Rise in neurological issues faced by recovered Covid patients

A private health facility in the national capital on Saturday said it is reporting a rise in neurological issues among post-Covid patients. In the out-patient department (OPD), up to 60 per cent of patients are presenting increasing mental health issues like anxiety, depression and suicidal thoughts, and majority of these are post-Covid cases, the Moolchand Hospital said in a statement.

Doctors at the private facility said the neurological issues among post-Covid patients have seen a “troubling rise” here. The Moolchand Hospital said it has been “recording increasing cases of intracerebral (brain) haemorrhage, and 50 per cent of the neuroscience department is filled with such cases”.

The doctors also said that people who have survived the pandemic and those who were infected with Covid-19 are increasingly coming to the hospital many weeks later with symptoms such as headache, giddiness, fatigue, cognitive difficulties, memory problems, anxiety, depression, stroke, pain and sleep disorders. 

In the OPD, up to 60 per cent of patients are coming with mental health issues like headache, anxiety, depression, suicidal thoughts, feeling of loneliness etc, the statement said. “Majority of these cases are those who have had Covid-19 infection in the past, with a gap of two to three months,” senior neurosurgeon at Moolchand Hospital, Dr Asha Bakshi, said.

“Such issues are severely affecting their personal as well as professional lives. Many complained that they find it extremely tough to focus during work. People are struggling with work-life adjustment issues as well,” she said. Bakshi said the pandemic has led to some long-term neurological issues. She cited the Global Consortium Study of Neurologic Dysfunction in Covid-19 (GCS-NeuroCOVID) and the European Academy of Neurology Neuro-COVID Registry (ENERGY) of over 3,700 patients.

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Covid-induced ‘black fungus’ cases on the rise in some hospitals

Doctors at a private facility in Delhi are seeing a rise in the number of Covid-triggered mucormycisis cases, according to a statement from the hospital.

Mucormycisis is a fungal infection triggered by Covid-19. Black fungus or mucormycosis has been a cause of disease and death of patients in transplants, ICUs and immunodeficient patients since long.

According to Dr Manish Munjal, senior ENT surgeon at the Sir Ganga Ram Hospital, "We are seeing a rise again in this dangerous fungal infection triggered by Covid-19. In the last two days, we have admitted six cases of mucormycisis. Last year, this deadly infection caused high mortality with many patients suffering from the loss of eyesight and the removal of the nose and the jaw bone."

Dr Ajay Swaroop, the chairman of the ENT department at the hospital, said the use of steroids in the treatment of Covid-19 coupled with the fact that many coronavirus patients have diabetes could be one of the reasons for this rise in the number of black fungus cases again.

He said the infection is commonly seen in patients who have recovered from Covid-19 but have comorbidities such as diabetes, kidney or heart failure or cancer.

Munjal concurred with his colleague and said Covid patients with a weak immunity are more prone to this deadly infection.

"Early clinical suspicion on symptoms such as nose obstruction, swelling in the eyes or cheeks and black crusts in the nose should immediately prompt a biopsy and start of anti-fungal therapy as early as possible," he said.

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Scrutinizing the effects of digital technology on mental health

• There is an ongoing debate about whether social media and the use of digital devices are detrimental to mental health.
• Adolescents tend to be heavy users of these devices, and especially of social media.
• Rates of teenage depression began to rise around 2012, when adolescent use of social media became common (Fig. 1).
• Some evidence indicates that frequent users of social media have higher rates of depression and anxiety than do light users.
• But perhaps digital devices could provide a way of gathering data about mental health in a systematic way, and make interventions more timely.

A sudden increase in the rates of depression, anxiety and self-harm was seen in adolescents — particularly girls — in the United States and the United Kingdom around 2012 or 2013 (see go.nature.com/2up38hw). Only one suspect was in the right place at the right time to account for this sudden change: social media. Its use by teenagers increased most quickly between 2009 and 2011, by which point two-thirds of 15–17-year-olds were using it on a daily basis1. Some researchers defend social media, arguing that there is only circumstantial evidence for its role in mental-health problems2,3. And, indeed, several studies2,3 show that there is only a small correlation between time spent on screens and bad mental-health outcomes. However, I present three arguments against this defence.

First, the papers that report small or null effects usually focus on ‘screen time’, but it is not films or video chats with friends that damage mental health. When research papers allow us to zoom in on social media, rather than looking at screen time as a whole, the correlations with depression are larger, and they are larger still when we look specifically at girls (go.nature.com/2u74der). The sex difference is robust, and there are several likely causes for it. Girls use social media much more than do boys (who, in turn, spend more of their time gaming). And, for girls more than boys, social life and status tend to revolve around intimacy and inclusion versus exclusion4, making them more vulnerable to both the ‘fear of missing out’ and the relational aggression that social media facilitates.

Second, although correlational studies can provide only circumstantial evidence, most of the experiments published in recent years have found evidence of causation (go.nature.com/2u74der). In these studies, people are randomly assigned to groups that are asked to continue using social media or to reduce their use substantially. After a few weeks, people who reduce their use generally report an improvement in mood or a reduction in loneliness or symptoms of depression.

Third, many researchers seem to be thinking about social media as if it were sugar: safe in small to moderate quantities, and harmful only if teenagers consume large quantities. But, unlike sugar, social media does not act just on those who consume it. It has radically transformed the nature of peer relationships, family relationships and daily activities5. When most of the 11-year-olds in a class are on Instagram (as was the case in my son’s school), there can be pervasive effects on everyone. 

Children who opt out can find themselves isolated. A simple dose–response model cannot capture the full effects of social media, yet nearly all of the debate among researchers so far has been over the size of the dose–response effect. To cite just one suggestive finding of what lies beyond that model: network effects for depression and anxiety are large, and bad mental health spreads more contagiously between women than between men.

In conclusion, digital media in general undoubtedly has many beneficial uses, including the treatment of mental illness. But if you focus on social media, you’ll find stronger evidence of harm, and less exculpatory evidence, especially for its millions of under-age users.

What should we do while researchers hash out the meaning of these conflicting findings? I would urge a focus on middle schools (roughly 11–13-year-olds in the United States), both for researchers and policymakers. Any US state could quickly conduct an informative experiment beginning this September: randomly assign a portion of school districts to ban smartphone access for students in middle school, while strongly encouraging parents to prevent their children from opening social-media accounts until they begin high school (at around 14). Within 2 years, we would know whether the policy reversed the otherwise steady rise of mental-health problems among middle-school students, and whether it also improved classroom dynamics (as rated by teachers) and test scores. Such system-wide and cross-school interventions would be an excellent way to study the emergent effects of social media on the social lives and mental health of today’s adolescents.
NICK ALLEN: Use digital technology to our advantage

It is appealing to condemn social media out of hand on the basis of the — generally rather poor-quality and inconsistent — evidence suggesting that its use is associated with mental-health problems7. But focusing only on its potential harmful effects is comparable to proposing that the only question to ask about cars is whether people can die driving them. The harmful effects might be real, but they don’t tell the full story. The task of research should be to understand what patterns of digital-device and social-media use can lead to beneficial versus harmful effects7, and to inform evidence-based approaches to policy, education and regulation.

Long-standing problems have hampered our efforts to improve access to, and the quality of, mental-health services and support. Digital technology has the potential to address some of these challenges. For instance, consider the challenges associated with collecting data on human behaviour. 

Assessment in mental-health care and research relies almost exclusively on self-reporting, but the resulting data are subjective and burdensome to collect. As a result, assessments are conducted so infrequently that they do not provide insights into the temporal dynamics of symptoms, which can be crucial for both diagnosis and treatment planning.

By contrast, mobile phones and other Internet-connected devices provide an opportunity to continuously collect objective information on behaviour in the context of people’s real lives, generating a rich data set that can provide insight into the extent and timing of mental-health needs in individuals8,9. By building apps that can track our digital exhaust (the data generated by our everyday digital lives, including our social-media use), we can gain insights into aspects of behaviour that are well-established building blocks of mental health and illness, such as mood, social communication, sleep and physical activity.

These data can, in turn, be used to empower individuals, by giving them actionable insights into patterns of behaviour that might otherwise have remained unseen. For example, subtle shifts in patterns of sleep or social communication can provide early warning signs of deteriorating mental health. Data on these patterns can be used to alert people to the need for self-management before the patterns — and the associated symptoms — become more severe. Individuals can also choose to share these data with health professionals or researchers. For instance, in the Our Data Helps initiative, individuals who have experienced a suicidal crisis, or the relatives of those who have died by suicide, can donate their digital data to research into suicide risk.

Because mobile devices are ever-present in people’s lives, they offer an opportunity to provide interventions that are timely, personalized and scalable. Currently, mental-health services are mainly provided through a century-old model in which they are made available at times chosen by the mental-health practitioner, rather than at the person’s time of greatest need. But Internet-connected devices are facilitating the development of a wave of ‘just-in-time’ interventions10 for mental-health care and support.

A compelling example of these interventions involves short-term risk for suicide9,11 — for which early detection could save many lives. Most of the effective approaches to suicide prevention work by interrupting suicidal actions and supporting alternative methods of coping at the moment of greatest risk. If these moments can be detected in an individual’s digital exhaust, a wide range of intervention options become available, from providing information about coping skills and social support, to the initiation of crisis responses. So far, just-in-time approaches have been applied mainly to behaviours such as eating or substance abuse8. But with the development of an appropriate research base, these approaches have the potential to provide a major advance in our ability to respond to, and prevent, mental-health crises.

These advantages are particularly relevant to teenagers. Because of their extensive use of digital devices, adolescents are especially vulnerable to the devices’ risks and burdens. And, given the increases in mental-health problems in this age group, teens would also benefit most from improvements in mental-health prevention and treatment. If we use the social and data-gathering functions of Internet-connected devices in the right ways, we might achieve breakthroughs in our ability to improve mental health and well-being.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
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Statins could increase your daily fat intake

The Indian Express reported a study which revealed that individuals taking statins (cholesterol-lowering drugs) tend to gradually raise their consumption of fat and calories.
 
It’s a 12-year study on statin use involving 27,886 men and women participating in a 24-hour dietary recall interview for cholesterol levels and body mass index. It was found that statin use increased from 7.5 per cent in 1999 to 16.5 per cent in 2010 in the group of participants. The cholesterol levels reduced in statin users but their daily calorie intake raised by 9 per cent, and fat consumption increased by 14.4 per cent. Non-users did not show any significant changes in either measure. Body mass index raised in statin users by 1.3 compared with an increase of 0.4 in the non-user group. The effect was seen despite control over factors like age, race, education and conditions like of diabetes and high cholesterol. (Read: Is it necessary to take statins for preventing heart diseases?)

How do statins work? How they prevent heart disease?
‘Cholesterol is a type of fat made by our body. It’s essential for good health and is found in every cell in the body. However, if you have too much ‘bad’ cholesterol (low-density lipoprotein or LDL) in your blood, it can cause fatty deposits to build up on the walls of your arteries. This is known as atherosclerosis – a condition that narrows your arteries.

Statins work by reducing the amount of LDL cholesterol your body makes. They do this by blocking an enzyme in your liver needed to produce cholesterol. This slows down the production of cholesterol by your liver. By reducing cholesterol, statins can help to reduce your risk of having a heart attack, stroke or developing peripheral arterial disease.

There is some evidence to suggest that statins may also work in a number of other ways to help reduce your risk of cardiovascular disease.

One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilise the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart to blood vessels and organs throughout the body.

What precautions should a person take while on statins?
‘Too much of a good thing can be bad, but too little of a bad thing can be even worse. So, first of all, patients on statins should have regular blood tests to monitor their lipid levels,’ says Dr Bela Sharma, senior consultant, internal medicine, FMRI.
Other important things to remember:

• Adherence to prescribed medication dosage is extremely essential.  
• Avoiding drug interactions, mainly with drugs (erythromycin, simvastatin, cyclosporine) that block liver enzymes.
• In case you experience any adverse side-effect, consult your doctor immediately. 
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