p>Ramona was advised in-patient care for 12 weeks, to which she agreed to after a bit of convincing. During this period, a special form of counselling called ‘dialectical behavioural therapy’ was initiated. Ramona was empowered with skills to tolerate her distressing situations without indulging in self-harm behaviour. The cycle of cutting herself off during periods of imminent crises was finally broken through skills transferred during counselling sessions. Ramona started having a low dose of an anti-depressant to tide over her symptoms. She was told that the medications were safe, effective and devoid of side-effects.</p> <p>&nbsp;</p> <p>After a year of treatment with an anti-depressant and intensive counselling sessions, Ramona was finally back on track and went on to establish new business ventures. Not just that, she even formed a support group for people with borderline personality disorder.</p> <p>&nbsp;</p> <p>It is stories like these that inspire mental health professionals to give their best to every patient.</p> <p>&nbsp;</p> <p><b>The author is senior consultant psychiatrist at Manas Institute of Mental Health in Hubli, Karnataka.</b></p> Sun May 29 12:03:12 IST 2022 how-support-groups-help-people-with-parkinsons <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Brigadier G.R.C. Rajan served in the Army for over three decades before retiring in 1998. He was in the best of health till he was diagnosed with Parkinson's disease (PD) six years ago. Now, the 78-year-old has tremors in his limbs, jaw and face; he moves slow and has poor balance and coordination. He has difficulty performing simple day-to-day tasks and is embarrassed by his condition, leading to him limiting social interactions.</p> <p>&nbsp;</p> <p>A chronic and progressive nervous system disorder, PD inhibits bodily movement. Tremors are one of its most noticeable and early features. As the disease progresses, typically because of the loss of dopamine in the brain, patients also tend to experience depression, sleep problems and trouble chewing, swallowing or speaking. Though commonly considered a geriatric disorder, PD has been diagnosed even among the 18-to-40 age group; this is known as YOPD—young onset Parkinson’s disease. PD is estimated to have affected close to 10 million people till date, but a cure remains elusive.</p> <p>&nbsp;</p> <p>Therefore, it is crucial to alleviate symptoms via medication, physiotherapy and other treatments to maintain quality of life for patients. This is where support groups come in. They provide mental and emotional support to patients and families. Rajan said that when he was diagnosed, the prospect of being bedridden and immobile was too much to handle. “My family and I had no idea what this disorder meant and it was as if our lives had come to a halt,” he said. But, luckily, he came to know of Parivarthan for Parkinson's Foundation, a community support group that organises events and activities for PD patients and caregivers. Rajan said that Parivarthan transformed his life. “The negativity went away and I realised that I could carry on,” said Rajan.</p> <p>&nbsp;</p> <p>He now attends online sessions held by the foundation and receives instructional video clips on WhatsApp. These include interactions with renowned doctors from India and abroad, speech therapy sessions, yoga sessions, art classes and more. He has been contemplating taking up singing as a hobby, too. With the help of his physiotherapy sessions, which take place thrice a week at home for an hour-and-a-half, he is able to go on his morning walks, shave, brush and exercise on his own. He also finds the time to exchange notes on PD with others members of the NGO. Pointing out the benefit of the interactive sessions, he said that recently a question by a member on severe constipation, which is among the most common symptoms of PD, was of interest to him and the replies answered some of his queries on the subject.</p> <p>&nbsp;</p> <p>Vidhya Krishnan, 60, was diagnosed when she was 40. She was a school teacher and had two young children. Joining Parivarthan offered her reassurance that she was not alone. She said the yoga and therapy sessions were helpful and that there was a lot of encouragement from other members. “In the prime of my youth, I was facing difficulties lifting my left hand,” said Vidhya. “Wearing a sari and driving became difficult. I was not able to cook... even scraping a carrot became so challenging, as if I was a three-year-old.” Now, she keeps herself busy with Parivarthan's numerous programmes. She also conducts tuition classes at home.</p> <p>&nbsp;</p> <p>Parivarthan was started by Sudha Meiyappan in 2014. She left her job as an international trade analyst in the US to set up the NGO, which is based in Chennai, but now has over 250 members across Tamil Nadu. Meiyappan said that Parivarthan was a platform for patients as well as their families to share information and experiences and foster a positive environment.</p> <p>&nbsp;</p> <p>According to a 2005 research paper titled 'Online support groups for Parkinson's patients: A pilot study of effectiveness', 40 per cent to 60 per cent of patients suffer from clinically significant depression. They also become increasingly disabled and frequently less mobile with problems that include sleep disturbances, difficulty with swallowing, bladder and bowel disturbances and sexual dysfunction. To address the impact of these issues, many patients turn to support groups, the study concluded.</p> <p>&nbsp;</p> <p>Another study published in 2021 in Global Public Health, an international journal, said that in high income countries, the benefits of support groups have been well-established. The groups filled gaps in information and services, while acting as an important source of care and support for patients and caregivers.</p> <p>&nbsp;</p> <p>A study published in the journal Dementia and Neuropsychologia, of 20 PD patients who were part of support groups and 20 patients who were not, concluded that participation in support groups was associated fewer symptoms of depression, anxiety and social phobia.</p> <p>&nbsp;</p> <p>Hospitals too, have support groups for their people with Parkinson's (PwPs). Dr Pavan Pai, a neurologist at Wockhardt Hospital, Mira Road, Mumbai, ensures that he attends support group meetings at least once every six months. “I think it adds immensely to the morale of a person affected with Parkinson's and that is the kind of emotional support which cannot come from medication,” he said. “These groups are very significant and supplement the treatment.” He added that there was a lack of awareness regarding PD. “People ignore signs like tremors and slowness, attributing them to old age, stress or depression,” he said.</p> <p>&nbsp;</p> <p>Dr Sudheer Ambekar, a neurologist with Jaslok Hospital, Mumbai, which has a patient support group for PD and stroke patients, said that with the help of support groups, patients will be able to deal with mental, emotional and physical changes. The support group at Jaslok meets once every month.</p> <p>&nbsp;</p> <p>Apollo Hospitals recently organised an awareness meeting on PD and formed a support group that will, the hospital said in a statement, have a “multi-disciplinary team with patients, caregivers, physicians, surgeons and neuroscientists”.</p> <p>&nbsp;</p> <p>Most of the patients who spoke to THE WEEK lamented the limited awareness of PD in society, resulting in insensitivity. “Please know a few things: the blank face of a person with PD does not indicate a blank mind,” said Bharatnath Mothiye. “Drooling or spitting while talking is not something we enjoy doing. It is beyond our control.” He said that the only request from PD patients would be that people be more sensitive to their predicament and have patience. “We would also like for many more support groups to mushroom so that [more PD patients can get support],” said Mothiye, who, in his late 60s is “still trying to come to terms with the PwP label”.</p> Fri May 27 15:33:41 IST 2022 dr-mathew-r-john-on-the-roots-of-fury <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Anger is only a letter away from danger, wrote Eleanor Roosevelt. But the truth is that we know very little about the science of anger. And we hardly care.</p> <p>&nbsp;</p> <p>Anger was in the limelight once again at this year’s Oscars. In fact, it seemed to grab all the limelight. Almost two thousand years ago, the Roman Stoic philosopher Seneca wrote a book on anger titled De Ira. He thought of anger as utterly useless and greatly harmful, whereas Greek philosopher Aristotle had a slightly different take on it, considering it a difficult but useful skill. The inimitable Socrates, in his typical style, is said to have spoken this when he felt great anger towards another man—‘I would have hit you were I not angry’. Well, worth pondering.</p> <p>&nbsp;</p> <p>Charles Darwin noticed emotional expressions in animals and Walter Cannon discovered the fight or flight response as a universal response to myriad stressors. In simple terms, this is the brain’s decision to run or fight when you encounter a threat. Anger was thought to be a part of the fight response.</p> <p>&nbsp;</p> <p>Then came the psychologists followed by the neurologists. Psychologist Albert Ellis wrote of the rigid and distorted beliefs that led to anger and, quite naughtily, coined the term—‘musturbation’ in reference to the unrealistic ‘musts and shoulds’ that angry folks impose on and expect from others.</p> <p>&nbsp;</p> <p>Bob Abelson, psychologist, wrote of hot cognition—decision making under the influence of emotion as being different from the usual cold cognition or thinking. The parts of the brain involved in hot cognition are also different, which might explain the strange decisions we all tend to make when angry.</p> <p>&nbsp;</p> <p>Daniel Goleman, author and psychologist, proposed the phenomenon of ‘Amygdalar Hijack’. This refers to a part of the brain called the ‘Amygdala’ (a vital orchestrator of the stress response) hijacking a logical and calculated response and launching an emotional assault.</p> <p>&nbsp;</p> <p>Anger does not seem to be everybody’s problem. But, for some, it can be a lasting behavioural attribute. In psychiatric terms, anger can be a part of many mental health conditions. It can be associated with something as universal as chronic stress. It may be associated with certain personality disorders.</p> <p>&nbsp;</p> <p>In a minority of cases, it can be associated with severe mental illnesses like bipolar disorder and schizophrenia.</p> <p>&nbsp;</p> <p>There is also an interesting entity called ‘Intermittent Explosive Disorder’ wherein the patient predominantly complains of intermittent episodes of explosive anger. The standard treatment approach to an anger problem involves a comprehensive mental health evaluation followed by psychotherapy or drug treatment or a combination of both.</p> <p>&nbsp;</p> <p>Why do we react suddenly when somebody swears at us in public? Why do we react explosively when somebody abuses us taking the name of our father or mother? We still do not know the exact mechanisms of these deceptively simple questions but evolution seems to shine some light on these. Factors like loss of social status and insult to kin have been proposed to be evolutionary triggers for activating the anger response.</p> <p>&nbsp;</p> <p>What Seneca wrote seems still very relevant today—‘Time is the greatest remedy to anger.’ Delaying a response is the mainstay of the Tucker Turtle strategy wherein the angry person retreats into his shell like a tortoise when angry, and comes up with a good response when cool.</p> <p>&nbsp;</p> <p><b>The author is a consultant psychiatrist.</b></p> Fri May 27 15:26:26 IST 2022 here-is-why-buying-a-pug-is-a-cruel-act <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Pugs are considered one of the “cutest” canine breeds. But a new study from Royal Veterinary College of the United Kingdom says that pugs can no longer be considered a “typical dog from a health perspective” and their breeding leads to a “lifetime of suffering”.</p> <p>&nbsp;</p> <p>The study—that analysed the records of 16,218 pugs and 8,89,326 non-pug breeds—found that pugs were at higher risk for 23 out of 40 common disorders. The study points out that pugs are more likely to be obese; one in six pugs are obese compared to one in 15 for other dogs. Pugs are also 11 times more likely to have a skin-fold dermatitis. The study was published in the journal Canine Medicine and Genetics.</p> <p>&nbsp;</p> <p>The “brachycephalic” features—variably shortened muzzle and a rounded, often massive, head—of pugs did not evolve naturally. Those were the results of genetic manipulation by selective breeding. The Lo-Sze dogs of ancient China are considered the predecessors of modern-day pugs. Historians suggest that pugs existed even in the 4th century BCE, and were developed as pets for the Chinese elite. Pugs came to Europe in the 16th century.</p> <p>&nbsp;</p> <p>The flat-faced look with characteristic squashed nose appearance makes pugs “cute-looking”. However, this facial structure is responsible for a range of health issues faced by the breed. In April, another study from the RVC—that assessed 30,563 dogs from 18 breeds— revealed that short flat-faced breeds like pugs (7.7 years), English Bulldogs (7.4 years) and French Bulldogs (4.5 years) have a short life span.</p> <p>&nbsp;</p> <p>RVC researchers point out that pugs lack even “core body functions” expected of a dog breed. They point out that pugs cannot sleep properly as they constantly have to wake up to breathe. They also point out that most pugs cannot sit without snoring and snorting.</p> <p>&nbsp;</p> <p>The RVC study found that the breed is 54 times more likely to have brachycephalic obstructive airway syndrome (BOAS) and 51 times more likely to have narrow nostrils. Those animals suffering from BOAS may struggle to breathe during exercise and suffer collapse due to lack of air. The breathing difficulties of a BOAS affected pug will amplify in hot conditions.</p> <p>&nbsp;</p> <p>Pugs have more skin on their face than they require, so they are at higher risk for skin infections. Soreness and itchiness are conditions commonly seen in pugs. Their “beautiful” tail is a “malformed vertebra” which may lead to more slipped discs. The pugs are, however, at less risk for developing conditions like heart murmur and aggression.</p> <p>&nbsp;</p> <p>Veterinary experts warn that dog lovers should stop buying pugs. They also advise that existing pug owners should carefully watch for symptoms like excessive panting and breathing difficulties. Pugs require special care in hot seasons. They add that weight management is crucial as an “overweight” pug is at a greater risk to develop serious issues.</p> Fri May 27 15:18:23 IST 2022 attention-everyone <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Vivek comes home exhausted from school. Everyone at school calls him naughty, and he hates that. He really does try but is just unable to sit still. His fidget spinner helps, and he is always happy to be asked to run errands by the teacher. Getting up and walking around the classroom helps him focus better. He loves playing with the other boys in class, but lately, he has found that they are ignoring him. The teacher noticed this and asked one of his peers why they were ignoring Vivek. “It’s really hard to play with Vivek,” said Mani. “He keeps playing out of turn and sometimes even leaves the game halfway. The other day, he had the den when we were playing hide and seek, and he just left without telling us. It was 10 minutes before we realised that he had stopped playing and, afterwards, we saw that he was busy running after pigeons in the playground!”</p> <p>&nbsp;</p> <p>Perhaps one of the most common neurodevelopment disorders that remains a mystery to the population at large is the spectrum of attention deficit disorders. As the term enters popular culture, it is unfortunately also thrown around quite casually as an excuse for when one tunes out of a conversation or forgets to do something they were meant to. While the awareness is welcome, it can also serve to undermine the true nature of difficulties that individuals with attention-deficit/hyperactivity disorder may experience, which is many a time more than just a lapse in attention. Without a thorough understanding of how this experience manifests, it is easy to label children with ADHD as naughty and defiant, resulting in a negative approach by parents and educators alike, with the result of children being misunderstood and losing support.</p> <p>&nbsp;</p> <p>Contrary to the prevalent notion that children with ADHD are intentionally misbehaving, children genuinely have difficulty focusing and staying on task. This, however, is just one aspect of attention. Rather than being a unitary concept, there are several subtypes of attention. There is selective attention—the ability to selectively attend to some stimuli while filtering out others. While sustained attention is the ability to stay on a task over an extended period of time, divided attention is the ability to divide your attention between two tasks such as listening to the teacher and making notes. And, switching attention is the ability to shift your attention between two or more tasks as required. Children with ADHD may have difficulty with one or multiple types of attention. The condition can also negatively impact higher-level cognitive skills such as planning, organisation, impulse control, decision-making, initiation—a group of skills collectively referred to as executive functioning.</p> <p>&nbsp;</p> <p>Cognitive limitations are just one part of the story though. Whether it is a lack of understanding from family, peers and educators, a keen awareness of the limitations posed by one’s ADHD or shared neurobiological pathways, children with this condition are more prone to developing a mental illness. Research suggests that a staggering 60 per cent of individuals with ADHD have a co-morbid psychiatric condition. Additionally, children with ADHD and a co-morbid anxiety disorder are reported to have, on average, a ten-fold higher chance of poorer academic performance. Appropriate and timely diagnosis can result in better outcomes for children. Lack of awareness, on the other hand, may compound these deficits.</p> <p>As with all relatively unknown conditions, building awareness is the first step to assisting these children. Specifically, awareness will help dispel the myth of children with ADHD being intentionally difficult or them just not trying hard enough—negative labelling is likely to only worsen the situation. Positive support from family, peers and educational institutes can go a long way in nurturing a happy child. Interventions are numerous and can range from behavioural to pharmacological.</p> <p>&nbsp;</p> <p>Behavioural strategies to adopt in the classroom could include seating the child at the front of the class to ensure minimal distractions. Similarly, working in a quiet environment (for example, at a clutter-less desk, in the absence of a TV or radio playing in the background) is likely to result in a more fruitful learning experience for the child. Highlighting or underlining key points in notes would help the individual focus on the important parts, and not get overwhelmed. Allowing children with ADHD to work for brief periods of time—20 minutes at a stretch—followed by a break, would facilitate focus. Expecting them to work for hours on end, however, is merely setting them up for failure. Social skills training and occupational therapy intervention can also assist in improving the child’s functional skills. Team sports or yoga can be other opportunities to build attention span and improve focus on the task at hand. Medication can also serve as an adjunct in improving attention span and reducing hyperactivity. However, consultation with a specialist is recommended before commencing any pharmacological intervention.</p> <p>&nbsp;</p> <p>Most important though, compassion and a positive attitude are vital for our neurodiverse population to blossom. All of us have strengths and weaknesses and it is important that we not let a diagnosis define an individual, but simply speak to one facet of their personality. With awareness and acceptance, we can strive for a society where neurodiversity is embraced and individuals are supported to make for a healthy, happy new tomorrow.</p> <p>&nbsp;</p> <p><b>Bapat is adjunct faculty (psychology) at FLAME University.</b></p> Fri May 27 15:12:13 IST 2022 our-minds-are-caught-up-in-wandering-between-30-and-47-per-cent-of-our-waking-time <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p><b>Q/ What is the basic premise of Mindwandering?</b></p> <p>&nbsp;</p> <p>A/Mindwandering is the first popular book to explore the multi-faceted phenomenon of the wandering mind. Our mind has different states that are dynamic and that cluster together the many aspects of our mental being: perception, attention, thought, openness and mood. There is a right mind for the right occasion, and our mission is to maximise the match and minimise the friction.</p> <p>&nbsp;</p> <p><b>Q/ What happens inside the brain during mindwandering?</b></p> <p>&nbsp;</p> <p>A/ Research has revealed that our brains are inherently active. A number of brain regions connected in what is dubbed the default mode network (DMN) are always grinding away, engaged in a number of different involuntary activities that neuroscientists collectively call mindwandering: from daydreaming to the incessant self-chatter and from ruminating about the past to worrying about the future. The brain regions most often identified as being part of the DMN include the medial prefrontal cortex, the posterior cingulate cortex, and the angular gyrus, but there are several more that come and go as part of this massive, large-scale network.</p> <p>&nbsp;</p> <p>Not only does all this inner commotion tug our attention away from the present moment, but it can also dampen the quality of our experience, lowering our mood and potentially contributing to anxiety and depression. Yet there is a method to this apparent madness. Evolution has clearly taught our minds to wander. According to various studies, they are caught up in mindwandering between 30 and 47 percent of our waking time, gobbling up a great deal of energy. The logic of evolution suggests there must be something beneficial about it, and over the course of the past couple of decades, my neuroscience compatriots and I have identified a core set of its important functions.</p> <p>&nbsp;</p> <p><b>Q/ What has been your most fascinating discovery of the brain since you took up neuroscience?</b></p> <p>&nbsp;</p> <p>A/ Just like my kids, all my discoveries are dear to my heart (and mind). The highest sense of mission I get is from my findings on how thinking can affect mood, which we are currently using to try to alleviate the suffering of people with depression and anxiety (through science-based games). My work on predictions and mental simulations in mindwandering is another flagship of my laboratory, and it gives me immense pleasure to be able to share it with the general public. My other research ranges from aesthetics and urban design to first impressions and visual perception. One can get a sense of my ADHD from the diversity of my research questions, I guess.</p> <p>&nbsp;</p> <p><b>Q/ How have you personally mastered the art of mindwandering and how has it enriched your life?</b></p> <p>&nbsp;</p> <p>A/ Mindwandering is a wild beast with a mind of its own, no mortal can master it really. But being aware of this science and ideas can go a long way towards helping us gain some control over our mental lives. Mindwandering is a major activity in the brain. While it is not always welcomed—such as when we really need to accomplish something else or when it sends us ruminating and thus dampens our mood—in the right context it is a precious resource. We should not feel guilty when we catch ourselves wandering; it could be an inventive habit that is worth deliberately allocating time for. Once we do, we should get the most out of it.</p> <p>&nbsp;</p> <p>Two examples of how we can make use of our wandering thoughts are through learning from simulated experiences and through semi-directed mindwandering.</p> <p>&nbsp;</p> <p>A great deal of what we have in memory is a result of actual experience, but some of it is also the outcome of imagined experiences and simulated scenarios. My research into the possibility that our brain also stores memories of imagined experiences, although they have never taken place, started a while ago on a flight. I was reviewing a paper, and my mind drifted until it landed on the emergency door, which triggered the following simulation: what if the door suddenly opens while we are in the air? I will need a parachute. I could probably use the airplane blanket on my lap, but I will not be able to hold on to it in the strong wind—it needs holes. I can use my pen for making the holes, and so on. Far-fetched, funny every time, but nevertheless, I now have a script of an imagined experience stored in memory, and it would be helpful should the unlikely event ever take place.</p> <p>&nbsp;</p> <p>In semi-directed mindwandering, while we cannot really tell our mind where to wander about, we can strive to fill the mental space of possibilities with content that we would have liked to be wandering about. Before I go on a long walk, I ask myself what is on my mind. If it is something like the bills I just paid or an annoying email, I try to replace it with something that I would rather be spending my mindwandering stretch on, such as re-reading a paragraph that caught my interest recently. Or I might revive the idea of an upcoming trip so that I can fine-tune the details as I simulate the future with my mind.</p> Fri Apr 29 19:47:36 IST 2022 how-to-channel-ones-thoughts-for-a-more-fulfilled-life <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Some time ago, Israeli neuroscientist Moshe Bar caught up with two friends, Daniel Gilbert and Jonathan Schooler, for dinner in Massachusetts. During dinner, Gilbert told him that he was to be awarded the prestigious William James Prize. His three best friends, he said, would be taking him for drinks to celebrate after the ceremony. “I thought that I perceived that he was testing whether I felt like a close enough friend to suggest that I would join them,” writes Bar in his new book, Mindwandering. “I said I would, and he responded that they would love for me to come along.”</p> <p>&nbsp;</p> <p>However, the next couple of days, Bar found himself tormented with the question of whether Gilbert really wanted him to join them or whether he was just being polite. Had he misread the situation? Had he barged in on their BFF gathering?</p> <p>&nbsp;</p> <p>Most of us have felt conflicted in a similar way, when we have tried to second-guess someone else’s thoughts to discern what was going through their mind. This is called Theory of Mind—our continuous attempt at deriving others’ intentions, emotions and beliefs. It is one of the activities our minds are constantly engaged in, which is the core premise of Mindwandering. It posits that certain regions of our brain, collectively called the ‘Default Mode Network’, are constantly involved in activities like daydreaming, worrying about the future and self-chatter. When these activities divert our attention from the present, they can cause anxiety and depression. However, in his book, Bar shows us how we can channel this chatter to bring happiness, boost creativity, increase focus and solve problems.</p> <p>&nbsp;</p> <p>“As I contemplated all our findings about the brain’s default network and mindwandering, I came to what, for me, has been a groundbreaking realisation,” says Bar. “We don’t want to just clamp down on all mindwandering, which is just as well because that is virtually impossible. What we want to do instead is become more aware of when and how our minds are wandering. Then we can become more effective at directing that activity voluntarily as much as possible, so we can buckle down and focus on tasks or, alternatively, let ourselves be truly, deeply immersed in the experience of the moment. At other times, when we want to stimulate our creativity, as well as our mood, we will do best to free our minds to indulge in a good broad-ranging stroll. We want, in short, to work towards bringing the right mind to the right time.”</p> <p>&nbsp;</p> <p>Bar’s interest in the brain was triggered while studying electrical engineering to fulfil his father’s ambition for his life. “I had quickly learned that I had absolutely no interest in chip design and that the only area of research in the field that captivated me was computer vision,” he says. It was while researching how to make computers mimic the way the human brain recognises images that Bar realised how little we knew about the functioning of the brain. With the zeal of youth, he told his professor how outrageous this was. His professor responded that he would soon come to appreciate how complex the workings of the brain were. He soon did.</p> <p>&nbsp;</p> <p>“Sadly, it is still largely true that we have no hard knowledge of how the brain recognises images, only some intriguing theories with preliminary support,” he says.</p> <p>&nbsp;</p> <p>When he was working extensively in the cognitive psychology lab of a pioneer in brain studies, an exciting new development took place in neuroscience, which he began to pursue: the invention of fMRI (functional magnetic resonance imaging). While MRI had been around for a few decades, the functional aspect of it was a breakthrough that neuroscientists had been waiting for. By measuring blood flow, fMRI allowed them to infer where and when brain activity took place.</p> <p>&nbsp;</p> <p>“This was a moment of extraordinary adventure; we were roaming around inside the pathways of the mind like hikers in the woods at night with flashlights,” says Bar.</p> <p>&nbsp;</p> <p>Excited by the explosion of research, he went to Harvard Medical School to examine the human brain and mind “in earnest and with insatiable passion”.</p> <p>&nbsp;</p> <p>Afterwards, he moved back to Israel, where he currently lives with his wife and three children. Until recently, he headed the Gonda Multidisciplinary Brain Research Centre at Bar-Ilan University. Beyond research, teaching and writing, he has also founded a startup to fight depression and anxiety through games.</p> <p>&nbsp;</p> <p>In the book, there are chapters on connecting with our thoughts, learning from imagined experiences, how to practise immersed living and the benefits of meditation. The last section is a practical one, in which Bar explains how one can implement the research, theories and ideas expounded in the book. For example, he says that if we are aware of our state of mind, it is easier to manipulate it. When we are in a happy mood, it is hard to sit still, and thus it is best to avoid boring chores then. This is also when we tend to take riskier decisions. But this state of mind is best for coming up with a nonconventional solution for a problem. “When I am in a broad and open state of mind, I allow myself to stay upbeat and seek out some exploratory activity to take advantage of that mood, or I let my mind wander in the hope of coming up with some good new ideas to pursue in my work,” says Bar. If you want to explore the treasures hidden in the human brain, it might be a good idea to start with picking Bar’s brain through his book.</p> <p>&nbsp;</p> <p><b>Mindwandering: How It Can Improve Your Mood and Boost Your Creativity</b></p> <p><i>By</i> <b>Moshe Bar</b></p> <p><i>Published by</i> <b>Bloomsbury</b></p> <p><i>Price</i> <b>Rs599;</b> <i>pages</i> <b>253</b></p> Sun May 01 11:39:22 IST 2022 help-children-cope-with-pandemic-by-setting-predictable-routines-dr-alok-kulkarni <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Rohit was a chirpy 26-year-old software professional who loved hanging out with his buddies on weekends. He would plan an outdoor biking trip to one of the many beaches on the coastline of Karnataka. But things took a drastic turn for the worse with the outbreak of the pandemic; Rohit’s weekend escapades came to a halt, and he could now socialise with his friends only virtually. The warmth and tenderness of a physical meeting was now being missed. Rohit’s youthful restlessness and zest for life had to cope with an unprecedented challenge. It was not long before he slipped into clinical depression, and was referred to have a chat with me.</p> <p>&nbsp;</p> <p>Covid-19 has thrown a bevy of complex variables before us. Among these, uncertainty, social isolation, and disrupted routines have had an impact on the mental health of children and adolescents alike. Children have understandable worries related to the consequences of Covid-19. Many are wondering if they will ever be able to freely play with their friends as during the pre-Covid times. Parents are not equipped to calm their children’s anxieties as they themselves are battling numerous uncertainties.</p> <p>&nbsp;</p> <p>At this critical juncture, one can barely hope to plan for the future as everything is on hold. The challenges facing parents may interfere with their usual ability to address their children’s emotional needs. The United Nations Children’s Fund (UNICEF) recently conducted a poll to assess the impact of Covid-19 on the mental health of adolescents and young people in Latin America and the Caribbean. It assessed 8,500 adolescents and young people between the ages of 13 and 29 in nine countries and territories. The report gave an account of the feelings children and adolescents faced in the first months of the response to the pandemic. Among the respondents, 27 per cent reported feeling anxious, and 15 per cent reported feeling depressed in the last seven days before the poll was conducted. Interestingly, for 30 per cent respondents the main reason that influenced their current emotional state was the economic situation. A significant proportion (46 per cent) of the respondents reported a perceptible lack of motivation to do tasks which they previously enjoyed. Their perception of the future has also been negatively affected, particularly in the case of young women.</p> <p>&nbsp;</p> <p>In India, schools have remained shut for the entire academic year. Classes are being conducted virtually. This has presented a new set of challenges to both the teaching and student community. Teachers have had to adapt to newer technologies, and students have had to adjust to attending classes from home. Online classes have provided children and adolescents an opportunity for increased internet usage. Students tend to remain glued to their screens long after the classes are over. Alarmingly, frequent and unsupervised internet use is associated with self-harm and suicidal behaviour in adolescents with psychological risk factors. I have had ophthalmology colleagues complain that cases of myopia, dry eyes and computer vision syndrome are increasingly coming to their attention.</p> <p>&nbsp;</p> <p>I ventured to ask my house-help how her children were coping during the pandemic. Her answer disturbed me a great deal. “My elder son does not want to go back to school. He wants to start working. He is barely fifteen. His father and I are doing everything possible to give him an opportunity to educate himself—something that we were denied. This virus has shattered our dreams,” remarked Shobha, who has been with us for the past 12 years.</p> <p>&nbsp;</p> <p>Disturbingly, many adolescents have had to deal with the demise of a family member. This itself can spark a range of psychopathology in the longer run. Shalini, a 21-year-old medical student, has had to process the demise of her aunt. Her aunt came down with fever followed by breathlessness. She was immediately shifted to the ICU of a well-known hospital. The very next day she was declared dead. “The randomness and acuteness of the situation is what scares me,” said Shalini during one of the counselling sessions.</p> <p>&nbsp;</p> <p>I have always been a great believer in the fortitude and resilience of people in the face of a crisis. Children and adolescents have shown remarkable maturity in coping with the ongoing crisis. One of the ways in which we can help our children to cope with this randomness is by setting predictable routines. Structuring their day will enable them to cope better with uncertainty. This is also a great time to pick up new hobbies and skills. Reading is one useful pastime that can be incorporated now more than ever before. It is advisable to indulge in reading physical books which will enable us to switch off from online spaces. Children are filled with boundless energy and enthusiasm. We will have to resort to finding creative ways to channelise this youthful energy productively. Combined workout sessions can be organised at home. This will also provide an opportunity for the parents to bond better with their children. Yoga and aerobic exercises have a calming effect on the mind. I have also been encouraging adolescents to dedicate 15 minutes a day doing nothing. In these 15 minutes, I have been asking them to contemplate as to what they would do once this pandemic settles down. I have had adolescents come to me and say that those 15 minutes have renewed their hope that things will eventually fall into place. It is also vital that children and adolescents seek professional mental health support during this crisis. A great deal of stigma is attached to seeking help to mental health in our country, and it is our responsibility to ensure that every individual has access to good quality mental health care.</p> <p>&nbsp;</p> <p><b>The author is senior consultant psychiatrist at Manas Institute of Mental Health in Hubli, Karnataka.</b></p> Sun May 01 11:36:50 IST 2022 covid-like-tb-may-keep-coming <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p><b>DR FAHEEM YOUNUS,</b> chief of infectious diseases at the Maryland University, is on a mission to combat disinformation. In an exclusive interview, Younus expresses his concerns on how the pandemic could widen the gap between the haves and the have-nots. Excerpts:</p> <p>&nbsp;</p> <p><i><b>Tell us about the Covid situation in the US.</b></i></p> <p>&nbsp;</p> <p>I think in 2020 we handled it poorly. In 2021, we handled it better. Now it’s a combination. We are handling it better as well as the virus is receding. So everything is going in our favour, which means we have vaccines, we have all the therapeutics. The government is mailing rapid tests to people at home, which is a huge step forward. As the winter months and holiday season is ending, people are not congregating as much and the Omicron surge has really plummeted about 90 per cent in most states in the country. So we are in a much better shape.</p> <p>&nbsp;</p> <p><i><b>How do you deal with misinformation?</b></i></p> <p>&nbsp;</p> <p>That is the most purposeful work I’ve done in my career—to go out of the frontline, take abuse even where people felt they could not rationally discuss an issue. But I think good information saves lives.</p> <p>&nbsp;</p> <p>So how I do it? Multiple ways. You’ve to look again. Everybody has his own fears. You’ve to understand where they are coming from. You’ve to start with the position of empathy.</p> <p>&nbsp;</p> <p>There is a huge history in America of African Americans being marginalised and not treated fairly when it came to medical research. So their distrust is rooted in history. When I talk to the African American communities, I link them with one of the inventors of the Moderna vaccine who is an African American physician. And I make them realise it’s one of their own daughters who is on the front lines of developing this vaccine.</p> <p>&nbsp;</p> <p>I give them data. Look, this vaccine allergy has no close reactivity with food allergy. So the point I’m making is we can’t broad-brush everyone. Not everyone is a conspiracy theorist. Some people have valid reasons and you engage with them on those valid subjects.</p> <p>&nbsp;</p> <p><i><b>How dangerous is the BA.2 variant?</b></i></p> <p>&nbsp;</p> <p>I don’t think it is wise to say that it is more dangerous than BA.1 or Omicron. Because, as of today, we know that it spreads fast. What we don’t know is whether it’s going to evade vaccine-based-immunity any more than Omicron. I don’t think there is any evidence. And is it going to cause significant number of reinfections in people who have recovered from Delta or Omicron? I don’t think there is any evidence for that either. Rare cases will happen, of course.</p> <p>&nbsp;</p> <p>So I feel the jury is still out and the numbers are telling me that it is most likely not going to be as different as BA.1 and Omicron.</p> <p>&nbsp;</p> <p><i><b>Have we reached the endemic stage?</b></i></p> <p>&nbsp;</p> <p>Some places, yes. Some place, no. Endemic is not a sign of victory. When we say it’s endemic we are actually saying we’re unable to kill you. So let’s shake hands.</p> <p>&nbsp;</p> <p>That’s what we are saying. Because ideally small pox or polio are not endemic. They have been eradicated. That’s victory. Endemic is like influenza. We accept it’s going to come every year and kill 20,000-30,000 Americans. I don’t know what that number is in India.</p> <p>&nbsp;</p> <p>If another variant comes, it can be devastating.</p> <p>&nbsp;</p> <p><i><b>What are your biggest concerns about Covid 19?</b></i></p> <p>&nbsp;</p> <p>Generally I’m an optimistic person. I don’t usually think of fears as much. One of the fears I have is that Covid may keep coming [back] like Tuberculosis (TB). Which means a disease that still kills over a million people every year but it’s largely forgotten because those people are dying in poor countries. And the rich countries continue to gain more control over the virus and more options to keep their economies open. I fear that the world may move on while it is still a huge problem for some .</p> <p>&nbsp;</p> <p><i><b>What lessons did you learn during the pandemic? How did you deal with the virus?</b></i></p> <p>&nbsp;</p> <p>We learnt a lot. I think this pandemic has been a humbling experience. First of all we learnt that none of us can win this war by ourselves. We are all interdependent.</p> <p>&nbsp;</p> <p>The vaccination would have taken 10-15 years without that massive funding that sped up things. That sort of process cannot be accomplished in a fast amount of time unless regulatory bodies speed up things and give us quick, appropriate and safe approvals, and get rid of bureaucracy.</p> <p>&nbsp;</p> <p>We cannot project this pandemic just because of basic research or frontline clinicians. We need mathematicians, statisticians and modellers who can project where this pandemic is going in six or twelve months. We cannot decide whether to keep an economy open or shut because now we need economists who can look at the big picture and say what are the risks and benefits—these are the risks of the virus and these are the risks of shutting down an economy and so on and so forth.</p> <p>&nbsp;</p> <p><i><b>How much do we know about long Covid?</b></i></p> <p>&nbsp;</p> <p>Not much. Even though we feel we have hundreds of studies on this subject, we still don’t have a unified definition of long Covid. We don’t have any specific lab tests. Like if this test is positive, you’ve long Covid. It’s all based on history and symptoms. And they vary from one study to another. So it’s very difficult to make comparison. There are about 200 symptoms out there. If you said you have any of those symptoms after weeks of recovering from Covid, then you’ll be considered long Covid. It’s sort of extremely vague. That’s not to say it doesn’t exist. It’s absolutely real. It happens with other viral infections as well. A subset of patients will have long term side effects.</p> <p>&nbsp;</p> <p>What should we do? People who are currently suffering from it should probably go to a specialised centre. Not everyone can handle those cases. Wherever you’ve a specialised centre, there is more experience and they can get empathetic, timely care. If nothing else, symptom management. But at the same time we need prospective double blind studies with sharp, specific definitions and criteria. And only then we’ll know.</p> <p>&nbsp;</p> <p><i><b>Some people seem immune to Covid. How do you explain this?</b></i></p> <p>&nbsp;</p> <p>It’s hard to say. I don’t think we can say some people never get Covid. We are not doing mass sero testing. We can only say that when everybody was getting tested.</p> <p>&nbsp;</p> <p>About 30 per cent of people will have no symptoms, remain asymptomatic or have very mild symptoms. So, it is possible that some people are getting milder disease than others.</p> <p>&nbsp;</p> <p>At the same time, there are genetic determinants. I’ve had HIV patients for 20 years who have had no treatment and they are not getting worse. So it’s known even with other viruses. But I think at this stage we know that there are genetic determinants. But unless we do large sero studies, we’ll never know if some people are truly immune against this virus.</p> <p>&nbsp;</p> <p><i><b>Some experts believe that mRNA vaccines are superior to DNA vaccines. What’s your take?</b></i></p> <p>&nbsp;</p> <p>It is hard to say because I have not seen any head to head trials between the two. The reason we keep talking about mRNA vaccines are: one, they were the first to come out on a mass scale with FDA approval. Two, over a billion people have received them by now. So we know that they are widely used. Three, we have a lot of sub-group analysis published on mRNA which we don’t have on DNA vaccines yet.</p> <p>&nbsp;</p> <p>We know the mRNA vaccines and their effect on health care providers. We’ve studies on pregnant ladies, we’ve studies on fertility, we’ve studies on lactation, on immunocompromised people. So mRNA vaccines and their sub-group analysis and the published data is so much now. There is a higher comfort level. There is more safety data published.</p> <p>&nbsp;</p> <p>With DNA vaccines as more and more data gets published, it will be in a better position.</p> <p>&nbsp;</p> <p><i><b>Do vaccines provide better immunity than actual infections?</b></i></p> <p>&nbsp;</p> <p>When I get a natural infection, I may inhale a thousand viral particles or I may inhale a million viral particles. You don’t know. The degree of exposure is not in my control. It’s going to happen randomly, accidentally.</p> <p>&nbsp;</p> <p>Whether I’m wearing a mask, whether the other person is wearing a mask—all of those are going to determine the amount of virus I’m inhaling. As a result, I may get a different level of immunity. With the vaccine you are getting the exact same dose that has been given to thousands of people in clinical trials that has been measured. So there is a measurable response. The action reaction is more measured. So you can feel like I’ll get reliable protection because it has been tested. So there’s more predictability with that. And then there are follow up studies. You are getting immunity with natural infection but it’s hard to measure. Therefore, I think you are sort of flying blind.</p> <p>&nbsp;</p> <p><i><b>How do you assess India’s response to the pandemic?</b></i></p> <p>&nbsp;</p> <p>I think people living in India are a better judge of that. From the distance I can see that, like the US, India also struggled in the beginning. The first wave hit it really bad. But I’m very pleased to see many nations, including India, ramping up their vaccinations.</p> <p>&nbsp;</p> <p>Disinformation is going down a little bit. Overall, I think most countries are catching up.</p> Sun May 01 11:38:11 IST 2022 low-chance-of-fourth-wave-in-india-says-expert <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>India witnessed a sharp rise in active Covid-19 infections in April—close to 2,500 cases were recorded in 24 hours. Delhi alone recorded 501 fresh cases in a day, taking the daily positivity rate from 4.42 per cent to 7.72 per cent. Haryana, too, reported close to 250 cases, of which around 200 were from Gurugram.</p> <p>&nbsp;</p> <p>The governments of both Haryana and Uttar Pradesh have brought back the mandate of masking and following Covid-appropriate behaviour, less than a month after the country was opened up post the third wave. What does this mean for India? Should we brace ourselves for another wave?</p> <p>&nbsp;</p> <p>Professor Manindra Agrawal is in-charge of the IIT Kanpur-CII Risk Surveillance Centre—a collaboration between the IIT and the Confederation of Indian Industry, to monitor infectious diseases. Agrawal, who developed the Sutra mathematical model (to predict the trajectory of a pandemic), shares his thoughts on the situation. Excerpts:</p> <p>&nbsp;</p> <p><b>Cases have risen and masking has returned as a mandatory measure in some places. What does this mean? Is there a fourth wave coming?</b></p> <p>&nbsp;</p> <p>Very unlikely. The reason is that there is little evidence of any new mutants so far and the old mutants or variants have already run through our population. So, it does not look like these can cause any waves now.</p> <p>&nbsp;</p> <p><b>But there remains the possibility a new variant.</b></p> <p>&nbsp;</p> <p>Yes. But so far, there is not much evidence of any such mutant. As per reports, the XE variant, which is a recombinant variant of Omicron’s sub lineages BA.1 and BA.2, has not been detected so far.</p> <p>&nbsp;</p> <p><b>Is that because of a lack of sufficient monitoring of new genomic variations?</b></p> <p>&nbsp;</p> <p>That is quite possible. We cannot rule it out. That is the only reason why the possibility of a fourth wave exists.</p> <p>&nbsp;</p> <p><b>Why do you think we are not doing it aggressively?</b></p> <p>&nbsp;</p> <p>I suppose it is expensive. A single genome testing costs several thousand rupees. Also, our capacity for genomic testing is limited. We do not have that many labs. It is just 38. So large-scale genomic testing is not feasible.</p> <p>&nbsp;</p> <p><b>Can the acquired immunity wane, leading to infection among those who are vaccinated or were already infected?</b></p> <p>&nbsp;</p> <p>Yes. But when you look at the overall percentage of people among whom the immunity has waned, and here I am talking about immunity acquired by previous infections, it does not seem to be more than 10 per cent. The other 90 percent will remain immune.</p> <p>&nbsp;</p> <p><b>As per reports, the B.1.617 variant (Deltacron XE) was first sequenced in October 2020, but it went largely unnoticed.</b></p> <p>&nbsp;</p> <p>The way these viruses mutate is a mysterious phenomenon. What is certainly known is that a large number of variants get created. Most of them die out and only a few survive who have a higher potential. Genome sequencing or any other mechanism is always a delayed observation. Because when a new variant gets created, for a significant time the number of such mutants in the overall population will remain small and it will take time to spread. So genome sequencing is unlikely to catch it. For example, in South Africa, the first observation of Omicron was in November 2021. But it is likely that Omicron may have been created a year before that. So the variants may be present long before they are found.</p> <p>&nbsp;</p> <p><b>Tell us about your own mathematical model.</b></p> <p>&nbsp;</p> <p>I have been saying consistently that there is a low chance of a fourth wave in India. The model—Sutra—computes the trajectory of the pandemic by estimating certain parameter values. These parameter values tell us how the pandemic has been spreading in the country. Right from September-October last year, the pandemic had spread all over the country, more or less, as per our model. The immunity level had crossed 75 per cent. After the Omicron wave, it crossed 90 per cent. The immunity I am talking about here is not vaccine immunity, but natural immunity.</p> <p>&nbsp;</p> <p>We applied the model to 40 other countries and observed the trajectory of the Omicron wave. What became clearly is that in the countries where natural immunity was high, the impact of the Omicron wave was low. In the countries where natural immunity was low, Omicron was serious. And this is independent of how much vaccination happened in that country. So what that tells us is that maximum immunity has protected well against Omicron and we believe that this will continue against any other variant in the future. So with India showing a natural immunity of over 90 per cent, the chances of a fourth wave are not high.</p> <p>&nbsp;</p> <p>What we are seeing today is only a ripple. And this ripple is bound to come any time when you remove restrictions. So the current rise in numbers may well be because of that. This will subside after some time.</p> <p>&nbsp;</p> <p><b>India is giving the same vaccines as booster or precautionary doses. Should we not find out which vaccine would work best as booster?</b></p> <p>&nbsp;</p> <p>Personally, I do not think that booster is of any use. May be in those who are immunocompromised. In the rest of us, it is important to remember that the vaccine does not protect against the infection, but against serious infection. So it is not clear why most of us need the booster dose at all. It is more psychological than anything else.</p> Sun May 01 11:36:04 IST 2022 hidden-darkness <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Which is the most dangerous personality type? Which group is more dangerous than psychopaths? Some psychologists say that it is the “dark empaths”.</p> <p>&nbsp;</p> <p>Traditionally, people with “dark” traits—psychopathy, Machiavellianism and narcissism—were considered the most dangerous. Psychopathy is a personality disorder characterised by an inclination to violence and a lack of remorse. Machiavellianism—a trait named after Italian philosopher Nicolo Machiavelli, who advocated using deceit and treachery to pursue and maintain power—refers to an exploitative and manipulative nature. Narcissism is extreme self-involvement to the degree that it makes a person ignore the situation or needs of people around him. These three traits are collectively called the “dark triad”. Until recently, those with these dark traits were considered unempathetic.</p> <p>&nbsp;</p> <p>However, a recent study challenges this idea.</p> <p>&nbsp;</p> <p>Published in Personality and Individual Differences, the study identified a group of individuals with dominant dark traits, but with above-average empathetic capacities. The researchers named them the “dark empaths”.</p> <p>&nbsp;</p> <p>As part of the study, researchers used a method called latent profile analysis to establish clusters of people with different personality trait combinations. They found four major categories: a traditional dark triad group with low empathy scores; a group of “typical ones” who had exhibited lower to average scores across all traits; a group of “empaths” with low dark traits and high empathy; and a group of “dark empaths” with higher scores in both dark traits and empathy.</p> <p>&nbsp;</p> <p>Psychologists consider that there are two primary forms of empathy: cognitive empathy and emotional empathy. Cognitive empathy refers to the ability to understand another person’s mental state while affective empathy is the ability to respond with an appropriate emotion to another person's mental state. The researchers found that the dark empaths scored higher scores on both types of empathy than the “dark triad” group and “typical" group.</p> <p>&nbsp;</p> <p>It was also observed that the dark empaths were not as aggressive as the traditional dark triad group, but they scored high scores in indirect aggression—hurting or manipulating people through social exclusion, malicious humour and guilt induction. Another interesting observation was that dark empaths were more extroverted than the other groups—they had shown a high tendency to be sociable and active.</p> <p>&nbsp;</p> <p>Since the study was published, the “dark empaths” group has been termed by many as the most dangerous personality profile—in fact, more dangerous than the traditional “dark triad” group. What makes this personality profile dangerous? The study authors say that dark empaths have the capacity to be ruthless and callous, but, with their empathy and social skills, they can easily hide their traits.</p> Fri Apr 29 18:41:19 IST 2022 ukraine-multi-front-war <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Ukraine is at war—not just with its neighbour, but also with infectious diseases. The country has been facing troubles in controlling Covid-19. In the last two years, Ukraine reported more than 50 lakh cases and 1.12 lakh deaths because of Covid-19. On February 12, just 12 days before the start of the war, Ukraine had 42,967 new cases. According to Johns Hopkins University, only 35 per cent of the Ukrainian population is vaccinated against Covid-19. With the Russian invasion of the country raging for three weeks and more, prospects for health care are now bleak for Ukrainians.</p> <p>&nbsp;</p> <p>Before the war, Ukraine had around 1,50,000 doctors, 1,630 hospitals, and 10,000 or so primary care facilities. However, several medical facilities have become non-operational since Russia started the military action. According to the WHO’s surveillance system for attacks on health care, Russians made 43 attacks on health care institutions, ambulances or personnel.</p> <p>&nbsp;</p> <p>Access to primary care has been severely curtailed in Ukraine. It is estimated that more than 60 lakh Ukrainians require humanitarian assistance; more than 20 lakh have fled the country. The conditions in vehicles transporting people to the border are conducive to the spread of Covid-19 and other pathogenic diseases. A lot of Ukrainians have been forced to take shelter in bunkers and underground metro stations, with limited access to clean water, sanitation, and ventilation. All these are acute conditions that would increase the risk for the spread of Covid-19.</p> <p>&nbsp;</p> <p>Health experts warn that the country may soon face a polio outbreak also if the conflict continues for too long. On March 1, WHO pointed out that routine immunisation and outbreak control efforts for polio have been suspended in Ukraine. This is worrying as last October Ukraine reported a polio case—a 17-month-old paralysed child—19 years after Europe was declared polio-free. Another polio-paralysed case was reported in January. Subsequently, the country identified 19 more children with a vaccine-derived form of poliovirus (but without symptoms). Ukraine started a nationwide polio immunisation programme on February 1. But it has been halted since the Russian forces invaded the country. Surveillance to detect and report new cases of polio is also disrupted.</p> <p>&nbsp;</p> <p>Medical experts point out that there is a risk for a measles outbreak as well among Ukrainians. The country had seen many outbreaks in the past. In 2019, Ukraine reported 57,000 measles cases. Tuberculosis is also a major health issue in Ukraine. It is among the 27 high multidrug-resistant tuberculosis (MDR-TB) burden countries. More than 32,000 people develop TB each year in the country, and about 33 per cent of all new TB cases are drug-resistant. Another shocking data is that around 22 per cent of Ukrainians with TB are infected with HIV also—TB is the leading cause of death among Ukraine’s HIV patients. The country has over 2.5 lakh HIV patients—the second-highest in Europe. The United Nations agency for HIV/AIDS had recently noted that Ukraine’s stock of drugs for HIV patients might not last for more than a month. Even if the Russian aggression ends, Ukraine will have a major fight to continue—to avoid severe public health crises.</p> Wed Mar 23 15:16:49 IST 2022 a-long-shadow <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Vrinda Arora, 29, from Bengaluru loved to eat raw vegetables. “I would even eat raw onion and capsicum,” said Arora, a sales professional in an IT company. Life has not been the same for Arora after she recovered from Covid-19. She has had persistent symptoms, from headache and fatigue to loss of taste. “I can’t taste food like I used to,” said Arora who got Covid-19 in April 2021, “I used to love onion, capsicum, ginger and garlic but now they give me a foul smell and I have stopped having them. I prefer junk food now.”</p> <p>&nbsp;</p> <p>Long Covid is absolutely real, said Dr Faheem Younus, chief of infectious diseases at the University of Maryland. “It happens with other viral infections as well. A subset of patients will have long-term side effects. That’s well known.”</p> <p>&nbsp;</p> <p>However, there is no clarity on how long it takes to completely recover from Covid-19. “Even though we feel we’ve hundreds of studies on this subject, we still don’t have a unified definition of long Covid. We don’t have any specific lab tests. It’s all based on history, symptoms. And they vary from one study to another,” said Younus.</p> <p>&nbsp;</p> <p>A study by researchers at the University of Michigan showed that more than 100 million Covid survivors worldwide have had long Covid. It could take a toll on vital organs like the brain, heart, lungs and kidney. Symptoms of long Covid could range from fatigue, aches and pains, to brain fog, and sleep problems that linger months after recovery.</p> <p>&nbsp;</p> <p>Long Covid, however, is yet to be recognised as a legitimate disease. Does it mean it is all in the head? Dr Sushila Kataria, senior director, internal medicine, Medanta, Gurugram, begs to differ. “People definitely have long Covid or post-Covid problems. They have problems like lethargy, sleep disturbances, anxiety, palpitations, hearing loss, problems related to smell, concentration, muscle pain, tiredness, and mild breathlessness.”</p> <p>&nbsp;</p> <p>Brain fog, in fact, is one of the most commonly reported persistent symptoms in patients after recovering from Covid-19. The person may have difficulty with everyday tasks because of impaired cognitive functioning. “Typical fog complaints people describe are memory loss, trouble finding words, problems with attention, and being overwhelmed by simple tasks,’’ said Dr Sagar Mundada, a consultant psychiatrist at Healthspring, Mumbai. “A lot of these patients have not had stroke or infection of the brain, no seizures or anything that was neurologically obvious during their infection.”</p> <p>&nbsp;</p> <p>Dr H. Sudarshan Ballal, nephrologist and chairman of Manipal Hospitals, Bengaluru, tells his patients that Covid-19 is not a simple acute viral illness. It is important to get yourself tested for signs and symptoms of long Covid including kidney disease, he said. “As far as kidneys are concerned, during an acute infection of Covid, especially in the sicker patients, there may be acute kidney injuries due to multiple reasons like a direct impact on the cells of the kidney, inflammatory syndrome associated with Covid damaging the kidney, coagulation effects seen in Covid, secondary causes like sepsis medications and hypoxaemia associated with Covid,” said Ballal.</p> <p>&nbsp;</p> <p>Usha Gulati’s road to recovery has been long. The 65-year-old suffered from Covid-19 in April 2021 and developed acute respiratory distress syndrome (ARDS). She had persistent symptoms even two months after getting infected and was admitted to Apollo Hospitals in Delhi. “Her oxygen requirement was very high and it wasn’t coming down. Most patients get better within three to four months but Gulati didn’t. Her family refused the transplant and the best thing we could do for her was to prevent her from getting any kind of secondary infections like a bacterial infection or tuberculosis,” said Dr Viny Kantroo, consultant, respiratory, critical care and sleep sciences at Indraprastha Apollo Hospital.</p> <p>&nbsp;</p> <p>Being in the hospital for six months, Gulati was homesick. Her husband, meanwhile, succumbed to Covid-19. Gulati was sent home. She required 10 to 15 litres of oxygen per minute. With regular physiotherapy, Gulati’s oxygen requirement started coming down. “It has been a year since she has been on oxygen. She is getting better,’’ said Kantroo.</p> <p>&nbsp;</p> <p>I would discourage people from doing blanket investigations, said Kataria. “We don’t want people to be pushed into investigations. Unlike the Delta wave, in the Omicron wave, the patients who have residual effects are fewer. And these effects are not per se related to any biological abnormalities in the blood investigations. Routine screening tests like complete blood count (CBC), lactate dehydrogenase (LDH) and high-resolution computed tomography (HRCT) are not recommended.” Kataria prefers a follow up with the primary care physicians to be sought if the symptoms persist even a month after recovering from Covid-19.</p> <p>&nbsp;</p> <p>Apollo Hospitals had launched its post-Covid clinics equipped with neurologists and immunologists in October 2020. Dr Sudarshan S., the consultant physician at Medall Healthcare, Chennai, felt primary care centres should also run ‘Covid Recovery Clinics’.</p> <p>&nbsp;</p> <p>Dr Pritha Nayaar, a respiratory specialist at Asian Hospital, Faridabad, prescribes tests like ECG, echo and computed tomography (CT) pulmonary and angiography for people who develop chest pain, shortness of breath or blood-tinged sputum to rule out myocarditis, myocardial infarction and pulmonary problems. “People with persistent fever should check for fungal infection and those with persistent body ache should get their electrolytes, Vitamin-D and calcium levels checked,” said Nayaar.</p> <p>&nbsp;</p> <p>Cognitive training is an established method to improve cognitive functions in individuals with neurological and psychiatric conditions, said Keshav Kumar, professor, department of clinical psychology, National Institute of Mental Health and Neurosciences, Bengaluru. “The cognitive retraining includes both in-person programmes using paper and pencil format as well as the online programme via cognitive apps," he said.</p> <p>&nbsp;</p> <p>NIMHANS' neuropsychology unit has been developing comprehensive cognitive training programmes for the clinical population for over three decades targeting specific brain circuitry and cognitive domains.</p> <p>&nbsp;</p> <p>‘Rewire’, an Indian commercial app available on Google play store, can also be used to improve cognitive function and mental health outcomes in people with long Covid.</p> <p>&nbsp;</p> <p>Arora does 40 minutes of yoga every day and goes for regular walks. It helps her manage long Covid symptoms to a certain extent. “I make sure I step out and take a walk once a day,” she said.</p> Wed Mar 23 12:04:47 IST 2022 some-people-have-the-ability-to-resist-infection <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Ever wondered why some people never get Covid-19? “In every disease, there is a group of people who don’t get it,” said Dr Shiv Pillai, professor of medicine and health sciences and technology at Harvard Medical School. An India-born immunologist and geneticist, Pillai said our immune systems are designed to be a little diverse. That diversity protects us as a species, he said.</p> <p>&nbsp;</p> <p>In an exclusive interview, Pillai discusses the aftermath of the pandemic among other things. Excerpts:</p> <p>&nbsp;</p> <p><i><b>How long do you think Omicron will hold sway?</b></i></p> <p>&nbsp;</p> <p>As long as I’m alive something like this will be around. We can only hope that it will become something like the common cold coronaviruses. We may come to a point where we have variants that are transmissible but are less pathogenic.</p> <p>&nbsp;</p> <p>The virus has no interest in killing anybody. The virus’s evolution is not directed towards killing. It is directed towards the entry. To survive, it has to evade our immunity to some extent. We can hope that evolution will take us to the point where it will still be transmissible but not that virulent.</p> <p>&nbsp;</p> <p>We are lucky in some sense that Omicron has changed so much. Its biology has changed a bit. That is not to say something worse cannot come. The reasonable hope is that these types of viruses like Omicron will dominate. It is hard to get rid of this virus.</p> <p>&nbsp;</p> <p><i><b>What are your biggest fears about Covid-19 right now?</b></i></p> <p>&nbsp;</p> <p>We fear that something like Delta can come back. Delta can be somewhere where there is no Omicron. It may hang around. But it still needs a human host to transmit it. The whole world is connected. So anything could happen.</p> <p>&nbsp;</p> <p>The general hope is that Omicron and its other variants are taking over. They will spike. They will decline. They will come back in unvaccinated populations in particular. Hopefully, it will be a little milder next time.</p> <p>&nbsp;</p> <p>Omicron does not give very good immunity against Delta. We are okay if it stays with something like Omicron.</p> <p>&nbsp;</p> <p><i><b>The WHO has issued a warning against the BA.2 sub-variant. How worried should we be?</b></i></p> <p>&nbsp;</p> <p>In India, it is mainly BA.2. which is somewhat different from BA.1. Not huge. Some differences. There may be biological differences. Denmark has had BA.2. The whole of South Asia has BA.2. It has been less virulent than the past variants. The peaks are coming down. But yes, let us not assume the virus will not cause severe disease, death, and infection. It will. But the vaccinated are better off. With vaccines, drugs, and so on, we can come to a decent equilibrium where we live with the virus and not be worried about it that much.</p> <p>&nbsp;</p> <p><i><b>What are the chances of further mutations and something more severe emerging out of Omicron?</b></i></p> <p>&nbsp;</p> <p>There is always a chance that it will happen. It is possible. It will use this form or change a bit so it can enter but maybe not go into the lung as much. That’s the hope.</p> <p>&nbsp;</p> <p><i><b>How confident can one be that we wouldn’t see another wave as we saw in the last few months?</b></i></p> <p>&nbsp;</p> <p>I think you can be confident that it will never be as major as the Delta wave in India. There could be a new virus that comes, not coronavirus. Maybe in ten years, it could happen.</p> <p>&nbsp;</p> <p>In India people got complacent. They were not looking at data. People were holding all sorts of things and declaring victory over coronavirus. We should have seen what was happening in South Africa or Brazil at that time. There was no reason to believe we are superhumans. There was this broad thinking that we have some trained immunity.</p> <p>&nbsp;</p> <p>If there is going to be a new and dangerous variant, the chances of infection are higher in South Africa, Brazil, and India. Why? In India, there are a lot of people with Tuberculosis (TB). People with TB and HIV are on the margins of society and are not looked after. When you are immunodeficient, the virus can start to mutate more. There should be monitoring in India, as everywhere in the world.</p> <p>&nbsp;</p> <p><i><b>People in the US live in a highly sanitised environment and yet it was the worst-hit country.</b></i></p> <p>&nbsp;</p> <p>Indeed, the US was badly hit. I’m not questioning that the US managed it badly. But I’ve no doubt the rates in India are much higher. In the US, everything has been accounted for. That is definitely not the case in India. If you look at deaths due to Covid-19 in India in a careful manner, you’ll understand it. In Brazil also, things were not fully accounted for. But that is not important. The US was not strong in its response.</p> <p>&nbsp;</p> <p><i><b>Why is Omicron affecting children more than the previous variants?</b></i></p> <p>&nbsp;</p> <p>Let me first say that there are two things here. First, Omicron is much more easily transmitted. In the past, children were somewhat protected. They stayed at home. They didn’t go out that much. And the virus was not easily transmitted as it is now.</p> <p>&nbsp;</p> <p>Now what has happened is that we have a highly transmitted virus that may not be so pathogenic. But the number of children getting infected has gone up dramatically. There is not strong enough data to say it is more pathogenic in children.</p> <p>&nbsp;</p> <p>I think a lot of it may be related to transmissibility being higher in Omicron. So, more children got infected. Especially those who were not vaccinated. Even now children under five are not vaccinated. So the chances of children getting infected are higher.</p> <p>&nbsp;</p> <p><i><b>Some people never get Covid-19. How would you explain this?</b></i></p> <p>&nbsp;</p> <p>In every disease, there is a group of people who don’t get it. Even in HIV, which was thought to be lethal. One of my colleagues here discovered this phenomenon called ‘Elite Control’. Some people get infected and they clear the virus. They don’t get the severe disease.</p> <p>&nbsp;</p> <p>For every disease, there is a range of pathologies. I can become a carrier of hepatitis and never get hepatitis, I just have that virus; or I can get acute hepatitis, chronic hepatitis, or cirrhosis. We are all genetically variable. We are not meant to be the same as far as our immune systems are concerned. That diversity exists to protect us as a species.</p> <p>&nbsp;</p> <p>If a species loses its diversity, it will become extinct. Take for instance, the cheetah. Its immune system is not diverse. Those animals are becoming extinct. They are not becoming extinct because somebody hunted them. They are becoming extinct because they can’t handle viruses. They get cancers from viruses and also viral infections.</p> <p>&nbsp;</p> <p>If you are in the same household and everyone has got infected and you looked after people, then we can say you have a genetic difference. Some people have the ability to resist infection. It is also possible that you were more careful.</p> <p>&nbsp;</p> <p><i><b>Why is it that vaccines can provide better immunity than actual infections?</b></i></p> <p>&nbsp;</p> <p>It is related to the work we did. The virus disrupts and incapacitates the better parts of our immune system.</p> <p>&nbsp;</p> <p>Vaccination gives a good response. The infection makes your response less broad. Less broad means you can’t handle new variants. That’s the reality. That’s why I tell everybody not to rely on your infection. Vaccination after infection makes you very strong. But if you are not vaccinated, you’ll always be at a disadvantage.</p> <p>&nbsp;</p> <p><i><b>How do you assess India’s response to the pandemic?</b></i></p> <p>&nbsp;</p> <p>Initially, we took it seriously. I was in India when the pandemic broke in March 2020. I took the last flight out of India. That was when the lockdown came. Maybe there could have been more planning about the lockdown. I’m not blaming anyone. But I think they let down their guard ten months later.</p> <p>&nbsp;</p> <p>Now they are serious. Vaccination has been a success in India. India has great drug companies and scientists. India has got great minds. You cannot get everybody to be vaccinated. Education is an issue. Those who wanted to get vaccinated have got vaccinated early. That is a success.</p> <p>&nbsp;</p> <p>The licensing of drugs is all worked out. The companies in India can make the right drugs. The physicians are well informed. India can do extremely well. Much better than the US.</p> <p>&nbsp;</p> <p>When I came to Delhi in March 2020, at least I was screened in the airport. People took it seriously. The country is big. It is difficult. All of that is true. You need a strong mindset that is pro-science.</p> <p>&nbsp;</p> <p><i><b>In some of your previous interviews, you’ve spoken about how mRNA vaccines are superior to DNA vaccines. Could you elaborate on that?</b></i></p> <p>&nbsp;</p> <p>I’m just going by the levels of antibodies. I’m not saying the other vaccines are not protecting. They are protecting.</p> <p>&nbsp;</p> <p>People have measured protection from infection. They have made some head-to-head comparisons between mRNA vaccines and some of the adenovirus vaccines or what you call the vector vaccines. The protection levels are better with mRNA vaccines. That’s definitely the case. If I had a choice, I’d go with mRNA vaccines.</p> <p>&nbsp;</p> <p>The way it is making the spike and giving you an immune response seems to be better. A paper from Stanford that came out a few days ago made a head-to-head comparison between vaccines. The levels of antibodies are better with mRNA vaccines. There is no question about it. Overall, the results on protection are better for mRNA vaccines.</p> <p>&nbsp;</p> <p><i><b>Do you think gargling or steam inhalation helps in preventing Covid 19?</b></i></p> <p>&nbsp;</p> <p>No. I know in India somebody is trying to sell you nasal drops. Of course, they’ll protect you for a few minutes. But then it’s going to disappear. It’s not going to be there forever, unless you keep putting drops in your nose every two minutes. I don’t think we’ll be protected.</p> <p>&nbsp;</p> <p><i><b>Has India reached the endemic stage?</b></i></p> <p>&nbsp;</p> <p>No. It will reach. I think the whole world is reaching an endemic stage. We’ll get there maybe in a few weeks or so. I can’t officially call something endemic when the peak is still coming down.</p> <p>&nbsp;</p> <p><i><b>Tennis player Novak Djokovic said he’d rather miss tournaments than be forced to get vaccinated.</b></i></p> <p>&nbsp;</p> <p>Everyone is free to have their own opinions. I consider him to be not well educated on certain matters. I’m not well educated on other matters. You ask me about Serbian history, I’ll be terrible.</p> <p>&nbsp;</p> <p>There are a lot of people who are poorly educated and they assume because they are good at one thing, they know everything. I think you should have some humility about what you know and what you don’t know. On this issue, he has zero credibility. I love his tennis. I’m a great fan. I think he’s a great comedian as well on the sets. But I don’t think he has got it right here.</p> <p>&nbsp;</p> <p><i><b>What did you miss the most during the pandemic?</b></i></p> <p>&nbsp;</p> <p>Going out to eat. Meeting friends. Going to a big party. Enjoying with our students. All those things. We’ve had batches of students whom we’ve seen only with masks or on screens. Students who come in and then they don’t have cohorts to mix with because everything was restricted at that time. Things are getting better.</p> <p>&nbsp;</p> <p>I miss coming home to India. I love India so much. I have not come for two years. I used to come twice a year.</p> Sun Mar 27 14:09:59 IST 2022 our-strength-is-our-staff <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>SNM is a district hospital, but for the people of Leh and thousands of migrants and tourists, it is a one-stop solution for most of their health concerns. Our strength is our staff braving challenges like the extreme weather and the pandemic.</p> <p>&nbsp;</p> <p>The shortage of staff continues to be an issue, though we hired some because of the Covid-19 emergency. We now need specialists to perform major surgeries so that patients do not have to travel to Srinagar or other places. We have three pathologists, but we need microbiologists.</p> <p>&nbsp;</p> <p>Despite the challenges, I feel proud that the hospital won the best Kayakalp award (a Central government cleanliness award) in Jammu and Kashmir in 2015-16 and 2018-19 for best performance in patient care hygiene and disposal of biomedical waste. It was an acknowledgement of our staff’s dedication.</p> <p>&nbsp;</p> <p>Our new RT-PCR lab is functional at Chushul [village] thanks to the efforts of the Union territory administration. The lab has equipment and trained staff, and can do 1,000 tests a day. The National Health Mission has also been very supportive. Under eSanjeevani, our doctors offer online consultations to patients at home. We also provide conveyance to the patients who are referred to Srinagar for specialised treatment.</p> <p>&nbsp;</p> <p>We are hopeful that the sanction to upgrade the hospital to 500 beds and build the first medical college in Ladakh will help resolve most of our problems. We are highly thankful to the Centre for addressing this need.</p> <p>&nbsp;</p> <p><b>As told to Tariq Bhat</b></p> <p>&nbsp;</p> <p><b>Angmo is medical superintendent, SNM Hospital</b></p> Wed Mar 23 11:50:11 IST 2022 attitude-at-high-altitude <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>To the outsider, Ladakh may seem one of the most inhospitable places on earth. It is 12,000 to 18,000 feet above sea level, low on oxygen, bitterly cold and desert-like most of the year. But work at the Sonam Norbu Memorial Hospital in Leh never freezes over. This government district hospital is the only medical centre in India that works at above 12,000 feet and in minus 25 degrees Celsius. It is named after the heroic engineer Sonam Norbu, whose work saved Ladakh from being captured by Pakistan in 1948.</p> <p>&nbsp;</p> <p>Born in Leh in 1909, Norbu graduated from the university of undivided Punjab and was at the peak of his engineering career when India and Pakistan were fighting over Jammu and Kashmir, and Ladakh, in 1947. By that December, Pakistan had taken over most of Gilgit-Baltistan and state forces were defending Leh in the biting cold. To assist them, Norbu crossed Zojila, the treacherous mountain pass that connects Ladakh with Kashmir, and built an airstrip for the Indian Army to land. It helped India thwart Pakistan.</p> <p>&nbsp;</p> <p>In 1961, Norbu was awarded the Padma Shri. Norbu's son Sonam Wangchuk told THE WEEK: “He was not a politician; he would not stoop to cheap tricks to win elections but he led by example and won the trust and devotion of all he came across.” He added. “His whole life was a saga of hard work... [and] his overriding interest was the betterment of Ladakh and Ladakhis.”</p> <p>&nbsp;</p> <p>Apart from the airstrip, Norbu also built a highway in Ladakh in his early years as an engineer; later, as Ladakh development commissioner, he undertook several projects and, in essence, became the architect of modern Ladakh.</p> <p>&nbsp;</p> <p>Recalled Wangchuk: “Sheikh Sahib's (Sheikh Abdullah) earnest desire for the equitable development of all three regions of the state saw him bring back my father, who at that time (1975) was India's ambassador to Mongolia, as the state's works and power minister; (the ministry) controlled 70 per cent of the state budget.”</p> <p>&nbsp;</p> <p>Norbu died in 1980, and the hospital was soon named after him.</p> <p>&nbsp;</p> <p>The 250-bed facility, with 40 doctors and 230 other staff, does not have advanced infrastructure, but has all the basic services. The outpatient department is in the main building, a two-storey rectangular structure that almost touches the base of a nearby hill. It is open seven days a week. Some wards and laboratories are outside the main building.</p> <p>&nbsp;</p> <p>Dr Chawng Phunsugh, a senior consultant, said the hospital does all general surgeries, and only procedures that require super-specialists are referred to the Sher-i-Kashmir Institute of Medical Sciences in Srinagar. In summer, affluent patients may go to Delhi or Chandigarh for treatment, but in winter, when Ladakh is shut from the outside world, they all depend entirely on Sonam Norbu Memorial. For the poor, some of them from remote areas like Zanskar and Transingla, it is the only hope. For them, there are free medical camps that super-specialists from All India Institute of Medical Sciences organise at the hospital with the support of charities like the Ashoka Mission in Delhi. During one such camp in 2018, AIIMS doctors flew in 500kg of medical equipment and performed 27 surgeries. Last September, the Centre sanctioned the first medical college and a paramedical college for Ladakh.</p> <p>&nbsp;</p> <p>The hospital generally receives a lot of cases of hypertension, acidity and joint pain, but its doctors have also conducted major procedures related to neuro-trauma, spinal tuberculosis, and neonatal and plastic surgeries. Such efforts have earned the hospital awards and international scholarships.</p> <p>&nbsp;</p> <p>“In neuro-surgery, we do epidural haematoma,” said Dr Padma Deskit, Ladakh’s first female surgeon. The procedure involves removing blood clots between the skull and the membrane that surrounds the brain. The first such surgery at the hospital was done in 2016. “The patient was a young recruit who had left the Army,” said Deskit. She said the BJP block development council chairman also underwent the procedure recently. “He was injured in a car crash,” she said. “Arrangements had been made to fly him out to Delhi for surgery, but because of bad weather the evacuation did not happen.”</p> <p>&nbsp;</p> <p>The most complicated surgery at the hospital was the chronic subdural haematoma on a migrant labourer. The procedure involves drilling small holes in the skull to relieve pressure and allow movement of blood and fluids. Before the operation, surgeons create an opening at the front of the neck to insert a tube into the windpipe (tracheostomy) for breathing. “Managing a tracheostomy in an arid region for a fortnight led to the formation of mucus in the tube due to zero humidity,” Deskit recalled. “And having no air conditioning was a challenge in itself. But through a jugaad, we pulled it off and the patient survived and is now doing fine.”</p> <p>&nbsp;</p> <p>During the complex procedure, the surgeons here remained in touch with neurosurgeons at AIIMS and Sher-i-Kashmir Institute on WhatsApp. As internet services in Leh were erratic, it took a long time to upload the images. The surgeons had to run around in the hospital for a spot with better connectivity.</p> <p>&nbsp;</p> <p>During emergencies, doctors at the hospital often seek guidance from specialists outside. “Some time back, I had to operate on a three-month-old,” Deskit said. “Since we do not have paediatric anaesthesia at the hospital, we did the surgery under the guidance of Professor Rajinder Prasad of AIIMS. After the surgery, the baby was fine.”</p> <p>&nbsp;</p> <p>For her exceptional work in a place like Ladakh, Deskit was awarded a scholarship by the Royal College of Surgeons in England. “The training was beneficial for me, and I learned a lot,” she said.</p> <p>&nbsp;</p> <p>Though there is a lack of specialists, doctors here also do flap surgeries—a technique in plastic and reconstructive surgery where tissue is lifted from a donor site and moved to a recipient site with blood supply intact. “Such surgeries require a plastic surgeon, but we do it with the help of experts like Dr R.K. Srivastava, who heads the department of plastic surgery at Safdarjung Hospital,” said a doctor. “Whenever we get a complicated case, he guides us.”</p> <p>&nbsp;</p> <p>The orthopaedics department conducts more than ten surgeries every week. “We only refer cases that are not in our competence,” said Dr Anwar Hussain, an orthopaedic consultant. “We also do spinal tuberculosis surgery and Ilizarov (a technique to lengthen or straighten bone and soft tissue),” he said.</p> <p>&nbsp;</p> <p>According to one of the doctors, there has been a recent increase in cases of high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). The former is often characterised by ataxia (impaired muscle coordination), fatigue, and altered mental status. It generally happens to tourists and migrant labourers whose bodies are not used to the sudden change in altitude.</p> <p>&nbsp;</p> <p>HAPE constricts vessels in the lungs, resulting in increased pressure. This leads to fluid leaking from the blood vessels into the lung tissues and eventually into the air sacs. “Earlier, such cases were reported in soldiers deployed at higher altitudes in Ladakh, like Siachen,” said Deskit. “But now, we are witnessing increased cases of vascular thrombosis (blood clotting) among tourists, whose footfall has increased after Ladakh was declared a Union territory, and in migrant labourers, who are arriving in large numbers to work with the Army in the aftermath of the border issues with China. Some people are also becoming blind in summer and in winter. There is a need for research to understand why this is happening.”</p> <p>&nbsp;</p> <p>Over the years, the hospital has developed expertise in dealing with HACE and HAPE cases, and has reserved special wards for these. In one such ward, Subhas, a chartered accountant from Kolkata, was being treated for HACE in November. “My family and I arrived in Leh a few days back and we went sightseeing to Pangong and stayed there for the night,” he said. He came to the hospital as he was feeling breathless. The doctors treating him said his oxygen saturation was becoming normal.”</p> <p>&nbsp;</p> <p>In another ward, Stanzing Thanchi, a monk from Spituk Monastery, was being treated for hip fracture. “I came here a few days back and will stay till I make a full recovery,” he said. “This is the only place in Leh during a medical emergency.”</p> <p>&nbsp;</p> <p>Dr Lobzanag Dasa, an ENT surgeon, said the doctors were well qualified to detect all malignancies, but lacked facilities to treat them. “Malignancy and cancer-related cases are referred outside,” he said. “We need facilities for radiotherapy and chemotherapy and an ICU for post-operative care.”</p> <p>&nbsp;</p> <p>One of the busier departments at the hospital is dentistry. Department head Dr Phunsung Narboo, who did his MS in dentistry from Post Graduate Institute of Medical Education and Research in Chandigarh, said, “On average, we treat 50 patients daily. We are well-equipped and also have a dental CT scan to diagnose cancer, musculoskeletal disorders and infections.” The department also has an orthopantomogram (OPG) for a panoramic image of the teeth. “But we do not provide orthodontic treatment (correction of malpositioned teeth and jaws) yet,” he said.</p> <p>&nbsp;</p> <p>The hospital has well-trained paramedical staff and technicians like Kesar Dawa, who operates the CT scanner, and radiologists Tashi Namgyal and Deachen Angmo, who run the MRI unit. “We do about 15 CT scans a day, and the facility remains open round the clock,” said Dawa. He said the hospital arranged for his training to operate the machine before its installation.</p> <p>&nbsp;</p> <p>Namgyal did a three-and-a-half-year training course in radiology in Delhi, and Angmo did a two-year course in Chandigarh. “The MRI was installed in August this year,” said Namgyal.</p> <p>&nbsp;</p> <p>Sonam Lamo from Nubra, 116km from Leh near the Line of Actual Control, said, “I have a regular headache, and a doctor prescribed an MRI. This facility is not available anywhere in Leh except this hospital. So I came here. My doctor wants to understand the cause of my constant headache.”</p> <p>&nbsp;</p> <p>The X-ray and the ultrasound units are the busiest. “We do about 150 X-rays a day in summer because of the presence of migrant workers and tourists. In winter, it is less,” said technician Ghulam Rasool. Rukhsana Parveen, who operates the ultrasound machine, said at least 70 patients came every day from all over Leh.</p> <p>&nbsp;</p> <p>The doctors here have noticed a rise in stomach cancer cases in Ladakh. They attribute it to excessive consumption of gur chai (butter tea), salted meat and dry food in winter. Increase in breast cancer and colorectal cancer among the rich, doctors said, was because of lifestyle change. Deskit said a study had found that H. pylori, a bacteria found in the stomach, is higher among inhabitants of Ladakh. “There is a need for research on that,” she said.</p> <p>&nbsp;</p> <p>A doctor said there was an urgent need to equip the hospital for mammography. There is only one CT scanner in the hospital. “Army personnel also come to the hospital for CT scans as their machine has not been working for the past one year,” the doctor said.</p> <p>&nbsp;</p> <p>During the peak of the Covid-19 pandemic, the hospital worked on a war footing. It first reserved wards for Covid patients and then initiated testing. “We never had a shortage of oxygen even during the peak,” said medical superintendent Dr Nurzin Angmo. “We are thankful to Prime Minister Narendra Modi for providing us with an additional 1,000 litres per minute oxygen plant. Now we are self-sufficient and do not need to buy oxygen from private vendors.”</p> <p>&nbsp;</p> <p>It might not be the most advanced, but what SNM hospital lacks in infrastructure, it makes up for with dedication and heart.</p> Wed Mar 23 11:47:04 IST 2022 finding-succour-online <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Last year Jiya Udenia, 21, decided to join her parents in Tel Aviv where her father is a senior diplomat with the Indian embassy. Jiya flew from Delhi in April even as the deadly second wave of the pandemic was raging, and no sooner had she completed the mandatory weeks of quarantine in Tel Aviv when fighting escalated between Israel and Palestine.</p> <p>&nbsp;</p> <p>“It was a nightmare. Despite being a safe diplomatic zone, our residential area became the target of rocket attacks.And while several were intercepted, one rocket did land in the sea close to our house. The war noises were deafening and there was a constant sense of danger. Hours were spent in underground bunkers. I spent sleepless nights and was very disturbed. But then, therapy came from a very unusual source,” Jiya told THE WEEK from Tel Aviv. She is a volunteer with CRY (Child Rights and You) and is taking online classes for underprivileged children in Delhi. It provided her the much-needed distraction, and peace, in the war zone.</p> <p>&nbsp;</p> <p>Jiya is one of 3,000-odd volunteer facilitators of CRY's online mentorship programme. They engage with 4,800 underprivileged children from 13 states to provide them a safe and interactive space to learn and to spend time with peers, even as schools remained mostly closed during the past two years.</p> <p>&nbsp;</p> <p>In Delhi, about 600 online volunteers teach around 730 children. Jiya had joined the South Delhi Public Action Group (PAG) of CRY in March last year.</p> <p>&nbsp;</p> <p>“I was always interested in doing something that would help society, and I love spending time with children. The CRY online mentorship programme caught my attention and I volunteered,” she recalled. “But within a few weeks, I was in Tel Aviv and almost close to giving up. However, I kept remembering my interaction with children, and how it made me happy. It was therapeutic for me. I never shared my harrowing experience with children; just interacting with them gave me strength.”</p> <p>&nbsp;</p> <p>An unusual bond has developed between Jiya, now a student of MA in security and diplomacy with Tel Aviv University, and the children of Kanak Durga settlement in Sector 12, R.K. Puram, Delhi, as they find mutual succour.</p> <p>&nbsp;</p> <p>Said Soha Moitra, regional director, CRY, north zone, “CRY believes that volunteering not only helps and supports underserved communities, it is a mutual connection and helps even volunteers. Jiya and children from her classes are one such example, where they helped each other in coping with the worst situation. She might not have ever thought that children as young as eight years old will become her biggest strength amid such distressing situations. Similarly, for children, Jiya and many other volunteers are like a window to explore the world amid limitations.”</p> <p>&nbsp;</p> <p>CRY was started in 1979 by Rippan Kapur and six friends who volunteered to spend Rs 50 each for the better future of children from underserved communities. Today it impacts more than three million children in various ways. “This is the power of volunteering and its need is much evident in the current situation,” said Moitra.</p> Sun Feb 27 11:50:04 IST 2022 a-journey-of-hope <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Perhaps it is the mystery at the heart of birth—our inability to explain how a group of cells turns into a living, breathing baby—that lends it such importance. And a woman who is not able to give birth is regarded deficient in some crucial way. Society’s worst form of cruelty is often not obvious; it is in the hushed whispers, the slanting looks, the pointed hints, the condescending ‘tips’. And this is what Neena George writes about in Just A Miracle: My Tryst With Infertility.</p> <p>&nbsp;</p> <p>The fact that infertility is painful is known. But the magnitude of the pain, and how it plays out in daily life, was a revelation. It is not simply a problem you have to face; it is a paralysis of life as you know it. For George, it started while she was living in Goa with her husband, an engineer in the Navy. One day, during a holiday in Mumbai, she experienced an excruciating pain in the lower abdomen. The diagnosis: An ovarian cyst which would need to be removed surgically. Afterwards, she developed adhesions in her abdomen which made it difficult to conceive, if not impossible. The young couple was shattered.</p> <p>&nbsp;</p> <p>“I considered myself worse than the most worthless creature I could find around,” writes George. “I even suggested to my husband that he could leave me and get married again.”</p> <p>&nbsp;</p> <p>What followed was a series of experimental treatments, hours of waiting outside doctors’ offices, clutching at the slightest straws— which included driving eight hours to see a tribal doctor—and resorting to superstitions like keeping a coconut husk shaped like a cradle. Her sense of worthlessness increased and she started imagining that everyone she knew was discussing her problem behind her back. Infertility shatters your sense of self, narrowing your identity into the single fact of your inability to conceive.</p> <p>&nbsp;</p> <p>But through it all, George does not give up hope. The development, and, in a deeper sense, enlargement of her personality through her infertility is wonderful to behold. She grows strong mentally, leaning on faith to carry her through. George is testament to the truth that the problems you face in life are not meant to hinder you, but rather to set you free. And it is often when you have made peace with yourself that a miracle happens.</p> <p>&nbsp;</p> <p>There is an honesty to her writing. She does not hold anything back, like the heart-breaking description of how she used to weep in bed every night, trying to keep it quiet so as not to wake her husband. It takes courage to reveal your deepest vulnerabilities, and a genuine desire to help others who are experiencing the same pain. George evidently has both.</p> <p>&nbsp;</p> <p><b>Just A Miracle: My Tryst With Infertility</b></p> <p><b>By Neena George</b></p> <p><i>Published by</i> <b>Notion Press</b></p> <p><i>Price</i> <b>Rs399</b>; pages <b>176</b></p> Thu Feb 24 18:46:49 IST 2022 bezos-bets-on-biotech <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Bezos, born on January 12, 1964, in Albuquerque in New Mexico, has for the past few years been actively chasing the gateway to longevity. He is one of the bigshot investors in Altos Labs, a California-based startup, which is working towards creating a technology aimed at resuscitating human cells and stretching life, or, to put it plainly, infringing age.</p> <p>&nbsp;</p> <p>Altos Labs, with the solid support of Bezos, is attracting talent with salaries as high as $1 million a year, while also offering them the flexibility and freedom to do anything they wish, to understand how cells age, and, if possible, reverse it. Spanish biochemist Juan Carlos Izpisua Belmonte, who is known for his research in mixing embryos of humans and monkeys, will be taking charge soon at the San Diego branch of Altos Labs.</p> <p>&nbsp;</p> <p>Bezos Expeditions, which manages Bezos’s investments, has also invested in other biotech companies that are studying human cells, working towards curing cancer and trying to solve hunger. In April 2014, Bezos Expedition invested close to $200 million in Juno Therapeutics, a clinical-stage biotechnology company. Three years later, BE invested in the future of food—Plenty—a vertical farming startup that develops methods for crops to flourish in a pesticide-free habitat.</p> <p>&nbsp;</p> <p>Bezos has also invested in Unity Biotechnology, a startup that not only focuses on ageing but also makes drugs that can make a person totally free of diseases related to ageing.</p> <p>&nbsp;</p> <p>People close to Bezos say he has always had an inclination towards the unfathomable and likes to delve into uncharted territories. Now, he wants to spend time on projects that interest him, like his space venture Blue Origin. The world’s richest man made a short journey into space in July 2021, in the company's rocket—New Shepard.</p> <p>&nbsp;</p> <p>It is said that once Bezos sets his eye on something, he gets it. Many are betting big on Bezos’s hopes to get the better of eternal life. While different studies have said that ageing cannot be stopped, backers of biological reprogramming believe ageing is far more pliable than how one perceives it to be. Bezos believes an elongated life could actually happen, and aiming at this, he most likely will continue investing in biotech companies.</p> <p>&nbsp;</p> <p>In a letter to Amazon shareholders before he resigned as the company’s CEO in 2021, Bezos quoted British biologist Richard Dawkins, “Staving off death is a thing that you have to work at… If living things don’t actively work to prevent it, they would eventually merge with their surroundings and cease to exist as autonomous beings. That is what happens when they die.”</p> Tue Feb 22 16:40:04 IST 2022 as-fit-as-a-billionaire <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Pictures of Jeff Bezos and his glamorous girlfriend, Lauren Sánchez, spraying each other with a hose on a mega-yacht moored near St Barts are a far cry from the old image of super-rich fat cats, overweight from the high life. In the photos, which went viral, the 58-year-old founder and former chief executive of Amazon shows off his shirtless physique, revealing super-toned arms, a six-pack, and pecs that could be the envy of someone half his age. Forget the paunchy playboy, this is the era of the buff billionaire.</p> <p>&nbsp;</p> <p>Harry Jameson, a personal trainer whose clients include billionaires, businessmen, and CEOs, says there has been a noticeable lifestyle change among the high-net-worth demographic he has worked with in recent years. “Over the last decade, I’ve seen a real shift in mentality from these high achievers. They used to live the high life and partied to extremes—not anymore,” Jameson says. “For many, they have spent a long time working very hard to get very rich, and now they want to strive for the ultimate status symbol of longevity and looking good in the process.”</p> <p>&nbsp;</p> <p>Undoubtedly, their winner-takes-all mentality is a big contributing factor. “These people are very driven,” Jameson says. “And they tend to apply the same mindset to other goals; so, the person who has been disciplined enough to get up at 4.30am to get rich can now apply the same approach to getting fit and healthy.”</p> <p>&nbsp;</p> <p>No billionaire achieves their desired physical appearance without top-notch professional help and in Bezos’s case, it is, reportedly, the trainer Wesley Okerson, who has honed the physiques of the Hollywood set for more than two decades. Okerson, who appeared in the Netflix show Strong, has a client list that includes Tom Cruise, Gerard Butler, and Isla Fisher. Bezos’s girlfriend Sánchez, 52, recently gave him the nod of approval. Beneath an Instagram post of herself and a topless Bezos looking buff, paddling a canoe, she commented, “Good Job Wes!” In another of her Instagram snaps, Bezos is featured looking equally ripped on horseback.</p> <p>&nbsp;</p> <p>Okerson is known for his diverse approach to training, which includes plenty of outdoor pursuits including hill running and rowing, weights, and paddleboarding. He believes that mixing things up is the key to optimum fitness. “When you do things a different way it disrupts the system and gives you better results,” he says. “I like to change things up.”</p> <p>&nbsp;</p> <p>Bezos’s newfound interest in the pursuit of supreme health is clear. He recently recruited one of the world’s most respected scientists to be the chief executive of his “anti-ageing” biotech venture Altos Labs. Hal Barron, previously the chief scientific officer for GlaxoSmithKline, has been tasked by Bezos to further develop a “cellular programming” technique that has already been shown to rejuvenate cells. He’s not the only billionaire to invest in companies promising to uncover the elixir of youth, with the Facebook founder Mark Zuckerberg and Google co-founders Larry Page and Sergey Brin also ploughing funds into cutting-edge scientific anti-ageing research.</p> <p>&nbsp;</p> <p>Jameson is not surprised by this: “Longevity and physical wellness are things money can’t buy but these people want to exhaust every bio-hack that might help them achieve it.” The rest of us may not want to go to such extremes—but we can adopt some basic rules from the top.</p> <p>&nbsp;</p> <p><b>Start simple</b></p> <p>Okerson, who is too discreet to name his clients, will say he insists they all go back to basics and learn simple exercises that involve elements of pushing, pulling, squatting, and pressing well. “So many people have bad habits and if you exercise with poor technique, you will be prone to overuse injuries,” he says. “Very tight or weak muscles are almost always the reason for the injury, so I reduce things to a simple level until they get these moves right.” Basic squats, lunges and push-ups are performed using only bodyweight at first.</p> <p><b>Invest in resistance bands and dumbbells</b></p> <p>Okerson encourages his clients to lift increasingly heavyweights—but slowly and progressively, and only after they have mastered good technique. He says starting with resistance bands helps someone feel the muscles they need to be using for each move. He also suggests investing in some dumbbells. “When they have got the technique, I add some weights to the moves.”</p> <p>&nbsp;</p> <p>But if there’s one item he recommends for his clients, it is a pull-up bar. “The pulling action on a bar is the very best thing you can do for your abs and core,” he says. “You won’t get strength and definition from doing crunches; the pull-bar is the thing.”</p> <p>&nbsp;</p> <p>There is plenty of research to back up Okerson’s philosophy on resistance training. A 2019 study presented to the European Society of Cardiology found that people with greater muscle power—achieved through five to six fast repetitions with weights—tended to live longer than people who didn’t lift weights. The study author, Claudio Gil Araujo, the director of research and education at the exercise medicine clinic Clinimex in Brazil, recommended starting with a weight “not so easy to lift and not so heavy that you can barely lift it” and performing one to three sets of six to eight repetitions, moving the weight as fast as possible.</p> <p><b>Run up hills</b></p> <p>Okerson is a big fan of running and regularly posts images of himself running on his Instagram account (@wesokerson). He ran the 2019 LA Marathon and crossed the finish line of the New York Marathon with the actress Katie Holmes, Cruise’s ex-wife, in 2007. He incorporates running into gym sessions for his clients—a favourite gym session of his is press-ups followed by a 1km treadmill run.</p> <p>&nbsp;</p> <p>“If they aren’t into running or it doesn’t suit them, I get them to set a treadmill on an incline and walk at 2.8mph,” he says. His favourite approach, however, is outdoor hill running, which he says is fantastic for fat-blasting and fitness.</p> <p>&nbsp;</p> <p>“If you can find a hill or incline to run up it’s absolutely the best way to improve your aerobic engine,” he says. “Hill repeats and hilly running have been staples in my workouts for a long time.” He adds that it is important to combine running with other forms of exercise, too—canoeing and rowing are his favourite activities. His best advice to clients who are not planning to run a marathon is “to change things up”.</p> <p><b>Train twice a day</b></p> <p>Okerson is known for his attention to detail when it comes to planning training to fit in with hectic A-lister schedules. “Everyone is different and it all depends on their goals and how much time they have,” he says. “Rest and recovery are very important so that needs to be factored in, too.” Since Bezos stepped down as the Amazon chief executive last July, he has had more time to dedicate to exercise, Jameson says, observing that his now super-trim body is that of someone who is doing low-impact cardio such as rowing in the morning and strength work in the afternoon. “This is a combo that will ramp up the body’s metabolism and help to offset some of the hormonal changes that lead to fat deposition in the form of moobs and a paunch.”</p> <p><b>Eat less (but don’t starve yourself)</b></p> <p>“It all comes down to calories in versus calories out,” Okerson says. “There are elements of different dietary approaches that I like, but the bottom line is it must work for my clients and they need to eat smaller portions while getting all the nutrients they need.” Bezos is lean but not scrawny, which means he probably aims to keep his body fat percentage at the sweet point—12-14 per cent—which is healthy and sustainable for a man, Jameson says. “If you dip under that and below 10 per cent, it can make you look haggard, so fantastic- looking over-40s tend to stick within that range,” Jameson says many of the execs he has trained adopt time-restricted eating, a form of fasting that involves consuming all calories with an eight or ten-hour daily window. It has been shown to produce a drop in body fat and prompt a corresponding rise in HGH levels. “Since low levels of HGH are associated with belly fat, this is a good thing,” Jameson says. “But intermittent fasting also triggers autophagy, the body’s way of cleaning out damaged cells to generate new ones.”</p> <p>&nbsp;</p> <p><b>Eat more protein and healthy fats</b></p> <p>Healthy fats such as avocado, nuts and coconut oil feature in the diets of Okerson’s clients, as well as protein. He also recommends they eat healthy carbs such as porridge and bananas to fuel a workout. “The message about protein has gone into overdrive and you don’t need huge amounts more unless you are a bodybuilder looking to get bigger,” Okerson says. “Aim for a good balance of protein, fat and healthy carbs, with slightly more emphasis on protein and healthy fats as you get older.”</p> <p>&nbsp;</p> <p>How much extra protein you might need as you reach midlife was the subject of a review conducted at McMaster University in Canada and published in the British Journal of Sports Medicine, which showed that men and women who ate more protein while weight training developed larger, stronger muscles than those who did not. The researchers found that the middle-aged and older weight trainers were unlikely to be consuming enough protein: about 1.6g per kilogram of body weight per day. As a result, they showed smaller gains in strength and muscle size than people in their twenties and thirties.</p> Thu Feb 24 18:43:25 IST 2022 vow-row <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>I solemnly pledge...” vow doctors around the world as they begin their journey of healing. The universal code of medical ethics, based on the Hippocratic oath, symbolises the dedication of their lives to the service of humanity. Named for the Greek physician Hippocrates, the oath has, over the years, undergone multiple revisions to suit an evolving society. And India could soon join a host of countries that have either revised or replaced the ancient oath.</p> <p>&nbsp;</p> <p>The National Medical Commission (NMC) is reportedly thinking of replacing the Hippocratic oath for MBBS graduates with the Maharishi Charaka Shapath—an oath in the name of Charaka, the “father of Indian medicine” and the author of the Charaka Samhita, a treatise on ayurveda.</p> <p>&nbsp;</p> <p>The speculation began when the minutes of a February 7 meeting—hinting at the change—were circulated on social media. Dr Aruna V. Vanikar, president of the Undergraduate Medical Education Board, had chaired the meeting. The 32-member NMC, which regulates medical education and practices in India, has neither confirmed nor denied the news. “The NMC has not held any meeting to discuss replacing the Hippocratic oath with the Charaka Shapath yet,” said Dr M.K. Ramesh, former president of the Post-Graduate Medical Education Board. “The issue had cropped up during a virtual meeting chaired by the UGMEB president to discuss the time table and curriculum with the deans and principals of medical colleges. Apparently, one of the attendees prepared an informal MoM (minutes of the meeting) and shared it on social media. It was certainly not the official proceedings of an NMC meeting, but informal minutes of a UGMEB meeting.”</p> <p>&nbsp;</p> <p>However, the speculation was enough to spark a debate and divide medicos.</p> <p>&nbsp;</p> <p>While several doctors have welcomed the proposal, saying it honours an Indian icon and acknowledges India’s contribution to the field of medicine, many others want to maintain “uniformity” and avoid exclusion of Indian doctors from the global community. Some also suspect a “hidden agenda” of the BJP government to undermine allopathy and promote AYUSH—the indigenous systems of medicine. They have called it “mixopathy”.</p> <p>&nbsp;</p> <p>Karnataka Health Minister Dr K. Sudhakar recently held an online poll to gauge people's response to the speculation. Around 70 per cent of the 2,000-odd polled supported it. “I see no reason why we should not accept and welcome the Charaka Shapath, which is a great tribute to the legendary Indian physician,” he told THE WEEK. “It will help instil deep-rooted pride among our young doctors—who are the inheritors of such a great intellectual heritage—on being Indian in thought, spirit, intellect and deeds.”</p> <p>&nbsp;</p> <p>Renowned cardiologist Dr Devi Shetty has also endorsed the move. “We should be proud of our ancestry,” he said. “We inherited medical education from the British and have hardly made any changes. It is good that we are [thinking of] taking oath in the name of our ancestor rather than in a foreigner’s name.”</p> <p>&nbsp;</p> <p>Agreed Dr Ramesh: “Both Hippocrates and Charaka existed when allopathy was unheard of. The purpose of administering an oath is to instil ethical values in a person entering the profession. Both oaths stress on professional ethics and conduct of medical practitioners. Let us not forget that Charaka was no ordinary man. What is wrong in honouring an Indian physician who was meritorious like Hippocrates?”</p> <p>&nbsp;</p> <p>Not everyone is on board, though. In a joint statement, IMA Kerala president Dr Samuel Koshy and secretary Dr Joseph Benaven said: “Oaths should follow an international outlook and must be beyond the views of caste, race, gender and creed. The oath is meant for the betterment of human beings and it [should] be suitable for modern science, which promotes constant questioning and corrections... the Charaka Shapath is based on regionalism and it insists on aspects that hinder the personal freedom of woman patients, promotes superstition and is not suitable for scientific methods.”</p> <p>&nbsp;</p> <p>IMA national president Dr Sahajanand Prasad Singh said there had been no official confirmation about the move, but added that the IMA would oppose it.</p> <p>&nbsp;</p> <p>Said former IMA president Dr Ravi Wankhedkar: “The decision to replace the oath is totally irrational. Instead of creating unnecessary controversies or symbolism, the NMC should focus on improving quality of medical education, protecting the dignity of modern medicine and welfare of young medicos.”</p> <p>&nbsp;</p> <p>Tejas J., president of the Karnataka Association of Resident Doctors, said, “All residents, interns and doctors are not in favour of changing the Hippocratic oath as we want to continue with the old tradition. Localising the oath looks good for non-medical persons. I graduated two years back and we have taken the oath as per the Geneva declaration (The World Medical Association revised the Hippocratic oath and promoted it as the Declaration of Geneva in 1948. It was last revised in 2017). We want the oath to be universal.”</p> <p>&nbsp;</p> <p>He admitted to not having read the Charaka Shapath, but added, “The government is free to revise the oath depending on current demands. But it should focus on enhancing the health care infrastructure in government teaching hospitals and also reduce the medical fee if it is serious about producing quality doctors with professional ethics. Replacing or renaming an oath helps little to boost health care in the country.”</p> <p>&nbsp;</p> <p>Congress MP Shashi Tharoor tweeted: “Many doctors are expressing concern. I am all in favour of introducing Indian elements into Indian education, but not at the expense of universal values and standards. Why can’t the Charaka Shapath supplement rather than supplant the Hippocratic oath that doctors worldwide take?”</p> <p>&nbsp;</p> <p>Indian Medical Association Karnataka president Dr Kateel Suresh Kudva argued that both oaths were outdated. “Both are ancient and irrelevant today,” he said. “Not many have read the Charaka oath. This code cannot be followed by modern medical professionals. For instance, it prescribed that one must not treat persons who are against the king. Similarly, the Hippocratic oath is also not relevant today and the World Health Organisation had to come up with the Geneva declaration. In India, we follow many oaths—Hippocrates, Charaka, Geneva declaration, MCI ethics, IMA prayer. The oath needs to undergo change from time to time.”</p> <p>&nbsp;</p> <p>Both Hippocrates and Charaka were early proponents of preventive health care and contributed to the understanding of human anatomy, pharmacology and medical geography. The former oath is believed to be written between the 5th and 3rd century BCE in Ionic Greek, while the latter was written in Sanskrit in the 2nd century BCE. If the Hippocratic oath swears by Greek gods, the Charaka Shapath reveres the holy fire and learned people.</p> <p>&nbsp;</p> <p>Both oaths profess total dedication to the guru, and underline the importance of professional ethics and conduct. Both have also been called out for being “sexist”. While the former says: “I will not give to a woman a pessary to cause abortion”, the latter reads: “I shall treat a woman only in the presence of her husband or a near relative”. The reference to “Dwija” (twice born) has also been tagged as “casteist”.</p> <p>&nbsp;</p> <p>“If the Geneva declaration has been revised multiple times, the Charaka Shapath, too, holds ample scope for revision to address current challenges and ethical dilemmas,” said Dr Ramesh. “This fine-tuning will come only out of discussion. It is too early to dismiss the proposal as redundant.”</p> <p>&nbsp;</p> <p>Also, Dr Sudhakar pointed out that there was no single universally accepted version of the physician’s oath. “The American Medical Association describes its Code of Medical Ethics as a living document that has evolved as medicine and society have changed,” he said. “The AMA’s Code was adopted in 1847, and saw updates in 1903, 1949, 1957 and 2008. The WMA adopted an international code of medical ethics in 1949, which was amended in 1968, 1983 and 2006. Last May, the WMA published a proposed modernised version of the international code, outlining physicians' duties towards their patients, other physicians, health professionals and society as a whole. At AIIMS, the undergraduates have been taking the Charaka oath during their annual convocation for several years now.”</p> <p>&nbsp;</p> <p>A section of the medical fraternity has also alleged saffronisation of medical education and undermining of modern science.</p> <p>&nbsp;</p> <p>Dr Kudva said: “There appears to be a hidden agenda to push indigenous systems of medicine. Our doctors will be expected to be jacks of all trades and masters of none. This will eventually eliminate the modern system of medicine and also alternative systems like ayurveda and homoeopathy. India is a hub for medical tourism, but pushing for integrated medicine will affect the health care industry and also deny our doctors opportunities outside India.”</p> <p>&nbsp;</p> <p>Recalling the constitution of the NMC by an act of Parliament in September 2020, he said: “We had also opposed the NMC replacing the MCI (Medical Council of India) as we doubted the intent of the government. In sections 50 and 51 of the NMC Act (on exchange of ideas), the government has indicated that it wants to bring in an integrated system of medicine. In the Medical Education Policy, too, it was clearly spelt out that, by 2030, India would only have an integrated system of medicine.”</p> <p>&nbsp;</p> <p>Dr Ramesh, who recently became vice-chancellor of Rajiv Gandhi University of Health Sciences, Bengaluru, said “misconceptions” abound. “Integrated medicine does not mean mixing of two different systems,” he said. “Here, different modalities of treatment are practised in their pure form without any overlap. Integration at the level of availability [of treatment] is what the government has been trying to achieve. As medical practitioners, we must build harmony rather than create animosity towards different systems of medicine. We must be open to cross referral of patients.”</p> Thu Feb 24 18:37:00 IST 2022 the-deadly-sleep <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>The passing of legendary composer Bappi Lahiri, at the age of 69, has given rise to discussion on an inherently dangerous health complication where a person’s breathing halts for a few seconds before it starts all over again while he or she is sleeping.</p> <p>&nbsp;</p> <p>Lahiri, the musician who popularised disco music in Hindi cinema, died of Obstructive Sleep Apnoea (OSA) on February 16 in Mumbai. Though he had multiple health issues over the last few years, OSA, in particular, was bothering Lahiri since 2021, after which he was regularly visiting hospitals.</p> <p>&nbsp;</p> <p>According to a recent study, close to 70 lakh Indians are suffering from OSA. There are different kinds of sleep apnoea, but OSA is the most common. It occurs when your throat muscles recurrently block your airway during sleep.</p> <p>&nbsp;</p> <p>Said Dr Shyam Kalyan N., an ENT surgeon in Noida, “Though OSA is mainly seen in obese, middle-aged men, it can also occur in children. When a person is affected with OSA, oxygen levels in the blood drop, which then leads to the brain being alerted and the person waking up, leading to normal breathing.”</p> <p>&nbsp;</p> <p>Kalyan said OSA is seen in people who have excess neck fat. “It is also seen in people who lead a sedentary lifestyle, have deviated noses and bulky tongues. Some of it is inherited via genes from parents.”</p> <p>&nbsp;</p> <p>Preventing OSA, he said, involves maintaining a healthy lifestyle with body weight appropriate to the height. “It is important to keep a person’s weight within the Body Mass Index (BMI) range [18.5 to 25 kg/m2]. If you are a habitual snorer, you should visit an ENT surgeon and get a sleep study done. Simple snoring is not dangerous but it can lead to OSA left untreated,” said Kalyan.</p> <p>&nbsp;</p> <p>Dr Asha M. Sasidharan, a Kochi-based ENT surgeon, had some months ago come across a middle-aged man who was diagnosed with mild OSA. “He was tall, obese and visited my clinic with issues of snoring and disturbed sleep. On examination, the patient’s BMI was 30.5. He had a short, bulky neck. Our examination revealed a deviated nasal septum. We conducted a sleep study that revealed an AHI [Apnoea Hypopnea Index that is used to indicate the severity of OSA] value of 10, which is categorised as mild,” said Sasidharan.</p> <p>&nbsp;</p> <p>She said the man was told to reduce his weight through diet control and exercise. “Also, a surgery was done to correct his deviated nasal septum. He was advised to use the device CPAP [Continuous Positive Airway Pressure, which provides a steady pressure of air in the airway] during sleep, and had to adhere to the diet regime, which he did. On follow-up, after a few months, we found that he could sleep without disturbance, and was feeling far better.”</p> <p>&nbsp;</p> <p>Suhasini Vasu, 48, an IT professional in Bengaluru, hopes to feel better the same way. Vasu felt anxious after hearing about Lahiri’s death. She has been of late having bouts of breathlessness while sleeping. “I wake up at least twice in the night, all of a sudden, finding it difficult to breathe. During the pandemic, my diet regime went for a toss. I have put on some weight. Anxiety and work-related pressures, I guess, are taking a toll. My husband said I have started snoring loudly at night. I think I need to consult a doctor at the earliest. I am not sure whether it is OSA, but Lahiri’s death is a wake-up call for people like me. I can’t believe that someone who roared with his music had to die of OSA,” said Vasu.</p> <p>&nbsp;</p> <p>While diagnosing patients with sleep disorders, doctors also measure the patient’s daytime sleep with the Epworth Sleepiness Scale (ESS). ESS is used to screen for the symptoms associated with OSA. It describes eight situations where a person might fall asleep---like reading, watching television, sitting inactive at a public place, lying down to rest in the afternoon, as a passenger in a car, while talking to someone, sitting quietly after a lunch without alcohol, and while in a car when it is stopped in the traffic. The patient then rates it using the following scale:</p> <p>&nbsp;</p> <p>0 = would never doze</p> <p>1 = slight chance of dozing</p> <p>2 = moderate chance of dozing</p> <p>3 = high chance of dozing</p> <p>&nbsp;</p> <p>The score ranges from 0 to 24, with scores above 16 indicating severe sleepiness.</p> <p>&nbsp;</p> <p>Sleep apnoea is mostly either obstructive [OSA] or central sleep apnoea, says Dr Ahamed Subir, a neurologist at the MES Medical College in Perinthalmanna, Kerala. “As per my sources, about 80 per cent of the middle-aged population [in the country] are snorers, of whom about a quarter are heavy snorers suffering from OSA. There could be respiratory failure [in OSA patients] if the condition is severe. It will result in complications like hypertension and sudden death depending on the duration of the illness and on whether any treatment was instituted.”</p> <p>&nbsp;</p> <p>Subir said central sleep apnoea, which accounts for less than 10 per cent of apnoeas, occurs when the nervous system controls breathing. “We [neurologists] come across a few cases of a mixture of these two apnoeas, which we call mixed apnoeas. The diagnosis is made with a polysomnogram machine, which helps in timely diagnosing and instituting treatment in patients so that they don’t have any complications,” said Subir. “But it is a medical quandary when an obese patient has apnoea, while also having lifestyle diseases with lung, heart or neurological conditions.”</p> Thu Feb 24 18:34:09 IST 2022 it-is-important-that-parents-look-after-themselves-first <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>A friend—a first-time mother—recently shared a post on her WhatsApp status: ‘Parenting hack: There are no hacks. Everything is hard. These kids don’t listen. This is your life now. Godspeed.’</p> <p>&nbsp;</p> <p>Parenting can be an overwhelming experience, especially for those new to the job. And, the pandemic is making it worse. Recently, in Boston, a group of exhausted mothers gathered at a high school football field to scream and rage into the dark, cold night. Parenting is a lot about learning on the go and dealing with its never-ending demands, especially during a pandemic, in your own way—some, like the friend, find comfort in funny posts and memes while some, like the Boston mothers, come together and scream.</p> <p>&nbsp;</p> <p>That parenting hack post is not all true though. The internet itself is full of hacks, not all of which is useful. Everyone from grandparents and extended family to friends and well-wishers swears by a hack or two. But all that information overload can leave a parent confused and anxious. That’s where Dr Saroja Balan and her new book come in. A senior consultant neonatologist at Indraprastha Apollo Hospital, New Delhi, Balan has been fielding queries from parents and calming their nerves, sometimes even at 3am, for more than three decades.&nbsp;<i>It’s Your Baby: The Indian Parent’s Guide to the First Two Years&nbsp;</i>packs in all those years of medical expertise and her own experience at motherhood. She tackles everything from the word go—from inside the delivery room to taking the baby home and beyond. The book is divided into different sections, each dealing with a specific theme like sleep, breastfeeding, vaccinations and diseases, including the latest Covid-19. Each section features frequently asked questions, all of which Balan answers sans medical jargon, making it a cakewalk of a read. And, the cherry on the top—her recipes for the babies. In an email interview with THE WEEK, she talks about her writing process, parenting and, of course, Covid-19. Excerpts:&nbsp;&nbsp;&nbsp;&nbsp;<i>&nbsp;</i>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><b>&nbsp;</b></p> <p><b>You were initially sceptical to write a book on parenting as there were already too many books on it. What do you think was lacking in the segment? And, do you think you have managed to fill that gap with this book?</b></p> <p>&nbsp;</p> <p>When I finally consented to write a book on parenting, I strove to research the genre as much as I could, and I soon realised that there aren’t many books catering to Indian parents and their specific struggles. Naturally, I seized the opportunity to share with new parents what years of experience as a paediatrician have taught me. I hope to advise new parents on how to bring up their children and care for them during emergencies. I felt that this book needed to bust common myths, many of which I have had to dispel, and guide new parents, following which they would be free to heed the advice or disregard it. Like, how I treat the parents of my patients in my outpatient practice. It is my hope that this book answers most everyday questions, but conventions change in medicine frequently, so I shall try my best.</p> <p><b>There is an easy flow in your writing as you move from one topic/illness to another. But writing didn’t come easy to you. How was the process like for you? What was the most challenging part about it?</b></p> <p>&nbsp;</p> <p>Writing this book was harder than I imagined it would be. The first draft read more like the&nbsp;<i>Nelson Textbook of Pediatrics</i>&nbsp;than a parent-friendly guide to raising a child, although by the second draft I had managed to keep the unnecessary medical jargon to a minimum. Of course, I had to enlist the help of my youngest daughter for this. She pulled no punches with me, and I am very grateful for that.</p> <p><b>When and how did you find the time to write? And how long did it take you to finish the book?</b></p> <p>Initially, I didn’t think that I would have time to write, seeing as I was responsible for Apollo hospital’s neonatal ICU and outpatient clinic as well as my own private practice. Luckily, because of the pandemic, I had more time to myself, and I managed to churn out the entire book in four months. Although, to be very honest, typing out the whole thing was maddening because I mostly just jab at the keyboard with two fingers suspended mid-air, while I squint at the screen.&nbsp;</p> <p><b>You have a section on babies and social media, which is very relevant in today’s times. But that is just one aspect that new-age parents have to deal with. How do you think parenting has changed in recent times?</b></p> <p>&nbsp;</p> <p>More than social media, the rules regarding how much screen time is allowed have been bent ever since the pandemic began. Prior to this, we (paediatricians) were advocating for zero screen time for children under two. But with children at home and parents working remotely, we have relented a little. We would still like it to be as little as possible and ideally a parent should engage in this activity with their child so that what they are watching is meaningful. Parents can also make this process more interactive by explaining things to their children along the way.</p> <p><b>We are seeing a lot of Covid-19 cases among children in this wave. Why do you think that is happening?</b></p> <p>&nbsp;</p> <p>Children are getting Covid when there is an adult in the family with it. They are getting relatively mild illness, but we must be careful in case the child has comorbidities.&nbsp;</p> <p><b>You have a section on Covid-19 in children, where you have discussed the disease and the precautions to be taken. Is there anything that parents should do differently, apart from observing the Covid-19 protocols, to keep their children safe?</b></p> <p><b><br> </b>The WHO, UNICEF and even the IAP [Indian Academy of Pediatrics] have always discussed that masking, social distancing and hand washing are the three pillars to fight the spread of this disease. Most children only need paracetamol and rest and hydration. Always speak to your paediatrician if you are worried and don’t start any medication on your own like an antibiotic from a previous prescription.&nbsp;</p> <p>&nbsp;</p> <p><b>How has the pandemic impacted children?</b></p> <p>School is essential for psychosocial development and enables children to grow into capable young adults. Mentally healthy children function well at home, in school, in their communities, and have a greater chance of leading a happy and successful life. Although the lockdown has been hard on us all, it has been especially hard for children who have had to continue their studies virtually. Isolating at home has proved detrimental to their physical and mental health, further evidencing the need for a return to pre-pandemic school routines. Grief, fear, social isolation, increased screen time and parental fatigue have negatively impacted the mental health of our children. It has become extremely difficult for parents to calm their children’s anxieties because of the stresses and uncertainties in their lives.</p> <p><b>What can parents do to help children deal with the isolation?</b></p> <p>It is not easy being a parent during these times, with all this talk about quarantine and social distancing, and relevant information changing constantly.&nbsp;</p> <p>1. It is important that parents look after themselves first. Only then can they look after their children.</p> <p>2. You need to check in with your children regularly in a calm manner to see how they are doing, especially if they are having classes online.&nbsp;</p> <p>3. You can set out time to engage children in creative activities, storytelling and board games. These help them express their anxieties and fears in a stable environment. It is important that adults remain calm and manage their emotions well as children are very perceptive and pick up emotional cues from parents and teachers.&nbsp;</p> <p>4. Children and adolescents should be encouraged to reach out to friends or a family member about their feelings and anxieties during this pandemic.&nbsp;</p> <p>5. If a parent or teacher notices a vast and sudden change in the behaviour of a child that lasts for over a week, they should try and seek professional help. In younger children, it may be bed-wetting, clinging to parents, excessive thumb-sucking, sleep disturbances, loss of appetite and even withdrawal.&nbsp;</p> <p>6. Older children may get very aggressive, have nightmares and poor concentration. Adolescents can exhibit hyperactivity, aggressive behaviour, have eating irregularities or disorders and increased conflicts with parents.</p> Sun Jan 30 12:07:01 IST 2022 aster-medcity-new-one-stop-centre-to-diagnose-and-manage-heart-rhythm-issues <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Human life expectancy has increased in the last few decades. Better access to health care and sufficient food means we can now expect to live much longer than our ancestors. But with the increasing longevity, certain diseases have also became common. Heart rhythm abnormality is an example. </p> <p>An abnormal heart rhythm or arrhythmia is defined as a condition when a person’s heart beats too fast, too slow, or irregularly. Heart rhythm abnormalities can cause stroke, heart failure, even death. General symptoms for heart rhythm disorders are fatigue, dizziness, sweating, shortness of breath and fainting.</p> <p>There are different types of abnormal heart rhythms. “Atrial fibrillation (AF) is the most common form of arrhythmia,” says Dr Praveen Sreekumar, consultant cardiologist and electrophysiologist, Aster Medcity, Kochi. It is characterised by an irregular and rapid heart rhythm. Dr Praveen points out that those with AF can face two major issues. “One issue is that when the heart rate suddenly rises, the patient may feel breathless and faint,” he says. “Another risk is stroke. As the episodes of AF increase, the risk of stroke would also increase. The patient may be unaware of many such episodes [of abnormality in heart rhythm]. There may be many episodes without any apparent symptoms. But such episodes may finally lead to stroke.” </p> <p>Cryoablation is one of the advanced treatments to restore normal heart rhythm. “This treatment is particularly effective in AF cases,” says Dr Praveen. “It is a common procedure now in countries like the US, but it is relatively new in India.” Aster Medcity is one of the few hospitals in India to provide this treatment.</p> <p> Cryoablation procedure involves restoring normal heart rhythm by disabling heart cells that create an irregular heartbeat. In this minimally-invasive procedure, a thin flexible tube called a balloon catheter is used to locate and freeze the heart tissue that triggers an irregular heartbeat.</p> <p>Earlier, doctors used to rely on a technique called 3D mapping to treat arrhythmia cases. In this procedure, a doctor would insert a specialised cardiac mapping catheter (a flexible tube with sensors at the tip) through an artery in the patient’s groin or arm and then advance the catheter into the heart. The cardiac mapping system would track the catheter’s location as the doctor moves it to different areas throughout the patient’s heart. The system uses the information to create an electrical map of the patient’s heart. </p> <p>“The 3D mapping procedure would normally take four hours,” says Dr Praveen. “If the procedure is not complete this would lead to the recurrence of arrhythmia. But in cryoablation, we can ensure the almost complete disappearance of irregular heart rhythm. It is a fast procedure, too. The entire procedure would take just 20 minutes.”</p> <p>Aster doctors recently did cryoablation for a 63-year-old lady from Malappuram. “She was hypertensive; she had atrial fibrillation, fast heart rates and breathlessness when she was admitted,” says Dr Praveen. “The procedure was successful, and we are still following up. She will have to take medications to prevent stroke for another couple of months.”</p> <p>The cardiologist says he sees at least 10 patients with arrhythmia every month. Recognising rhythm disorder is the biggest challenge, according to him. “Heart rhythm problems are usually under-recognised,” says Dr Praveen. “Sudden problems rising from an arrhythmia may not be understandable for the population. Because they just collapse suddenly. Or, there will be sudden breathlessness. In some cases, there will not be any other symptoms. The variations in heart rhythm may be visible electrocardiogram only during a heart rhythm abnormality episode. So, we need to use long-term monitors to identify the heart rhythm issue. A Holter monitor (a small, wearable ECG device) is one such. If a person had heart disease in the past, his probability of having rhythm problems will be high.”</p> <p>Aster recently opened a heart rhythm centre to provide treatment for all kinds of heart rhythm disorders. “It is a one-stop centre to diagnose and manage heart rhythm issues,” says Dr Praveen. The centre also does follow up for those patients who are implanted with a pacemaker.</p> <p>“The follow-up after implanting a pacemaker is important,” says the doctor. “We have both physical clinic and e-clinic. Modern pacemakers provide a wireless monitoring option. We manage these patients via our e-clinic. These pacemakers with the help of AI would allow us to predict heart-related events, too. So, we can provide warnings to patients by remotely monitoring the data from these pacemakers. Our physical clinic mainly takes care of all device-related issues. The heart rhythm centre also does follow up of patients who need long-term monitoring for heart-rhythm problems.”</p> Thu Jan 27 14:41:26 IST 2022 book-excerpts-from-it-your-baby-caring-for-your-child-in-covid-times <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Since 8 December 2019, an epidemic of coronavirus disease (Covid-19) has spread rapidly across the world.</p> <p>&nbsp;</p> <p>Studies since then have shown that it is likely to affect older men with comorbidities, and only a few infections were seen in children. It mainly happened in family clusters. One study from China found that out of 9 children affected and admitted in a hospital, 7 were female.</p> <p>&nbsp;</p> <p>Children of all ages can get affected with Covid, but all those who get infected don’t show any symptoms of illness.</p> <p>&nbsp;</p> <p>Scientists are still not sure why children react differently from adults. Some experts feel it may be due to other coronaviruses that spread through the community and produce common cold in children, and since children get frequent colds, their immune systems may be primed to provide them some protection again Covid-19. Another possibility is that children’s immune system interacts with the virus differently in comparison to adults’.</p> <p>&nbsp;</p> <p>Newborns can get affected with Covid-19 during childbirth or after delivery, from a sick caregiver. If you develop Covid-19 prior to delivery or are waiting for the test results, you can feed the baby wearing a mask and make sure you wash your hands frequently. You can keep a 6 feet distance with your baby at other times. When these steps are taken, the chances of the baby getting Covid are very small. Research shows that only 2% to 5% of infants were infected from mothers who tested positive just prior to delivery.</p> <p>&nbsp;</p> <p>However, if the mother is severely ill with corona, she may need to be temporarily separated from the baby. Babies who test positive but are not symptomatic can be sent home with instructions that the caregivers frequently wash hands and wear a mask to protect themselves. They should be in frequent touch with the paediatrician through virtual consultations. Similarly, since infants less than 2 years cannot wear masks, they need specific protective measures. Adult caregivers should wash hands, wear masks, sterilise toys and clean tableware regularly.</p> <p>&nbsp;</p> <p>★★★</p> <p>&nbsp;</p> <p>If you suspect your baby may have Covid, call your paediatrician and keep the baby at home. If possible, keep the baby in a separate room. Your paediatrician will decide about doing a test for Covid. A nasopharyngeal swab is taken from the back of the nose and it usually takes 24 hours to get the report.</p> <p>&nbsp;</p> <p><b>Multisystem Inflammatory Syndrome in children (MIS-C)</b></p> <p>MIS-C is a serious condition in which some parts of the body, such as the heart, kidney, lungs, blood vessels, digestive system, brain, eyes and skin, get inflamed. The presence of Covid-19 antibodies in these children reveals a past Covid-19 infection, suggesting an immune system reaction against Covid.</p> <p>&nbsp;</p> <p><b>Signs and symptoms of MIS-C</b></p> <p>♦ high fever that lasts longer than 24 hours</p> <p>♦ vomiting and diarrhoea</p> <p>♦ pain in the stomach</p> <p>♦ skin rash</p> <p>♦ red eyes; swollen, red tongue</p> <p>♦ breathlessness</p> <p>♦ fast heartbeat</p> <p>♦ red and swollen hands</p> <p>♦ feeling excessively tired</p> <p>♦ headache and lightheadedness</p> <p>♦ enlarged lymph glands</p> <p>&nbsp;</p> <p>Emergency warning signs that you need to take the baby to hospital or contact your doctor:</p> <p>♦ drowsiness or inability to stay awake</p> <p>♦ difficulty in breathing</p> <p>♦ bluish discolouration of lips and face</p> <p>♦ severe stomach ache</p> <p>&nbsp;</p> <p><b>Tips to prevent Covid-19</b></p> <p>Most of you reading this book must be well aware about all the precautions one needs to take but here they are again. The CDC and WHO recommend that you and your family follow these precaution:</p> <p>♦ Keep your hands clean.</p> <p>♦ Wash your hands often with soap and water for at least 20 seconds. If you are unable to wash, use a hand sanitiser that contains at least 60% alcohol.</p> <p>♦ Cover your mouth and nose with the inside of your elbow when you sneeze or cough or use a tissue. After discarding the tissue, wash your hands.</p> <p>♦ Avoid touching your face frequently.</p> <p>♦ Have the children wash their hands after returning home. Teach them to wash with soap, especially between the fingers right up to the fingertips, including the thumbs and back of the hand.</p> <p>&nbsp;</p> <p>They can be taught to sing the ‘happy birthday’ song twice while washing their hands – that is around 20 seconds.</p> <p>&nbsp;</p> <p>♦ Practice social distancing: Maintain a distance of 6 feet or 2 metres with anyone who is sick or has any symptoms. Go out only when needed and leave children at home, if possible. Avoid playdates during the pandemic. If other children are playing outside, try to keep a 6 feet distance.</p> <p>♦ Clean and disinfect your home: Focus on everyday cleaning of surfaces that are frequently touched, such as tables, doorknobs, hard-backed chairs, switches, desks, handles, toilets and sinks.</p> <p>♦ Clean areas that babies touch frequently, such as changing tables, bed frames, toys, among others.</p> <p>♦ Use soap and water to clean toys that babies put in the mouth and make sure you rinse them well. Wash the baby’s bed linen and soft toys regularly.</p> <p>♦ If your baby has Covid, caregivers must ensure they wash their hands well after changing diapers and handling toys.</p> <p>&nbsp;</p> <p>* Wear a face mask: The CDC recommends face masks in public spaces, such as grocery stores, where it is difficult to maintain social distance. Children under 2 don’t need to wear a mask, and the same applies to children who have breathing problem or an illness that would prevent them from being able to remove the mask without help.</p> <p>&nbsp;</p> <p>♦ Finally, don’t delay your doctor’s visits, especially with regard to vaccines. Ensure they are done on time.</p> <p>&nbsp;</p> <p><i>Excerpted with permission from It’s Your Baby: The Indian Parent’s Guide to the First Two Years, published by HarperCollins India.</i></p> <p>&nbsp;</p> <p><b>It's Your Baby: The Indian Parent's Guide to the First Two Years</b></p> <p>By <b>Dr Saroja Balan</b></p> <p>Published by <b>HarperCollins</b></p> <p>Price <b>Rs499</b>; Pages <b>428</b></p> Mon Jan 31 15:26:54 IST 2022 childproof-no <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Pratha Narang Naik’s world turned upside down after her six-month-old daughter Tara tested positive for Covid-19 on December 28.</p> <p>&nbsp;</p> <p>Tara had high fever. “I gave her Calpol. The fever wasn’t coming down yet and she was very lethargic. We thought it was dengue and took her to hospital. By then, her oxygen levels had dropped to 88,” said Naik, a travel photographer based in Mumbai.</p> <p>&nbsp;</p> <p>Tara was the first one to have Covid in the family. “I was absolutely clueless. I don’t know how she got Covid. We barely stepped out of our home those days, and until then we were told children don’t get Covid,” she said.</p> <p>&nbsp;</p> <p>Omicron is spreading like wildfire in India and children are increasingly getting infected. “When I reached the ICU, there were only two or three kids, infected with Covid-19. All beds were empty. By the time we got discharged on January 3, there were two more Covid wards for children. One of the babies admitted to the Covid ward was just 26-days-old,’’ said Naik, who also got infected while in the ICU with Tara.</p> <p>&nbsp;</p> <p>The fear of reinfection has made Naik and her family move to Pune. “We don’t know how long the antibodies stay for. Also, many in Mumbai are testing positive at home and are not reporting it to the health department. If my neighbour has Covid, I won’t know. Half the people who test positive for Covid at home are roaming around. I didn’t want my baby to get reinfected with Covid. So we have moved into a villa in Pune,” she said.</p> <p>&nbsp;</p> <p>The third wave is hitting children hard. Between June 2020 and February 2021, children made up to 2.72 per cent to 3.59 per cent of the total Covid caseload in the country. Now they account for 7 per cent of cases in the country, said Dr Harish Chafle, senior consultant, pulmonology and critical care at Global Hospital, Parel, Mumbai. In the city, a large number of children in orphanages and children’s homes have got affected during the third wave. The test positivity rate among children in Bengaluru in the age group of 0-9 years has climbed to 9.5 per cent during the third wave.</p> <p>&nbsp;</p> <p>Body ache, headache, throat pain, mild cough and cold with high grade fever are symptoms commonly seen in children in the third wave. “The difference between the second wave and third wave in my experience is that the fever is high grade now. It literally disappears after the third day. And then the child is completely normal,” said Dr Supraja Chandrasekhar, consultant paediatric intensivist at Manipal Hospital, Yeshwanthpur, Bengaluru.</p> <p>&nbsp;</p> <p>When the Omicron led third wave peaks in India (some said around February 3), 12-14 year olds and those under 12 will continue to remain unvaccinated, for vaccinations for the 12-14 age group in the country will begin by February end or early March. This has been a major cause for concern.</p> <p>&nbsp;</p> <p>It remains to be seen what share of 15-17 year olds will get vaccinated and develop immunity by the time the third wave peaks. This is an age group that is particularly vulnerable. Campus outbreaks make them more prone to the infection. Also, children tend to socialise frequently, flouting pandemic rules.</p> <p>&nbsp;</p> <p>India started its vaccination drive for teenagers aged between 15 and 18 on January 3. Over 3.3 crore teenagers have received their first dose of the Covid 19 vaccine, which means we are nearly halfway through. There are around 7.4 children in the country in the age group of 15-17. The government aims to vaccinate the rest of them by January end.</p> <p>&nbsp;</p> <p>A significant portion of children in India seem to have the redeeming feature of antibodies. At Manipal Hospital, Yeshwanthpur, any febrile child (having or showing symptoms of fever) is asked to get a Covid antibody test done. The data show that 70 per cent of the children who got admitted in the last six months had already developed antibodies to Covid 19. In most cases, parents were unaware that the child had Covid, said Chandrasekhar. “More than 70-75 per cent of children in India have developed Covid antibodies. They would have got exposed and not even known,” she said.</p> <p>&nbsp;</p> <p><b>Can babies get Covid?</b></p> <p>Studies show that Covid worsens maternal and foetal outcomes. “When the pandemic started, one of our concerns was could Covid actually be transmitted to the baby when inside the uterus? We hardly had any data on this. We had very little information on how Covid would affect the baby when the baby was born. However, we now have two years of data which by and large indicates that newborns are not affected, in the sense that the infection is not passed on to them,’’ said Dr Prathimas Reddy, director and lead consultant, department of obstetrics and gynaecology, Sparsh Hospital for Women and Children, Bengaluru. That said, there are three scenarios that we need to take into consideration, she said. “One, there are a small number of babies who can become infected with Covid in the womb itself. Two, there are chances of the newborns catching the infection after delivery because the mother is already infected. Additionally, in the last year we noticed that many newborns had a multi-system involvement (that can affect vital organs like the heart, lungs and kidneys) wherein they would become quite sick. When we looked into it, we found that Covid had actually given rise to the multi-system involvement in the newborn babies.”</p> <p>&nbsp;</p> <p>Since there are no Covid-19 vaccines for newborns as of now, the treatment currently is to stabilise the newborn with supportive treatment, said Reddy.</p> <p>&nbsp;</p> <p><b>What to do if your child gets sick with Covid-19?</b></p> <p>High grade fever is common among children with Covid-19 and sometimes it is the only symptom. While caring for such children, it is important to do frequent temperature checks and control fever with paracetamol. Also children, especially infants, tend to get dehydrated quickly, so they must be made to sip liquids frequently.</p> <p>&nbsp;</p> <p>Children with Covid don’t require any fancy medications, said experts. “They don’t require antibiotics, antivirals or antibody cocktails. They are not authorised or licensed for children,” said Chandrasekhar. The current protocol being followed is in line with the national guidelines issued during the second wave.</p> <p>&nbsp;</p> <p>Sometimes children who test positive for Covid-19 are taken to general physicians who give them blanket treatment meant for adults. It is harmful. “They do beautifully well with home monitoring. Check breathing rate, temperature, saturation, and pulse rate. If fever persists for more than three days, they would require physical consultation,’’ said Chandrasekhar.</p> <p>&nbsp;</p> <p><b>Lingering complications</b></p> <p>If your child has fever along with signs and symptoms like rashes, joint pains, breathing difficulty, diarrhoea, stomach pain, eyes congestion, a few weeks after getting infected with Covid-19, do not hesitate to seek help.</p> <p>&nbsp;</p> <p>Multi-system inflammatory syndrome (MIS) is seen in children, post-Covid, after three to six weeks, said Dr Himanshu Batra, consultant—paediatrics, HCMCT Manipal Hospitals, Delhi, “It is a serious condition that requires prompt diagnosis and management to prevent long-term complications.’’</p> <p>&nbsp;</p> <p>Blood reports of children with MIS suggest increased levels of inflammatory markers and presence of anti-Covid antibodies. “Once diagnosis of MIS is suspected on basis of above symptoms and reports, 2D echo is done to assess heart involvement and management is aimed at controlling inflammation with steroids and immunity modulator like intravenous immunoglobulins,’’ said Batra.</p> <p>&nbsp;</p> <p><b>When Covid fear lurks…</b></p> <p>When Ruchi Dwivedi from Bengaluru tested positive for Covid-19 two weeks ago, she was concerned that she might pass it on to her children. “Adults at home were vaccinated so had some amount of protection but kids were not. Kids of my friends and families who were infected had shown much strong symptoms like high fever, vomiting, loose motions and this further worried me,’’ said Dwivedi, “Shreya, my younger daughter, is just one-and-a-half-years old, and can't even express her discomfort so we had to be very careful.’’</p> <p>&nbsp;</p> <p>A hands-on mom, Dwivedi found it hard to ignore her daughter's calls during bedtime. “Shreya would come knocking at my door, calling 'mamma' in her sweet, innocent voice,’’ she said. Dwivedi’s mother-in-law and husband took care of the children and kept them engaged while she was in isolation. “Technology came in handy as when they were too upset, video calls with family and friends were made and that helped a lot,’’ said Dwivedi.</p> <p>&nbsp;</p> <p>Parents and grandparents can do a lot to support their children through the pandemic and make life easier for them. The Covid fear has taken a toll on the mental health of children. This is further compounded by lack of social interaction and physical schooling.</p> <p>&nbsp;</p> <p>Said Dr Veena Raghunathan, senior consultant, paediatric critical care, Medanta, the Medicity Hospital, Gurugram, “Children should be reassured that this is not permanent, and the situation will improve. With increasing vaccination coverage, we are sure to see light at the end of the tunnel.’’</p> <p>&nbsp;</p> <p>If your children are eligible for vaccination, do not hesitate to get them vaccinated, said Raghunathan. “There is increasing evidence to show that vaccination decreases the severity of Covid. Vaccination of children is going to be a major step in halting the progress of this pandemice,” she said.</p> <p>&nbsp;</p> <p><b>Keep smiling, no matter what</b></p> <p>Your state of mind is your child’s state of mind. If your child gets infected, don’t panic. Like Naik, who made sure her baby had a good time in the ICU. Tara’s routine had got disrupted while she was in the hospital. She looked uncomfortable as she was surrounded by cries of pain and distress. Naik, however, did all she could to make her feel better. She got her toys. “If you get scared, your child will also get scared. They mirror your feelings and emotions,’’ said Naik, who was amused to see Covid positive kids in the ward making friends with each other.</p> <p>&nbsp;</p> <p>“You’ve to be sane to keep your child sane. If you keep your face glowing for your kid, it will make your kid feel a lot better,’’ she said.</p> <p>&nbsp;</p> <p>Naik returned from the hospital as a changed woman. "I value life more now,” she said.</p> Tue Jan 25 14:27:43 IST 2022 a-blind-cyclist-pedals-7-500km-for-road-safety-awareness <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>You don’t dream with your eyes, but your heart, says Ajay Lalwani, who is 100 per cent blind. And if you are an adventurer at heart like him, then your dreams know no bounds.</p> <p>&nbsp;</p> <p>Lalwani’s latest adventure saw him cycling 7,500km across 12 states, from Mumbai to Srinagar to Kanyakumari and back to Mumbai. And, all for a cause—road safety.</p> <p>&nbsp;</p> <p>But a cause that underlines all his adventures or attempts at them is to show the visually impaired in a new light. “Through whatever I do, I want to create awareness about what a blind person can do,” says Lalwani, 25. “Some people even ask stupid questions like, ‘How does he eat if he is blind?’ I want to change that thinking.”</p> <p>&nbsp;</p> <p>Lalwani was not born blind, but he has little information about what went wrong with his eyes. “I don’t know when I went completely blind,” he says. “I was told by my family that I could see a bit when I was a child. But as far as I can remember, I have always been blind.”</p> <p>&nbsp;</p> <p>Lalwani was born to a homemaker mother and a fruit-seller father in Ulhasnagar, Thane district, Maharashtra. He has three elder brothers and a younger one. It was when his father or brothers took him to school on a cycle that Lalwani first harboured the desire to ride one on his own. He started cycling on his own when he was seven or eight and has not looked back since.</p> <p>&nbsp;</p> <p>In 2019, he did a Mumbai-Goa-Mumbai expedition. In 2020, he cycled to and from Gondia in Maharashtra. But it is not just cycling that has him hooked. He swims and treks, too. “Who doesn’t want to be fit? So, I have been focusing on sports activities for 15 years now and have won some medals over the years,” says Lalwani, who plans to complete his graduation next year. But adventure is key for him. “I want to do something that no other visually impaired person has done before,” says Lalwani, who works as a telephone operator with the Brihanmumbai Municipal Corporation and lives alone in an office accommodation in Worli.</p> <p>&nbsp;</p> <p>And that thought drives all his adventures. That is how and why he came up with the Blind Cycling Expedition, which began on November 15 and ended on December 29, 2021. But it wasn’t a smooth ride all along. “I had been practising for the expedition for more than a year and exploring sponsorships,” says Lalwani. “I had approached many companies, but got no response. Then I started crowdfunding. The initial response was good but after a while there was none.”</p> <p>&nbsp;</p> <p>While the crowdfunding didn’t help much with funds, it did help him with contacts. Lalwani met a person who helped him get in touch with Signify (previously Philips Lighting). “I soon met with [Sumit Joshi, CEO and MD, Signify Innovations India Ltd-South Asia] and explained what the expedition was all about and he came on board because road safety was a cause close to Signify as well,” he says.</p> <p>&nbsp;</p> <p>Lalwani cannot stress enough about the importance of road safety. “Even during our expedition, we found that around 3,000-3,500km of our roads are either dug up for works or in a bad shape and have been neglected by the authorities,” he recalls. “Roads do not have lights. Along with creating a world record, we also wanted to create awareness about road safety. So many accidents take place on highways. We also witnessed many accidents while on the journey.”</p> <p>&nbsp;</p> <p>Signify not only sponsored the expedition, but also helped promote it on social media. Its employees also made it a point to welcome and felicitate Lalwani and his 15-member support team every 200km and offer any help required. “[Lalwani] has cycled on his fair share of roads and highways across India and during his journeys experienced firsthand how lack of adequate illumination on roads can result in increased incidence of accidents,” says Nikhil Gupta, head of marketing and integrated communications and commercial operations, South Asia, at Signify. “Through this campaign, we wanted to draw the country’s attention towards the importance of adequate street lighting for enhancing road safety.”</p> <p>&nbsp;</p> <p>Lalwani’s team comprised five navigation coordinators, drivers, a cook, a masseuse and a photographer. One of his elder brothers, too, joined him—a first in all his journeys so far. The team would travel in two cars, one in the front and the other behind him. “I had invited people who were interested in sports to join the expedition as volunteers,” says Lalwani. “Five people from different districts joined us as navigation coordinators. The rest were hired for different roles.”</p> <p>&nbsp;</p> <p>The navigation coordinators were his eyes on the road. Two of them would sit in the car’s trunk and give him instructions via walkie-talkie. “We would change volunteers every three hours so that there was no room for error, as that would have resulted in me falling or getting hurt,” says Lalwani. “Despite that, I did fall a couple of times, either owing to a misunderstanding or my inability to hear the instructions clearly. But we have learnt from it and used new tricks, too.”</p> <p>&nbsp;</p> <p>This was the first time that Lalwani was able to use cars; his previous expeditions involved either navigation coordinators on cycles or bikes. Also, he used a cycle with gears for this expedition. As backup, he had carried two cycles—one with gear and one without. He was planning to use the non-gear one for this journey as well, but experienced cyclists advised against it.</p> <p>&nbsp;</p> <p>That was a good call as it proved helpful during the most challenging part of the journey. The stretch between Udhampur and Srinagar was particularly difficult because of the incline and the cold weather. If he had used the non gear cycle, he would have struggled to walk all the way up through the narrow ghats with the cycle. During the journey, the brakes of both his cycles had failed. But Lalwani managed to keep himself from hitting the stone wall on one side or falling into the valley on the other. “My cycles were injured, but I wasn’t,” he says. He later repaired the brakes on his own. “The soldiers stationed there offered help, but I told them that I can repair it,” he says.</p> <p>&nbsp;</p> <p>Gupta shares a navigation coordinator’s experience in Kashmir: Lalwani was carrying the national flag on his bicycle and soldiers posted in the area started saluting the flag. “It was a proud moment for the entire team,” says Gupta, adding that random strangers stopped to assist the team.</p> <p>&nbsp;</p> <p>Agrees Lalwani, who says that villagers would help them with whatever they needed. Lalwani and his team would not always find hotel accommodation; at times they would pitch tents at the edge of forests. “This was not just a cycling expedition, but an adventure, too,” says Lalwani. “We camped near forests, spoke to villagers, who were very helpful when we needed anything. I didn’t want to feel that despite travelling the country, we did not have fun.”</p> <p>&nbsp;</p> <p>Lalwani is now all set for his next adventure—climbing Mt Everest in 2023. “This year,” he says, “will be all about preparing for that.”</p> <p>&nbsp;</p> <p><b>RIDING ROUTINE</b></p> <p><b>3am</b> – wake up, freshen up, black coffee and eggs for Ajay Lalwani, breakfast of choice for others</p> <p><b>4am-7am</b> – ride</p> <p><b>7am-7.10am</b> – fresh juice for Lalwani, snacks for team</p> <p><b>7.10am-9am</b> – ride</p> <p><b>9am-9.10am</b> – coffee for Lalwani</p> <p><b>9.10am – 12pm</b> – ride</p> <p><b>12pm-1pm</b> – lunch (boiled egg, chicken, salad, brown rice for Lalwani)</p> <p><b>1pm-4pm</b> – ride</p> <p><b>4pm-4.10pm</b> – eggs for Lalwani</p> <p><b>4.10pm-7pm</b> – ride</p> <p><b>7pm</b> – stop riding, freshen up, black coffee</p> <p><b>8.30pm</b> – dinner (paneer, salad, sprouts, dal for Lalwani)</p> <p><b>9.30pm</b> – lights out</p> Sun Jan 30 12:18:20 IST 2022 surviving-cancer <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>At the age of three-and-a-half Pranay Laccheta had one of his kidneys removed. Six solid tumours had formed around his kidney, making it extremely painful for the toddler to move. By the time he turned six, three solid tumours showed up again. This time near his spinal cord but relatively smaller in size. A second surgery was performed early this year that led to the diagnosis of Wilms' tumour—the most common type of kidney cancer in children, also known as nephroblastoma. By then Pranay's parents—Ritesh, a farmer and Pooja, a housewife—had already spent close to Rs6 lakh for the two surgeries, and treatment for cancer was beyond their means. Natives of Dhar—a district in Madhya Pradesh—all the couple was left with was a strong willpower to see their son through a disease they had heard for the first time in their lives.</p> <p>&nbsp;</p> <p>Five months ago, hope came riding in the form of free paediatric cancer treatment offered by the Tata Memorial hospital in Mumbai and a 'home away from home' offered by the St. Jude India Childcare Centre in Mumbai's suburb of Sewri, where the family has been provided free lodging and boarding for as long as Pranay's treatment lasts. While the family is being given full support from the hospital and St. Judes in terms of medical treatment costs, daily food expenses and accommodation, it is the future that worries them.</p> <p>&nbsp;</p> <p>"Given that our child had cancer, he will have to undergo expensive tests and routine check-ups even after he is cancer free. The expenses will never end," rues Ritesh. So far Pranay has undergone six chemotherapy cycles and 15 radiation cycles.</p> <p>&nbsp;</p> <p>Bhars, a family of three from Bengal's Begampur, found shelter at St. Judes when they came for the treatment of their nine-and-a half-year-old son, Rana Bhar, at Tata Memorial after he got diagnosed with blood cancer eleven months ago. On January 7, 2021, Rana celebrated his ninth birthday. Within the next 15 days he was diagnosed with blood cancer. Now, less than a week to go for his 10th birthday, the young boy hopes to be free of the disease and head home.</p> <p>&nbsp;</p> <p>On a bright afternoon a lean-looking Rana—his head shaven—immerses himself in a colouring book as his father Robin, a construction worker, looks on. Rana's teeth in the upper jaw have been completely extracted because of cancerous infection, due to which the boy is unable to eat comfortably; the doctor has advised plastic surgery when he turns 18. "We do not have the wherewithal to pay for the expenses once we are out of here," says Robin.</p> <p>&nbsp;</p> <p>This predicament of the impending and long-term medical expenses long after a patient has been declared cancer free is commonly seen among families of cancer patients. According to a review analysis of the financial toxicity of cancer care in India carried out by a team of researchers comprising Kochi-based oncologist Dr Aju Mathew, Kozhikode-based medical student Jeffrey Mathew Boby and Hyderabad-based oncologist Senthil Rajappa, and published in the latest issue of Lancet Oncology, it is found that cancer is among the leading causes of morbidity and mortality in India and around 50 per cent of cancer patients and their families struggle financially to manage care for the disease. In India one-third of households with a cancer patient is estimated to spend more than half their annual per capita household expenditure on hospitalisation due to the disease.</p> <p>&nbsp;</p> <p>To pay the ‘catastrophic health expenditure’, patients and families often resort to distress (or hardship) financing—they borrow money, pawn jewellery, use up all their savings or sell assets. The main reason for this is the lack of insurance coverage for cancer patients in the country. "And for children suffering from cancer this is a big hit because for the rest of their lives they are denied insurance," says Anil Nair, CEO, St. Jude Childcare Centre, "The IRDA, which is the regulatory body for insurance coverage, has not allowed insurance companies to [cover]cancer patients. This is even if these patients are medically declared cancer survivors—which means after five years from the date of diagnosis they're not detected with cancer cells."</p> <p>&nbsp;</p> <p>St. Judes, which provides free accommodation and holistic support to over 400 children with cancer, has been trying hard to get an insurance coverage for them. The organisation is currently present in nine cities, with 37 centres that can accommodate children with cancer and their families. In November, for the first time, children supported by St. Jude India ChildCare Centres (St. Judes India) during their treatment, and who are now cancer free for five years, will be provided health and accident coverage by Chennai-based Star Health and Allied Insurance Company.</p> <p>&nbsp;</p> <p>The initiative will cover 596 children in its first year [270 children under health category and 326 children under accident category]. Each year at least 500 children are expected to be added to this group as part of a new St. Judes programme called St. Judes for Life, which ensures that children who have won the battle against cancer can fulfil their potential. “We at Star designed this cover to enable children who were diagnosed, treated and are cancer free for 5 years fulfil their aspirations without worrying about the cost of medical emergencies," says Dr Prakash, managing director, Star Health and Allied Insurance.</p> <p>&nbsp;</p> <p>"It will help us live a normal tension-free life, and help us focus on our careers ahead," says Nazia Sayyed, 26, a cancer survivor who spent ten years at St. Judes since she was diagnosed with bone cancer as a nine-year old. She is now pursuing her masters after completing her B.Ed degree.</p> <p>&nbsp;</p> <p>The pandemic further brought the need for health insurance for cancer patients into focus. "In the last two years I must have shelled out approximately Rs20,000 from my pocket for routine tests and ultrasounds as my doctor at Tata Memorial had asked me not to travel unless there's an emergency. This health insurance will benefit me a lot," says Ankit Mourya, 22, who is a cancer survivor and is currently pursuing a diploma in pharmacy.</p> Wed Dec 22 14:57:29 IST 2021 catch-it-early <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Ruchi Gupta, a 36-year-old from Delhi, delivered twins on December 13. She had undergone IVF treatment and had pregnancy-induced hypertension from week 20 onwards. “Because of potential complications, the babies had to be delivered pre-term. The mom and the little ones are doing well,” says Dr Archana Dhawan Bajaj, a gynaecologist, obstetrician and IVF expert at Nurture IVF, Delhi.</p> <p>&nbsp;</p> <p>Gupta was lucky. As the preeclampsia was caught early, she could seek timely help. Preeclampsia is a pregnancy complication associated with high blood pressure, protein in the urine and swelling of the hands, feet and face. It occurs due to endothelial dysfunction (a type of non-obstructive coronary artery disease). Women with this condition have compromised blood vessels that cannot support pregnancy. “It happens after 20 weeks of pregnancy and can present up to six weeks post-delivery as well in women whose blood pressure was normal previously,” says Dr Prathima Reddy, director and lead consultant, obstetrics and gynaecology, Sparsh Hospital for Women and Children, Bengaluru.</p> <p>&nbsp;</p> <p>In pregnant women, the blood vessels get enlarged to support pregnancy. When there is a problem due to some oxidative stress (caused by an imbalance between antioxidants and free radicals—oxygen-containing molecules with an uneven number of electrons) early during pregnancy, the blood vessels do not become large enough to allow enough blood supply. This can result in the blood flow not happening in the way it should. Injury to blood vessels is common during pregnancy. Usually, when there is an injury, clotting factors are used up to form blood clots. But when there is preeclampsia, oxidative stress is exaggerated, and after a point, the blood fails to clot and there can be bleeding.</p> <p>&nbsp;</p> <p>“If untreated, preeclampsia can cause serious harm to the mother and baby,” says Reddy. "It could also affect the mother’s kidneys and liver, and can also cause complications post-delivery, especially in the first six weeks."</p> <p>&nbsp;</p> <p>Worldwide, preeclampsia complicates about 5 per cent of pregnancies. In India, this is close to 20 per cent. Preeclampsia is one of the most common causes of maternal mortality in India. In rural India, maternal deaths due to preeclampsia often go undiagnosed or unreported. A 2019 survey conducted by a team of researchers led by economic activist Jean Dreze showed that 63 per cent of women in rural India work till the day of delivery.</p> <p>&nbsp;</p> <p>Preeclampsia can be a silent killer, and so pregnant women need to have their blood pressure checked regularly. “Blood pressure that exceeds 140/90 mmHg on two occasions at least four hours apart is abnormal,” says Reddy. “Other signs could be protein in the urine and sudden, excessive weight gain. Headache, vomiting and pain in the upper abdomen are signs of what is known as impending eclampsia or a more severe form of preeclampsia.”</p> <p>&nbsp;</p> <p>Low-dose aspirin has been found to reduce the risk of developing preeclampsia by 15 per cent. “This is started at about 12 weeks of pregnancy,” she adds. “Medication to reduce blood pressure can be given to prolong the pregnancy to gain foetal maturity, as long as the mother’s health is not compromised. The only treatment or cure for preeclampsia is delivery,” she adds.</p> <p>&nbsp;</p> <p>A novel study conducted by a team of researchers led by Dr Revathi S. Rajan, chief consultant, maternal foetal medicine and managing director, Mirror Health, Bengaluru, offers hope. The study emphasises the use of angiogenic biomarkers (biomarkers in the blood vessels) to predict adverse maternal and prenatal outcomes. The study team screened 50 high-risk pregnant women in their third trimester in Bengaluru. “Angiogenesis means blood vessel growth,” says Rajan. “The whole idea was to find a tool to identify women who can suffer complications, particularly preeclampsia. We wanted to find a single marker that can alert the clinician if a lady is likely to develop complications soon. Using a simple blood test that can be done in an OPD setting, we were able to identify who is safe and who is unsafe, much before the actual symptoms of preeclampsia arose, and transfer them to a tertiary hospital. When things got unstable, we decided to deliver the patient with full clinical help. The outcomes in such cases were much better as we were armed with all the resources, including blood products and NICU (neonatal intensive care unit) facilities.”</p> <p>&nbsp;</p> <p>The study, she hopes, will help the health care system make better use of available resources. The test would allow hospitals to channel their resources towards at-risk mothers. “Our study found that any pregnant mother who is hypertensive and has a [angiogenic biomarker] value of less than 38 beyond 24 weeks of pregnancy till 37 weeks of gestation is safe and will not develop preeclampsia, whereas anyone with a value greater than 85 is likely to develop serious disease 60 per cent of the times within a week of prediction,” says Rajan. “A woman with normal biomarkers should be allowed to continue her pregnancy without unnecessary interventions.”</p> <p>&nbsp;</p> <p>The amount spent on managing women with preeclampsia in a critical care unit is huge, she says. “NICU is something not many people can afford easily.” Rajan claims the cost of doing the test is much lesser than spending on unnecessary admissions or early delivery at NICU setups.</p> <p>&nbsp;</p> <p>The test has a high degree of sensitivity and specificity, says Rajan. “It reflects the level of blood vessel integrity. Also, you can even get a nurse to do this blood test.”</p> Wed Dec 22 14:51:11 IST 2021 revived-but-restricted <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Early this year, during the peak of the second wave of Covid-19, Gurugram-based Shiksha Thakur's 24-year-old sister Diksha tested positive. Her lungs were 90 per cent damaged. As hospitals were overrun, the Thakurs turned to their family physician—Noida-based Dr Raman Kumar. Having been their physician for several years, he was familiar with their general health status.</p> <p>&nbsp;</p> <p>Kumar assessed Diksha's condition through a video call and said that she had to be hospitalised within four hours and needed ventilator-assistance to survive. The family panicked because there was an acute shortage of beds, but Kumar used his contacts to get them a ventilator-installed bed. “My sister is alive because of him,” said Shiksha. Diksha recovered after 45 days of hospitalisation.</p> <p>&nbsp;</p> <p>When others in the family tested positive for Covid, Kumar became their foremost point of contact. “We have blind faith in him,” said Shiksha. “His assessment is on point and unlike the big, expensive superspecialists, he knows us and is warm. He consults for us all, from my three-year-old son, to me and my sister who are in our 20s, to my mother-in-law who is a sexagenarian. He gives us time, patience and explains complex medical issues in simple language.”</p> <p>&nbsp;</p> <p>Kumar, who is president of the Academy of Family Physicians of India, said that the pandemic had resurrected the waning popularity of the general practitioner in India. “During both waves, for Covid-19 patients who could be managed at home and the ones who were critical, but facing an acute bed shortage, authentic medical advice became precious,” he said. “People then began to realise the importance of their GP, who could guide them over the phone or in person, be available for them at any time of the day and had decades of experience practising within the community or area.”</p> <p>&nbsp;</p> <p>Experts agree that superspecialists had become the norm before the pandemic and patients themselves decided “the organ that should be treated and the specialist who can do it”. Dr Vishanji Nagda, a GP based in Santacruz, Mumbai, said that while superspecialisation was vital, it was not for patients to self-diagnose and decide who to approach. “The family physician had been doing this job of assessing a person's health, while going through the medical history, and then recommending which specialist to go to,” he said. Nagda's son, Nimit, is a general practitioner and his daughter Niyati is a gynaecologist.</p> <p>&nbsp;</p> <p>In 2016, a parliamentary report said medical education was designed in a way that led to the concept of family physicians being ignored. Ironically, the Medical Council of India's new MBBS curriculum does not even mention the words general practice, family medicine or family physicians, according to Kumar.</p> <p>&nbsp;</p> <p>In a paper criticising the council for the “abolition of the academic discipline of family physicians and general practitioners”, Kumar said the curriculum leaves MBBS students on a road of no return towards specialisation and tertiary level hospitalist care. He wrote there was a “treacherous hierarchical monopoly” of hospital-based specialists over community-based GPs within the health care delivery system in India. “Keeping out family physicians and general practitioners from the health system means a free flow of patients to expensive tertiary care facilities in the absence of any structured referral system,” he argued.</p> <p>&nbsp;</p> <p>He also wrote that the medical education system in India had not been reformed for the last six decades. “Unlike most of the world, medical education is imparted at tertiary care hospitals (medical college hospitals) and by specialist doctors only,” he wrote. “Family physicians are not eligible to become teachers because of the lack of PG qualification and disabling regulations; their practices are not considered teaching locations. Therefore, medical students do not have any exposure to this wonderful, viable and lucrative career option.”</p> <p>&nbsp;</p> <p>The number of traditional general practitioners is definitely decreasing. In cities like Mumbai, Chennai, Kolkata and Pune, the older generation is retiring in their 70s and 80s and no one is opening new practices in their localities. This, in turn, will have an effect on local communities. Mohini Khurana, a homemaker in Pahar Ganj, Delhi, said their family physician was a guide when she and her seven-year-old daughter tested positive for Covid. “Also, we have developed such friendly relations that we can literally go to him for anything,” she said. “Otherwise, whom to approach for something as simple as a wound or acidity?”</p> <p>&nbsp;</p> <p>In a way, the pandemic brought out the best in GPs. For instance, Nagda was attending to 25 to 30 patients a day through voice and video calls. “Initially, people called out of anxiety and it became difficult for me to convince them that they didn't have Covid,” he said. “As a doctor, I was learning, too.” In the last week of May, he stepped out of his house for the first time for an emergency visit to a 67-year-old hypertensive patient, who refused to accept his recommendation. “His CT scan showed signs of pneumonia,” said Nagda. “So I asked him to get tested for Covid, but he just did not go. At the time, the stigma was so high that patients became defensive and the doctor's inquiry became akin to police inquiry. I had to hand-hold him, which worked.”</p> <p>&nbsp;</p> <p>While Nagda has an MBBS, Nimit went a step further and completed post graduation in family medicine. “The difference is that while my father can only refer patients to hospitals, I can actually admit them under my name at the hospital I am attached to,” said Nimit. “Which means that the post graduation allows me to go beyond a local clinic and attend to patients inside hospitals as well. In that sense, family medicine is evolving in India.” Nimit consults in the hospital in the mornings and at their clinic in the evenings.</p> <p>&nbsp;</p> <p>Dr Balram Bhargava, director general, Indian Council of Medical Research, said a post graduate degree in general medicine after MBBS adds immense value. “Because it forms the foundation of medicine in its entirety,” he said. His son, Madhav is MD (general medicine) and is working at AIIMS. He was clear that he did not want to go for a specialisation, unlike his cardiologist father or endocrinologist brother, Raghav. Madhav said that general medicine prepares you to look at the human body in its entirety.</p> <p>&nbsp;</p> <p>Postgraduate programmes in family medicine is making the discipline increasingly significant inside hospitals. In the corporate model, the GP can demand a huge fee, in line with growing purchasing power. But, the family physician continues to be important in smaller towns and rural areas. The issue going forward is that in India medical students are largely unaware about family medicine as a career because this concept is not introduced at the MBBS level.</p> <p>&nbsp;</p> <p>Experts believe that in India faculty and senior doctors from other disciplines are not able to answer the queries related to family medicine as they themselves have not learned it. “Yet, with postgraduate programmes in family medicine, we are gearing up towards creating awareness regarding this discipline,” says Dr Kishore Madhwani, MD (community medicine), who practices at the upscale Mumbai neighborhood of Napean Sea Road. Dr Jayshree Mondkar, who served as dean, Sion Hospital, said: “We need to have more medical colleges actually offering the degrees in family medicine.” While the devastation of the pandemic helped to reaffirm the significance of the role of family physicians, medical colleges clearly need to do a lot more to ensure that the discipline gets due importance.</p> Sun Dec 26 11:47:44 IST 2021 what-inside-the-yellow-healer <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Researchers at the Indian Institute of Science Education and Research, Bhopal, recently published a pathbreaking finding—they unveiled the genome of turmeric for the first time in the world. The genome sequencing revealed many hitherto unknown details on the herb. This would help in a more advanced analysis of the efficacy and adverse effects of the drugs made from it. There have been numerous studies about the medicinal traits of turmeric, but its genetic makeup was unknown until the IISER team came up with its findings.</p> <p>&nbsp;</p> <p>Turmeric has been traditionally used as a herb and spice in south Asia, especially India, for more than 4,000 years. It is most known for its anti-inflammatory properties. The medicinal applications of the herb are mentioned in various Ayurvedic treatises like Charaka Samhitha, Ashtanga Hrudayam, Susrutha Samhitha and Sarngadhara Samhitha. Charaka Samhita mentions turmeric as the main ingredient in several medical formulations—to treat ailments ranging from skin diseases to psychiatric problems. It is believed that the herb reached China by 700AD and East Africa by 800AD. In 1280, Marco Polo mentioned the herb in his travel notes in China. In medieval Europe, it was known by the name “Indian saffron”.</p> <p>&nbsp;</p> <p>It is estimated that a tablespoon of ground turmeric offers 29kcal, 9g protein, 4g carbohydrates, 1g fibre, 3g fat, 196mg potassium and 7mg iron. It has hundreds of bioactive compounds—curcumin is arguably the most famed one among them. A 2015 study found that these compounds help the body combat the damaging effects of the oxidation process that may lead to conditions like heart disease, diabetes, chronic inflammation and cancer. An animal study in 2018 produced encouraging results on the therapeutic potential of curcumin for treating arthritis. Studies also suggest that curcumin may act as an immune modulator influencing immune cells and natural killer cells. Another active ingredient in turmeric, turmerone, was found to have properties to trigger cell repair and support recovery of brain function in conditions like stroke and Alzheimer’s.</p> <p>&nbsp;</p> <p>There are certain conditions where people are advised not to take turmeric in high quantities. For instance, it can worsen the condition in those patients suffering from iron deficiency anaemia and gallstones. During pregnancy, it is advised not to consume turmeric in medicinal quantities as it may alter levels of the oestrogen hormone.</p> <p>&nbsp;</p> <p>As part of the study, the IISER researchers performed a comparative evolutionary analysis of 17 plant species. This revealed that several genes in turmeric have unique genetic pathways for the synthesis of secondary metabolites such as curcuminoids to survive environmental stressors, and these metabolites are responsible for the herb’s medicinal properties. Even now, the use of turmeric in western medical practices is limited. IISER’s findings could change that.</p> Wed Dec 22 14:35:36 IST 2021 how-to-diagnose-folio-a-deux-a-mental-illness-that-affects-two-or-more-individuals <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Recent media reports have focused on the peculiar case of Purushottam Naidu and his spouse Padmaja, who murdered their daughters. This gory incident took place in Chittoor district of Andhra Pradesh. When police rushed to the scene, they found the bodies of the couple’s daughters, Alekhya, 27, and Sai Divya, 22. They were allegedly bludgeoned to death using dumbbells. The Naidus thought that ‘evil spirits’ had infested their younger daughter’s head, which is why they had to break open her skull to rid her of the ‘evil forces’. The couple was distressed that their ‘ritual’ was broken by the police while they tried to resurrect their dead daughters. The wife even instructed the police to come back the next day to witness a miracle, wherein the dead daughters would be brought back to life. Police found the couple to be in a state of complete denial, trance and disorientation, amid a pool of blood. The Naidus told the police, that they received signals from heaven and had a house of miracles.</p> <p>&nbsp;</p> <p>Netflix is now streaming a three-part documentary series titled House of Secrets: The Burari Deaths. Apart from India, the series is also trending in Pakistan and most countries in south Asia. It details the suicide pact of ten members of a Delhi family. They were found hanging from the ceiling, blindfolded, gagged, and with their hands tied behind their back. The eleventh member—the oldest woman in the house—lay strangled in a corner of the room. The cops found diaries in the house written over 11 years. It had detailed instructions on how every single member of the family was supposed to go through life, where they are to invest money, and explicit instructions for ‘mass salvation’, including how the hangings should be conducted. The primary source of all these oddities is finally pointed to a relatively young family member with a history of unaddressed trauma.</p> <p>&nbsp;</p> <p>In November 2019, Ellen Barry, a journalist with The New York Times, wrote a highly cited article titled ‘The Jungle Prince of Delhi’. In it, Barry chronicled the ‘royal family of Oudh’ that had been deposed, and had resigned to their fate of living in a ruined palace in Delhi.</p> <p>&nbsp;</p> <p>The cases reflect an uncommon but intriguing psychiatric disorder, known by many names. Some of these names include double insanity, psychosis of association, shared psychotic disorder, and induced psychosis.</p> <p>&nbsp;</p> <p>Folie a deux (‘madness for two’) is the French terminology for this disorder, which is characterised by the presence of similar psychotic symptoms (usually delusions) in two individuals. A delusion is defined as a fixed, false, unshakeable belief that is out of keeping with a person’s social and cultural background. The person who first develops the delusional symptoms is referred to as the ‘primary’ patient. He/she can be distinguished from one or more ‘secondary’ patients. In these secondary patients, the delusional symptoms are induced by the primary patient. This phenomenon of transmitting symptoms is not seen in any other psychiatric disorder, and this lends intrigue to this complex phenomenon.</p> <p>&nbsp;</p> <p>The term folie a deux was coined in the 19th century by two French psychiatrists—Charles Lasegue and Jean-Pierre Falret. It is posited that transmission of psychiatric symptoms from one individual to another occurs under a special set of circumstances. A more active and intelligent person generates delusional themes and ideas, while a submissive person can act as a passive recipient of these ideas. It is in this context that assimilation of these delusional ideas occurs.</p> <p>&nbsp;</p> <p>Covid-19 and the consequent global lockdown have served as a ground for social isolation and depravity. Under such unprecedented circumstances, having close physical and social ties becomes next to impossible. This facilitates the easy transmission of delusional ideas, in persons having close associations via common interests, opinions, values and emotions.</p> <p>&nbsp;</p> <p>As with any other psychiatric disorder, genetic and environmental factors play a pivotal role in the genesis of this disorder. It is more common in families who have had members suffering from any other psychiatric disorder, particularly schizophrenia. The family climate serves as the environmental trigger in the pathogenesis of this disorder. The key factor in precipitating induced delusional disorder is disturbed interpersonal relationships.</p> <p>&nbsp;</p> <p>An interesting offshoot of folie a deux is folie a famille. It is characterised by the presence of delusional ideas in more than two members of the same family. In most cases, individuals across several generations are affected such as grandparents, parents and children. Typically, these families shun treatment as they have little to no insight into their delusional belief systems. Folie a famille is a common occurrence in the context of socially isolated families, in closely enmeshed families wherein there is a high and abnormal degree of interdependence, in unstable families who have frequent crises, and in families having highly dominant personalities who serve to transmit these delusions.</p> <p>&nbsp;</p> <p>The diagnosis is made on clinical grounds, and includes detailed assessments of all the affected family members. In some contexts, brain scans (MRI, CT) are ordered especially if the symptoms are secondary to organic brain conditions such as brain tumours, metastasis to the brain secondary to cancer, head injury and dementia. A panel of blood investigations to rule out thyroid abnormalities, vitamin B12 and vitamin D deficiencies are also commonly ordered.</p> <p>&nbsp;</p> <p>A multi-component treatment approach is essential as for any other psychiatric disorder. The key treatment aspect involves physically separating the passive recipient/s of delusions from the more active primary member. This will automatically lead to the secondary family members ridding themselves of their delusional belief systems, as they are no longer controlled by a more dominant person. Treatment approaches include a specialised form of talk therapy called cognitive behavioural therapy (CBT), which encompasses two processes---the cognitive component and the behavioural aspect. The cognitive component will explore the way the affected family members think about themselves, the world, and other people including other family members. The behavioural component of CBT will examine how their actions further influence their thought processes and feelings. CBT adopts a ‘here and now’ approach to problem solving. CBT may involve anywhere from five to 20 sessions, and each talking session lasts between 30 to 60 minutes. Inputs are also given in the form of family therapy. This involves all the family members and tries to address the interpersonal conflicts that may be present within families. In some persons wherein the symptoms continue even after physical separation, low dose medications that block chemical messengers in the brain are given for a short period. The technical term for this class of medications is dopamine receptor blockers (DRBs), and these are commonly referred to as anti-psychotics. Careful consideration is given to personalising the right medication for each individual.</p> <p>&nbsp;</p> <p>The prognosis for affected family members is good, and most members make a full functional recovery with the right support.</p> <p>&nbsp;</p> <p><b><i>Dr Alok Kulkarni is a senior consultant psychiatrist at the Manas Institute of Mental Health, Hubli.</i></b></p> Mon Nov 29 09:04:47 IST 2021 how-2-researchers-made-mrna-vaccines-safe-for-people-with-cancer <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>The story of the mRNA vaccine is an interesting one that began three decades ago, with a little-known scientist duo who refused to quit. For more than 30 years, biochemist Katalin Karikó researched synthetic messenger RNA (ribonucleic acid), or mRNA—a genetic code. Her path was not easy.</p> <p>&nbsp;</p> <p>Karikó left her native Hungary in 1985 and settled in Philadelphia. But while she landed teaching positions, her grant applications to study mRNA were repeatedly turned down. Karikó kept her focus on mRNA, exploring how the single-stranded molecules of genetic code could treat a wide range of conditions—from strokes to cancer—and also protect against influenza, among other ailments. Karikó’s luck turned in 1998, when she met immunologist Drew Weissman, a professor of medicine at the University of Pennsylvania, and the two formed a research partnership.</p> <p>&nbsp;</p> <p>For over a decade, Weissman, professor in vaccine research, University of Pennsylvania, and Karikó, an adjunct professor of neurosurgery at Penn and a senior vice president at BioNTech, worked to chemically modify mRNA so it could be used safely and effectively in vaccines.</p> <p>&nbsp;</p> <p>Many vaccines stimulate immunity and prepare the body to fight against a specific virus by using a weakened or dead version of the actual virus. mRNA vaccines, however, carry a genetic code that causes the body’s cells to produce proteins that the immune system recognises as the virus. The immune system then builds up the necessary defences against the viral proteins to protect against future infection and severe disease.</p> <p>&nbsp;</p> <p>Prior to Weissman and Karikó’s breakthrough research, mRNA vaccines being developed to prevent infectious diseases did not effectively and safely elicit protective immune-system responses in animal models. Weissman and Karikó changed the way the mRNA was made by including specific naturally occurring mRNA modifications that make the mRNA safer, more stable, and effective for prophylactic and therapeutic purposes.</p> <p>&nbsp;</p> <p>Every strand of mRNA is made up of four molecular building blocks called nucleosides. But in its altered, synthetic form, one of those building blocks, like a misaligned wheel on a car, was throwing everything off by signalling the immune system. So Karikó and Weissman simply subbed it out for a slightly tweaked version, creating a hybrid mRNA that could sneak its way into cells without alerting the body’s defences.</p> <p>&nbsp;</p> <p>The US Food and Drug Administration (FDA) has given the first full approval to a Covid-19 mRNA vaccine, which uses modified mRNA technology invented and developed by Weissman and Karikó, whose years of research in mRNA science laid a critical piece of the foundation for the largest global vaccination campaign in history.</p> <p>&nbsp;</p> <p>The FDA’s first Covid-19 vaccine approval comes at a critical point in the pandemic, as more contagious and deadly variants continue to spread. According to the World Health Organization, more than 211 million people have been diagnosed with Covid-19 worldwide, and the virus has taken the lives of more than 4.4 million people.</p> <p>There are many grey areas as far as the vaccine response is considered due to lack of data, two of them being the duration of action of the vaccine’s immune response and the effectiveness of the vaccine in the immunocompromised or people with cancer.</p> <p>&nbsp;</p> <p>The latest data from Pfizer shows high antibody levels at six months and it could well offer the protection for a year, but whether we are looking at protection for five or ten years cannot be predicted in the wake of lack of long-term data. Moreover, vaccines elicit responses from memory cells and effector cells, the former of which cannot be measured by antibodies in the blood. So it's really going to take following people over time and seeing when they start getting the disease again, to decide when the vaccine needs to be boosted.</p> <p>On the effectiveness of mRNA vaccines in the immunocompromised like those with cancer, Weissman opines that the more immunosuppressed a person is, the less well they're going to respond to a vaccine because when your immune system is impaired you just don't respond well to vaccines. However, any kind of response, however small it is, would help the patient and should be considered. Patients with cancer can be at high risk of severe COVID-19 due to their age, disease, cancer treatment, and medical comorbidities.</p> <p>&nbsp;</p> <p>Dr Shaji Kumar, oncologist-haematologist at the Mayo Clinic, Rochester, says that to the question of should cancer patients get the vaccine, “the simple answer is yes”. He goes on to clarify that, ‘until we have more definitive data on the efficacy of vaccines in cancer patients, we should work on the assumption that at the minimum it will be better than not getting a vaccine, it still is going to be valuable in potential prevention of infection or at least decrease the severity of infections if someone gets it.’</p> <p>&nbsp;</p> <p>However, evidence is in. As per study results revealed at the annual congress of the European Society for Medical Oncology earlier this year, individuals with cancer have an appropriate, protective immune response to vaccination without experiencing any more side-effects than the general population. Indirect evidence also suggests that a third “booster”shot could further increase the level of protection among this patient population. The high rates of efficacy of the vaccine observed across the trial population, regardless of the type of anticancer treatment, constitutes a strong and reassuring message for patients and their doctors.</p> <p>&nbsp;</p> <p>To explore the potential impact of chemotherapy and immunotherapy on the protection afforded by vaccination against Covid-19, one of the studies enrolled 791 patients from multiple hospitals in the Netherlands in four distinct study groups comprising individuals without cancer, patients with cancer treated with immunotherapy, patients treated with chemotherapy and finally patients treated with a chemo-immunotherapy combination, to measure their responses to Moderna’s two-dose mRNA vaccine.</p> <p>&nbsp;</p> <p>At 28 days after administration of the second dose, adequate levels of antibodies to the virus in the blood were found in more than 80 per cent of patients receiving various cancer therapies. These results compare favourably with the antibody responses seen in almost all of the group of individuals without cancer. The study further highlighted the importance of ensuring complete, two-dose vaccination for patients with cancer to develop enough protective antibodies against the virus, as the trial data also showed that only about one in three of those receiving treatment had achieved a sufficient response after their first shot.</p> <p>Patients with cancer were excluded from the clinical trials conducted to develop the Covid-19 vaccines. The questions of whether the vaccines are safe in this vulnerable population and whether they provide adequate protection against severe forms of Covid-19 to individuals whose immune system may be weakened by various anticancer medicines had until now been left open. Research studies are offering conclusive evidence that while being largely effective, anti-Covid vaccination is just as safe for people with cancer as it is for the general population.</p> <p>&nbsp;</p> <p>Weissman adds a word of caution, “We still don't know how good a single patient is going to respond to the vaccine. On a population basis, people with active cancer have reduced immune responses, but for each individual patient, we just don't know what that means. Ideally, we want to reach herd immunity to slow and stop this pandemic. Once that occurs people can go back to normal. My advice to my immune deficient patients is to wait for herd immunity to be achieved before going out without a mask and return to your normal life.”</p> <p>&nbsp;</p> <p>Of course, your oncologist is your best adviser as to the best time to take the vaccine based on the treatments you are undergoing.</p> <p>&nbsp;</p> <p>Weissman and his colleagues are studying mRNA for other infectious-disease vaccines, including one for influenza and a single vaccine that may prevent various types of coronaviruses like Covid-19, SARS, and MERS—because even after the Covid-19 pandemic, other coronaviruses will still pose serious threats to public health.</p> <p>&nbsp;</p> <p><b>Priya Menon is scientific media editor at TrialX/Applied Informatics Inc. She manages and hosts CureTalks, an international online radio talk show on cancer research and health care.</b></p> Sun Nov 28 13:02:43 IST 2021 how-apollo-hospitals-saved-17-lives-using-ecmo-during-second-wave-of-covid <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>How far can a machine go to save lives? Can it save a Covid-19 patient whose lungs are severely infected? Can it act as an artificial heart when the real one is close to collapsing? For a multidisciplinary team of doctors at Apollo Hospitals, the answer is yes. During the pandemic, they used Extracorporeal Membrane Oxygenation (ECMO) therapy to save several critically ill patients. “For patients who cannot be saved when on ventilator, ECMO is a lifesaver,” said Suneeta Reddy, managing director of Apollo Hospitals.</p> <p>&nbsp;</p> <p>During the pandemic, Apollo had brought together a 143-member ECMO team that had cardiothoracic surgeons, pulmonologists, perfusionists, nutritionists, technicians and nurses.</p> <p>&nbsp;</p> <p>Since 2010, Apollo has used ECMO to treat 270 patients. Before the pandemic, it was used in a variety of situations, including to treat poisoning, trauma, infections such as H1N1, and to stabilise pre- and post-transplant patients.</p> <p>&nbsp;</p> <p><b>What is ECMO?</b></p> <p>The ECMO machine is like a heart-lung bypass system. The patient’s blood is collected into the external machine through tubes placed inside large veins (close to the heart). It is then purified, oxygenated and pumped back into the body. It lessens the load on the lungs and the heart.</p> <p>&nbsp;</p> <p>The majority of Covid-19 patients have respiratory problems and only lung support is required. In a smaller number of patients, the heart, too, needs help.</p> <p>&nbsp;</p> <p>At Apollo, the multi-disciplinary team used ECMO to save 17 patients during the second wave of the pandemic. “If given enough time, the lungs can recover in a majority of Covid-19 patients,” Paul Ramesh, senior consultant, cardiothoracic and heart and lung transplant surgeon, Apollo Hospitals, told THE WEEK. Of the 17, there was a 28-year-old patient from Gujarat who was on ECMO for 116 days. He recovered fully. Apollo had placed 23 patients on ECMO during the second wave; of the lot, 10 were discharged, one had a successful transplant and two are off ECMO and currently undergoing rehabilitation. Four are still on ECMO. “The average period on ECMO prior to discharge is 60 days,” said Ramesh. “The current survival rate at six months for ECMO patients is 73.9 per cent [at Apollo], which is higher than the global average of 40 to 50 per cent.”</p> <p>&nbsp;</p> <p>Said Dr K. Madhankumar, senior consultant, cardiothoracic and heart and lung transplant surgeon, Apollo Hospitals: “The reasons for our team’s success include awake ECMO, which allows patients to remain awake and engage with their families, which boosts their morale and enhances the likelihood of faster recovery and better treatment outcomes. Patients on ECMO are urged to exercise on a regular basis, and physiotherapy is provided to fully mobilise them quickly after they have been [taken off] the machine.”</p> Sun Nov 28 13:03:55 IST 2021 how-air-pollution-can-cause-depression <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Delhi has become a smog-house in the last couple of weeks. The air quality in the city dropped to alarming levels; schools have been shut; power plants and other industries have halted operations, and the Supreme Court called the capital city’s condition a “crisis”. There have been numerous studies about physical health problems—for instance, the development of respiratory and cardiovascular diseases—caused by air pollution. But its adverse impact on mental health is often overlooked. Now a new study reveals that “air pollution is changing the expression of genes that are conducive to depression”.</p> <p>&nbsp;</p> <p>There have been several studies in the past observing how air pollution is linked to depression. But this new study published in the journal Proceedings of the National Academy of Sciences is the first to show a direct neurological cause for this link.</p> <p>&nbsp;</p> <p>The study observed 352 residents from Beijing—a city with high levels of pollution. As part of the study, the researchers analysed their genetic susceptibility to depression. It is observed that those with a genetic predisposition for a particular disease have an increased likelihood of developing that condition depending on certain environmental factors.</p> <p>&nbsp;</p> <p>The researchers investigated the effects of having exposure to fine particulate matter (PM 2.5, which contains inhalable particles smaller than 2.5 microns), in combination with a genetic predisposition for depression, on brain networks involved in social stress.</p> <p>&nbsp;</p> <p>The subjects were asked to take a cognitive test involving reason and problem-solving. The researchers found that during the test, the activity in the dorsolateral prefrontal cortex—a brain region that is involved in cognitive functions such as response selection and working memory—changed in individuals with higher PM2.5 exposure and a genetic predisposition for depression.</p> <p>&nbsp;</p> <p>The researchers further wanted to examine the interaction between genetic risk for depression and air pollution. They mapped brain regions in subjects expressing high levels of depression-associated genes. Allen Brain Atlas, an online database, helped the researchers identify brain regions that are supposed to show correlated expression of genes associated with depression. The pattern derived using the Atlas and brain connectivity patterns observed during the cognitive task in those with greater exposure to air pollution and a higher genetic predisposition for depression, were found to be similar. This correlation was weaker in those exposed to lower levels of PM2.5, which suggests individuals with a genetic susceptibility to depression may be more vulnerable to the adverse effects of air pollution. The study shows that those with depression, and those with a high genetic predisposition for depression, should take extra care as the pollution level rises.</p> Sun Nov 28 13:06:34 IST 2021 how-climate-change-impacts-mental-health <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>The world is getting ready for the 26th UN Climate Change Conference (CoP26). Scheduled to be held in Glasgow, Scotland, from October 31 to November 12, the CoP26 will discuss health as a science priority area.</p> <p>&nbsp;</p> <p>It needs to be, as climate change is the “single biggest health threat facing humanity”—according to a new report published by the World Health Organization. Climate change is already causing damage to global health in multiple ways. Some of the climate-sensitive health risks are injury and death from extreme weather; heat-related illness; respiratory issues; water-borne diseases; zoonotic diseases; vector-borne diseases; malnutrition and food-borne diseases; non-communicable diseases; and mental and psychosocial diseases.</p> <p>&nbsp;</p> <p>The impact of climate change on mental health is often ignored by policymakers. According to the American Psychiatry Association (APA), extreme weather events have been associated with an increase in aggressive behaviour and domestic violence. The 2015 Lancet Commission on Health and Climate Change had observed that floods and prolonged droughts have been associated with elevated levels of anxiety, depression and post-traumatic stress disorders.</p> <p>&nbsp;</p> <p>The APA also observes that people with mental health conditions are more likely to be affected by extreme weather events for several reasons. One major factor is that psychiatric medications can interfere with a person’s ability to regulate heat and their awareness that their body temperature is rising. And this could result in injury and death. It has been observed that exposure to extreme heat may lead to increased use of alcohol—to cope with stress—and an increase in suicide rates.</p> <p>&nbsp;</p> <p>People suffering from mental illness are also more likely to live in poverty or to have co-occurring substance use disorders. These factors make it harder for them to cope or adapt to changes related to the climate crisis. In addition, service, infrastructure, and medicine supply chains are often disrupted after disasters. This would severely affect those undergoing treatment for mental illness.</p> <p>&nbsp;</p> <p>Every year since 2008, an average of more than 20 million people are being displaced because of climate and weather-related incidents like floods and wildfires. Slower moving events like droughts and coastal erosion are also causing migration. This movement along with food scarcity and uncertainty have long-term effects on mental health. The APA warns that children are more likely to be impacted by disasters than adults. They are more likely to have continued trauma-related symptoms after a climate disaster.</p> <p>&nbsp;</p> <p>A recent report from the Academy of Medical Sciences and the Royal Society says that “taking action on the climate crisis is a ‘win-win’ as it will also produce positive impacts on health”. The earth needs healing, and CoP26 has a huge responsibility to take rapid action to reverse climate change.</p> Sun Oct 31 11:51:23 IST 2021 alcohol-dependence-is-a-brain-disorder-not-moral-weakness-dr-alok-kulkarni <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Arjun Sharma was a dynamic and talented bank executive who had come up in life the hard way. He had a warm personality and gelled well with colleagues. Arjun had only one vice: consumption of alcohol since age 19. Beena, Arjun’s wife, had grown tired of this habit from the first day of their marriage. She had to put up with it for 15 long years.</p> <p>&nbsp;</p> <p>Beena tried to convince Arjun, but he just couldn’t stop drinking. Fed up, she mulled divorce. That is when Arjun agreed to see a psychiatrist.</p> <p>&nbsp;</p> <p><b>What is alcohol use disorder?</b></p> <p>Alcohol use disorder, or AUD, is also called alcohol dependence syndrome or ADS. Laymen use terms such as ‘alcoholic’, ‘addict’, etc., to describe a person who is dependent on alcohol.</p> <p>&nbsp;</p> <p>Alcohol dependence is a brain disorder and not a moral weakness. It needs to be evaluated and treated in the same manner as one treats medical conditions like diabetes and hypertension. The stigma attached to alcohol dependence is in part due to the relapsing nature of the disorder. Alcohol use becomes a clinical entity when (a) usage becomes compulsive (b) there is loss of control over one’s drinking (c) there are physical signs of withdrawal following cessation or abstinence (d) increasing amount of alcohol needs to be consumed to obtain the same ‘’high’’ (e) there is progressive neglect of alternative sources of pleasure or interests as a consequence of alcohol usage (f) alcohol usage continues despite clear evidence of harmful consequences.</p> <p>&nbsp;</p> <p><b>Consumption of alcoholic beverages in India: 2016-2020</b></p> <p>In 2016, alcohol consumption in India was about 5.4 billion litres. It was estimated that the consumption would scale up to 6.5 billion litres by 2020. Rising levels of disposable income and a growing urban populace are contributing factors to this rise in alcohol consumption.</p> <p>&nbsp;</p> <p>Another important contributing factor that leads to alcohol usage is boredom, particularly among the youth. When people can’t keep themselves meaningfully engaged in any activity, the ensuing boredom and idleness may trigger the need to consume alcohol, to rid oneself of boredom.</p> <p>&nbsp;</p> <p><b>What is a standard drink?</b></p> <p>A standard drink is used to measure the alcohol intake. It always contains the same amount of alcohol regardless of the container size or type of alcoholic beverage. This varies from country to country. In India, a standard drink corresponds to 10ml of absolute alcohol.</p> <p>&nbsp;</p> <p><b>What are binge and heavy drinking?</b></p> <p>Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) to 0.08 or higher levels. Typically, this occurs after 4 drinks for women and 5 drinks for men—in about two hours. Heavy alcohol use is defined as more than four drinks on any given day for men or more than three drinks for women.</p> <p>&nbsp;</p> <p><b>Why is the risk increased in women?</b></p> <p>Many studies have shown that women tend to have alcohol-related problems sooner and at lower-drinking levels than men. This is called “telescoping’’ to signify that their alcohol-related problems quickly escalate. This is caused by a multitude of factors. Women tend to weigh less than men. Alcohol resides predominantly in body water, and women have less water in their bodies than men. After a woman and a man of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher, making her prone to a plethora of alcohol-related harm.</p> <p>&nbsp;</p> <p><b>What are the consequences of alcohol usage?</b></p> <p>Broadly, increased alcohol usage predisposes oneself to become prone to accidental injuries, physical and mental health problems, birth defects, relationship problems and problems in the interpersonal sphere.</p> <p>&nbsp;</p> <p>Alcohol usage may also contribute to increased risk of sustaining life-threatening burn injuries, accidental drowning, homicides, road traffic accidents, suicides and fatal falls. It also increases our chance to develop cancer of the breast, liver, colon, oral cavity, oesophagus, larynx, pharynx and rectum. Alcohol usage is a risk factor for developing heart diseases. Alcohol usage also puts us at increased risk of mood disorders, particularly anxiety and depression. It also alters the sleep architecture and can result in insomnia or fragmented sleep.</p> <p>&nbsp;</p> <p>When alcohol is ingested while a woman is pregnant, it may lead to congenital birth defects in babies. When babies get exposed to alcohol in the intra-uterine environment (womb), they may be at increased risk of brain damage, resulting in lifelong physical, cognitive and behavioural health problems. Categorically, women who are pregnant should not drink alcohol, as a safe limit for consumption in pregnancy has not been established.</p> <p>&nbsp;</p> <p><b>Is risk reduction possible?</b></p> <p>People who drink alcohol on a regular basis should keep track of how much they drink. Notes can be entered in a pocketbook or in the mobile phone. This may help in slowing down on the amount of alcohol consumed. Before drinking, it makes sense to measure the drink. Never mix drinks as it becomes difficult to gauge the amount consumed. It is also important to set limits and goals on the amount of alcohol to be consumed. And once these limits are set, one should proactively try to stick to these goals. Specified days in a week should clearly be marked as non-drinking days.</p> <p>&nbsp;</p> <p><b>What are the benefits of having a social-support group?</b></p> <p>Rebuilding a life without alcohol can be challenging. It is vital to seek assistance from external support systems, such as a social-support group. Joining mutual support groups such as Alcoholics Anonymous (AA) will help people maintain abstinence. Support groups educate the person’s family and friends about the harms associated with alcohol usage.</p> <p>&nbsp;</p> <p><b>What role do professionals play?</b></p> <p>The importance of consulting mental health professionals like psychiatrists cannot be over-emphasised. Since it is a brain disorder involving specific brain circuitry, treatment options have to be individualised to have the best possible outcome.</p> <p>&nbsp;</p> <p>Treatment goals are stratified into three domains. Immediate treatment goals constitute detoxification and medical management of symptoms. Short-term treatment goals encompass management of medical and other co-morbid psychiatric disorders. Long-term treatment goals constitute relapse prevention, vocational rehabilitation, improvement in quality of life and re-integration into society.</p> <p>&nbsp;</p> <p>The US Food and Drug Administration (FDA) has approved three medications for treating alcohol dependence syndrome. These are naltrexone, acamprosate and disulfiram. Naltrexone and acamprosate exert their mechanisms by negating the brain changes caused by alcohol usage. Disulfiram works by causing unpleasant reactions when a person taking this medication drinks alcohol. Baclofen, otherwise used in certain neurological conditions, has found off-label usage in alcohol dependence syndrome. In the Indian scenario, baclofen and disulfiram are the most widely used drugs to treat alcohol dependence. It is beyond the scope of this article to delve into the nuances and specifics of each of these drugs. Contrary to popular belief, none of these medications is addictive. Efficacy of treatment increases manifold when drug therapy is combined with counselling and psychotherapy.</p> <p>&nbsp;</p> <p><b>What are the various behavioural interventions available?</b></p> <p>Behavioural interventions constitute counselling and “talk therapy’’. These may include cognitive, behavioural, motivational, family and marital paradigms. Motivation Enhancement Therapy (MET) is an interventional approach designed specifically to evoke behavioural change in the client so that alcohol usage is either reduced or completely stopped. Client’s motivation to quit alcohol usage is enhanced through these counselling sessions.</p> <p>&nbsp;</p> <p>Network therapy relies on adopting a multimodal approach. It enlists friends and family members to provide ongoing support to promote an attitudinal change in the client’s behaviour.</p> <p>&nbsp;</p> <p>Family and marital therapies entail working closely with family members of the client to resolve on-going crises and to build closeness and intimacy among the client and family members.</p> <p>&nbsp;</p> <p>Psychiatrists are trained in conducting various behavioural interventions along with drug therapy. It is useful to remember that alcohol dependence is a medical condition which needs scientific treatment backed by empathy and care. It is criminal to label it as a symptom of the weak mind.</p> <p>&nbsp;</p> <p>Dr Kulkarni is a senior consultant psychiatrist.</p> Sun Oct 31 11:26:25 IST 2021 a-lost-childhood <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Former US first lady Michelle Obama started kindergarten in the fall of 1969 with “twin advantages”—she could read basic words and had a popular older brother who had gone ahead of her. Such advantages, Obama writes in her memoir, Becoming, could have a ripple effect in a child’s development. As early as 1969 in a public school in America, she was learning a basic truth: “If you’d had a head start at home, you were rewarded for it at school, deemed ‘bright’ or ‘gifted’, which in turn only compounded your confidence,” she writes. “The advantages aggregated quickly.”</p> <p>&nbsp;</p> <p>Instead of twin advantages, children growing up during the pandemic are facing twin disadvantages: lack of play and lack of learning in a physical classroom. Such disadvantages, too, can have a ripple effect, says Delhi-based clinical psychologist Prerna Sharma. She feels the pandemic generation is going to be different. “Covid-19 has deprived children of some of their development needs,” she says. “For young children, lack of contact with their peer groups in schools and parks could lead to poor emotional development, anxiety and isolation. Teenagers are finding it difficult to come out of their private zones and be with families, primarily due to their digital addiction.” Sharma says that many longitudinal studies are needed to assess the pandemic’s long-term impact on children; ultimately, only time will tell.</p> <p>&nbsp;</p> <p>According to the UNICEF, children younger than five years impacted by the pandemic may display symptoms like thumb sucking, bedwetting, sleep disturbances, loss of appetite or fear of the dark. For children between five and 10 years old, these symptoms may mutate to irritability, aggression, clinginess, school avoidance and poor concentration. Adolescents might show hyperactivity, agitation, increased conflicts or delinquent behaviour.</p> <p>&nbsp;</p> <p>Parents are worried. “I feel some stunting of development has taken place,” says Reshma Adarsh Varghese, mother of two boys, Ayaan, 9, and Aaryan, 5. “My sons’ tantrums are not age appropriate. There has been a character change brought about by the pandemic. The sad thing is that I cannot do anything about it.”</p> <p>&nbsp;</p> <p>But she might not have much cause to worry. Children might be more resilient than we give them credit for. Also, we have a precedent. In the 1930s, sociologist Glen Elder started tracking 167 adolescents who were born in 1920-21 and grew up during the Great Depression. At least economically, the conditions then can be compared with what we are experiencing now—poverty, loss of job, starvation, bankruptcy and downward mobility. At that time, too, it was speculated that children of the Great Depression would be permanently scarred with anxiety, fear and depression. The reality turned out to be different. The trauma of their childhood translated to greater success in adulthood. Children grew up to be more self-confident, content and less defensive.</p> <p>&nbsp;</p> <p>As Sharma says, the most we can do for our children currently is to ensure an environment of security and trust. “How safe have we made the world around them?” she asks. “How can we ensure some kind of peer support? How can we engage with our children more effectively as parents? If we can ensure all this, we can help our children emerge from this phase in a healthier and emotionally balanced manner.”</p> <p>&nbsp;</p> <p>DR AYESHA SUNAVALA, infectious disease specialist</p> <p>&nbsp;</p> <p>“<b>I feel guilty for not realising how insecure my child got”</b></p> <p>&nbsp;</p> <p>The pandemic was especially hard on my daughter, Anoushka, 7. All children went through the dilemma of not being able to process what was happening around them. The difference for the children of frontline workers was that they did not have the security of having their parents with them at home. Anoushka is a single child, and both my parents and my husband are doctors. So she had neither her grandparents nor her parents at home as security; that really took a toll on her. I did not realise it initially. Only a couple of weeks later did it strike me that the child was much shaken and was having a hard time dealing with it.</p> <p>&nbsp;</p> <p>There were signs of depression—loss of appetite, lack of sleep and many insecurities and fears. I had to try to undo certain things that I was doing. Like, for example, discussing disturbing things over the telephone in her presence or answering calls while she was sleeping. I had not realised it was disturbing her sleep, which she told me about later. I had to get a school counsellor to intervene.</p> <p>&nbsp;</p> <p>During the second wave, we were in a better position to deal with things. But yes, we went through a hard time. It is very difficult for single children of health care workers, especially when they see that their friends have their families with them. Every time you come home with a sore throat or stuffy nose, it worries you, but there’s little you can do.</p> <p>&nbsp;</p> <p>On the positive side, my relationship with my daughter has become more honest. I have shared my feelings and fears with her and taken the time to know her better. I have understood the depth of her feelings and how receptive and sensitive a child she is. I am grateful to the pandemic for that.</p> <p>&nbsp;</p> <p>As a doctor and working woman, you have a very strong sense of guilt every time you have to wriggle out of something pertaining to your child or her school. The pandemic has made it clear to me that I would like to prioritise different things. I want to be a mom first and foremost.</p> <p>&nbsp;</p> <p>RESHMA ADARSH VARGHESE, businesswoman</p> <p>&nbsp;</p> <p>“<b>I have become a parent, friend and teacher. I have not yet adapted to these roles.”</b></p> <p>&nbsp;</p> <p>I am a mother to two boys—Ayaan, 9, and Aaryan, 5. During the pandemic, I have had to fill in many roles—that of a parent, friend and teacher. I have not adapted to those roles. It frustrates me and has affected our rapport. I find myself more irritated with them. Being with them the whole day is draining. Kids are such that if you give them some attention, they want more.</p> <p>&nbsp;</p> <p>If I play one board game with them, they want me to play for the next two hours. Some days, I include them in my cooking or baking. I wake up every day thinking I have to be a good mother, do this and that for them, but 80 per cent of the time, that does not happen. Last year, I tried to do too much. This year, I have realised I cannot do it all. I have decided not to let parent guilt get to me and to give myself as much leeway as I give them.</p> <p>&nbsp;</p> <p>I have noticed some behavioural changes and stunting of development in them due to lack of social interaction. Aaryan feels he has to match his older brother. So I have seen him play video games that he is not supposed to be playing. Before the pandemic, he went to playschool for seven months. So he does not have his own set of friends. He thinks that his brother’s friends are his. When children his age come, he does not like playing with them. He says they are babies.</p> <p>&nbsp;</p> <p>As for Ayaan, now in the third standard, validation from his teacher is very important. During online classes, that does not necessarily happen. So he expects from me everything that he expected from his teacher. They are craving more attention. Their only window to the outside world is through their parents.</p> <p>&nbsp;</p> <p>Adjusting to online education was tough. These kids are small—they have not had much access to gadgets. Ayaan did not know how to log in to Zoom, mute the screen or other similar things. So, on the one hand, I am telling him that he has to learn how to use the computer. On the other, he is not allowed to spend too much time on the internet. It confuses him. Ayaan asked me the other day to buy him a phone so that he can start an Instagram account. If it were not for the pandemic, he would have been exposed to all this at a much later stage.</p> <p>&nbsp;</p> <p>FATIMA ALI, homemaker</p> <p>&nbsp;</p> <p>“<b>I am worried about my son’s future”</b></p> <p>&nbsp;</p> <p>When he was nearly two years old, my son, Syed Ali Mohammad, was diagnosed with Fragile X and autism. During the pandemic, the lack of social interaction has affected him a lot. He misses going to the mall or to the movie theatre. He watches videos of places he wants to visit—like the UK and Dubai.</p> <p>&nbsp;</p> <p>My husband and I are worried about his future. What next, we wonder. During the pandemic, when he did not have to go to school, we got to spend more time with him. That’s when we realised what needs to be done and where he is at. We are using this time to do various therapies and understand things better. The big question still remains: What is he going to become? He thinks about it. He has aspirations and wants to do something that matters. It is now up to us to see that his dreams are fulfilled.</p> <p>&nbsp;</p> <p>I think the lack of social engagement could impact him in the long run because of his anxiety issues. Just a change of scene—going from one room to another or entering a different house—is a big deal for him. He does not take well to change. You have to prepare him for it. When we visit someone, he will stand outside the door until he feels he is ready. He is very sensitive. If you look at him in a way he interprets as not acknowledging him, then he will remain outside and the anxiety builds up. So, if he is not used to it anymore, it will take time to get him to go to places where he would have normally gone more easily.</p> <p>&nbsp;</p> <p>We have to consider all possibilities. What if we get hospitalised? We are preparing for that by writing our will and appointing a guardian. We try and keep safe, especially because we have a responsibility towards our son.</p> <p>&nbsp;</p> <p>SUMITRA NAIR, journalist</p> <p>&nbsp;</p> <p>“<b>I am concerned about my daughter’s emotional development and social skills”</b></p> <p>&nbsp;</p> <p>During the pandemic, my two-year-old, Eka, has become very clingy. Initially, when I was working from home, she would barge into the room whenever she wanted to play. I had to make her understand that she could not do that. Even now, some days in the mornings, she cries for me or my husband to stay with her and not go to work.</p> <p>&nbsp;</p> <p>I think most of the problems stem from a lack of interaction with other kids her age. In our neighbourhood, the kids nearest to her in age are six and 12 years old. Still, they were providing her with some exposure to other children. With the pandemic, especially during the first lockdown, no one was allowed to visit. Her only extended interaction was with my mother and my in-laws, who stay with us. We were forced to give her more screen time because we had no other way to keep her entertained.</p> <p>&nbsp;</p> <p>She has been throwing a lot of tantrums. Things like not being permitted to play with the neighbour’s dog would make her sulk. She had a lot of pent-up energy and would not let us switch off the TV or prepare her for bed. We, as parents, could not do anything about it. Even toys, after a point, start losing their charm.</p> <p>&nbsp;</p> <p>This is a very important developmental stage for children. I am most concerned about my daughter’s emotional development and social skills. What if she goes to school and does not understand reasoning? What if her teacher says no to something and she thinks she can get her way by throwing a tantrum, because that’s what she has been doing at home? What if other kids are not cordial? All these children are seeing are imaginary people on TV, so they will not know how to interact with each other. Many shared experiences are lost, like sharing a playground, toys, or a classroom space.</p> Mon Oct 25 16:49:22 IST 2021 kalki-koechlin-reveals-the-messy-and-marvellous-secrets-to-parenting <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p><i>Before I got pregnant, I had a vague idea that one has to 'rest' in the first trimester and that it is a 'sensitive' time, but nobody told me to prepare for an alien invasion that would turn my insides out and transform me into a human incubating system of toxic gases and chemical imbalances...That was my first few months—every day a struggle, every smell a possible trigger, every effort disorienting and no one around me seemed to understand…. Generally popular culture doesn't talk about pregnancy except in stereotypes. She's either the crazy hormonal bitch who needs to park herself on the sofa for nine months and eat a lot of junk, or the magical, maternal, filtered Instagram mum, who seems perpetually caught photographed in soft sunlight falling on her newly found curves... The truth is pregnancy is a raw and overwhelming journey at best, and the more we talk about our real experience of it, the more the world around will accommodate our real needs….</i></p> <p>&nbsp;</p> <p>This is an excerpt from Kalki Koechlin's recently launched illustrative book on motherhood, The Elephant In The Womb, a no-holds-barred account into motherhood, which the actor and now first-time author put down for "anyone who wants to veer away from some of the cliches attached to birth and babies and discover messy and marvellous secrets to parenting".</p> <p>&nbsp;</p> <p>Last year, on February 7, Koechlin delivered her baby girl, Sapho. A few days later the pandemic hit India and about three weeks later the government announced a nationwide lockdown. A surge of emotions overwhelmed the first-time mom—ecstasy on being blessed with a baby and anxiety on managing everything alone. The struggles of breastfeeding, the hourly diaper changes, minute-by-minute caregiving and the incessant sleep deprivation in the face of a weak body have all been captured by the actor in the book. The Elephant In The Womb is a compilation of all her doodling and journalling during the lockdown as a way of keeping "the memory of motherhood alive", long after it got over.</p> <p>&nbsp;</p> <p>"This is not a job meant to be done alone. Or with just a caregiving partner for that matter. The village theory proves to be true, it takes a whole community to satisfactorily share the exhaustive work of taking care of a new born, so that a mother can recuperate not only from the insane physical trauma of birthing but also from the emotional and mental toll it takes on the good part of a year of her life," writes the actor.</p> <p>&nbsp;</p> <p>For Koechlin, who had a water birth, motherhood became even more significant given that the actor had in her past been through two abortions—the first in her 20s when she was "passionately against having children" and the second in her 30s in 2016 when her life was "significantly more independent, the pregnancy was unplanned and she didn't feel ready." Three years later, she decided to have a child.</p> <p>&nbsp;</p> <p>"Writing this book gave me direction at a time when everything in the world came to a stop. I couldn't have done it without the practical help, mental strength and consistent love of my partner, Guy Hershberg. During the first lockdown in Mumbai, our cook, Sangeeta Kisane, agreed to work for us full time for a few months, helping with house work and our new born, and staying away from her own teenage daughter for six months. Her support and love also helped me find the time and energy to write," says Koechlin, in an interview to THE WEEK inside the living room of her modest residence in Mumbai, when she's able to spare close to an hour for uninterrupted conversation as her daughter takes a snooze in the adjacent bedroom.</p> <p>&nbsp;</p> <p>In the book, the actor writes how (post-delivery) she found herself with "an identity crisis that makes me struggle with ambition and jealousy. I'm OK with breast pumps, bottle feeds, daily heartbreaks and not being able to please everybody. I'm OK with asking family, friends, doctors, therapists, nannies, neighbours and traffic cops to understand me. I'm OK with being late, with taking a breath. With just hanging on by a thread or a couple of minutes sleep, knowing I'm nothing but a small cog in evolutionary biology. I'm OK with not being OK," she writes.</p> <p>&nbsp;</p> <p>Was it difficult to get back to normalcy, as we've known Koechlin to be quite fit? She says she had always been fit and yet, "Here I was unable to get back to my headstand or the wheel stretch in yoga, unable to zip my high-waist jeans. And mentally, I didn't know day from night, who I was and who I'd be. I had only the present to contend with and presently I felt old."</p> <p>&nbsp;</p> <p>One year and seven months after the birth of Sapho, Koechlin seems radiant, confident, assured and not a wee bit exhausted. She looks fit as a fiddle in a sleeveless tee and denims as she holds her ukulele in her hand while sitting on the sofa and sharing extremely simple and useful notes on weight loss and the journey to fitness post pregnancy. "Postpartum depression, as I experienced it, was an emotionally and physically depleting time full of hormonal inconsistencies and practical gaps in our social support system,” she says.</p> <p>&nbsp;</p> <p>Towards the end of the book, Koechlin leaves the reader with stories of her interactions with other women who have been through the same "arduous" journey of motherhood and whose experiences can perhaps give the reader (a to-be mother) a sense that she's not alone and gain confidence from the solidarity of "being in this together”.</p> Sun Oct 31 11:31:33 IST 2021 quality-first <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>At a time when the world is still reeling from the crisis unleashed by Covid-19, how are our health care institutions coping? How are they catering to a growing number of Covid-19 patients while adhering to changing norms? And, how are they still providing affordable and quality health care while ensuring revenues are not hit?</p> <p>These questions were addressed at the webinar 'Sustaining quality and affordable health care in the post-Covid world,' conducted by THE WEEK andMedi Q Healthcare Group. On the panel were Latesh Sen, group CFO, Medi Q Healthcare Group, a Dubai-based company that provides organisations with comprehensive health care advisory services globally; Dr Kovelamudi Hariprasad, president, Apollo Group of Hospitals; Dr Harish Pillai, CEO, Aster India, Aster DM Healthcare; Davendra Singhvi, group CFO, Saudi German hospitals in the UAE; Sameer Agarwal, group CFO, Manipal Health Enterprises; and Cdr Navneet Bali, director, northern region, Narayana Health.</p> <p>Hariprasad said that as the virus underwent changes, their understanding of it improved. "A study in our hospital found that among vaccinated health care workers, the number of people who needed hospitalisation after turning positive was less than one per cent and there was no mortality in these patients. Vaccines did work and helped health care workers attend to patients well," he said.</p> <p>Pillai compared the health care ecosystem between the UAE and the India during the pandemic and said that the health insurance in the Dubai market works to its advantage. Talking about investment opportunities in the Middle East health care market, Singhvi said that visa and investment regulations have been relaxed by the UAE government and the medical tourism scope has increased in the country. "Friendly relations with its neighbours, an ageing population and the increase in lifestyle diseases will contribute towards a tremendous growth of health care in the Middle East in the coming years post-Covid," he said.</p> <p>According to Sen, India is still behind in adopting scientific cost management, and the immediate step is to devise strategies to keep the cost of care under control and immune to changing situations.</p> <p>At Narayana Health, Bali said they made it their mission to provide affordable health care to all during the pandemic, while not compromising on quality. "We need to make our systems, processes and people more efficient and productive," he said. "Narayana Health was in talks with large vendors to bring the cost down."</p> <p>Agarwal's Manipal hospitals used technology to their benefit to make sure patients did not suffer. "Manipal also led the way in transparency between the hospital and patients," he said, emphasising its importance at a time like this.</p> Thu Sep 23 14:47:13 IST 2021 de-stigmatising-mental-health-conversations-in-pandemic-times <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>T he Saxenas were a regular middle class family of four in Lucknow—the father an advocate, mother a homemaker and two sons in class IX and XI. Then, in May, the second wave of Covid-19 took away the mother and destroyed their happiness. The pandemic isolated them, first because the family was tested positive, and later, because no one was meeting anyone anyway. They tried resuming their normal lives online. But something had snapped. There was just nowhere to go, no friends who could lend a shoulder or share a joke. A few weeks later, the Saxenas were back in hospital; the elder son had attempted suicide. He survived. The family is now going to counselling, and hoping to make it back to some semblance of normalcy.</p> <p>Almost everyone in the country by now has had a brush with the pandemic, be it getting infected, losing a loved one or taking financial hits. And almost everyone has encountered someone who has had some sort of mental problem because of the pandemic, be it anxiety, anger, depression, losing the will to live or actually trying to take their lives. Or even kill someone.</p> <p>It is almost as if the nation is reeling under a collective post-traumatic stress disorder. A young doctor who was inundated with serious cases and had to make difficult triaging decisions ended up a nervous wreck herself. Wracked with guilt at having to select which patients to prioritise, given limited facilities, she first had sleeplessness, then crying spells and, then, totally lost the will to work. She reached out for psychiatric help and took a break from work—a guilt-ridden choice given the need for doctors. But she was brought back from the brink. Then there was the grandfather in Karnataka, who saw his entire family perish one after another, till just he and a grandson remained. Troubled with survivor's guilt—he could not understand why he was alive while the younger ones died—he tried taking his life. He survived, and is now trying hard to get back to his normal self.</p> <p>Manisha Sharma, 35, was a cheery, chirpy woman till April, when she got Covid. Shut in her home, the only news she got from the outside world was of near and dear ones dying. Within weeks of her recovery, Sharma realised she was in bigger trouble, as she was not able to perform even everyday tasks without having panic attacks. The mobile ringing in the morning would bring a knot to her stomach; she still associates morning calls with bad news. She is on anti-anxiety medication, and thought she was improving till she heard of a colleague dying of cancer, and she experienced another meltdown. “I am recovering, but I can never be certain when the panic attacks will return,” she says. She also developed an aversion to closed rooms and hates being alone. All these bring back memories of her isolation days, and the helplessness she battled then.</p> <p>The mental health problems during the two lockdowns were different. Last year, the trigger was job loss and the suddenness of being cramped into limited space. Home was no longer the best place. In fact, one couple, which decided to return to the joint family during the first lockdown, found the adjustment so difficult that the wife became suicidal.</p> <p>This year, it was the sheer scale of death and devastation that triggered mental health issues. Add to it Covid protocols for funerals and mourning, which did not allow people to meet and share grief. For many, there was no closure, which is what these functions are largely about.</p> <p>The brave new world that has once again returned to work, has brought with it a whole set of demons. There is mental baggage from the past, adding to the fears of the uncertainties ahead. Will there be a third wave? Is there a job after my graduation? Those with existing mental health issues have had it even worse. Already, several medical groups, including Alzheimer's Disease International, have flagged the issue that a Covid-19 infection could accelerate the rate of dementia in a patient. What this means is that even after the pandemic is over, the mental health burden will linger.</p> <p>Can the workplace be empathetic to mental health? The silver lining is that conversations about mental health have started, people are realising it is no longer a shameful and taboo subject, notes Debanjan Banerjee, geriatric psychiatrist at NIMHANS, Bengaluru. “The discourse on mental health was long pending, the pandemic has brought it out in the open at least,” he says. One sees rays of hope in certain decisions of the judiciary. For instance, the Gujarat High Court recently said that depression can be classified as a serious illness in the context of the pandemic. It was ruling on the case of an engineering student whose admission was cancelled as he had not written his exams and earned the requisite credits. The student said that he had “severe depressive episodes with suicidal ideation” from January 2020, and his condition worsened by June 2020; he could not write the exams.</p> <p>The Supreme Court recently told the government to consider Covid patients who had committed suicide also as Covid deaths. The bench of Justices M.R. Shah and A.S. Bopanna, said: “If the government is paying compensation to a particular class (of persons who died due to Covid), what about those who died by suicide because they were suffering from the illness? Ultimately, we have to consider the suffering of the people. Nobody will commit suicide without reason.”</p> <p>For once, planners and medical experts had factored mental health during the pandemic into their planning right at the start. The Telemedicine Practice Guidelines 2020, in which the home patient treatment protocol included patients being repeatedly asked to discuss their fears and anxieties, was a welcome and proactive step. Many people reached out to helplines and counselling through telemedicine. “Last year itself, NIMHANS, in association with the Centre, had predicted there would be a rise in mental health issues because of the pandemic, and gave guidelines to all psychiatrists on identification and treatment for all groups, from paediatrics to geriatrics,” says Mayurnath Reddy, consultant psychiatrist with Yashoda Hospitals, Hyderabad.</p> <p>In his practice, he has noted an increase in patients across all levels of severity and age groups. “There is a 20 to 30 per cent rise across all groups, and up to a 10 per cent rise in severe cases,” he says. The reasons are both a rising mental health pandemic and a recognition for treatment. The most common cases are panic attacks, in which a patient can, within the span of 15 minutes, go from normal to having palpitations and restlessness and a sudden feeling that she might even die. There are anxiety disorders and depression cases, and an increasing number of digital addiction cases, especially among the youth. Digital addiction manifests itself when the person shows symptoms of sleeplessness, anger and violence. Long hours of online existence during the pandemic resulted in this side effect.</p> <p>Just how important timely counselling is cannot be better highlighted than by the experiences of Sarla Samaiya, 68, in Bhopal, who lost her husband and two sons to the pandemic this May. Samaiya may not be highly educated, but she knows that while her sons Subodh, 47, and Saurabh, 36, succumbed to the infection, her husband, Satish Kunar, 71, died because he lost the will to live after his sons' deaths. They all died within ten days of each other. “If he could have spoken to Dr Rahul (clinical psychologist Rahul Sharma) he might have survived. He kept pulling out his mask and refused to eat and drink after he learnt about our sons,” she says. She, too, was admitted at the Hamidia Hospital, where Sharma went to talk to patients. “When I first met her, all her grief and helplessness were bottled up. I listened to her, allowing her to express her feelings. On my third visit, she said that had her husband met me, he might have survived,” says the psychologist. He noted that while she was suffering from PTSD, she might not require major psychiatric intervention now.</p> <p>Then there is Rakshina Khan, 38, who recalls the terrible times in hospital, for 50 days. Her oxygen mask may continue for more weeks, too. As she battled the disease, she worried about her children back home. In the hospital, there was death everywhere. One day, a patient jumped from the sixth floor ICU to his death. She used to feel so lonely that she would give tips to the hospital staff to talk with her. Then, Sharma visited her. “I could talk to him about everything, joys and sorrows and he listened to me,” she recalls. “He was clad in a PPE kit, but he would pat my head.” That tiny human touch, perhaps, saved her. “She was in need of emotional first aid and simply allowing her to speak out, feel comfortable and being attentive were a big boost to Rakshina’s energy levels and her will to beat her health challenges,” says Sharma.</p> <p>For every person who was able to get timely help, however, there are many others who could not. Despite conversations having started, recognising a case as one needing psychiatric intervention escapes most people, even doctors. Reddy recalls how a patient came to him. She had repeated breathlessness and palpitations. The doctors did a battery of tests, but simply did not think of a psychiatric assessment. It was a friend, who had had similar issues, who recognised the need and suggested she meet Reddy.</p> <p>If doctors themselves do not always recognise a case, expecting workplace empathy is a tall order at this stage. However, given the predictions of a rise in mental health problems over the next few years, triggered by the unsettling situation the pandemic has created, there is a great need for sensitising people about the issue.</p> <p>Then, there is this great shortage of mental health professionals in the country. As the most comprehensive study on mental health in India by NIMHANS shows (see box), there is a minimum need of one mental health professional per lakh of the population, but on an average, there is one psychiatrist for every 10 lakh Indians. The distribution, too, is not uniform, with some states like Madhya Pradesh having as low as .05 per cent psychiatrists per lakh population, while Kerala being better at 1.2.</p> <p>While addressing this shortage is another matter entirely, experts say that the important thing at present is to ensure that available facilities are maximised. Banerjee notes that there are many people who are in the “pre-psychiatric stage” and reaching out to them could help stem their progress into a stage where they may require severe treatment and medication. “It is like identifying people who are predisposed to diabetes, and getting them to make lifestyle changes so that they either do not get diabetes, or can at least delay its onset,” he explains. And how exactly does one identify prospective cases? It often comes up at general screenings at primary and secondary health care sectors, just as one checks for anaemia and other conditions. “One or two simple questions to ask the patient’s state of mind, or an inquiry about their families can reveal a lot of information,” says Banerjee.</p> <p>Also, target groups can be reached out to. People who have been in isolation for long periods are one such group, those who have had tragic losses another. Students who are anxious about their future after graduation are yet another. “There will always be a shortage of resources,” says Banerjee. “But if we have to tackle the rising mental health issues in the wake of the pandemic, we just have to optimise what we have.”</p> Thu Sep 23 14:07:41 IST 2021 how-9-11-brought-dramatic-changes-in-treatment-of-post-traumatic-stress-disorder <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>The 9/11 terror attack on American soil resulted in a collective trauma to the western world. The world learned many hard lessons, and it has started moving in a different trajectory since then. And, one good thing that happened is that in the last 20 years, there have been dramatic innovations in the treatment of trauma and post-traumatic stress disorder (PTSD).</p> <p>PTSD is a disorder characterised by the difficulty to recover after being a witness to a terrifying incident. The condition may last months or years, with triggers that would bring back the memories of the trauma. Nightmares or flashbacks, heightened reactivity to stimuli, avoidance of situations that bring back traumatic memories, anxiety and depression are the common symptoms of PTSD.</p> <p>In the aftermath of 9/11, the World Trade Center Health Registry that tracks the health effects of the attacks found in a study that 16 per cent of its respondents—who lived, worked or studied close to the attack sites—experienced probable PTSD five to six years after the incident. A study of low-income people seven to 16 months after the terror attack found that those suffering a 9/11-related loss were “twice as likely to be diagnosed with a mental health condition, such as depression, anxiety or PTSD”. It was found that a substantial number of people not directly affected also met the criteria for probable PTSD.</p> <p>Mental health experts point out that before 9/11, the public understanding of PTSD and trauma was limited. They were earlier considered as conditions that would arise only for war veterans. However, 9/11 proved that trauma could happen to anyone, and this changed the mental health specialists’ thinking about care for trauma victims. They also found that some existing treatments were doing more harm than good to trauma victims. For instance, there was a treatment method called critical incident stress briefing in which the victims were asked to talk about their experiences. It was found that this method was activating high emotional arousal that would lead to PTSD and depression.</p> <p>Post 9/11, there has been a significant advancement in studying the role of genetic factors in the development of PTSD. There has also been a huge growth in imaging, biomarkers and brain-related research. Many biomarkers, like an increase in certain hormones or inflammation, are known to be associated with PTSD, and now there is increased emphasis on targeting the right ones, in the right combinations, for diagnosing and treating the mental disorder.</p> <p>The terror unleashed on 9/11 made several institutions prepare protocols that could be used in a crisis, and psychological first aid—psychological treatment to be given in the immediate aftermath of a traumatic event—became an important part of these protocols.</p> <p>In the last 20 years, the world learned a lot about the links between disasters and mental health. And this paved the way for a better and quicker response to mental health concerns during the Covid-19 pandemic, at least in the developed countries.</p> Thu Sep 23 13:57:40 IST 2021 anger-and-what-it-does-to-us-extract-from-hinge <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Blame may not necessarily be placed on others or on external circumstance alone. Its force could be pointed towards one’s own self. The propensity to place blame within, for missed opportunities or perceived failure, acutely distresses the inner balance. It is as potent in causing disequilibrium and angst as the frustration one feels in holding others responsible for things gone wrong.</p> <p>Self-blame, within a reasonable context and to a measure, may serve as a tool for reflection. However, more often than not, it breaks beyond its constructive use to indiscriminately urge the power of rage within. The mind calls itself names. These can be intense expletives and violent imaginings. It degrades itself and whips itself. Most of all, it calls itself a failure. The brain rages at this professed failure, while simultaneously pushing every system to perform and counter the notion of having flopped. A sense of urgency pervades the mind and psyche. Impatience heightens.</p> <p>The contradiction is immense—one part is stuck in anger-blame, another pushes desperately to move on to disprove the belief of having failed. The image is akin to having a leash around one’s own neck, tightly held in one hand, while the other hand wields a whip and flogs one, in a desperate bid to move on to negate failure.</p> <p>Vital energy, overwhelmed with anger-blame, is expended on the fight within. The body, injured and compromised by the effect of anger, is pushed further by this sense of urgency and impatience. The act of eating is also ridden with impatience. Such induced compulsion and despair stresses and strains the body and its systems to deplete resources and reserves. Fatigue sets in and the will to engage outwardly is repressed. The outcome, commonly, is depression.</p> <p>Pico was 23 when she fell in love for the first time with a senior at work. A few years older than her, the man was well- travelled, well-spoken and attractive. His career was poised to take off and he had the attention of everyone around him. Pico was besotted and the man found that endearing. They saw each other for a while, and were talked about as a handsome couple. Then he moved on, unexpectedly, leaving her bereft.</p> <p>On the rebound, she began to date a man who had pursued her, instead. He was younger and indulged by a rich father. He showered her with attention, and smothered her with presents. He took her around, and was always by her side. Vulnerable and unsure, she gave in to him.</p> <p>The young man was high strung and in constant need of stimulation. Initially, the excitement and flux he sought worked for her. It distracted her from the grief she bore from before. But as his amusement took more intense forms, she began to feel exhausted. Her upbringing had been modest. Simplicity, routine and ethics were emphasized at home, all through her growing- up years. This new world was alien to her—the talk, the attire, the manner, the hours and the substances—all of it challenged her comfort and her roots. Yet, she stayed with it, for a while, in her defiance to prove herself a woman of the world. She’d felt betrayed by her naiveté in her previous relationship; this time, she was determined to break out of that image.</p> <p>However, within the year, she felt emotionally conflicted and spent in energy. As she began to withdraw, her boyfriend expressed his disappointment in verbal abuse and once, in physical assault. It shocked her. He apologized quickly and profusely and professed his love for her. Confused, she let it pass. The next time, though, when he threatened to raise his hand, she found her voice and shouted him down. He cowered, and suddenly she saw him as a weak, fearful boy, spoilt and dependent on the whimsical largesse of his father. He hadn’t worked a day in his life and was incapable of respecting anyone else’s work or the processes that build character. She couldn’t believe she had been with him for almost a year. She knew she had to leave.</p> <p>Back at work, Pico expected a few months of focus to put her on track. Work was busy and she had little time to think of anything else. But as the year wore on, she felt more unsettled than before. Something within was gnawing at her. She began to snap at her parents every time she spoke with them. This was unlike her. She knew it and they noticed it. Her mother enquired if something was amiss. It’s hectic at work and I’m tired, she’d reply, each time her parents expressed concern. At work, she increasingly felt disengaged, internally. A stance of reluctance seemed to engulf her. Her actions were ahead of her awareness of them. She went out with friends and partied hard, but felt no pleasure. Her spirits dipped; her fatigue grew. One morning, she awoke without the will to get out of bed. Her mother called as was customary, and instead of the usual exchange, Pico sobbed uncontrollably into the phone. She said she did not wish to do anything, any more.</p> <p>The therapist Pico’s parents took her to, diagnosed depression. Counselling revealed a mound of unprocessed emotions. There was anger from her first relationship. She had been in love and had felt betrayed by her boyfriend’s sudden and casual change of mind. She still grieved his absence and more, she couldn’t deal with his abandoning her. It had shaken her confidence. Her inherent softness and positivity had been disregarded, and she felt she couldn’t trust what life might bring her.</p> <p>That mistrust congealed with her second relationship. The fact that she’d been with someone she could never have respected, affected her own sense of worth. She felt a loss of dignity, which was heightened by the thought that she’d partaken of his world. She hated herself for it. Her experience the second time, so removed from her own leanings and preferences, left her mistrusting of her own self. It was something she would’ve liked to change but couldn’t, and it had cost her her respect, she thought. She blamed herself constantly for being so mindless about it. Her anger at herself burnt beyond what she’d known it to be. The cocktail—of anger, self-blame, hate and hurt—kept her stuck around a whirlpool of despair.</p> <p>The power of anger is immense, but it asks for transformation—into resolve—for affecting change through thought or action. Blame can get in the way of transformation. Blame is the glue on which anger sticks. Dark and trolling, it can pull in all of one’s attention and consume one’s inner resource.</p> <p>While stuck in blame, anger, with all its energy and momentum, drives us around the edge of a whirlpool—raging, but in loops and circles, to cause significant emotional volatility.</p> <p>&nbsp;</p> <p>C C C C C C</p> <p>&nbsp;</p> <p>Telly was eight when her mother died. Her father, ill-equipped and unable to devote time, left her in the care of his extended family. It was a house filled with uncles, aunts and cousins. Telly had no siblings and though her relatives were well-meaning, the girl felt daunted and isolated in this bustling home. There was speculation, too, on how and why her mother had died. She overheard the word ‘suicide’ a couple of times, and then her aunts would hush up as soon as they would spot the child.</p> <p>Ill at ease and starved for attention, the girl began to play pranks that were beyond innocent ones. She wrung the neck of a cousin’s parrot. She tore another’s notebook before an examination. She mixed ditch water in the food. She poked the point of a pencil into the arm of an infant cousin. It was her way of demanding attention.</p> <p>Whenever she was confronted, she would lie, to save herself from the consequences of her actions. A sympathetic aunt or two would explain to the child not to create such trouble, but the girl thrived on the initial thrill it gave her, a sense of quiet power, this ability to create trouble and command notice.</p> <p>The more she lied to save herself from punishment of any kind, the more she believed her lies were true. Tired of not being able to reason with the child, the family members left her increasingly to herself. She became more alone. From deep want of a parent, she would idolize her father, who when present, would sexually abuse her.</p> <p>Confused and profoundly conflicted, Telly grew into a young woman with an excessive hatred and resentment for people who were leading positive, happy lives. One part of her desperately wanted their attention; another part wanted to hurt them.</p> <p>One moment she sought to endear herself to them; another moment she would trash them. Unusually bright, but coupled with a deep sense of resentment, her mind began to pull at its extremes. She would profess great interest, kindness and inclusivity, but could swing to being abusive and violent within the course of an hour. Two people seemed to dwell in her. Either one of the two could show up at an instant. For anyone in her presence, it was exhausting. As a teenager, she was unable to retain friends. Her three marriages failed. She lied compulsively, creating serious misunderstandings between family members wherever a harmonious relationship existed. She felt the urge for something dramatic to happen, and when things were peaceful, she would stir up trouble. When confronted, she displayed no concept of reasonability. In two of her marriages, she instigated legal cases against her husband and his relatives, accusing them of mistreating her. Eager to rid themselves of her and her confounding behavioural patterns, the men would pay to settle the matter and get a divorce. This became a pattern, but Telly was in denial. She was unwilling to accept her role as perpetrator. She showed no remorse for her actions, and rejected the idea that she was responsible in any way. She visualized her own reasons for her pushes and pulls, and then would believe her reasons were true, honest and justified. I’m the victim, she told herself and anyone who cared to listen.</p> <p>She, too, was a victim of an abhorrent childhood. Her mother’s death left her abandoned; her father left her abused.</p> <p>She denied this abuse, coercing her mind instead to invent explanations both for her father’s behaviour and for how it was making her feel within. Her imaginings impinged on all reality and obliterated facts. Reality, imaginings, hurt and desire became indistinguishable. She felt wronged, and she found others to blame, anyone but her father. She projected her victimization on acquaintances, or on random others within her zone of influence at any given point in time.</p> <p>Her resistance to one expression of her psyche was so complete, that she couldn’t see any of it. It was blocked to conscious reckoning.</p> <p>Resistance, in any measure, interferes with the emotional narrative. Layered over time, it obstructs mental processes, and, when in excess, it may split the psyche. It hinders the fluid functioning of various organ systems in the body. Bodily interruptions loop back signals of distress to the brain. The immune system may answer with an inflammatory response to create blockages, and further, disruption and even disorder.</p> <p>Any kind of force, to break through, is pointless; force creates more resistance as a counter. Evidently, then, the probable routes to hinge the mind and psyche to stability would lie in approaches that have the power to dissolve such resistance.</p> <p>C C C C C C</p> <p>Anger, for instance, is known for its destructive power. In one particular Buddhist tradition, anger is considered pure energy. To that effect, I once witnessed a hen chase a cat, three times her size, across a sprawling compound, because it tried to get at one of her chicks. She ran after it, squawking and screaming with such ferocity, that the cat darted 50 metres and out of the gate. The energy of anger is thus sharp and concentrated. How we express it though is of importance. In moments of real threat to life or safety, revealed in its raw force, it strengthens us momentarily to push back the threat or to flee from it. At other moments, however, it asks for transformation, which is possible when we become aware of anger as it arises. Simply watching it spark, when it does, creates space between the emotion and its expression. In that space and instant itself, it is partially transformed. It no longer wields the same control over us. We free ourselves from its impulsive grasp and can now decide to put it to use, the way we wish to. The more and longer we watch our anger, the more aware we become of it and the greater our ability to choose how to use its energy. Significant movements—individual, social and political—have often been sparked by anger, but have sustained themselves on its transformed energy aspiring, not for violent destruction, but rather for positive change.</p> <p>Anger, therefore, needn’t be suppressed. It needs to be processed, instead, so that its expression takes such form for it to not feed or create more anger around. To be ruled by anger and to run our work and lives on it, is like ‘running our car on bad fuel’, says Jaggi Vasudev . ‘You make things move ahead, but the car leaves behind a terrible black smoke that impacts everyone around negatively.’</p> <p><b>EXCERPTED WITH PERMISSION FROM RUPA PUBLICATIONS.</b></p> <p><b>Hinge: (Re)discovering Emotional and Mental Wellness</b></p> <p><b>By Vandana Kohli</b></p> <p><b>Published by Rupa Publications</b></p> <p><b>Price Rs195; pages 244</b></p> Mon Sep 27 12:24:48 IST 2021 lockdown-inadvertently-helped-a-medical-segment-find-out-how <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Video conferencing applications like Zoom have enjoyed a big boom during the pandemic. The wide use of these applications has inadvertently helped a segment in the medical industry, too. The impact of people seeing their own faces on Zoom had led to a global growth for the plastic surgery industry. And, this phenomenon has got a name—Zoom Boom.</p> <p>A study by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) showed that around 70 per cent of plastic surgeons experienced an uptick in the number of consultations during the post-lockdown phase. Similarly, the French Society of Aesthetic Plastic Surgeons reported that cosmetic surgeries are up nearly 20 per cent in France after the lockdown was eased.</p> <p>Notably, 83 per cent of the doctors who participated in the AAFPRS study said that their clients came to them because they wanted to look better on Zoom calls.</p> <p>Cosmetic plastic surgery procedures range from non-invasive skin fillers to invasive rhinoplasty. The study conducted among the US plastic surgeons says that the demand for rhinoplasty (also referred to as nose surgery) saw the largest increase—up to 78 per cent. Other surgical procedures like facelifts (69 per cent), eye lifts (65 per cent) and neck lifts (58 per cent) also reported a rise.</p> <p>The 20 to 40 age group accounts for a major share of the total plastic surgery market. Industry experts suggest that in the last few years there has been a remarkable shift in people’s attitude towards plastic surgery. This is largely visible in countries like China. As for the number of cosmetic surgeries, China now stands second—after the US. A recent report by Deloitte suggests that the Chinese plastic surgery market has trebled in value in four years from 2015. In 2019, the country reported a 28.7 per cent growth in the segment—the global growth rate was 8.2 per cent—with a total value of 117 billion yuan ($27.3 billion). The country reportedly had more than 60,000 illegal plastic surgery clinics in 2019.</p> <p>In June 2020, the American Society of Plastic Surgeons surveyed 1,000 people who had never done a plastic surgery before. Among them, 49 per cent respondents said they are open about going under the knife. The Zoom Boom and the pandemic-induced mascne (acne caused by continuous use of masks) played a major role in this attitude change towards cosmetic treatments and surgeries.</p> <p>Industry experts say the fact that the millennial generation (born between 1981 and 1996; considered having more liberal attitudes towards cosmetic surgeries compared to preceding generations) is approaching their 30s and 40s is also driving the trend.&nbsp;</p> Thu Aug 26 20:26:02 IST 2021 insulins-journey-in-india-100-years-on-it-continues-to-save-lives <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Death seemed imminent for Leonard Thompson. The 14-year-old with type-1 diabetes was drifting in and out of diabetic coma. He weighed just 30kg when he was brought to Toronto General Hospital in Canada in 1922. His father, Harold Thompson, held on to hope as he allowed doctors to treat his son with insulin—it had never been tested on humans before. The wonder drug, discovered by Frederick Banting and Charles Best in 1921, gave Leonard a new lease of life.</p> <p>Interestingly, insulin was in use in India in 1923. A group of Indian researchers have found interesting facts about India’s long-forgotten early recipients of insulin. "Nothing has been written on them in the last 50 years," said Dr V. Mohan, chairman of Dr Mohan’s Diabetes Specialities Centre, Chennai. "The first Indian to be treated with insulin was a 35-year-old in a diabetic coma. The patient most likely had type-1 diabetes. In 1929, a 12-year-old girl named Kumudini who was admitted to the Carmichael Hospital in Calcutta received insulin. Kumudini who was married at 11 had type-1 diabetes." While delving into the history of insulin in pre-Independence India, Mohan came across an article by Dr J.P. Bose on diabetes in children, wherein he mentioned how two children, a boy and a girl, dramatically recovered after receiving insulin.</p> <p>This year, as the world celebrates the 100th anniversary of the discovery of insulin, Jazz Sethi, 26, gifted herself an artificial pancreas. Jazz is the first user of the DIY artificial pancreas system in India. A professional dancer and daughter of former world billiard champion Geet Sethi, Jazz has been living with type-1 diabetes for 12 years. Artificial pancreas system is a real gamechanger, said Jazz. “It works by using a third-party communication radio device to communicate between the pump and the continuous glucose monitor. The third-party rig I have costs $150. And then, you have to actually build and code the app.” The DIY artificial pancreas system, she said, is very efficient in managing sugar levels.</p> <p>To celebrate insulin’s 100th anniversary, Jazz is launching an ‘I Love Insulin’ campaign in September. “Have you seen those ‘I Love New York’ T-shirts? We are planning something along those lines,” she said. “It is about making insulin the hero of the story, to say that this is your lifelong companion. So, we are going to have a party and celebrate. We are also going to be working on distributing free insulin to those who cannot afford it because that is a big issue in our country; a lot of kids do not have access to insulin.”</p> <p>The discovery of insulin as a medication is considered one of the greatest breakthroughs in modern medicine. On July 30, 1921, Banting and Best injected a diabetic dog (dog 410) with a pancreatic extract that they prepared, and found that the hormone lowered the dog’s blood sugar levels to normal.</p> <p>Even 100 years after its discovery, there is no substitute for insulin. “Insulin is the only treatment for type-1 diabetes,” said Dr Ambrish Mithal, chairman, endocrinology and diabetes, Max Super Speciality Hospital, Saket. “People with type-1 diabetes cannot survive without insulin as they cannot produce insulin on their own. Before insulin was discovered, a child with type-1 diabetes would live only for a few months or years. Today they can live much longer,” said Mithal.</p> <p><b>Forgotten history</b></p> <p>What young Leonard Thompson received as the first shot were crude extracts of insulin from a dog. Commercial production of insulin started in 1923, said Mohan, who is currently working on a book titled <i>Banting, Bose, and Beyond: The Journey of Insulin in India.</i></p> <p>Dr J.P. Bose of Kolkata received a stock of insulin the same year the commercial production began. “Bose, a Fellow of the Royal Society, got insulin from his sources in London,” said Dr Sathinath Mukhopadhyay, professor, department of endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata. “Bose was the first doctor to use insulin in India on a patient. Also, his clinic at the Calcutta School of Tropical Medicine was the first diabetes clinic in the country.”</p> <p>&nbsp;</p> <p><b>Insulin resistance</b></p> <p>“I know patients who allow their children to die by not letting them take insulin,” said Mohan. His centre has been providing insulin to poor patients free of cost since 1991. Geetha Murukan, one of the first patients selected for the centre’s free insulin programme, was short for her age. She was 13 and did not have her period yet. She had type-1 diabetes and her sugar was not controlled. “She started getting her periods after she took insulin. She grew taller and her parents were happy,” said Mohan. They would meet him once a month to follow-up. After a year, they stopped showing up. “We called her father. He said the girl had died. A village quack told him that insulin may cause cancer and suggested the girl be given some traditional medicine. The quack assured him that she would be cured of diabetes if she took those medicines instead of insulin,” he said.</p> <p>Mohan explained to him that patients with type-1 diabetes cannot survive without insulin. “Murukan said the girl went into a coma three days after she discontinued insulin. He got her admitted to a hospital but she soon died,” said Mohan.</p> <p>Denying insulin to a child with type-1 diabetes is nothing short of murder, according to Mohan. He held a press meet in Chennai after the incident, passionately appealing to the press to cover it. Shortly after, he was bombarded with phone calls threatening to kill him. “One person even told me that he would hire goons and get me killed if I tried to promote insulin,” he said.</p> <p>&nbsp;</p> <p><b>Rising cost</b></p> <p>The cost of insulin used to be Rs12 when I started my practice, said Mohan. Now a vial costs about Rs150. This means that a patient would have to shell out Rs5,000-6,000 a year even if they take the cheapest insulin. Middle-class and poor patients would struggle, unless the government gives it for free.</p> <p>But even making it free may not be enough. Perumal, 13, one of Mohan’s patients had high sugar levels. His glucose level was in the range of 300-400mg/dl. “Every time I would increase his insulin, but his sugar levels would not come down,” said Mohan. Once when Perumal came for a check-up along with his father, Mohan told the father to wait outside the room. He asked the boy whether he took the insulin. After much resistance, the boy eventually admitted that his dad would take away the insulin vials he got from the clinic free of cost and sell them to a pharmacy. He would spend the money on alcohol. The boy said he would give him a quarter of the dose. He would give him just enough insulin to keep him alive, but not enough to control his sugar.</p> <p><b>Spread the word</b></p> <p>If Nupur Lalvani were born about 100 years ago, she would not have survived with a diagnosis of type-1 diabetes. “I feel incredibly lucky to be born in this century and have access to insulin, thanks to Banting and Best, other tools related to diabetes and the right support and education,” said Lalvani, who was diagnosed at eight. She has been taking four to six injections a day from the first day. An avid marathoner, writer, diabetes activist and panellist, she has represented people with diabetes on several fora organised by the WHO. “Insulin is a magic hormone that keeps me alive and I have zero complaints,” she said.</p> <p>The 33-year-old from Mumbai, however, feels there is no room for complacency. “I think it is not enough to celebrate my own good fortune because there are millions out there without the basics. Blue Circle Diabetes Foundation, our NGO, will be shortly launching Project Isha, where we will not only provide glucometers, syringes and insulin, to the socially and economically disadvantaged, but also weekly diabetes education and mentoring through trained mentors living with diabetes themselves,” said Lalvani. She also wants to address the stigma and hesitation around taking insulin.</p> <p>&nbsp;</p> <p><b>Insulin, once a week?</b></p> <p>The last 100 years have witnessed tremendous advancement in insulin therapy, from the initial crude extracts derived from animals to novel human insulin analogues produced by use of biotechnology, said Dr Sarah Alam, consultant, endocrinology, Asian Institute of Medical Sciences, Faridabad. “Insulin is required in diabetic patients if there is initial presentation with very high HbA1c (haemoglobin A1c test), prominence of catabolic symptoms like weight loss, HbA1c remains above target despite triple therapy (oral antidiabetic agents) or possibility of type-1 diabetes mellitus (autoimmune disease) or pancreatogenic diabetes,” said Alam.</p> <p>At present, insulin needs to be given once daily or multiple times a day depending on the glucose values. Newer insulins that are being developed offer much hope. “There are several trials going on for a weekly insulin. There is much excitement with the novel bioengineered insulins aiming to improve absorption, meal timing flexibility and lesser hypoglycaemic events and thus improvement in quality of life of people living with diabetes,” said Alam.</p> <p>&nbsp;</p> <p><b>Good news for pregnant mothers</b></p> <p>Until insulin was discovered, pregnant women with type-1 diabetes could not have a baby. During pregnancy, they would develop complications. Most of them did not live long enough to get married or conceive.</p> <p>Insulin changed lives. However, to what extent you can control sugar levels in pregnant women is still debatable. “We usually aim for a tighter target so that the baby is not impacted by the mother’s abnormal sugar levels,” said Dr S. Nallaperumal, a consultant diabetologist at Prashanth Hospital, Chennai. “Ideally, a pregnant mother’s fasting glucose level should be less than 90mg/dL and the post-meal glucose level should be less than 120mg/dL. It is less than the normal range for non-pregnant adults and is more stringent than what we aim to achieve for sick patients in an ICU. We need to control it that way for 300 days.”</p> <p>Maintaining a fine balance between avoiding hypoglycaemia in the mother and reducing the exposure to the foetus is challenging. “The arrival of analogue insulin—a modified human insulin, which closely resembles naturally produced human insulin—has helped us towards that goal. Now, the risk for hypoglycaemia is vastly reduced for the mother. The foetal outcomes are also better.”</p> <p>&nbsp;</p> <p><b>Type-2 diabetes</b></p> <p>While insulin is the undisputed lifesaver for those with type-1 diabetes, for people with type-2 diabetes it is commonly needed as the beta cells of the pancreas gradually fail and insulin production declines.</p> <p>However, the advent of newer drugs has led to a delay in the need for insulin for people with type-2 diabetes. “Not in the late phase, but in earlier phases of type 2, the advent of newer drugs like GLP1-related molecules and SGLT2 inhibitors may preclude the use of insulin in some cases,” said Mithal.</p> <p>&nbsp;</p> <p><b>What happened to Kumudini?</b></p> <p>Kumudini probably did not live long as there is no record of a follow-up. The insulin given to her was crude and the doctors did not know enough about the quantity to be administered. Now that it has been perfected, patients live long, said Mohan. “We have come a long way from when children with type-1 diabetes would live for only a few months. Today, such children can hope to live longer, even up to 90 years,” he said.</p> <p>Mina Fernandes is living proof that people with type-1 diabetes can expect to live as long as their peers who do not have the disease. The 72-year-old, who has lived with it for 62 years, is one of the oldest and longest type-1 diabetes survivor in India.</p> <p>Insulin’s success saga continues.</p> <p><i><b>(Some names are changed.)</b></i></p> <p>&nbsp;</p> Thu Aug 26 20:08:47 IST 2021 a-tiny-lifesaver-from-abbott <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Every year, more than 2,40,000 children are born with congenital heart defects in India. And, one in five such children would need early intervention to survive the first year of life. Yashbin, son of Dileep and Reshma—born at 27 weeks in the CIMAR Edappal Hospital in Kerala—was one such child.</p> <p>He was just 960g at birth and required continuous ventilation for more than 40 days. An echocardiogram revealed the boy was suffering from a condition called patent ductus arteriosus (PDA)—the presence of a fatal opening between two major arteries (the aorta and the pulmonary artery) that carry blood away from the heart.</p> <p>Before birth, the ductus arteriosus in the foetus is kept open by certain body chemicals to receive oxygen directly from the mother’s placenta, bypassing the lungs. Once born, the child should start breathing using the lungs, and the ductus arteriosus—which is no longer needed—should close. PDA arises if this does not happen spontaneously. A large PDA would allow oxygen-rich blood from the aorta to mix with oxygen-poor blood in the pulmonary artery. This would result in too much blood flowing into the lungs. Such a condition would put a strain on the heart and increase blood pressure in the pulmonary arteries. This has the potential to cause heart failure.</p> <p>PDA is one of the common congenital heart defects in preterm babies. The incidence of PDA ranges from 15 to 37 per cent in newborn babies weighing less than 1,750g. Overall, PDA constitutes 5 to 10 per cent of all congenital heart defects with a prevalence of “symptomatic” PDA being 0.5 per 1,000 live births.</p> <p>The cause for PDA is still unknown. Studies have suggested that genetics may have a role in it. PDA is observed in babies with genetic disorders like Down syndrome and those with neonatal respiratory distress syndrome. It has also been seen in the babies of mothers who had measles during pregnancy.</p> <p>A forceful pulse, poor growth and fast breathing are some of the common symptoms of this condition. The babies who are suffering from PDA may be non-responsive to medicine and are at high risk to undergo corrective surgery. To wean Yashbin off the ventilator, doctors considered two options: surgery, which comes with a lot of complications and risk to life; or, installing Amplatzer Piccolo Occluder, a self-expanding, trans-catheter occlusion device used for non-surgical closure of PDA. Soon, the doctors decided in favour of the second option. To install this device in the baby’s heart, he was shifted to Lisie Hospital, Ernakulam. Dr Edwin Francis, senior consultant, head of paediatric cardiology department, Lisie Hospital, did the life-saving implant in the baby.</p> <p>Developed by Abbott, Amplatzer Piccolo Occluder received certification from the US Food and Drug Administration for clinical use in January 2019. It was first implanted in a child with PDA at the Le Bonheur Children’s Hospital in Tennessee in March 2019.</p> <p>“Amplatzer Piccolo Occluder is the world’s first minimally-invasive medical device for the treatment of PDA,” said Dr Francis. “The Piccolo device, which is even smaller than a pea, can be implanted in the tiniest babies (weighing as little as just under 700g) and is the first transcatheter device to treat this life-threatening opening in the heart for pre-term babies. The device’s design allows the physician to insert it through the aortic or pulmonary artery of a premature infant over three days old, as well as to retrieve and redeploy the device for optimal placement.”</p> <p>Post-operation, Yashbin was gradually removed from the ventilator. “It was heart-warming for our entire team to see the baby turn the corner, get extubated and put on some weight,” said Dr Francis. So far, Yashbin is the tiniest baby in India to be installed with the Piccolo device. His father, Dileep, 38, who is a goldsmith, said the child has not faced any major issues post-surgery.</p> <p>Since the device is deployed with a minimally invasive procedure, artificial respiratory support to the patient can be removed soon after the procedure. “[Once done] there is no need for any additional procedures,” said Dr Francis. “Piccolo becomes part of the baby’s tissue, and once it is in place to seal the PDA, it is sealed for life. Follow-up treatment usually includes routine echocardiograms every six months for the child’s first two years of life following Piccolo implantation.”</p> <p>The doctor pointed out that the implantation is not too expensive when compared with the cost that would be incurred if the baby is kept in a neonatal intensive care unit for a long period.</p> Thu Aug 26 19:57:31 IST 2021 vex-kings-mission-is-to-teach-people-how-to-liv-a-good-life <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>For the world reeling under pandemic woes, his books have been an oasis of hope, healing, and positivity. They offer much-needed wisdom to navigate the uncertain times.</p> <p>Vex King, 34, is on a mission to teach people how to live a good life. <i>Good Vibes, Good Life,</i> his first book, was translated into 29 languages. <i>Healing Is the New High,</i> his latest, deals with self-healing techniques that can boost vibration­­­­—as he puts it.</p> <p>Getting familiar with your vibration, Vex says, is essential to inner healing. Vibration is “the energy that courses through you and you radiate out into the world”. Vex believes it is “the key component to a greater life”.</p> <p>“The feelings we project out into the universe are returned to us. If you feel joyful about life, you are going to receive more feelings of joy. Higher states of vibration promote positive feelings like gratitude and love,’’ Vex says, “Self-love can help you vibrate on a higher level and change your life for the better.’’</p> <p>In 2012, Vex launched the Good Vibes Only #GVO movement on Twitter to encourage more positivity. Twitter went abuzz, and soon he had two lakh followers on the page he had set up to promote the movement. It changed many lives. However, looking back, Vex feels people misunderstood it. “They thought, you never feel anything negative. If you feel good, essentially you are going to invite experiences that help you feel good. But it doesn’t mean you never feel bad. It doesn’t mean you are never going to experience negative feelings,” says Vex.</p> <p>Vex draws heavily from his own life. “My mother is from Gujarat and my father was raised in Uganda,’’ he says, “We have struggled a lot. I lost my dad when I was six months old. My eldest sister was four years old and I had another sister who was two years old.”</p> <p>After the death of his father, his mother helped a family member run his business. “That was kind of providing her a living. However, the family member was emotionally abusive, and eventually the business went bankrupt and we were homeless. We didn’t have a home for roughly three years. Along with three kids, my mom struggled for many years,” Vex recalls, as his voice starts quivering.</p> <p>Later, they moved to England; a relative asked Vex’s mother to run a shop there.</p> <p>The area where Vex grew up was “extremely racist”. “As an Indian kid, I remember feeling angry. It was very hard to be friends with anyone in my area. No one liked me, because I was brown. I looked different and straightaway I was rejected. I did not want confrontation. I didn’t want to lose my temper,” he says.</p> <p>Not one to give up, Vex looked for ways to shift the universe in his favour. During his teenage years, the internet was getting popular. He started reading stories of everyday heroes. They all had one thing in common—a different mindset or approach to life and they were reading certain books that would change their lives.</p> <p>Vex’s life is a testament to how one can change destiny. There has been a great deal of debate around the role of nature and nurture in human development. “Human mind is like a sponge. Without conscious awareness, we absorb things—from the music we listen to, the TV shows we watch, the people who are around, your teachers,’’ says Vex.</p> <p>You can change your life by rewiring your mind, Vex says. “If someone tells you that you are shy, you internalise it. When it is repeated so many times, it becomes a belief. It may stop you from interacting with people…. Some beliefs are helpful while some others are harmful. Once you are aware of these patterns, you can change them. You can change the way you view and approach life. But it takes commitment.’’</p> <p>Vex puts his heart and soul into his writings, be it books or social media posts. He hopes his books will help people find happiness and success. He also wants to shield people from all the pain and heartache that he went through.</p> <p>“People wrote to me and said they were experiencing depression and that my book was like a saviour for them. They were taking me seriously. My messages were helping people, and I felt good. Until then, I was just a YouTuber’s husband,” he laughs, referring to his wife, Kaushal Beauty, a popular make-up and beauty-related blogger. The couple tied the knot in a destination wedding in Mexico in 2018.</p> <p>Vex tells us not to bottle up emotions. But what if things don’t go your way, I ask? Suppose you post something on Instagram, hoping it would get 1,000 likes, but it gets only 800 likes. “If I don’t get as many likes as I expect, I start questioning myself. Did I not say something that is powerful? Am I not helping people? The expectation is what is creating the suffering within me,” explains Vex.</p> <p>A lot of times people can take a step back and detach from it, Vex says. “But some will continue to think about it. They’ll keep thinking of what other people think of their content. They value themselves based on other people’s responses. Why is it so important that other people like your content? You must think whether your worth is based on what other people think of you,” he says.</p> <p>Vex kickstarts his day by drinking around 600ml of water. “Drinking water first thing in the morning is good for the body and mind.... It helps with digestion and really energises you,” he says.</p> <p>Vex meditates for around half an hour to two hours every day. On a good day, he does stretching exercises as well. Vex doesn’t feel bad on days when he is not able to meditate. “If you are not able to do meditation today, that’s fine. You can do it tomorrow,’’ he says.</p> <p>Vex loves listening to music that uplifts him. He has songs that evoke good memories. Sometimes he finds himself visualising his day ahead.</p> <p>Vex finds 20 minutes each day to read, however packed his schedule. He also enjoys doing things with a structure, like writing or creating something artistic. “I do my work. I take breaks. I do fasting,” he says, “It reminds me of my childhood when I didn’t have food. It reminds me of how far I’ve come. That also gives me a sense of gratitude.”&nbsp;</p> Thu Aug 26 19:46:25 IST 2021 slow-down-effects-of-ageing-with-regular-exercise-dr-roopa-menon <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Did you ever go to a doctor and seen him tapping on your knee with a rubber mallet? Your leg kicks forward on its own. This is called knee jerk reflex. The tap makes your quadriceps muscle to contract and coordinates with the relaxation of the antagonistic flexor hamstring muscle to bring your lower leg forward. This is a reflex of proprioception, which helps maintain posture and balance.</p> <p>Let us think of another example. When you fall, reflexes automatically command your hands and arms to reach out and break your fall. When you pull your hand away from something hot, that is a reflex.</p> <p>&nbsp;</p> <p><b>Did you know that humans are born with most reflexes?</b></p> <p>A reflex is an involuntary and nearly instantaneous movement in response to a stimulus.</p> <p>&nbsp;</p> <p><b>What is a reflex arc?</b></p> <p>The path taken by the nerve impulses in a reflex is called a reflex arc. This is from the stimulus to sensory neuron to motor neuron to reflex muscle movement.</p> <p>&nbsp;</p> <p><b>What is a primitive reflex?</b></p> <p>Primitive reflexes are involuntary motor responses that are present after birth in early child development and disappear as the child grows. If you put your finger into a baby’s hand, the baby automatically grips it. This is an example of a primitive reflex called the palmar reflex.</p> <p>&nbsp;</p> <p><b>Types of reflex arcs:</b></p> <p>&nbsp;</p> <p><b>Autonomic</b></p> <p>Autonomic reflexes are unconscious motor reflexes relayed from the organs and glands to the central nervous system.</p> <p>They are generally far less apparent than somatic reflexes, given the unconscious nature within which they manage vital internal functions.</p> <p>&nbsp;</p> <p><b>Somatic</b></p> <p>Somatic reflexes involve unconscious skeletal muscle motor responses.</p> <p>Reflex arcs that contain only two neurons, a sensory and a motor neuron, are considered monosynaptic.</p> <p>Most reflex arcs are polysynaptic including multiple interneurons or relay neurons that interface between the sensory and motor neurons in the reflex pathway.</p> <p>&nbsp;</p> <p><b>Let us look at some of the examples</b></p> <p>* &nbsp;Abdominal reflex is stim-ulated by stroking around the abdomen, which helps in determining the level of CNS (central nervous system) lesion.</p> <p>* &nbsp;Cremastic reflex is elicited when the inner part of thigh is stroked in males. This helps in evaluation of acute scrotal pain and assessing for testicular torsion (associated with loss of reflex).</p> <p>* Corneal reflex is elicited by gentle stroking on the cornea with a cotton swab. This reflex helps in knowing the damage to nerves.</p> <p>* Biceps reflex is a jerking of the forearm when the biceps brachii tendon is struck with a tendon hammer</p> <p>* Triceps reflex is a jerking of the forearm when the triceps tendon is hit with a tendon hammer,</p> <p>* Brachioradialis reflex is a jerking of the forearm when the brachioradialis tendon is hit with a tendon hammer while the arm is resting</p> <p>* Pupillary light reflex is a reduction of pupil size in response to light.</p> <p>* Pupillary accommodation reflex is a reduction of pupil size in response to an object coming close to the eye</p> <p>* Cough reflex is a rapid expulsion of air from the lungs after sudden opening of the glottis, and usually following irritation of the trachea.</p> <p>* Babinski reflex is seen in infants up to one year of age and in older individuals with neurological damage. This reflex is in response to stroking the side of the foot resulting in a spreading of the toes and extension of the big toe.</p> <p>&nbsp;</p> <p><b>Hyper reflexes</b></p> <p>Hyperreflexia is defined as overactive or overresponsive reflexes. This can result in twitching or severe spasms. Hyperreflexia can be indicative of a motor neuron disease. They are also called exaggerated reflexes.</p> <p>&nbsp;</p> <p><b>Dysfunctional reflexes</b></p> <p>Dysfunctional reflexes could be a result of a trauma, an underlying disease, damage to the nerves, blockage of neural pathways, neurological disorder or may have congenital causes. This would need medical attention and it is very important to seek your doctor’s advice.</p> <p>&nbsp;</p> <p><b>Athletes and reflexes</b></p> <p>Studies show that athletes have a faster visual reaction and anticipation time response compared to non-athletes.</p> <p>&nbsp;</p> <p><b>Reflexes and age</b></p> <p>Reflexes do slow with age. Physical changes in nerve fibres slow the speed of conduction. The parts of the brain involved in motor control lose cells over time. But the effect of age on reflexes and reaction time varies greatly from person to person. You can slow down or even reverse the effects of ageing by staying physically active and doing regular exercises.</p> <p>&nbsp;</p> <p><b>How can you improve your reflexes?</b></p> <p>* Take up a sport like table tennis or badminton. Such sports must be played with rapid reflexes due to the small playing area, the size of the ball and the rapid movements involved to win the game.</p> <p>* Getting regular exercise is directly linked to a faster reaction time.</p> <p>* Make sure to get good sleep to prevent feeling sluggish. Ensure a balanced diet.</p> <p>* &nbsp;Hydration is very important. Even just a couple of hours without water can significantly slow your reaction time.</p> Thu Aug 26 19:15:19 IST 2021 a-new-alzheimer-drug-has-been-approved-for-use-in-the-us <a href=""><img border="0" hspace="10" align="left" style="margin-top:3px;margin-right:5px;" src="" /> <p>Almost four decades after a desperate woman sent John Hardy a desperate letter, and a decade after that the woman began, as she always feared, to lose her mind, came a vindication of sorts.</p> <p>&nbsp;</p> <p>It arrived in a fact sheet for doctors produced by the US Food and Drug Administration, giving information on the country’s newest drug. “Aduhelm,” it began, “is an amyloid beta-directed antibody indicated for the treatment of Alzheimer’s disease.”</p> <p>&nbsp;</p> <p>With that mundane opening sentence an experimental drug became a clinical one. The US regulators had, at last, approved a drug to treat Alzheimer’s.</p> <p>&nbsp;</p> <p>If you accept that regulator’s assessment, and we will come to that, it meant more than merely that Hardy was right—that the hypothesis he pioneered towards the start of his career has been proved towards its end. It meant the billions of pounds thrown at his idea had not been wasted after all.</p> <p>&nbsp;</p> <p>It was, said Hilary Evans, chief executive of Alzheimer’s Research UK, “a pivotal moment”. Bart De Strooper, director of the UK Dementia Research Institute, called it a “major milestone”.</p> <p>&nbsp;</p> <p>Yet, Hardy, a UCL (University College, London) professor, who works with De Strooper, is not quite as jubilant as you would think about a development that, without hyperbole, brings him significantly closer to a Nobel. “I wouldn’t put it as strong as vindicated,” he said, on a warm summer’s evening in his garden in Leytonstone, east London. “I guess… I don’t feel as depressed as I had been.”</p> <p>&nbsp;</p> <p>Aduhelm, also known as aducanumab, is the apotheosis of Hardy’s work. For aducanumab to work it means, as he predicted, that Alzheimer’s is caused by a toxic protein called amyloid.</p> <p>&nbsp;</p> <p>And for the first time it means there is a treatment to clear that protein: to deal with the causes, rather than the symptoms, of an insidious disease predicted to afflict millions more.</p> <p>&nbsp;</p> <p>The drug’s existence is so much more than many dreamt possible just two years ago. It is also so much less than Hardy hoped for.</p> <p>&nbsp;</p> <p>“We had this magic pill dream. One ring to rule them all,” he said.</p> <p>&nbsp;</p> <p>“And that’s clearly not the case.”</p> <p>&nbsp;</p> <p>The story of amyloid and aducanumab is a story of science itself. It is a story of dogged research; occasional inspiration; years of thankless, potentially futile graft; hubris and disappointment; feuds; triumph and caveats. Lots of caveats.</p> <p>&nbsp;</p> <p>It could begin in many places. It could begin with Roger Nitsch, the University of Zurich scientist, who in the early noughties identified a natural antibody that seemed to keep amyloid at bay. It began in 1905 with Alois Alzheimer, a German psychiatrist, whose patient lived in Frankfurt’s Irrenschloss, the “Castle of the Insane”. She was confused. She forgot her name. She forgot what to call the food on her plate. “I am lost,” she said. When she died, Alzheimer cut her open and found clumped-up plaques of protein in her brain.</p> <p>&nbsp;</p> <p>But there is a date in between, in the mid-eighties, when that letter landed in Hardy’s academic pigeonhole, that is as good a place to start as any.</p> <p>&nbsp;</p> <p>Genetics was a new field then and Hardy had been inspired by research into Huntington’s disease that had found a single gene was the cause. He put out an advert in an Alzheimer’s newsletter for people who thought the same was true in their family history of Alzheimer’s.</p> <p>&nbsp;</p> <p>Carol Jennings, from Nottingham, replied. “Dear sir,” she began in careful handwriting. “I was very interested to read of your research in the Alzheimer’s Disease Society News and think my family could be of use.”</p> <p>&nbsp;</p> <p>Her 63-year-old father had Alzheimer’s, she said, “as does his sister Audrey. His brother Arthur also may have the disease.”</p> <p>&nbsp;</p> <p>Hardy remembers reading it. “She said, ‘My doctor keeps telling me it doesn’t run in the family, but here’s my family tree, and it clearly does.’” Throughout her family were people who developed Alzheimer’s and did so in their fifties, and she wanted answers. “She’s a very determined woman, a remarkable woman.”</p> <p>&nbsp;</p> <p>This is the letter that launched a thousand studies, the letter that, in a roundabout way, led to investments worth billions. This letter is the reason not only that I am sitting in Hardy’s garden, but the reason that he has this garden at all. It is the letter that means, perhaps, we have the first glimmer of a hint of a glint that we can cure Alzheimer’s.</p> <p>&nbsp;</p> <p>Other families with genetic Alzheimer’s would be found. Other researchers, Hardy is keen to emphasise, would follow the clues down the same path he took. But he was there at the front, from the start.</p> <p>&nbsp;</p> <p>Most people don’t have genetic Alzheimer’s, not in the sense that a single gene causes the condition. But in those people like the Jennings family, he thought, might lie a clue. Their mutation could be a pointer to the disease in the population at large.</p> <p>&nbsp;</p> <p>These days, identifying the key gene from the family members might take a postdoctoral student a month. Back then it was very different. Without any modern tools, “It was chaotic really. There were a series of genetic markers scattered around,” Hardy said. It took six of them five years. “So, 30 person years of work.”</p> <p>&nbsp;</p> <p>They presented the results to the family, confirming what they suspected: that their situation was not normal. Each family member had a 50 per cent chance of getting the disease while young. They were, oddly, pleased. “They were just delighted that their fears, which had been dismissed, were proved.”</p> <p>&nbsp;</p> <p>Then began the job of working out what it meant.</p> <p>&nbsp;</p> <p>A gene is a code for making a protein. And protein is a building block for making a body. If you find out what a faulty gene is, you can find out what it codes for. If you find out what it codes for, you can identify the building block that has gone wrong.</p> <p>&nbsp;</p> <p>In the case of the Jennings family that building block was called amyloid precursor protein (APP). As its name suggests, this protein is part of a pathway that leads to the amyloid protein.</p> <p>&nbsp;</p> <p>In those genetically predisposed to early onset Alzheimer’s, they make too much amyloid, or it is not as soluble as it should be. From here, to Hardy, the chain of events seemed obvious.</p> <p>&nbsp;</p> <p>Too much amyloid is deposited, it causes tangles of another toxic protein called tau, which causes neuronal death. In those with genetic Alzheimer’s this happens early, because they make too much APP.</p> <p>&nbsp;</p> <p>In those with normal Alzheimer’s this happens a bit later, because their brains are too slow at clearing amyloid. Either way, amyloid is the trigger.</p> <p>&nbsp;</p> <p>In 1991, Hardy and his colleague David Allsop published what became known as the amyloid hypothesis. It would, they concluded, “facilitate rational design of drugs to intervene in this process”. A cure was just around the corner, and Alzheimer’s was a hot research topic.</p> <p>&nbsp;</p> <p>But when a topic is hot, it attracts the most ambitious researchers. And ambitious researchers have a tendency not to agree with each other.</p> <p>&nbsp;</p> <p>“The first thing we did was organise a meeting in Oxford and we invited all the other people who were starting out,” said Hardy. They all had their own ideas and not all saw the amyloid hypothesis as so obvious.</p> <p>&nbsp;</p> <p>Could it be triggered, in fact, by infection? Was tau the crucial target? Many old people die with lots of amyloid but no dementia—might it be irrelevant? Could it even be nature’s way of protecting the brain? Could it be that identifying it as the cause of dementia was like identifying a scab as the cause of a stab wound?</p> <p>&nbsp;</p> <p>It didn’t help that our knowledge of the brain was—is—so poor. “Obviously [APP] has a function. We don’t know what that function is,” said Hardy. “That’s embarrassing.”</p> <p>&nbsp;</p> <p>So the field fractured. “There was an editorial in Nature Genetics in 1997 saying that Alzheimer’s genetics was the most fractious field—even more fractious than Aids research, which was the standard applied.”</p> <p>&nbsp;</p> <p>There was one researcher, Mark Smith, from Case Western Reserve University, who would regularly challenge Hardy at conferences. “He was always saying amyloid was rubbish. We used to get on stage to debate each other and then go to the bar.”</p> <p>&nbsp;</p> <p>It was infuriating. Looking back, he thinks, “The disagreement was good because we did different experiments, and although we were denigrating each other’s work, that’s how we led to progress.”</p> <p>&nbsp;</p> <p>Progress, though, was slow. There were mutterings that amyloid was attracting all the funding but not providing the breakthroughs. In 2009, Hardy wrote an article in the Journal of Neurochemistry that addressed those who were claiming that his idea had corralled all the money to the detriment of the field.</p> <p>&nbsp;</p> <p>“Whether this chorus is like the dawn chorus, heralding a bright new era of Alzheimer’s research, or a malcontent’s chorus, merely whingeing that their grants go unfunded, is open to debate.” This is not the kind of language regular readers of the Journal of Neurochemistry would have expected.</p> <p>&nbsp;</p> <p>Still, consensus coalesced around amyloid. So much so that in 2015 Hardy received the $3 million Breakthrough Prize in life sciences, the largest cash prize in science.</p> <p>&nbsp;</p> <p>As luck would have it, he was moving house at the time. “You’re seeing the prize,” he said, with an expansive sweep around his garden.</p> <p>&nbsp;</p> <p>It’s a big house by London standards, though not absurdly so. There is a very big hot tub. There is a small mews house at the bottom of the garden where his nieces came to visit and all caught the coronavirus. “We call it the Covid incubator.”</p> <p>&nbsp;</p> <p>Soon after the award, the results of the first anti-amyloid drugs started coming through, and Hardy was not impressed. There was gantenerumab from Roche, solanezumab from Eli Lilly and bapineuzumab from Pfizer. Each ended in “umab”, meaning they used monoclonal antibodies: artificial proteins designed to attack amyloid, just as our own immune system makes antibodies to attack Covid.</p> <p>&nbsp;</p> <p>Each drug had made it as far as phase three trials, meaning that hundreds of millions of pounds had been invested—massive bets on the amyloid hypothesis. Each, in turn, failed.</p> <p>&nbsp;</p> <p>Time takes its toll. Smith died in 2010 after being hit by a drunk driver. That hopeful, argumentative group has grown old together. “We were young and fractious. Now we’re kind of resigned. We know that we’re not going to knock each other out.” Will they get dementia together? Or will there be a cure by then? He is more confident now than he might have been two years ago.</p> <p>&nbsp;</p> <p>In the late nineties, long before blockbuster failures had led some pharmaceutical companies to abandon Alzheimer’s research entirely, Roger Nitsch, from the University of Zurich, was taking a different approach. Instead of trying to find out what was going on in the brains of people who caught Alzheimer’s, he looked at the brains of people who hadn’t.</p> <p>&nbsp;</p> <p>“We turned the question around,” he said. Around a third of 85-year-olds have the disease. “It’s very interesting to look at the other two thirds who don’t have this disease or have very slowly progressing forms.”</p> <p>&nbsp;</p> <p>He and his colleagues looked at lifestyle explanations—smoking, diet, exercise—but also at the genetics of the immune system. Here they found a “striking effect”: some made antibodies against the amyloid protein.</p> <p>&nbsp;</p> <p>“We basically had the blueprints. We thought we just needed to decipher them and they would tell us how to treat the disease.”</p> <p>&nbsp;</p> <p>To pin down the precise antibody, they went to the brains of patients who had died of Alzheimer’s. Nitsch said that, for amyloid doubters, a demented brain is a persuasive counterargument.</p> <p>&nbsp;</p> <p>“When you see these, you intuitively understand the hypothesis because actually it’s very simple. There are these amyloid plaques in the brain. And then there are the neurons in the brain, all over the place. The closer they are to the plaque, the more messed up they are.”</p> <p>&nbsp;</p> <p>They tested hundreds of antibodies to see which bonded to the plaques in the brain sections. One of the ones that did is what became known, through Biogen and Nitsch’s company, Neurimmune, as aducanumab.</p> <p>&nbsp;</p> <p>The other drugs that came to market before it sought to remove amyloid in the blood. Aducanumab would do something different: it would eat away at the clumps themselves. Not merely arresting spread, but reducing it.</p> <p>&nbsp;</p> <p>The effects on amyloid were dramatic. “Here we have Hardy’s hypothesis at work in real patients. Amyloid takes about 20 years to build up. Within 12 months it’s down to normal levels—where the patient wouldn’t even be diagnosed as an Alzheimer’s patient,” said Nitsch.</p> <p>&nbsp;</p> <p>The effects on patient outcomes were less dramatic. Whatever the amyloid was doing, cognitively speaking they definitely did still have Alzheimer’s. It was only by looking at a particular slice of the trial, containing patients at an early stage in the disease, that any cognitive improvement was found. Even then it was minimal, reducing decline by a quarter.</p> <p>&nbsp;</p> <p>Nitsch hopes that ongoing research in those receiving the drug will reveal larger benefits when it is correctly targeted, but he makes no claims for it as a miracle cure.</p> <p>&nbsp;</p> <p>“It’s almost like you have to reduce that toxicity big time in order to get a positive effect on the neurons,” said Nitsch. It is in his view a proof of principle, of what could soon be possible. “This is not the end of Alzheimer’s disease, but it’s the beginning of the end.”</p> <p>&nbsp;</p> <p>Hardy agrees. In fact, when the announcement was made he used just those words.</p> <p>&nbsp;</p> <p>“From a scientific point of view, once you know something turns the curve, then it’s easier to do it the second time,” he tells me when we meet two days later. “The analogy I use is the Wright brothers. They just about got that plane off the ground, but within 20 years we would fly people commercially across the channel.</p> <p>&nbsp;</p> <p>“I think that this is a marginally effective drug, but I think it points the way and the next drug will be better still.”</p> <p>&nbsp;</p> <p>When the treatment was approved in the US, to headlines around the world, two members of the regulator’s advisory committee resigned, claiming it was too expensive, the statistics about its efficacy were too unclear, and that even if it did work, its effects were minimal. David Knopman, a neurologist at the Mayo Clinic, told The Washington Post after stepping down that it had been a “sham process”.</p> <p>&nbsp;</p> <p>It is possible, likely even, that the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) will concur, in more measured language, and the drug won’t receive approval there.</p> <p>&nbsp;</p> <p>As far as David Cameron is concerned, that will not necessarily lessen the importance of aducanumab. Speaking as the president of Alzheimer’s Research UK (ARUK), he concedes that the drug may be of “marginal benefit. But the excitement is around what are the consequences and where does this lead us? First, this is a drug that treats the disease, rather than simply the symptoms. Second, it’s going to stimulate a lot of research and work by other pharmaceutical companies.”</p> <p>&nbsp;</p> <p>Cameron joined the charity because of the impact he had seen it having on the nation.</p> <p>&nbsp;</p> <p>“I saw just what damage this was doing: the tens, hundreds, thousands, soon to be a million lives in this country thrown into darkness.”</p> <p>&nbsp;</p> <p>He said he was particularly struck by the resignation among many, the assumption it was just part of ageing. “Actually, it’s a disease of the brain. We’re cracking cancer, and so we should be cracking this disease, too.”</p> <p>&nbsp;</p> <p>One of ARUK’s key initiatives is early diagnosis. Is there something in your blood, your gait—even how you use a computer—that might indicate the sticky march of amyloid has begun? This is where marginal drugs may, just, become less so. “Treating people who’ve already been diagnosed with cognitive impairment is a bit like treating a cancer tumour when it’s the size of a tennis ball,” said Cameron. Get it earlier, though, give the drug like a “statin for the brain”, and you have a far more powerful treatment.</p> <p>&nbsp;</p> <p>In a sense, Hardy thinks his critics had a point all along. Amyloid was not enough, and perhaps they were led astray by, in his words, the hope of a “miracle cure”.</p> <p>&nbsp;</p> <p>Hardy has slightly tweaked his idea of the amyloid hypothesis. Amyloid is important, but it’s not as simple as just removing it. Imagine that today, in the instant reading this, your Alzheimer’s begins. Amyloid starts to be deposited and it does so faster than immune cells called microglia can remove it.</p> <p>&nbsp;</p> <p>“You’re intellectually fine and nobody, including yourself, can tell there’s anything wrong. It’s rather like the build-up of cholesterol in your heart vessels. Everything seems fine, but the disease process has started.” This is when, as Cameron suggests, attacking amyloid could really have dramatic effects.</p> <p>&nbsp;</p> <p>If we don’t, if we miss the signs, “Then, in three or four years, the microglia will start to give up.” Amyloid will build up, and so will tau tangles. This is when beating amyloid is not enough. “Think of the amyloid as a match. The tangles are rather like a fire. And once it’s lit, it starts to spread, independent of the initiating match.”</p> <p>&nbsp;</p> <p>There is now consensus (or as close to it as there will ever be) that we need to get to amyloid earlier. We probably need to get tau, too, and stimulate the immune cells that help carry it all away. It is possible the “failed” umabs of the past years may work in combination with aducanumab. It reduces amyloid build-up; they take it out of the blood. We need many therapies plural, not just one, and this shouldn’t be a surprise.</p> <p>&nbsp;</p> <p>“I’m a type 2 diabetic. I take insulin but like nearly all type 2 diabetics, I take statins and blood pressure medicines. Polypharmacy is where I go,” said Hardy.</p> <p>&nbsp;</p> <p>“And I think that’s where we’re going to end up with Alzheimer's disease. We’re going to end up with an amyloid drug that we should give as early as we can, and then we’re going to be looking at other drugs.</p> <p>&nbsp;</p> <p>“There’s a unity in the field now that we need all these targets. Of course, people always think there’s a unity of people who agree with them.”</p> <p>&nbsp;</p> <p>Hardy knows that there is only one prize bigger than the one that paid for his house. That prize, the Nobel, could only come with absolute confirmation of the amyloid hypothesis. As with all science there were many others involved—co-authors, competitors. Equally, though, his is the name that is most tied to amyloid. And in the month when amyloid produced the first Alzheimer’s treatment, he’s just trying not to think about it.</p> <p>&nbsp;</p> <p>“It drives you mad. I mean, you really don’t want to think like this. You want to get to the end of your career and think, I’ve done good work I’m proud of. You don’t want to get to the end of your career and think, those bastards didn’t give me the Nobel. Or, even worse, those bastards gave X the Nobel and it should have been me.</p> <p>&nbsp;</p> <p>“Those are two ways not to be happy.”</p> <p>&nbsp;</p> <p>For Carol, her future was always a coin toss. She lost. In her late fifties, the amyloid clumps began to twist like tangled vines. They squeezed her memory, her consciousness, her sense of self. They began to eat away at who she was.</p> <p>&nbsp;</p> <p>When she had approached Hardy first, “She said that she didn’t think it would help her, but she hoped it would help her kids,” said Hardy. “And in fact it didn’t help her.” She is still alive but, “She’s now severely demented.” The last time he met Carol was four years ago, and he is pleased to say she remembered who he was.</p> <p>&nbsp;</p> <p>In the very existence of aducanumab lies a clue to the treatment that might. It is just conceivable we are on the cusp of something astonishing.</p> <p>&nbsp;</p> <p>“If you’d have asked me how long it was going to take in 1991, I’d have said five years,” said Hardy. “And the trouble is, I’ve been saying five years ever since.”</p> Thu Jul 22 17:20:55 IST 2021