Regulate physical activity to reduce risk of sudden death

Besides taking preventive steps, it is vital to realise the importance of early cardiopulmonary resuscitation to save lives.

Prevention: People with an existing heart condition should avoid strenuous exercise.

DURING the recent Navratri celebrations in Gujarat, more than a dozen sudden deaths were reported. The victims ranged from adolescents to adults. While performing garba, they collapsed and died. This tragedy has again raised the question: does excessive physical exercise or exertion lead to sudden death? In recent years, famous singer KK and popular comedian Raju Srivastav collapsed during a performance and a workout, respectively. It has been observed that during vigorous exercise, there is a higher risk of sudden death. Thus, extreme exercise may result in sudden death in some individuals. Habitually sedentary people are 50 times more likely to die during vigorous exercise than those who engage in regular physical activity. Sudden death, though rare, is also observed in players during competitions or training. In most cases, sudden death is linked to heart conditions. It is important to understand the reasons for such sudden collapses so as to take preventive measures.

The medical truth is that exercise protects against heart diseases and is considered an important cardioprotective intervention. Sudden and excessive exercise may rupture an atherosclerotic plaque in the coronary arteries, which can result in heart attack and sudden death in individuals aged 30 years or above. Those who indulge in unhealthy activities such as smoking, drug abuse, excessive alcohol consumption and a sedentary lifestyle may develop plaques in the coronary

arteries that do not cause significant obstruction, rendering them asymptomatic. During excessive exercise, these vulnerable plaques have a tendency to rupture and result in thrombosis and blocking of the arteries, resulting in a heart attack and even sudden death. People with an existing heart disease should avoid strenuous exercise. Individuals aged 30 or above who have a family history of heart attacks or lead an unhealthy lifestyle should undergo a preventive cardiac evaluation before initiating heavy exercise.

Coronary artery obstruction is less likely in children and adolescents. Among those who died while doing garba recently, there were two youngsters aged 12 and 17. In this age group, underlying, unknown hypertrophic cardiomyopathy or inherited arrhythmic disorders may often be the causes. Usually, such disorders run in the family, so young children/adolescents with a family history of these conditions should undergo screening and be wary of engaging in strenuous exercise. However, sometimes too much/too fast exercise, without knowing one’s fitness level, may result in dehydration that can trigger an electrolyte imbalance and potentially result in fatal ventricular arrhythmia even in a normal individual. Some forms of dance, such as breakdancing or intense aerobic dancing, can be physiologically demanding. It is, therefore, important to be aware of these serious issues while exercising and take preventive steps, such as taking breaks to avoid excessive fatigue, ensuring proper hydration and refraining from sudden, excessive exercise if you are feeling tired. Further, if one feels dizzy, nauseated or breathless during an exercise, one should immediately stop.

Recently, the Indian Council of Medical Research (ICMR) reported that sudden heart attacks and deaths may also occur in those who had previously contracted Covid-19. This risk is higher in those who had experienced severe Covid and were hospitalised for some days. There is no definite scientific proof in support of this observation. Autopsy in such cases may help identify the cause of sudden death. It is unknown whether autopsies were performed on individuals who experienced sudden death related to previous Covid infections. Indeed, in approximately 30 per cent of sudden deaths in young patients, conventional autopsy may not provide a clear explanation. Molecular autopsy, which involves DNA (deoxyribonucleic acid) sequencing, can be a valuable tool for identifying underlying channelopathy disorders in such cases.

Besides taking preventive steps, it is vital to realise the importance of early cardiopulmonary resuscitation (CPR) to save lives in case of a sudden collapse. Time is important and any minute lost in initiating CPR leads to 10 per cent decrease in the survival rate of the victim. Thus, there is an increasing recognition of the need to coordinate with the community in providing emergency medical care to optimise patient survival. The community needs to be trained to understand and perform the bystander resuscitation protocol. For effective resuscitation, immediate recognition, rapid access, rapid CPR and rapid defibrillation are all crucial. Therefore, having an automated external defibrillator available with the resuscitative team is extremely vital.

Automated external defibrillators should be installed in places where there is a large gathering, such as airports, shopping malls and big residential colonies.

The treatment time is critical while considering the chance of survival in cases of cardiac arrest. If proper resuscitation is not done in the first 4-6 minutes, there is a significant risk of brain damage or brain death. In India, most people do not know how to respond when someone suddenly collapses. The only way to have a better outcome is to have effective bystander CPR and immediate resuscitation, including defibrillation. Many of these deaths are to some extent  preventable, so both preventive strategies and effective resuscitative measures are important for handling cases of sudden cardiac arrest.

https://www.tribuneindia.com/news/comment/regulate-physical-activity-to-reduce-risk-of-sudden-death-560126

WHO hailed India’s success in managing TB: Union Health Ministry

India’s efforts have resulted in the reduction of TB incidence by 16% from 2015 to 2022, almost double the pace at which global TB incidence is declining (which is 8.7%). TB mortality has also reduced by 18% during the same period in India, and globally Medical students and school children form a human chain that reads “TB” to mark the World Tuberculosis Day.

India has made tremendous progress in improving case detection and reversed the impact of COVID-19 on the tuberculosis (TB) programme, noted the World Health Organization’s (WHO) ‘Global TB Report 2023’ released earlier this week, the Union Health Ministry said on Wednesday.

TB treatment coverage, according to the report, has also improved to 80% of the estimated TB cases, an increase of 19% over the previous year.

India’s efforts have resulted in the reduction of TB incidence by 16% from 2015 to 2022, almost double the pace at which global TB incidence is declining (which is 8.7%). TB mortality has also reduced by 18% during the same period in India, and globally.

Quality of active TB case finding suboptimal nationally: study

“The WHO has made a downward revision of TB mortality rates from 4.94 lakh in 2021 to 3.31 lakh in 2022, a reduction of over 34%,’’ a release issued by the Health Ministry said.

It added that in the ‘Global TB Report 2022’, the WHO and the Ministry of Health & Family Welfare, Government of India, had agreed to publish the data for India as “Interim” with an understanding that the WHO would work with the Ministry’s technical team to finalise the figures.

The report notes that India’s intensified case detection strategies resulted in the highest ever notification of cases in 2022, when over 24.22 lakh TB cases were notified, surpassing the pre-COVID-19 pandemic levels. Key initiatives launched and scaled up by the government include active case finding drives, scaling up molecular diagnostics at the block level, decentralisation of screening services via the Ayushman Bharat Health and Wellness Centres, and private sector engagement have resulted in significantly bridging the gap in missing cases.

https://www.thehindu.com/sci-tech/health/who-affirms-indias-success-in-reduction-of-tb-incidence-by-16-and-of-tb-mortality-by-18-since-2015/article67513464.ece

Common drug may help manage osteoarthritis symptoms and pain

A low-cost, common drug may help improve pain with osteoarthritis.

Hand osteoarthritis is a condition that can cause joint pain and swelling, making it harder for people to go about their daily lives.

Research is ongoing about how to best treat hand osteoarthritis.

Data from a recent study found that methotrexate—a common treatment for other arthritis types—may help treat hand osteoarthritis and inflammation of the synovial membrane.

People use their hands daily to accomplish tasks and go about their lives. When the joints in the hand become stiff and rigid to move, it can be debilitating and hard to function. This can be the case for people who have hand osteoarthritis. Researchers are interested in understanding the most effective treatment options for people with hand osteoarthritis.

A recent studyTrusted Source published in The LancetTrusted Source examined how well the drug methotrexate may help treat hand osteoarthritis.

The study found that participants who received methotrexate over six months had moderate pain improvement.

The results indicate that methotrexate, which is helpful in treating other types of arthritis such as psoriatic or rheumatoid arthritis, may benefit people with hand osteoarthritis and inflammation.

What are the symptoms of osteoarthritis?

OsteoarthritisTrusted Source is a condition that affects the joints of the body. One of the most common places it happens is in the hands. People with osteoarthritis in their hands may report trouble with movement, swelling of the joints, and pain. The joint swelling or synovitis can be particularly troubling.

Dr. Fiona E. Watt, a reader in rheumatology, honorary consultant rheumatologist, UKRI Future Leaders Fellow, and part of the Osteoarthritis Research Group, Department of Immunology and Inflammation, Imperial College London, who was not involved in the study, explained to Medical News Today:

“Hand osteoarthritis is the [most common] form of arthritis affecting the hands—it is usually associated with some inflammation of the lining of the joint, also known as synovial inflammation (synovitis) although this may not be present all the time, or at all stages in the condition.”

Pain With Osteoarthritis

“Those with multiple joints affected by synovial inflammation are more likely to have significant symptoms like higher levels of hand pain and stiffness. They are also more likely to get progressive damage or ‘erosive’ osteoarthritis, which is linked to deteriorating hand function over time.”

— Dr. Fiona E. Watt

Hand osteoarthritis and associated joint swelling can be difficult to manage and treat. The current study’s authors wanted to see if the medication methotrexate may be useful in helping with pain relief among people with hand osteoarthritis and synovitis. Methotrexate is a common treatment for other types of arthritis, like rheumatoid arthritis.

Professor Philip Conaghan,director of the NIHR Leeds Biomedical Research Centre in the U.K., and arthritis expert, who was also not involved in the study, explained to MNT why this drug is not usually considered as first-line treatment for osteoarthritis:

“Methotrexate is the [most common] drug used around the world for treating immune-mediated inflammatory arthritis such as rheumatoid arthritis or psoriatic arthritis. It has multiple anti-inflammatory actions. Because the inflammation in osteoarthritis is not primarily driven by the immune system, it has not been clear if methotrexate would work in osteoarthritis.”

Methotrexate improves pain, stiffness with osteoarthritis

Study author Professor Flavia Cicuttini, the head of the musculoskeletal unit at Monash University and the head of rheumatology at Alfred Hospital, explained the difficulty surrounding treatment options for hand osteoarthritis.

“Hand osteoarthritis is a disabling condition that causes pain and affects function, impeding daily activities such as dressing and eating. It can significantly reduce quality of life,” she told MNT.

Lack Of Treatments For Osteoarthritis

“At the moment, if a person goes to the doctor with hand osteoarthritis, treatments are very limited and do not work well. Often, patients are told there is nothing much doctors can offer them except pain relief with paracetamol or anti-inflammatory medications such as Naprosyn or Celebrex.”

— Prof. Flavia Cicuttini

To look at the effectiveness of methotrexate in improving pain in people with hand osteoarthritis with synovitis, researchers conducted the current study.

The study was a double-blind, randomized, placebo-controlled trial. The researchers included 97 participants in their analysis. Of this number, 50 participants received methotrexate, and 47 received the placebo. Participants took either the placebo or methotrexate weekly for six months.

All participants had hand osteoarthritis and synovitis in at least one joint, as confirmed by MRI. They excluded participants who had other types of arthritis and certain conditions like cancer and hepatitis B.

In addition to their study participation, participants also got their typical care from their health practitioners. They took folic acid on any other day of the week that they weren’t taking methotrexate, as this can help with methotrexate side effects.

The methotrexate group had a slightly higher body mass index than the placebo group. Other than this, the groups were very similar.

Researchers found that the methotrexate group had a higher level of pain and stiffness reduction than the placebo group.

There were some reported adverse events in both groups, which could have been related to study medications. However, overall, methotrexate was well-tolerated.

“The main finding of this study is that methotrexate, a medication that is commonly used often used worldwide for conditions such as rheumatoid arthritis, works for hand osteoarthritis with inflammation. The results of our study support a potential role for methotrexate in the management of hand osteoarthritis and inflammation and provide clinicians with a safe treatment option for this common type of hand osteoarthritis.”

— Prof. Flavia Cicuttini

Prof. Conaghan further commented with his thoughts on the study:

“There is a believable mechanism for the benefit seen in this study, and generally, the study is well designed. For example, it was good to see people were excluded if they had blood test indicators of rheumatoid arthritis.”

Study limitations

The nature of this study allows for tight control and a low risk of bias. Regardless, researchers still acknowledge some potential limitations.

First, the intervention period only lasted six months. Thus, future studies could include longer follow-up time. There was some missing data from some participants, indicating the need for studies with even larger sample sizes. The researchers did not look at how methotrexate affected structural progression.

The researchers encountered a study pause due to the COVID-19 lockdowns. They were unable to collect data on the primary outcome from certain participants. They could not establish how methotrexate affected tender swollen joint count.

It’s further possible that the effects of the methotrexate were underestimated among some participants. There was a low risk of memory bias among participants. The research also included more women than men.

Prof. Cicuttini noted that they needed conduct further trials “to establish whether the effect of methotrexate extends longer than six months, for how long we need to treat patients, and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation.”

Can I get methotrexate prescribed for osteoarthritis?

Dr. Watts offered the following words of caution about using methotrexate for hand osteoarthritis in clinical practice:

“There are some practical considerations, too before this drug enters routine practice. The trial participants all had hand MRIs, not something we would do currently in usual practice. MRI is expensive and cheaper alternatives would probably need to be tested.”

Dr. Watts and Prof. Conaghan both noted that using methotrexate needed regular monitoring.

“Methotrexate is a drug which requires blood test safety monitoring for the duration of therapy, so before this type of treatment was implemented, we would need appropriate pathways of care to be established and funded in the NHS and other healthcare systems—these do not currently exist for this form of arthritis. The next step would be testing whether this drug is effective in practice, alongside or in addition to other standard treatments and this will be a really important next step,” said Dr. Watts.

“[B]ecause osteoarthritis is such a common problem, and because methotrexate requires monitoring, including regular blood tests (meaning more work for health systems), I think we will need a second trial to verify the findings in the Wang study before there is a big change in clinical practice,” said Prof. Conaghan.

Finally, Prof. Philip Conaghan reports that he also presented positive results for a methotrexate trial for knee osteoarthritis at an OARSI World Congress on Osteoarthritis meeting several years ago. However, the full results of that study have yet to appear in print.

https://www.medicalnewstoday.com/articles/common-drug-may-help-manage-osteoarthritis-symptoms-and-pain

National Cancer Awareness Day in India: All about the history and significance of the day

National Cancer Awareness Day in India is observed to spread awareness around the types of cancer, need for early detection, and important lifestyle changes.

Cancer, one of the deadliest diseases in the world, has been on rise globally and in India. One in 10 Indians would develop cancer in their lifetime and one in 15 will die of it, said the International Agency for Research on Cancer’s (IARC) World Cancer Report released by the World Health Organization (WHO). Lifestyle factors play a major role in development of cancer. No surprise that breast cancer and colorectum cancer that are associated with being overweight, low physical activity, and sedentary lifestyle have been on rise. National Cancer Awareness Day in India is observed to spread awareness around the various types of cancer, the need to detect cancer early on, and the important lifestyle changes one must take to fight the disease.

National Cancer Awareness Day in India is celebrated on November 7 every year in India.

According to WHO, cancer is a large group of diseases that can start in any organ or tissue of the body and occurs when abnormal cells grow uncontrollably and even spread to other body parts (metastatic cancer). A second leading cause of death globally, lung, prostate, colorectal, stomach and liver cancers are most common types of cancers in men. Breast, colorectal, lung, cervical and thyroid on the other affect women more.

Date of National Cancer Awareness Day in India

National Cancer Awareness Day in India is celebrated on November 7 every year in India to spread awareness around symptoms, severity and treatment of different kinds of cancer.

History of National Cancer Awareness Day in India

National Cancer Awareness Day was kickstarted by Dr Harsh Vardhan, the Union Minister of Health and Family Welfare in India in September 2014. A committee was formed and November 7 was designated as the day for annual observance aiming to inform and educate masses about cancer, its treatment, and how early action can drastically improve survival rates.

Significance of National Cancer Awareness Day

More than 50% of cancer cases are in advanced stages when detected which can greatly affect chances of survival. However, early detection can help in full recovery. Spotting the cancer or pre-cancerous changes early with the help of various screening methods will allow time for efforts that can help slow down or prevent cancer development.

https://www.hindustantimes.com/lifestyle/health/national-cancer-awareness-day-in-india-all-about-the-history-and-significance-of-the-day-101699268796603.html

Obstetric Emergencies: A Critical Perspective of an Obstetrician

Obstetric emergencies encompass a wide range of critical situations that can occur during pregnancy, labor, or the postpartum period.

Obstetrics is a medical specialty that deals with pregnancy, childbirth, and the postpartum period. While the majority of pregnancies progress smoothly, obstetricians are acutely aware of the potential for complications and emergencies. These emergencies can be life-threatening for both the mother and the baby. In this article, we will explore obstetric emergencies from the perspective of obstetricians, emphasizing the importance of prompt recognition, effective management, and the critical role obstetricians play in ensuring positive outcomes.

The Challenge of Obstetric Emergencies

Obstetric emergencies encompass a wide range of critical situations that can occur during pregnancy, labor, or the postpartum period. They are often unexpected and can escalate rapidly, necessitating quick decision-making and medical intervention. Common obstetric emergencies include:

Eclampsia: A severe form of preeclampsia, characterized by high blood pressure, seizures, and organ dysfunction.

Placental abruption: Premature separation of the placenta from the uterine wall, which can lead to severe bleeding and fetal distress.

Uterine rupture: A tear in the uterine wall or tear in the previous caesarean scar area during labor, which can be life-threatening for both mother and baby.

Shoulder dystocia: When the baby’s shoulder becomes trapped behind the mother’s pelvic bone, after the delivery of baby’s head, can cause birth injuries.

Postpartum hemorrhage: Excessive bleeding after childbirth, a leading cause of maternal mortality worldwide.

Cord prolapse: The umbilical cord slipping through the cervix ahead of the baby, which can compromise fetal oxygen supply.

Early Recognition and Diagnosis:

Obstetricians are trained to recognize the signs and symptoms of obstetric emergencies. Timely diagnosis is crucial, as it allows for swift intervention, reducing the risk of complications. Obstetricians regularly monitor pregnant patients through prenatal visits, where they assess blood pressure, weight gain, and fetal well-being. They also educate patients about potential warning signs.

For example, in the case of preeclampsia, early recognition of symptoms such as high blood pressure, proteinuria, edema, and severe headaches is essential. Timely diagnosis enables obstetricians to manage the condition with medications and close monitoring, preventing it from escalating into eclampsia.

Multidisciplinary Team Approach:

Obstetricians often work within a multidisciplinary team to manage obstetric emergencies effectively. This team may include obstetric nurses, anesthesiologists, neonatologists, and sometimes, even surgeons. The collective expertise of these professionals is invaluable in addressing complex emergencies.

For instance, in the case of placental abruption, obstetricians may need to quickly deliver the baby via cesarean section, and anesthesiologists play a pivotal role in ensuring the mother’s comfort and safety during the procedure. Neonatologists are on standby to care for the newborn, who may be premature or distressed due to the abruption.

Decision-Making Under Pressure:

Obstetricians often find themselves making critical decisions under immense pressure. Obstetric emergencies are inherently stressful, and the clock is ticking. Decisions must balance the well-being of both the mother and the baby.

For example, in cases of uterine rupture, obstetrician must proceed with an emergency caesarean section to avoid maternal and neonatal morbidity and mortality.

Surgical Expertise:

Obstetricians are skilled surgeons, capable of performing various procedures to address obstetric emergencies. Cesarean sections are one of the most common surgeries in obstetrics and are often performed in emergency situations to safeguard the well-being of both the mother and the baby.

In the case of placental abruption or cord prolapse, a prompt cesarean section may be the only way to ensure a safe delivery. Obstetricians are well-versed in the techniques and protocols required for this surgery, ensuring that it is performed swiftly and safely.

Emotional Support:

In addition to their medical expertise, obstetricians play a crucial role in providing emotional support to patients and their families during obstetric emergencies. These situations can be extremely distressing for all involved. Obstetricians must communicate with empathy, explaining the situation, the planned interventions, and the potential risks in a clear and reassuring manner.

Post-Emergency Care:

Obstetricians’ responsibilities do not end once the immediate crisis is resolved. Post-emergency care is equally critical in ensuring the well-being of the mother and baby. This may involve monitoring for complications, providing follow-up care, and addressing any psychological trauma experienced by the patient.

For example, after a postpartum hemorrhage, the obstetrician will closely monitor the mother’s vital signs, administer blood products if necessary, and ensure she receives the appropriate medications and treatments to prevent infection and other complications. Emotional support is also vital during the recovery process.

Advancements in Technology:

Advancements in medical technology have improved the management of obstetric emergencies. Tools like ultrasound, electronic fetal monitoring, and laboratory tests allow obstetricians to assess the well-being of the fetus and mother in real-time. This technology assists in making informed decisions and ensures timely interventions.

Obstetricians are at the frontline of managing obstetric emergencies, where their expertise, rapid decision-making, and surgical skills are put to the test. These professionals work diligently to ensure the safety and well-being of both the mother and the baby during critical situations.

While obstetric emergencies are often unpredictable and challenging, the dedication of obstetricians, in collaboration with multidisciplinary teams, continues to save lives and contribute to the overall improvement of maternal and neonatal outcomes. Obstetricians’ role extends beyond medical expertise; it encompasses empathy, emotional support, and a commitment to providing the best possible care in the most challenging circumstances. Obstetricians are the unsung heroes of the delivery room, ensuring that the miracle of childbirth remains a joyous and safe experience for all.

https://indianexpress.com/article/lifestyle/sponsored-lifestyle/obstetric-emergencies-a-critical-perspective-of-an-obstetrician-9007512/

Eye problems you never knew are due to your rising stress levels

Stress-induced vision problems

In today’s fast-paced world, stress has become an almost inevitable part of life. Stress, anxiety and depression are not just confined to affecting mental health; their impact can extend to various facets of our well-being, including something as fundamental as our vision. The link between mental health and vision is a complex one, where the two can both influence and be influenced by each other.

Mental health issues can manifest in physical ways throughout the body, including the eyes. When stress takes its toll on the mind, it can lead to physical changes in the body, affecting blood flow, muscle tension and even the functioning of the eyes.

Dry eyes

Stress can lead to reduced tear production, causing dry and irritated eyes. The link between stress and dry eyes is thought to be mediated by the autonomic nervous system, which controls tear production. Increased stress can disrupt the balance of this system, resulting in inadequate tear production and discomfort.

Blurry vision

According to Dr. Rishi Raj Borah, Country Director – India, Orbis, “Stress-induced muscle tension can lead to changes in the way the eyes focus. This can result in temporary blurry vision and difficulty in maintaining clear sight, particularly during periods of heightened stress.”

Eye twitching

Those pesky and prolonged eye twitches that seem to appear out of nowhere can also be linked to stress. Stress triggers nerve impulses that can cause the muscles around the eyes to contract involuntarily, resulting in twitches.Eye twitching for more than 2 weeks should not be ignored.

Less social interaction maybe the cause

While stress can affect vision, the relationship works both ways. Vision problems can also contribute to stress, anxiety, and depression. Vision problems can lead to poor quality of life. Living with eye disorders can exacerbate feelings of frustration and helplessness, contributing to mental distress. Vision problems can also sometimes result in withdrawal from social interactions. The fear of not being able to see things clearly or the embarrassment of wearing glasses can isolate people from their social circles, contributing to feelings of loneliness and depression.

How to manage stress for a healthy vision

Understanding that stress and eye health can be connected is the first step towards managing the impact. One can deal with stressful situations by engaging in techniques such as deep breathing, meditation or yoga. Besides, going for regular eye check-ups is a great way to catch any eye problem at an early stage and start treatment as required. Choosing a healthy lifestyle is important for one’s overall health.

To begin with, this could mean maintaining a balanced diet, staying hydrated, and keeping a check on quality sleep. Moreover, limiting one’s screen time and taking regular breaks if one’s work requires prolonged screen usage is a healthy practice to inculcate. It is important to seek professional help if a person is experiencing persistent stress, anxiety, or depression. A holistic approach to health involves addressing both mental and physical aspects.

https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/eye-problems-you-never-knew-are-due-to-your-rising-stress-levels/photostory/104889754.cms?picid=104889778

Extreme heat in the US may increase heart-related deaths; These people are at most risk

Rising heat-related deaths in the US

Extreme heat can take a heavy toll on your heart. Heart disease is the leading cause of death in the US overall. With rising levels of heat in the US, more heart-related deaths are predicted, according to a new report.

What does the data say?

According to the study published in the journal Circulation, the heat index (includes both temperature and humidity) between 2008 and 2019 in the US was associated with nearly 1,700 excess cardiovascular deaths each year. The heat index reached at least 90 degrees on an average of 54 days each summer in the US.

If fossil-fuel development continues to expand globally and the world only makes minimal efforts to reduce planet-warming pollution, there could be 80 days of extreme heat each summer. This will increase the number of heat-related cardiovascular deaths by about three times – 5,500 excess deaths per year, the researchers found. The analysis captured projections for the years 2036 through 2065, based on county-level data for the 48 states in the contiguous US.

Impact of heat on heart

The human body can operate only within a narrow temperature range. The heart is susceptible to the effects of heat. When the temperature in your environment goes up, "the heart beats faster and harder to get blood away from the core of the body, to transport heat away from the vital organs,” Dr. Sameed Khatana, an assistant professor of cardiovascular medicine at Penn Medicine and senior author of the new study said, quoted CNN. “For people with pre-existing cardiovascular diseases, their heart might not be able to keep up with the increased demands on the cardiovascular system that temperature is causing."

Heart risks associated with heat

Longer exposures to heat can also lead to more complex changes such as increased inflammation and blood clotting that can raise the risk for heart attack and stroke, he said.

Who is more at risk?

Black adults in the US are particularly vulnerable to the heart-related harms of extreme heat, the researchers found. Black people are also more likely to live with other heart-risk conditions, such as hypertension and diabetes. Further, seniors age 65 and older and adults living in metropolitan areas (perhaps living in areas with less tree cover or without access to air conditioning) are also projected to be disproportionately affected.

https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/extreme-heat-in-the-us-may-increase-heart-related-deaths-these-people-are-at-most-risk/photostory/104889481.cms

FDA approves Omvoh, a first-of-its-kind treatment for ulcerative colitis

Approximately 5 million people globally have ulcerative colitis.

Although there is currently no cure for ulcerative colitis, medications can help treat the condition’s symptoms.

The FDA recently approved a new medication by Eli Lilly, mirikizumab, sold under the brand Omvoh, for treating moderately to severely active ulcerative colitis in adults.

About 5 million people around the world have ulcerative colitis — a chronic inflammatory bowel disease.

There is currently no cure for ulcerative colitis. The symptoms of the condition are normally treated through medications and possible surgery, as well as dietary changes.

On October 26th, the Food and Drug Administration (FDA) approved a new medication for treating moderately to severely active ulcerative colitis in adults.

Called Omvoh™ (mirikizumab-mrkz), the drug made by Eli Lilly and Company is the first and only interleukin-23p19 (IL-23p19) antagonist for the treatment of this condition.

FDA approves Omvoh for treating ulcerative colitis

Mirikizumab — which was recently approved under the brand name Omvoh — is an interleukin-23p19 antagonist. The first three doses of the drug are administered by intravenous infusion, followed by subcutaneous injections administered once every four weeks.

Over-activation of the IL-23 pathway plays an important role in inflammation in ulcerative colitis. This medication works by targeting only the p19 subunit of IL-23 and stops the IL-23 pathway.

“Mirikizumab is the first antibody targeting p19/interleukin-23 to be approved for the treatment of ulcerative colitis,” said Dr. Bruce Sands, chief of the Dr. Henry D. Janowitz Division of Gastroenterology at the Mount Sinai Health System, and senior author of the clinical trial, and a paid consultant for Lilly USA, LLC. “Its performance in both induction and maintenance phases of the clinical trials is truly impressive.”

The FDA’s approval of Omvoh was based on results from two phase 3 clinical trials published in June 2023.

After 12 weeks of receiving Omvoh, researchers found that 65% of study participants achieved clinical response and 24% achieved clinical remission compared to placebo. And among those who achieved clinical remission at 12 weeks, about 66% of those participants maintained it through one year of continuous treatment compared to placebo.

Researchers reported the most common side effects of Omvoh were upper respiratory infections, injection site reactions, arthralgia, rash, headache, and herpes viral infection. The drug’s labeling contains warnings related to the risks of allergic reactions and infections, as well as precautions for those with tuberculosis or hepatotoxicity. In addition, individuals treated with Omvoh should avoid live vaccines.

Mirikizumab reduced ulcerative colitis symptoms

Additionally, study participants also experienced a decline in bowel urgency and rectal bleeding as early as three weeks into treatment.

“The Lucent program was the first clinical trial program that addressed bowel urgency in a meaningful way,” explains Dr. Marla C. Dubinsky, co-director of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center and professor of pediatrics and medicine at Icahn Mount Sinai, and co-author of published phase 3 clinical trials. “It is one of the most burdensome patient-reported symptoms, and a drug that achieves bowel urgency remission is an outcome of great importance to our patients with ulcerative colitis.”

“I see many people with ulcerative colitis who previously tried other biologic treatments, and they are still searching for an effective option that can offer rapid and lasting improvements. [This] approval represents a novel scientific advancement, providing a treatment that may offer relief from three key symptoms — stool frequency, rectal bleeding, and bowel urgency — regardless of past biologic use.”

– Dr. Bruce Sands, senior author of the clinical trial

What is ulcerative colitis?

Ulcerative colitis is a type of inflammatory bowel disease (IBD). It causes inflammation and ulcers, or sores, in the large intestine.

Symptoms range from mild to severe with periods of worsening symptoms — called flares — and diminished symptoms — called remission — occurring over time.

Common symptoms of ulcerative colitis include:

·        diarrhea

·        bloody stools with mucus

·        abdominal pain or cramping

·        nausea

·        inability to pass stools despite frequent urges

·        rectal bleeding

·        fatigue

·        unintentional weight loss

·        loss of appetite

·        dehydration

While scientists still do not know the main cause of ulcerative colitis, they do know that certain factors include exposure to environmental factors like air pollution, imbalance in the gut microbiome, and immune system issues.

Genetics also play a role in ulcerative colitis, as well as age — it is most commonly found in people between the ages of 15 and 30 — and ethnicity as Caucasians and those of Ashkenazi Jewish descent are at a higher risk for developing the disease.

How is ulcerative colitis currently treated?

As there is currently no cure for ulcerative colitis, doctors prescribe treatments to help manage the symptoms of a flare and maintain remission once the symptoms have decreased.

Common medications used to treat ulcerative colitis include:

·      aminosalicylates to help decrease inflammation in the lining of the large intestine

·      corticosteroid anti-inflammatory medications to treat flares and more severe cases of the disease

·      biologics that target proteins made by the immune system and help with inflammation in the gut

·i- immunomodulators to help suppress the body’s immune system to help treat inflammation

·  targeted synthetic small molecules that target specific areas of the immune system to reduce inflammation

·      In certain cases, doctors may also suggest surgery such as a colectomy, proctocolectomy, or ileostomy.

New medications for ulcerative colitis

Over the last few years, there has been a flurry of new medications for ulcerative colitis.

Earlier this month, the U.S. FDA approved an oral selective sphingosine-1-phosphate (S1P) receptor modulator called Velsipity™ (etrasimod) for treating adults with moderately to severely active ulcerative colitis.

In August 2023, pharmaceutical company AbbVie applied for a new ulcerative colitis indication for its Skyrizi® (risankizumab) interleukin-23 (IL-23) inhibitor, which is currently approved for use in the U.S. and Europe for the treatment of plaque psoriasis, psoriatic arthritis, and Crohn’s disease.

AbbVie did receive U.S. FDA approval in March 2022 for its Rinvoq® (upadacitinib) for the treatment of adults with moderately to severely active ulcerative colitis who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers.

And there are more potential ulcerative colitis therapies on the horizon, including cobitolimod for the treatment of moderate-to-severe left-sided ulcerative

colitis, which is currently in phase 3 clinical trials, and a micro-RNA-124 (miR-124) upregulator called obefazimod that is also in phase 3 clinical trials.

More treatment options needed

Dr. Glenn S. Parker, president of the medical staff and vice chairman and chief of colon and rectal surgery at Jersey Shore University Medical Center, told Medical News Today that Omvoh in the two clinical trials was shown to be safe with adverse events to be consistent with other biologic agents used in the treatment of ulcerative colitis.

“The Lucent program is the first clinical trial to address bowel urgency as a debilitating symptom which was tremendously improved,” he continued. “Continuing to follow the data will hopefully result in rapid relief of symptoms, long-term remission, and improve the quality of life for our patients.”

MNT also spoke with Dr. Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA, who said there has been a plethora of new drugs coming out over the last five years, and it’s always exciting to have more options.

He said as doctors are currently using traditional TNF-type medications, they are finding they may not work for all people with ulcerative colitis.

https://www.medicalnewstoday.com/articles/fda-approves-new-ulcerative-colitis-treatment-omvoh-eli-lilly

Is your blood sugar controlled? Not if your LDL cholesterol is higher than 70 mg/dl

Diabetes and cholesterol abnormalities commonly occur together, and much like diabetes and hypertension, confer a greater risk than either factor alone, says Dr Ambrish Mithal, Chairman of Endocrinology and Diabetes at Max Healthcare

Research has shown that people with diabetes are two to four times more likely to develop heart disease than those without diabetes. Yet, controlling sugar alone may not protect your heart. Your sugars may be well controlled and you may still be prone to heart attack or brain stroke if you don’t exercise, are overweight, smoke, have uncontrolled hypertension or very importantly, have high cholesterol levels. Unfortunately, diabetes and cholesterol abnormalities commonly occur together, and much like diabetes and hypertension, confer a greater risk than either factor alone.

It is, therefore, mandatory to check the lipid profile in people with diabetes at least once a year, and initiate appropriate therapeutic measures accordingly. Ignoring cholesterol means that your diabetes treatment is incomplete.

A lipid profile commonly measures the following:

1) Low-density lipoprotein (LDL) cholesterol or “bad” cholesterol, a high level of which is consistently associated with a higher risk for heart disease. An ideal LDL level is below 100 mg/dl.

2) High-density lipoprotein (HDL) cholesterol or “good” cholesterol is associated with a lower risk for heart disease in high levels but puts you at a higher risk of heart disease at low levels. HDL is often found to be low in Indians. Medications are not very effective in raising HDL and it is unclear if raising HDL by medication reduces the risk of heart disease.

3) Triglycerides are the most common type of fat in the body. The exact role of triglycerides in the development of heart or vascular disease remains uncertain. Very high levels of triglycerides ( > 500 mg/dl) are associated with a greater risk of pancreatitis.

How does diabetes affect cholesterol?

The most common abnormality seen in diabetes is low HDL levels and high triglycerides (diabetic dyslipidaemia), although the LDL also tends to be higher. Insulin resistance, typical of Type 2 diabetes, may be linked to the development of diabetic dyslipidaemia.

How do we manage cholesterol abnormalities in people with diabetes?

Lifestyle measures are important in reducing cardiac risk even though the impact on the chief culprit, LDL cholesterol, may be modest (10-15 per cent). Weight loss by restriction of calorie intake is associated with improvements in lipids and other cardiac risk factors. While everyone should follow lifestyle measures, most people with diabetes also require medication to bring their LDL cholesterol in target range

The most popular cholesterol-lowering drugs, statins, inhibit an enzyme that is responsible for cholesterol synthesis, and have several other cardio-protective actions. A meta-analysis of 18,686 people with diabetes demonstrated a nine per cent reduction in all-cause mortality for every 1 mmol/L (38 mg/dl) reduction in LDL-C. In individuals at high risk of heart disease, statins reduce the risk of heart attacks by about 40 per cent. The only group of people with diabetes, where one may sometimes avoid or delay statins, are those below 40 years of age, with no other risk factors and a normal LDL. In our practice, close to 90 per cent of people with diabetes are on statins.

However, at times statins may give rise to muscle pains or cramps. There is also a very slight risk of developing diabetes. However, the benefits of statins far outweigh the risks. A meta-analysis showed that four years of statin treatment in 255 patients would lead to one extra case of Type 2 diabetes while preventing 5.4 vascular events. Please take a statin if your doctor prescribes it and do not discontinue it on your own!

Other drugs that are used either as adjunct to statin or in those who are statin intolerant are Ezetemibe and the new (PCSK9) inhibitors. PCSK9 inhibitors have been shown to reduce LDL by as much as 60 per cent and also reduce cardiac events substantially. Although not studied specifically in diabetes, recent analyses suggest that PCSK9 inhibitors work as well in people with diabetes than those without. Treatment for high triglycerides includes fibrates, Omega 3 fatty acids and Saroglitazar, although the impact on cardiac outcomes is not proven.

https://indianexpress.com/article/health-wellness/blood-sugar-control-ldl-cholesterol-9008608/

Whole genome sequencing personalising TB therapy, ensuring complete treatment: Expert

A new technique that uses whole genome sequencing can help personalise drug therapy in tuberculosis (TB) patients and ensure complete treatment for the disease, according to a biotechnologist. Anirvan Chatterjee, founder & CEO of HaystackAnalytics, a start-up incubated at the Indian Institute of Technology (IIT) Bombay, noted that the method provides a means for conclusively ascertaining drug resistance in a TB patient. Complete treatment of TB patients is significant as being a transmissible disease; TB presents the risk of spreading and evolving into a superior drug-resistant version of itself. Caused by the bacteria Mycobacterium tuberculosis (MTB), TB is an infectious disease that spreads through the medium of air when people with lung TB cough, sneeze, or spit. The symptoms include prolonged cough, chest pain, weakness or fatigue and fever.

"Currently every TB patient undergoes a Nucleic Acid Amplification Test (NAAT) as the primary screening for confirmation of TB and detection of resistance to 1 or few drugs. If found resistant, the patient is advised more tests to get the complete drug-resistance profile," Chatterjee told PTI in an interview. NAAT is a molecular test that detects the DNA of the TB-causing bacteria in a patient's sputum or other respiratory sample. Leveraging whole genome sequencing (WGS), a method for analysing entire genomes, on a TB positive patient's sample can eliminate this need for multiple tests and provide a comprehensive drug resistance profile against all the drugs currently prescribed by the World Health Organization (WHO), according to Chatterjee. "In case a WGS report is available for a TB patient, the therapy can be fully personalised while adhering to the drug combinations determined by the WHO," he said.

The WGS testing process involves sequencing the entire DNA of the TB-causing bacteria in the patient's sample. Then, by analysing data from about 4.5 million data points on the genome using bioinformatics and machine learning technologies, the resistance of the bacteria to any of the 18 antibiotics is ascertained in under two weeks once the sample has reached the lab. "For the report, we analyse the (bacterial) strain type, depth of sequencing, coverage of the genome, drug resistance mutations which have been validated to be associated with in-vitro resistance, phylogenetic association with global strains," said Chatterjee, who was a postdoctoral researcher at the University of Oxford, UK, when he developed this technology.

He, along with colleagues from many international institutes, has published multiple research papers where TB-positive samples from patients in Mumbai, Oxford, and Birmingham, UK, were analysed for drug resistance to first- and second-line anti-TB drugs. "First-line tuberculosis (TB) treatment includes four drugs (rifampin, isoniazid, ethambutol, and pyrazinamide), but with the spread of multidrug-resistant strains, there is a growing need for data on second-line drugs, including the fluoroquinolones and aminoglycosides," the researchers wrote in their study published in the Journal of Clinical Microbiology. The incomplete drug resistance profile adjudged in a microbial culture test together with long waiting times for results not only enhances the risk of the spread of TB, but also the risk of it becoming more drug-resistant, according to Chatterjee. According to the National Anti-TB Drug Resistance Survey (NDRS) 2014-16, Multi-Drug Resistant TB (MDR-TB) was 6.19 per cent of all TB patients, or about 9.1/lakh population. "For every untreated or incorrectly treated TB case, there are 2.3 new potential TB patients. Mathematically, this amounts to the possibility of replacing a treatable disease with a very difficult-to-treat disease," said Chatterjee.

According to the WHO, multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat, with only about 1 in 3 people with drug-resistant TB accessing treatment in 2021.The National TB Elimination Programme (NTEP) in India lays down guidelines for clinicians around managing and treating drug-resistant TB patients in its document "Guidelines for Programmatic Management of Drug-Resistant Tuberculosis in India”. The NTEP advises, "Genetic sequencing can be used when reliable Drug Susceptibility Test (DST) is not available”. However, it also says that "concerns regarding costs, integration into existing laboratory workflows, and technical training have hindered (the technology's) uptake”. Chatterjee said his start-up HaystackAnalytics has received a BIRAC grant from the Department of Biotechnology (DBT) to make this technology available and accessible in India.

"We validated our technology and with that, we have been able to bring down the cost of the test significantly. Currently, the test is available in India at Rs. 6, 450,” said Chatterjee, whose validation work is published in the Global Journal for Antimicrobial Resistance. "Not only is the technology more superior, the turnaround time quicker, but also the (drug-resistance) information is much richer," said Chatterjee. Having been operational for more than a year and a half, he said, HaystackAnalytics has partnered with pathological laboratories across the country to enable them to make this test available to doctors and, through them, to their patients.

"A typical pathological lab associated with HaystackAnalytics for providing WGS-based testing of TB samples would perform pre-sequencing processes such as sample collection, sample decontamination, microbial enrichment, and DNA extraction. Since TB drug resistance testing is performed in central processing laboratories, these labs are fully equipped to perform these steps," explained Chatterjee. Chatterjee's eventual goal is for the WGS test to be included in the NTEP as, according to him, that is when "this entire conversation around TB elimination by 2025 (in India) will start looking real."

https://www.tribuneindia.com/news/health/whole-genome-sequencing-personalising-tb-therapy-ensuring-complete-treatment-expert-558519