New York, June 13 (IANS) Blood sugar-lowering drug Metformin can prevent pulmonary or lung inflammation, a major factor in Covid-19 severity and mortality, researchers have found in studies of mice infected by the SARS-CoV-2 coronavirus.
Metformin is often used as an early therapy for Type-2 diabetes. It works by lowering glucose production in the liver, reducing blood sugar levels that, in turn, improve the body's response to insulin. But scientists have also noted that metformin possesses anti-inflammatory properties, though the basis for this activity was not known.
A multi-institution team led by researchers at University of California San Diego identified the molecular mechanism for the anti-inflammatory activity of metformin.
The researchers focussed on a mouse model of acute respiratory distress syndrome (ARDS), a life-threatening condition in which fluids leak into the lungs, making breathing difficult and restricting oxygen supply to essential organs.
ARDS is triggered by trauma and by bacterial or viral infections. It is a frequent cause of death in patients hospitalised with Covid-19.
The findings published online in the journal Immunity showed that metformin administered to mice prior to or after exposure to bacterial endotoxin, a surrogate for bacterial pneumonia, resulted in the inhibition of ARDS onset and lessening of its symptoms. Metformin also produced a marked reduction in mortality in endotoxin-challenged mice and inhibited IL-1beta production and inflammasome assembly within alveolar macrophages -- immune cells found in the lungs.
IL-1beta, along with IL-6, are small proteins called cytokines that cause inflammation as an early immune response. Their amounts are often highly elevated in persons infected by SARS-CoV-2, creating "cytokine storms" in which the body starts attacking its own cells and tissues. They are signs of an acute immune response gone awry.
Production of IL-1beta depends on a large protein complex called the inflammasome, whose presence in lung tissue is found to be highly increased in deceased Covid-19 patients, researchers said.
The authors said the findings suggest metformin may have therapeutic potential for treating a variety of neurodegenerative and cardiovascular diseases in which inflammasome activation is a factor.
New York, June 13 (IANS) Blood sugar-lowering drug Metformin can prevent pulmonary or lung inflammation, a major factor in Covid-19 severity and mortality, researchers have found in studies of mice infected by the SARS-CoV-2 coronavirus.Metformin is often used as an early therapy for Type-2 diabetes. It works by lowering glucose production in the liver, reducing blood sugar levels that, in turn, improve the body's response to insulin. But scientists have also noted that metformin possesses anti-inflammatory properties, though the basis for this activity was not known.A multi-institution team led by researchers at University of California San Diego identified the molecular mechanism for the anti-inflammatory activity of metformin.The researchers focussed on a mouse model of acute respiratory distress syndrome (ARDS), a life-threatening condition in which fluids leak into the lungs, making breathing difficult and restricting oxygen supply to essential organs.ARDS is triggered by trauma and by bacterial or viral infections. It is a frequent cause of death in patients hospitalised with Covid-19.The findings published online in the journal Immunity showed that metformin administered to mice prior to or after exposure to bacterial endotoxin, a surrogate for bacterial pneumonia, resulted in the inhibition of ARDS onset and lessening of its symptoms. Metformin also produced a marked reduction in mortality in endotoxin-challenged mice and inhibited IL-1beta production and inflammasome assembly within alveolar macrophages -- immune cells found in the lungs.IL-1beta, along with IL-6, are small proteins called cytokines that cause inflammation as an early immune response. Their amounts are often highly elevated in persons infected by SARS-CoV-2, creating "cytokine storms" in which the body starts attacking its own cells and tissues. They are signs of an acute immune response gone awry.Production of IL-1beta depends on a large protein complex called the inflammasome, whose presence in lung tissue is found to be highly increased in deceased Covid-19 patients, researchers said.The authors said the findings suggest metformin may have therapeutic potential for treating a variety of neurodegenerative and cardiovascular diseases in which inflammasome activation is a factor.--IANSrvt/vd
Canberra, June 9 (IANS) Australia's peak medical body has called on the government to implement a tax on sugary beverages to combat obesity, diabetes and poor health.In an address at the National Press Club Wednesday, President of the Australian Medical Association (AMA) Omar Khorshid advocated for a tax that would reduce the consumption of sugary drinks, Xinhua reported."More than 2.4 billion liters of sugary drinks are consumed every year in Australia. That's enough to fill 960 Olympic-sized swimming pools," he said."Diabetes, obesity and poor vascular health are huge contributors to the burden on our health system.""Sugary drinks, and in particular those which have little or no nutritional value, fuel this problem. It is time for action."A study published by the Australian Institute of Health and Welfare in 2019 found that 9.1 per cent of Australian adults consumed sugar-sweetened drinks daily.According to the Australian Bureau of Statistics, an average Australian consumes 60 grams, or 14 teaspoons, of sugar every day.AMA has proposed that the retail price of sugar-sweetened beverages should increase by 20 per cent on average.According to Khorshid, this is in line with a recommendation by the World Health Organisation, and could, over a 25-year period, result in 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of heart disease and 1,100 fewer cases of stroke."It could save lives, and save millions of dollars in healthcare costs," he said. "It would also generate revenue - we estimate about 814 million Australian dollars (about 630 million US dollars) annually - which we believe could be spent on other preventative health activities."--IANSint/
Chandigarh, June 5 (IANS) In the first evidence-based multi-centre study on mucormycosis (black fungus) in India, doctors at the PGIMER here said on Saturday that uncontrolled diabetes and improper use of steroid were the major factors for its emergence.However, they said the study could not look into the role of the Covid-19 virus in causing immunity disturbance leading to mucormycosis.Already more than 20,000 cases have been reported across India, Arunaloke Chakrabarti, Professor and Head, Department of Medical Microbiology, PGIMER, said.In the MucoCovi network study, 16 healthcare centres participated to provide detailed information about proven mucormycosis cases with and without Covid-19 infection from September 1 to December 31, 2020.The prevalence of Covid associated mucormycosis (CAM) was 0.27 per cent in patients managed in hospital wards and 1.6 per cent in patients managed in ICUs.There was a 2.1-fold rise in mucormycosis cases during 2020 in India compared to 2019 and the research suggests that this increase is attributable to the pandemic.The mortality of the mucormycosis is much higher than Covid-19 infection. An early diagnosis and prompt management may save the patient.The emergence of mucormycosis is not new during the second wave. Even during the first wave last year, doctors of leading institutes of the country noted the rise of the number of mucormycosis cases. They were curious to know the reason of the emergence of mucormycosis.Led by doctors at the Postgraduate Institute of Medical Education and Research (PGIMER), a study was conducted with the name of MucoCovi (Muco from mucormycosis and Covi from Covid) study at 16 centres.The study results were published on Friday in the Emerging Infectious Disease Journal.Chakrabarti said it was seen that on an average CAM diagnosis was made 18 days after Covid-19 infection. The most common sites of infection were found to be nose with eye involvement (in 58 per cent cases) followed by nose with eye and brain involvement (27 per cent) and then lung infection (nine per cent cases).It shows a considerable number of patients reported late to the hospital after the disease progression to the brain. Besides, facial pain, nasal blockage and discharge; toothache and loosening of teeth were seen in a high number of cases for the first time.On comparing the cases of CAM with mucormycosis without Covid-19 (i.e. non-CAM) it was seen that uncontrolled diabetes mellitus was the most common underlying disease in both groups.In patients with CAM, newly detected diabetes mellitus was more frequent compared to non-CAM cases (20.9 per cent versus 10 per cent). This suggests the direct role of Covid-19 in causing or worsening diabetes, which may predispose these patients to mucormycosis.In fact, patients with diabetic ketoacidosis developed CAM early i.e. in less than eight days of Covid-19. On the other hand, those patients who developed CAM later had mostly received steroid treatment.It was seen that inappropriate use of steroids (63.3 per cent) i.e. either in very high doses or use in patients who did not need it was associated with development of late CAM, i.e. more than eight day after Covid-19 diagnosis.The overall death rate due to mucormycosis (both CAM and non-CAM) was 38.3 per cent at six weeks and 45.7 per cent after 12 weeks of illness, said the study.It was seen that patients less than 54 years of age, those with brain or lung involvement and those who had to undergo ICU admission had a higher risk for death.The authors conclude that the Covid-19 pandemic has resulted in a rise in cases of mucormycosis from India. Mucormycosis is a critical problem complicating the later part of the clinical course of Covid-19 in India due to improper glucocorticoid usage.Considering the gaps in the study, the doctors have planned another large-scale multicentre study at 30 centres of the country. They say the study results are likely within the next three months.--IANSvg/sdr
<br>India is known as the world's diabetes capital. Nearly one in six people with diabetes in the world is from India. Available scientific literature reveals that diabetes damages the pancreatic beta cells and leads to insufficient insulin production, resulting in hyperglycemia -- a condition which causes dysfunction of the immune response. Besides, diabetes medication also suppresses immune responses.Covid also decreases immunity and the drugs used for its treatment such as steroids and IL-6 inhibitors (tocilizumab) also leads to further immune suppression.The second wave of Covid has been more lethal in India. The country has also seen more persons with diabetes getting affected by Covid -- almost 76 per cent, Dr V. Ramana Prasad, senior pulmonologist, KIMS hospital Hyderabad, told IANS."Covid-19 itself is more common and severe in diabetic patients, and there is high likelihood that diabetic patients who developed Covid required ICU admission and use of drugs like steroids and tocilizumab. Such drugs also decrease immunity and make an individual more prone to opportunistic infection like mucormycosis," Dr Asmita Mehta, Head, Department of Respiratory Medicine at Amrita Hospital, Kochi.Mucormycosis was present even in the pre-Covid era, but is an opportunistic infection. The fungal infection is caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people with damaged tissue or decreased immunity.India has a very high incidence of mucormycosis cases when compared to other countries even prior to Covid. The incidence of mucormycosis in India is around 14/100,000 population while that in Australia is 0.06/100,000 population. The reason behind this is India's hot humid climate where the spores of mucor survive for a longer time.However, it has become one of the rapidly spreading infections observed in those recovering from Covid-19. India has so far reported approximately cases of 8,848 mucormycosis or black fungus.Gujarat has reported maximum of 2,281 mucormycosis cases followed by Maharashtra (2,000), Andhra Pradesh (910), Madhya Pradesh (720) Rajasthan (700), Karnataka (5,00), Haryana (250), Delhi (197), Punjab (95), Chhattisgarh (87), Bihar (56), Tamil Nadu (40), Kerala (36), Jharkhand (27), Odisha (15), Goa (12) and Chandigarh (8)."Ninety-four per cent of the people who developed black fungus infection after Covid had diabetes and 67 per cent of them had uncontrolled sugars," Mehta told IANS."When the sugars are not controlled, the increased level of sugar in blood provides acidic media which is a favourable environment for the growth of black fungus. Thus, the reason behind increased black fungus cases now can be attributed to uncontrolled diabetes and the use of drugs, which causes further decrease in immunity," Mehta added.The common symptoms of this fungal infection include unilateral facial swelling, loose teeth, headache, burning sensation in nose, nasal stuffiness, blackish discharge from nose, blurring or double vision. Few signs of severe mucormycosis infection are decreased vision, blindness, seizure or blood vomiting and altered sensorium.In post Covid patients, "Oculo-rhino-cerebral" mucormycosis is most commonly found. Rhino-oculo cerebral mucormycosis (ROCM) is a rare, invasive, and rapidly progressive fungal infection affecting nose, paranasal sinuses and often extending to orbit, brain, and palate.People who have had moderate to severe Covid illness must avoid crowded places, visiting construction sites, garbage dumping sites or indulge in gardening and should wear masks properly and keep safe distance while interacting with others.For those who have diabetes, they should try to keep their sugar levels under control. Judicial use of steroids and other immunomodulators in the treatment of Covid-19 has been recommended by all medical bodies, Mehta said.Maintenance of good hygiene and cleanliness is a must. Regular oral hygiene care with mouthwash, povidone-iodine gargles must be done. While administering oxygen, water for humidification must be sterile and there should be no leakage from the humidifier, Prasad advised.But for those infected, early diagnosis is a key point in initiating treatment, as the deadly disease has more than 50 per cent mortality even after best treatment possible. Early surgical debridement followed by antifungals like liposomal amphotericin B (3-5mg/kg) is the mainstay of treatment.(Rachel V. Thomas can be contacted at Rachel.firstname.lastname@example.org)--IANS<br>rvt/vd
Lucknow, May 16 (IANS) Uncontrolled diabetes is emerging as a major factor in acquiring black fungus infection or mucormycosis, which is surfacing in Covid-19 patients after recovery and is leading to further complicationsAn online event, hosted by Sanjay Gandhi Post Graduate Institute of Medical Sciences on Saturday with 52 experts discussing the issue, aimed to prepare the work force to prevent patients from falling prey to the infection while informing them about the relevant treatment protocols.SGPGI director Prof. R.K. Dhiman said: "Mucormycosis is an uncommon, opportunistic invasive fungal infection which occurs in immune-suppressed patients. Uncontrolled diabetes is the most common risk factor for acquiring this infection. These fungal spores are present in the air, soil and on decomposed debris and gain entry into sinuses and lungs by breathing contaminated air. Covid-19 patients with uncontrolled diabetes, undergoing treatment with steroids, are at heightened risk of the infection."The infection can be successfully managed and treated with a multi-disciplinary approach and the role of microbiologist, ENT specialist, ophthalmologist and diabetologist is crucial to achieve successful results, he said.Meanwhile, nine more cases of black fungus infection were reported at King George's Medical University (KGMU) on Saturday taking the tally to 17 since March.Among the nine cases, three patients have been referred from other hospitals after being diagnosed with the black fungus infection, while five developed the complication at their homes.One patient developed symptoms during treatment at the IDH ward of KGMU.With these nine new cases, the number of mucormycosis patients undergoing treatment at KGMU has gone up to 13.Of these, seven also have Covid, while others had recovered from the novel coronavirus infection and are admitted in the post-Covid ward, including one in intensive care unit, for black fungus treatment.KGMU spokesperson Dr. Sudhir Singh said that barring the patient in ICU, all others are stable.The patient in ICU has undergone a surgery in which ENT experts removed all the dead tissue.--IANSamita/pgh