Absolute Isolation Works Absolutely

As of this writing the total deaths in the US have mounted to 10,335. Never before mankind had seen such a fast moving, swiping infection. We knew Ebola, we knew Marburg viruses, and a few Prion diseases but collectively, we had never faced such a dreaded disease with high mortality. We were caught almost unprepared or at least we ignored with complacency. I have shared my thought on why isolation is important to contain this disease and how countries like Singapore, South Korea and japan are dealing planning isolation and intelligence in dealing with this crisis.

Absolute Isolation Works Absolutely

As noted in my earlier blog, viruses are obligate parasites that need (MUST) a host cell to survive. They go through their phases of replication and eventually, after not getting proper host cells to infect, die a natural death.

Strict Isolation Social Distancing

I have had many folks across the geographies asking me a few questions?

  1. Why is the incidence of Coronovirus so high in the US?
  2. Are certain ethnicities (such as Indians) immune to the Coronavirus?

I will emphasize the control of Coronavirus based on the viruses’ obligate dependence on live cells for survival. We all know that if we practice Isolation absolutely, we should be assured of not having the disease.

Two situations preclude our ability for Isolation –

  1. Our needs for Essentials
  2. Fundamental Sense of Liberty

I owe you all a clear and concise write up on the best practices and pragmatic guidelines on “How to Manage Essentials” giving an end to end perspective, that provides the best way to avoid getting the virus inside your home. Give me until later this late evening to fulfill that commitment.

Let us talk about the “Sense of Liberty”. The US, the EU, and most developed nations have an enshrined fundamental Right of liberty to move.  Isolation or ‘Shelter in Place’ equals to ‘House Arrest’ for them. The later nullifies isolation and thus provides a continuation of the propagation of the virus by allowing it to jump from people to people (aerosol, airborne, contact and fomites).

Aerosols Airborne Fomites

I see a dichotomy based on the above two practical limitations that are increasing the spread of Coronavirus in the US. Select countries like India and Japan are strongly considering the imposition of emergency. Whereas, many have implemented strict isolation even if the idea of isolation has emerged from behind the Iron Curtain of China.

The Bhilwara Model

The Bhilwara Model for containment of COVID-19 refers to imposing a curfew in the district including suspension of essential services, extensive screening, and house-to-house surveys to check for possible cases, and detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected. A similar model was followed in Singapore, South Korea, and Taiwan. Singapore had gone a step ahead and deployed its intelligence sleuths to extract the contact tracing, whereas, the draconian Chinese Govt deployed Bluetooth tracing abandoning the privacy laws (they do not exist in China, except while the couple is conjugating, I believe!).

The success of the Bhilwara model is attributed to controlling an outbreak within the first four days of the initial incidence (remember the Rho factor.

Absolute isolation works absolutely. Yes, it does but can we forego our sense of liberty? Can we minimize our needs and limit our consumption? Please visit my next blog on “Managing the Essentials”.

 

Also read – Support your service folks (maids, handyman, lawnmowers etc.) https://mymilieu.org/2020/04/02/supporting-service-folks-during-crisis/

Why is Coronavirus highly infective? https://wp.me/p7XEWW-1go

Additional Reading:

How do I know if I have a Coronavirus infection? Before reading further, I strongly advise and recommend that this should not be construed as advice. Your best recourse is your doctor or health care professional.

Doctors in China used a triage system for fast screening. This was published in the Lancet. Below flowchart from the Lancet.

COVID Symptoms Flowchart Lancet JPEG

 

 

WHY is COVID-19 HIGHLY INFECTIVE?

The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction).

Keeping my promise of sharing ACTIONABLE  INFORMATION, let me start with why COVID is so infectious.

Airborne Dispersal

MOSTLY, if not ALWAYS INFECTION:  After exposure to COVID-19 (Highly Infective). The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction). Visit this Youtube for learning the virus replication. https://www.youtube.com/watch?v=J4BN4dARpio

What do I do as a common man?

Isolation (lockdown), using masks and following all CDC, WHO, NIH, State, and Local guidelines. Build a staging area outside the home, do not get the virus inside the home. All essentials should be cleaned appropriately before those get ingress into your home. Presume everything from outside is contaminated until cleaned.

2) Lysogenic phase: Breaking the cells after making thousands of copies (lysogenic phase). Please visit https://www.youtube.com/watch?v=sQ0ShukSA5I. 

What do I do as a common man?

Clean after contamination. I follow the below steps – outer clothes removed in the Garage and set for laundry immediately, shower with soap/shampoo, nose blow, and peroxide gargles. The last two steps remove any adhered viruses from inside the nose and throat.

3) Early Symptoms: Step 1 follows in thousands of new normal respiratory cells. Fever, Nasal Congestion, loss of smell (because the olfactory cells are affected). Cells start producing exudate (copious secretions).

What do I do as a common man?

Get tested and isolate from other caregivers from the family and friends. Stay isolated (if mild symptoms and or test positive) until results are available or at the least 15 days after the lasts symptoms. If required, seek immediate help. DO NOT SELF MANAGE (explanation later).

4) Initial Phase of Lung Congestion: The virus travels inside to the Lungs and infects the respiratory lining cells. Visit the below video to learn more https://www.youtube.com/watch?v=4HPlSm94czk. Also, see https://www.youtube.com/watch?v=Xj1nUFFVK1E.

5) Cytokine Storm: Huge secretion of fluids (doctors call this as Cytokine Storm) blocking oxygen exchange. Ventilators are required to support oxygenation. However, I have had first-hand reports that it is painful to watch patients struggling to breathe even on ventilators.

What do I do as a common man?

Seek early help, Please do not self-treat? Why – You may have a sudden catastrophic fluid collection in the lungs. What else do I do? Of course isolation and other guidelines to be used as required)

6) Acute Respiratory Distress Syndrome and Mortality/Morbidity: This is the most dreaded step.

What do I do as a common man? Be careful at the initial steps (1-3) (Shashank Heda, MD).

COVID19 Local Statistics

Rule of Thumb

Folks, my neighbor taught me one simple rule of thumb – What is essential? Can I survive without this? If I can, then it is not essential.

Can we – STRINGENTLY FOLLOW THIS?

  • ISOLATION (LOCKDOWN)
  • PROPER DECONTAMINATION
  • EARLY PROFESSIONAL HELP
  • SPREADING AWARENESS (ask questions if required)
  • SUPPORT SERVICE FOLKS
  • No COMPLACENCY (THAT I HAVE BETTER IMMUNE SYSTEM THAN OTHERS)

 

Stay Safe!

—    —    —    —    —    —

 

Based on the latest research from Nature and Cell BioSciences and analyzing the data (first hand) from Texas, I see it important to be all the stricter with isolation. Let me take a few issues individually.

Why SARS-CoV2 (COVID-19) is so dangerous?

Primarily because of the

1) Ridge on the S protein that allows it for tighter binding to the ACE2 receptor on the human cell
2) Suppression of antiviral immune response and
3) Concurrent activation of the pro-inflammatory response
Simply speaking – SARS-CoV2’s S protein (Spike protein) after binding with the ACE2 receptor on the human cell, changes its conformation to and goes into a tight affinity, primarily because of the ridge present on the S protein. That makes the SARS-CoV2 very infectious. Now, add to that, the florid inflammatory exudate (cytokine storm) and you get a double whammy. SARS-CoV is known to be exceedingly potent in the suppression of antiviral immunity and the activation of proinflammatory response.

Researchers are working to block the affinity of S protein or reduce the affinity. Another direction for research is controlling the cytokine storm. Our Milind is working on the Stellate Ganglion Block. You should bring him back here to ask more about them later.

Excerpt from Nature below (citations removed, reference link included) – A key to tackling this epidemic is to understand the virus’s receptor recognition mechanism, which regulates its infectivity, pathogenesis and host range. SARS-CoV-2 and SARS-CoV recognize the same receptor – human ACE2 (hACE2). SARS-CoV-2 receptor-binding domain (RBD) (engineered to facilitate crystallization) in complex with hACE2. Compared with the SARS-CoV RBD, a hACE2-binding ridge in SARS-CoV-2 RBD takes a more compact conformation; moreover, several residue changes in SARS-CoV-2 RBD stabilize two virus-binding hotspots at the RBD/hACE2 interface. These structural features of SARS-CoV-2 RBD enhance its hACE2-binding affinity. Additionally, we show that RaTG13, a bat coronavirus closely related to SARS-CoV-2, also uses hACE2 as its receptor. The differences among SARS-CoV-2, SARS-CoV, and RaTG13 in hACE2 recognition shed light on the potential animal-to-human transmission of SARS-CoV-2. This study provides guidance for intervention strategies targeting receptor recognition by SARS-CoV-2.

(Simplified – @ Shashank )

https://www.nature.com/articles/s41586-020-2179-y

—    —    —    —

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074995/

The origins of SARS-CoV-2 and COVID-19. To make a long story short, two parental viruses of SARS-CoV-2 have now been identified. The first one is bat coronavirus RaTG13 found in Rhinolophus affinis from Yunnan Province and it shares 96.2% overall genome sequence identity with SARS-CoV-2 [3]. However, RaTG13 might not be the immediate ancestor of SARS-CoV-2 because it is not predicted to use the same ACE2 receptor used by SARS-CoV-2 due to sequence divergence in the receptor-binding domain sharing 89% identity in amino acid sequence with that of SARS-CoV-2. The second one is a group of betacoronaviruses found in the endangered species of small mammals known as pangolins [4], which are often consumed as a source of meat in southern China. They share about 90% overall nucleotide sequence identity with SARS-CoV-2 but carries a receptor-binding domain predicted to interact with ACE2 and sharing 97.4% identity in amino acid sequence with that of SARS-CoV-2. They are closely related to both SARS-CoV-2 and RaTG13, but apparently they are unlikely the immediate ancestor of SARS-CoV-2 in view of the sequence divergence over the whole genome. Many hypotheses involving recombination, convergence and adaptation have been put forward to suggest a probable evolutionary pathway for SARS-CoV-2, but none is supported by direct evidence. The jury is still out as to what animals might serve as reservoir and intermediate hosts of SARS-CoV-2. Although Huanan seafood wholesale market was suggested as the original source of SARS-CoV-2 and COVID-19, there is evidence for the involvement of other wild animal markets in Wuhan. In addition, the possibility for a human superspreader in the Huanan market has not been excluded. Further investigations are required to shed light on the origins of SARS-CoV-2 and COVID-19

 

 

Cuisines and Health

Like most of you, and as a gastronome, I often like to try different cuisines. Despite being reared on an Indian palate, I often find other cuisines scintillating. I especially gravitate towards Mediterranean, Ethiopian, TexMax, Majicano (not Spanish as is commonly called), Vietnamese, Nepali and Indian cuisine. Especially, I still have to develop taste for Sushi, though I haven’t taken a taste for Italian for its overwhelming Cheese and High Carb content. Maybe I am wrong and possibly, I have to try better restaurants.

Indian Cusine

As mentioned, I often bounce back to Indian cuisine after eating the different varieties. To admit frankly, I succumb to somnambulance from the food served at the Indian restaurants, mainly because of the high-fat content and the chef’s inadequate understanding of the composition of the ingredients. Often I tell my non-Indian friends that –

Home Cooked Food is the best:

Indian cuisine that is cooked at home is way different than what is served in Indian restaurants across the globe irrespective of the chef who cooked it. Mother’s handmade food is best, irrespective of where your mother hails from. There is more love and less of commerce admixed in that food.

The cuisine has various influences:

Cuisine varies from home to home but a regional pattern is pretty much common. Cuisine recipes differ every so many kilometer (Kilometer is the standard used in India, not miles). State and National boundaries have little impact on these varieties. These patterns have loco-regional influences that are intricately related to the weather, availability, and non-availability of ingredients and the culture of the region. In my view, the last aspect reflects our variations and a longing for identity.

Cuisines vary as you travel a few miles:

Indian subcontinental cuisine has differing shades as you traverse from Pakistan, India, Nepal, Bangladesh, and Sri Lanka. Generally, the Indian Continental Food served in restaurants here in the US or Europe is dominated by polar varieties that include either North and South Indian cuisine as the main (or multi) course meal that ideally terminates with either a dessert either from Bengali or North India.

Taste is developed in childhood:

Taste buds are developed until 5-7 years of age. I call it a native taste for cuisine. Though we all long for variety, eventually we all fall back to our native cuisine. Restaurants are thus dominated by the population it serves. As an example, here in Dallas, we have a dominant Telugu population and consequently, you see Telugu, North Indian and Tamil style food (Idlis, Dosas, etc.). Not sure if you folks have had an opportunity to taste Nepal, Ladakhi, Sikkimese of Kangra (Himachal Pradesh) food, but it is deeply rooted in the subcontinental style. We all know, Awadhi, Dakkhani, Punjabi, Marwari, Kachi, Goan, Bengali, Odisha, Assamese flavors. The list is endless and it is best to taste authentic local food when we are in the region.

Culinary has more influences too:

The cooking style is heavily influenced by the affluence, culture, nature of the work, religious and regional practices. This last aspect has not changed and though affluence and availability of ingredients are rising, we haven’t truly modified to our current lifestyle. Thus ghee, sweets, and dominance of high glycemic index foods that are destroyed by microwave heating, adulterants and high heat from Gas (stove) burners as against slow cooking on conventional chullas), has destroyed the true value of food.

Commercialization has an adverse impact:

Commercialization of crops like fertilization, high productivity pressure, faster Go To Market, our own need for picturesque rather than little blemished fruits and vegetables are adding a significantly damaging angle. When a vegetable or fruit grows naturally, it soaks all necessary ingredients from the soil. It grows slowly but gets all the necessary micronutrients while it is taking the time to ripen or mature. Vegetables or fruits grown on fertilizers, boost productivity, shorten the time to ripen/mature and thus, has fewer ingredients as compared to those that are not fed fertilizers. Also, often I observe my own behavior while at the grocery shop or farmers market. I tend to choose absolutely picture-perfect fruits/vegetables. Any blemishes by insects are discarded by me. Only retrospectively, I realized that those blemishes are a mark of quality because the insects tried eating those because of its quality. Have you tried feeding a dog or cat any sweets or milk with sugar? Try feeding some treated grains to birds and you will realize they all despise those feeds. We humans are different though. Our tongue dominates our satiety and we hardly realize that what is tasty and that which tickles our tongue is not good. Thus we end up with indulgence. We call ourselves intelligent creatures but we hardly know how to differentiate good food from not so good.

That which does not decay may not be good for health:

Most Vegetables and Fruits have a short shelf life. I often say, if a food does not decay, that’s not good food. If a pizza is seating at room temperature for more than a few days, without being spoilt or without any fungal growth, that is bad. I don’t mean we should eat food with microorganisms growing on it, I instead mean that pizza is not worth those fungi/algae than is it really good for humans? Natural decay is also influenced by weather conditions and this cannot be an ultimate gauge of quality. Unfortunately, we humans who bask on our intelligence can’t discriminate between good and bad, whereas the entire flora and fauna can.

Do you want to mix Cuisine:

You lose the authenticity, that signature of the food. A great example is Chinese-Indians. We cannot adopt best practices from other cultures, that identity of the food is lost. You may find a hybrid dish arising out of your experiment and that may still be good. However, the authentic flavor is definitely missing.

YouTube recipes are a great way to start learning but we have to mold those recipes to our lifestyle. We have to adopt authentic cuisine to our needs. Kids and pregnant/lactating mothers may need different food as compared to a father with a sedentary lifestyle. I still remember, when my wife was carrying our child, I too 😋 put on weight, it was right for her but for me 🤭. Someone recovering from illness may need different food as compared to normal healthy people. Our busy lifestyle does not offer us the liberty to adopt so much and consequently, food falters.

Spices have Special Value – Use those wisely:

For antiquity, Spices were exported from India across the Silk Route to Europe, Eastern Europe, China, and South East Asia for their medicinal and gustatory value. Kerala is the hotbed for spices though many are grown across India. Spices have been a reason for much of the Gold that accumulated from across the world into India. To avoid making this as a compendium on spices, I will cite two examples to emphasize the importance of spices.

Turmeric (curcumin) as an ingredient, is part of most Indian cuisine. As a fellow in molecular oncology, we learned in early 2000 that Indians have the least incidence and prevalence of colon cancer. One reason that was strongly associated with this finding was the vigorous use of turmeric. It has a Cox 2 inhibitory action that suppresses colon cancer progression.

Another spice that is well known is Capsaicin (Chillies). Capsaicin has a documented effect in modulating (decreasing) pain through its action on Substance P, a neuromodulator involved in the pain pathway. Amelioration of the neuropathic pain using topical capsaicin is an established remedy for Osteoarthritis and other acute pain. In addition, capsaicin is known for its gastroduodenal mucosal defense.

Animal studies suggest that capsaicin may merit clinical evaluation with respect to the progression of atherosclerosis and diabetics, angina, non-alcoholic fatty liver disease, cardiac hypertrophy, metabolic syndrome, hypertension, obesity, and gastric ulceration. In addition to the many studies assessing capsaicin’s impact on metabolic rate and adiposity, the trial of topical capsaicin in patients with angina, and the studies documenting capsaicin’s gastroprotective effects represent initial efforts in this direction. Assessment of the dose-dependency of these effects could provide useful insight into capsaicin clinical dosage to provide systemic metabolic benefits (Reference below).

Nepalese Cuisine

Spices and Disease Prevention (Cancer, Ischemic Heart, and Respiratory Diseases)

Spices and herbs such as clove, rosemary, sage, oregano, and cinnamon are excellent sources of antioxidants with their high content of phenolic compounds. It is evident that frequent consumption of spicy foods was also linked to a lower risk of death from cancer and ischemic heart and respiratory system diseases. This review highlights the potential health benefits of commonly used spices and herbs such as chili pepper, cinnamon, ginger, black pepper, turmeric, fenugreek, rosemary, and garlic.

J AOAC Int. 2019 Mar 1;102(2):395-411. doi: 10.5740/jaoacint.18-0418. Epub 2019 Jan 16. Health Benefits of Culinary Herbs and Spices.

Summarily, there is no problem with Indian cuisine, and by no means, I wish to indicate that Indian cuisine is the best. All cuisine is excellent, be it Icelandic or Afghani food, the problem is with us. Let us fix that and add an adequate dose of exercise and activity.

Ultimately, what and how we eat as well as our activities (physical, emotional and spiritual) will influence us within us and outside world. Below guidelines are best to keep a simple balanced diet that is rooted in our regiono-ethnic practices. I say this because our genome has a memory of the food we have been eating for millennia and it has built a repertoire of identifying good and not so good. The industrial revolution has brought too many changes too fast that our body hasn’t had enough time to adjust and assimilate those changes.

Grain Bowls

My 10 Commandments of Food: Keep a simple diet

  • Eat fresh and eat in moderation. Occasional bingeing is fine.
  • Possibly try to eat less of meat and non-vegetarian food if your protein demands are not high. Initially, try to cover protein demands with a mix of grains and pulses with high protein content.
  • Keep a healthy balance of gut biota (Gut bacteria). Fresh yogurt or curds are best. Those at the grocery stores usually have killed the lactobacilli and consequently, don’t provide the probiotics that we so much need for a healthy GUT.
  • It is needless to say do not eat sweets, but try eating those at the beginning of the meal to reduce your satiety.
  • Keep a balance between the three broader categories of food, namely carbs, proteins, and fats. Imbalance of any has a strong potential for adverse health effects.
  • Remember to keep changing variety as there are multiple micronutrients required by the body and those are spread across various forms of grains, vegetables, and fruits. Do not eat the same food every day, as a habit. Always try to eat seasonal grains, fruits, and vegetables from multiple sources. Understand, the body does not know it needs a particular micronutrient, an e.g. being Cobalt. All it knows is that it is craving for a specific micronutrient. If you observe craving, try swapping varieties rather than increasing the volume.
  • Once in awhile bingeing is not bad, do not be strict disciplinarian with yourself, I am afraid, you will bounce back and drop the practice of dietary restraint.
  • Avoid inordinate use of stimulants such as Tea, Coffee, and even carbonated drinks. The later one has a tendency to dissolve the bone calcium if indulged over a period of time.
  • Do not fool your system by taking aspartame or sweeteners.
  • Intermittent fasting is always good but it cannot be universally applied. A senior leader from the Industry started Intermittent fasting. Eventually, he developed acanthosis nigricans and I suspected glucose intolerance. I made him change to a normal diet and his acanthosis disappeared. Similarly, I saw some senior leaders adopting a ketone diet. Of course, ketosis resulted in the loss of weight, however, the weight bounced back after resuming a normal diet.

Spices and Cancer Prevention –

Chemopreventive properties of spices are mediated by functional bioactive ingredients that arrest the activity of cytochrome P450 and isozymes CYP 1A1, cyclooxygenase-2, reducing activator of transcription-3 (STAT-3) and signal transducer. They are closely associated with tumorigenesis activated by interleukin-6 (IL-6) receptors and epidermal growth factor (EGF) relate to an array of tumors. The bioactive constituents altering the expression of a protein involved in the cell cycle, activating caspases killer and suppressing Kappa-B activation. Alongside this, they also restrain causative agents of cell structure damage as in the lipid and protein membrane system and DNA that shifting a healthy body towards the cancerous state.

Spices phytochemicals have established as carcinogenesis blockers by modulating cell proliferation pathways transformation, inflammation, metastasis, etc. Promising compounds including curcumin and curcuminoids (turmeric), limonene (cardamom), allicin, allyl isothiocyanate (garlic), cinnamic aldehyde, 2-hydroxycinnamaldehyde and eugenol (cinnamon), gingerol, zingiberone, zingiberene (ginger), dipropyle disulfides and quercetin (onion), piperidine piperine, limonene, α- and β-pinene (black pepper), crocetin, crocin, and safranal (saffron) have been identified as chemopreventing agents against various malignancies. (Anti-oncogenic perspectives of spices/herbs: A comprehensive review; EXCLI J. 2013; 12: 1043–1065. Masood Sadiq Butt,*,1 Ambreen Naz,2 Muhammad Tauseef Sultan,3 and Mir Muhammad Nasir Qayyum;  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827078/)

Trying to reduce weight – 

If you are trying to reduce weight, increase your metabolism by recruiting various activities including resistance training, aerobics, proper sleep and reducing the Sugar PLUS Salts. Remember, the receptor for Glucose and Salt are shared receptors. The same pump (Sodium Potassium ATPase pump) facilitates the movement of salt and glucose inside the intravascular compartment. It is this principle that is leveraged in Oral Rehydration Theory while giving fluids to those with severe diarrhea.

I will keep updating this blog as and when I can. Meanwhile, please provide your suggestions.

Note: The above is based on my understanding of the principles of nutrition, medicine and observation/experience across a cross-section of the society with whom I interact. At this moment, I have little knowledge about spiritual food. So I have not made any comments about those.

Citations:

‘Indian food is terrible’ tweet sparks hot debate about racism – https://www.bbc.co.uk/news/world-us-canada-50550735

https://www.consumerreports.org/frozen-meals/grain-bowls-the-new-super-bowls/

A comparative chart that offers a good insight on the Scoville Scale of the different varieties of Chillies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462993/

https://www.sciencedirect.com/topics/neuroscience/capsaicin

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827078/)

Different ethnic Cuisine from China – Hunan, Sichuan, Cantonese, Shandong, XinJiang Cuisine, visit below link. https://www.chinahighlights.com/travelguide/chinese-food/regional-cuisines.htm

 

 

A Message For Elon Musk

I read an interesting article in the Nov 13, 2019 issue of JAMA. I found it interesting for three reasons –

  • First, it enlightened me on the updates on the physiology of cerebral circulation.

 

  • Second, it provided me an insight into the effects of space travel on the vascular pressure and fluid circulation during upright and recumbent positions and the effect of an absence of gravity that results in the above outcome. If Elon Musk or Virgin Airlines are thinking of planning to send frequent flyers across into space, they may either have to create gravity chambers inside the craft or ask the frequent flyers to collect frequent flyer miles and stagnation report. Possibly, Elon Musk should also consider something similar to dosimeters or Gamma counters.

 

  • Last, and most commonly, I see several patients with shifting edema that is idiopathic in nature. Does it have any relationship with an internal zero gravity like situation? I know this may sound dumb, but let us think on similar lines if any of the disease phenomena are creating any vascular or perivascular effects resulting in such outcome.

 

Excerpts from the article are included below for your easy perusal. A link to the article is provided at the end of this blog.

 

A gravity-induced head-to-foot (Gz) hydrostatic pressure gradient exists in the fluid-filled systems of the body in the upright position on Earth. In the supine position, the gravity vector no longer pulls in the Gz axis; therefore, blood and tissue-fluid pressures and volumes redistribute across the body. By spending approximately two-thirds of the day upright and the remaining one-third of the day supine at night, humans experience fluid shifts daily. However, crew members on the International Space Station (ISS) are weightless and thus experience a sustained redistribution of fluids toward the head that is not subject to daily diurnal posture-induced change in hydrostatic pressure. Headward fluid shifts during prolonged weightlessness result in facial puffiness, decreased leg volume, increased stroke volume, and decreased plasma volume. This fluid shift may also affect cerebral venous outflow as internal jugular vein (IJV) volume has been showed to be increased from 4.0 to 5.5 months of spaceflight exposure.

 

NASA Men Women

 

Cerebral venous outflow occurs predominantly through the IJVs in the supine position, whereas in the upright position, the IJVs partially or fully collapse due to atmospheric pressure being greater than intraluminal pressure, and cerebral venous outflow is diverted to the vertebral veins and vertebral plexus. However, in most cases, the IJVs do not completely occlude in the upright posture, and fluid communication is present between the cerebral and central venous systems.  Indeed, we observed a waterfall-like blood flow pattern through the left IJV in most participants during upright posture on Earth, despite the semi-collapsed state of the vein.

Cerebral venous drainage plays an important role in regulating intracranial pressure and intracranial fluid dynamics, and changes in cerebral venous pressure result in corresponding changes in intracranial pressure. In the upright position, venous pressure along the Gz body axis changes with respect to the venous hydrostatic indifference point because of hydrostatic effects. Notably, by collapsing, the IJVs act as Starling resistors, a protective mechanism preventing severely negative intracranial pressure in the upright position. The IJV cross-sectional area and flow are modulated by both cardiac and respiratory cycles and can be influenced by posture, anatomical variations, incompetence of the jugular valve, and changes in central venous or intrathoracic pressure. Pressure in the IJV is increased during short periods of weightlessness in parabolic flight, and in this study, we found that the IJV pressure remained elevated during long-duration spaceflight on the ISS relative to the upright posture.

This result concurs with previously measured increases in intracranial pressure and transmural central venous pressure during microgravity exposure relative to the upright position on Earth. It is common to see engorged IJVs during short- and long-duration spaceflight and frame the extent of the engorgement by comparing the IJV area to 3 postures on Earth; however, it is possible that cross-sectional area measures underestimated the extent of engorgement compared to volume measures of the IJV. Cephalad fluid shifts, secondary to the lack of gravitational vectors and the reduction of tissue weight and tissue compressive forces in microgravity, may account for the increase in IJV area and pressure.

Citation:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755307?guestAccessKey=853187ba-4d67-4bf8-8295-0eb2b48f24d8&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_term=mostread&utm_content=olf-widget_11252019

The Human Body in Space https://www.nasa.gov/hrp/bodyinspace

Detecting Fake Pills

It’s no exaggeration to compare illicit medicines with the nuclear and biological weapons of mass destruction we all fear. These WMDs, though, are largely aimed at people in poor countries who are already facing a multitude of social and economic ills. Sadly, these “track and trace” approaches suffer from a fundamental shortcoming: They authenticate the package, not its contents. A package of medicine is assumed to be genuine simply because it has a valid security mark. Unscrupulous manufacturers can readily circumvent such measures by putting the wrong stuff in the right package. And these approaches offer no help in detecting degradation.

I read this interesting article from my IEEE Spectrum subscription and I immediately correlated that with my recent experience of fake or substandard pills. The magnitude of the problem is humongous. Diabetic medicines that are not effective, to cancer cells that are not killed completely and eventually escape to proliferate further and become out of control to seemingly innocuous infections that are treated not with adequate dose (MIC levels). Sometimes, it scares me to think a patient dying because he had inadequate dose of chemo, and who knows, the antibiotic resistant bugs have evolved due to human greed. It is a massive industry fraud and the entire supply chain is involved.

Fake Pills

In my experience, substandard medicines are not just common in developing and underdeveloped nations. Recently, I took my pills for evaluation to Walgreen’s, a major pharmacy retailer, to inform them that the medicine I got from them was not effective, that a similar pill from another brand was effective and that, another patient, who was given a pill with same but one quarter ingredient had matching size. They evaluated and informed that the manufacturer from China was discontinued. However, their tracking was impressive, there was a alpha numeric inscribed on the tablet, which was visible only with a lens. This Alpha numeric correlated with the source and manufacturer.

It’s no exaggeration to compare illicit medicines with the nuclear and biological weapons of mass destruction we all fear. These WMDs, though, are largely aimed at people in poor countries who are already facing a multitude of social and economic ills. Sadly, these “track and trace” approaches suffer from a fundamental shortcoming: They authenticate the package, not its contents. A package of medicine is assumed to be genuine simply because it has a valid security mark. Unscrupulous manufacturers can readily circumvent such measures by putting the wrong stuff in the right package. And these approaches offer no help in detecting degradation.

When you purchase medicine at the drugstore, you assume that it’s what you think it is and that the active ingredient in the drug is present in the specified concentration. Unfortunately, your assumption might be all wrong. Counterfeit and substandard medicines have become widespread, particularly in low- and middle-income countries with weak regulatory systems. Indeed, according to the World Health Organization (WHO), one out of 10 medicines sold in developing countries should be considered “substandard.” Your drug could even be an outright fake.

Using a physical phenomenon called nuclear quadrupole resonance (NQR), you can test your pill and eat it, too. Nuclear quadrupole resonance requires an atomic nucleus with a nonspherical distribution of positive electric charge, which creates an electric quadrupole moment. The word quadrupole refers to the four electric poles that produce an equivalent nonspherical charge distribution when added to a set of spherically distributed charges. The electronic tester measures the NQR response of the sample at different frequencies. The resulting NQR spectrum is generated by energy transitions within the atomic nuclei of the chemical, providing a unique fingerprint for that compound. Nuclear quadrupole resonance is useful for testing specimens that are solids or powders, but not liquids. While that’s an obvious limitation, NQR has a lot of other things going for it. In particular, it’s insensitive to the presence of coatings or packaging materials. So it can be used to examine pills while they’re still in the bottle or blister pack. Indeed, it could be used to test an entire shipping carton of such bottles or packs, or a drum of powdered material. What’s more, the equipment could be built at low cost and would be amenable to miniaturization. And because NQR instrumentation relies on radio waves of relatively low frequency and power, it is inherently safe and could be used without special training. The prototype drug-­authentication device is portable, performs measurements automatically, and doesn’t require any special skills to operate. It could thus be used anywhere in the drug supply chain. It is estimated that such a device could be manufactured at a cost of about $100, which would, presumably, translate to a price for the end user of less than $1,000.

Credits –

The technology was invented at Nanoscape Research Laboratory Florida and Case Western University by Swarup Bhunia, a professor of electrical and computer engineering at the former, and Soumyajit Mandal, an assistant professor of electrical engineering and computer science works at the later, where he oversees the Integrated Circuits and Sensor Physics Lab. This article was published on August 21, 2019 in IEEE Spectrum and was accessed from my account. Excerpts are copied and credited.

https://spectrum.ieee.org/biomedical/devices/detecting-fake-pills-with-nuclear-quadrupole-resonance

Identifying Rapid Spread of Flesh Eating Infections

 

Thought of sharing this news since it may be a common occurrence if exposed to the bugs in hot swimming pool or any contaminated body of water with open wound.

A woman in her 70’s got flesh eating infection after a usual bruise and succumbed to her wounds. In medical parlance, this is called ‘Necrotizing Fasciitis’. Seemingly a small wound, the bacteria enter the body and start irreversible destruction of the soft tissues.

How do we identify and how to prevent?

The infection often spreads very quickly. Early symptoms of necrotizing fasciitis can include:

  • A red or swollen area of skin that spreads quickly
  • Severe pain, including pain beyond the area of the skin that is red or swollen
  • Fever
  • Ulcers, blisters, or black spots on the skin
  • Changes in the color of the skin
  • Pus or oozing from the infected area
  • Dizziness
  • Fatigue (tiredness)
  • Diarrhea or nausea

How to spot necrotizing fasciitis early on? Watch for –

  • Changes in skin color
  • A rapidly spreading inflamed or swollen area of the skin
  • Severe pain, including pain beyond the area of the skin that is red or swollen, and
  • Fever

Who is prone to Flesh Eating Bacterial Disease? Those with weak immune system are more prone to this disease:

  • Diabetes
  • Kidney disease
  • Scarring (cirrhosis) of the liver
  • Cancer

What to do if you suspect Necrotizing Fasciitis?

Clean wound with clean water, possible use soap and contact a medical facility to evaluate and manage. In my experience, Hydrogen Peroxide works great. Anytime, you have a cut bruise or bleed, washing with clean water and thereafter with peroxide, will remove all the dead tissues and bacteria.

https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html

https://www.cnn.com/2019/07/01/health/flesh-eating-florida-woman-trnd/index.html

Why am I blogging on health and diet?

For most healthy living is having a balance between eating and exercise. Well, it goes beyond that one will eventually comprehend the importance of spirituality and expand the dimension of health. Suffice it to say that, the most elementary blocks of health starts with Diet and Exercise and this blog is focused on diet and exercise.

Because it is core and critical to our efforts and initiatives in life.

Generalizing from decades of observations, understanding the molecular mechanism that cascades the physiologic pathways, and adding an angle of a spiritual journey to our living, I too believe that the source is within us. We pamper ourselves with indulgence and defend it with reason. That in itself is a root cause for systemic illnesses such as for overweight/obesity, insomnia, hypertension, and diabetes (well in exceptional cases, we do have hereditary, genetic and developmental factors that contribute).

However, once these systemic maladies set in, it takes a long time to revert to the original baseline. Here again, we try indulging in radical results with resultant generalized impact. Liposuction, extreme diets, such as keto diets, etc. cause untoward effects on the body. Dependence on drugs such as antidiabetic or antihypertensives keeps increasing, partly because of tolerance and mostly because the root cause is not addressed.

Restoring health is a discipline, not a snapshot event in time. It needs a comprehensive multidimensional change. I know if I haven’t slept adequately how that affects my work. Some maladies have an evident outcome, others have a long-lasting impact. Let’s have that balanced perspective to dart towards achievements.

I am often reluctant towards opting for radical options such as surgery (with exception), so also I am against drugs/medicines.

Every life journey is unique, complicated by a confluence of conscious and subconscious flows, that we alone can decipher and discern. Those moments of reflection should ideally help in putting up a roadmap towards the restoration of health. While that is the permanent way, we can and should rely on drugs or other means, while transiting towards that phase.

However, jumping directly to radical options is ill-founded and deficient. A gradual incremental reversal, though difficult, can be achieved through consistent behavior with discipline. Well, it is easy to say but difficult to implement. However, that’s the test of your grit and determination, that we all are born with.