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NEUROPROSTHETICS | BIG HOPE FOR PEOPLE WITH IMPAIRED BRAINS

Every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury (SCI). People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries.

At our Neurosurgery department at Bhagwan Mahavir Medica Superspecialty Hospital in Ranchi, I was discussing with my colleagues, Dr. Amar and Ms. Shayanti on how to apply neuroprosthetics in treatment of impaired brains. We discussed many futuristic options, which would revolutionize the management of impaired brains and SCI cases.

The impaired brain is often difficult to restore, owing to our limited knowledge of the complex nervous system. Accumulating knowledge in systems neuroscience, combined with the development of innovative technologies, may enable brain restoration in patients with nervous system disorders that are currently untreatable.

Where once prosthetics were crude and simplistic, now they’re carefully engineered works of art. In fact, with breakthroughs such as neuroprosthetic limbs, there’s even the potential for prosthetics to interface with the human brain.

As the name suggests, neuroprosthetics combines neural processing with prosthetics. Neuroprosthetics, also known as brain-computer interfaces, are devices that help people with motor or sensory disabilities to regain control of their senses and movements by creating a connection between the brain and a computer. In other words, this technology enables people to move, hear, see, and touch using the power of thought alone.

Although some neuroprosthetics, such as cochlear implants and visual prosthetics, have been around since the 1950s, they are just beginning to emerge as viable interventions in the field of brain injury. Neuroprosthetics encompass a variety of artificial devices or systems that can be used to enhance the motor, sensory, cognitive, visual, auditory, and communicative deficits that arise from acquired brain injuries. These include assistive technology, functional electrical stimulation, myoelectric prostheses, robotics, virtual reality gaming, and brain stimulation.

Implanted neuroprosthetics and neuroelectrode systems have been under investigation for a number of decades and have been proven to be safe and efficacious as treatments for several neurological disorders as well as for biosensor systems. Neuroelectrode technologies are typically fabricated from metallic conductors, such as platinum, gold, iridium, and their oxides, materials that while chemically inert and excellent electrical conductors are often not intrinsically cytocompatible and do not promote integration with neural tissues.

A brain-computer interface (BCI) relies either on a chip implanted in the user’s brain or electrodes placed upon the scalp. That way signals from the brain may be read by the prosthetic device itself. The BCI is an input/output device that bridges the brain and prosthetic devices. The same signals that would control an organic limb fire, and thus perform the desired function. The signals may be sent via electrodes on the scalp, the brain’s surface, peripheral nerves, and embedded within the brain. Depending on the type of electrodes used, it’s a pretty simple procedure or rather invasive implantation.

But it’s not as simple as hooking up a BCI and connecting everything. Rather, brain imaging is first necessary. Mapping the brain provides intent into what a brain signal means, and how the body is supposed to respond accordingly. Artificial intelligence can expedite this process. Still, there’s definitely a learning period wherein calibration is required.

Moe Long has aptly said prosthetics, both neuroprosthetics and otherwise, have evolved greatly. Even a prosthesis that allows for running is a massive improvement from where the field began. Yet now brain-computer interfaces have been successfully implemented. A paraplegic man, for example, pulled off the first World Cup kick with a neuroprosthesis. Similarly, a Roman woman began using a BCI-powered hand that even senses touch. Once the subject of science fiction, neuroprosthetics have seeped into the mainstream with field-tested hardware. Expect the accuracy and ease of implementation to only improve.

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Long COVID | Lasting Illness After Recovery

Long COVID a.k.a. post-COVID-19 syndrome, post-acute sequelae of COVID-19 (PASC), chronic COVID syndrome (CCS) and long-haul COVID is a condition characterized by long-term sequelae — appearing or persisting after the typical convalescence period — of coronavirus disease 2019 (COVID-19).

Earlier in the pandemic, it appeared that the majority of people infected with the coronavirus experienced mild-to-moderate symptoms and generally recovered within two to three weeks, depending on the severity of their illness. However, as time has passed, it’s become clear that some people, regardless of the severity of their disease, continue to experience symptoms beyond the acute phase of infection. This has become known as “long COVID”.

Long COVID is a patient-created term that was reportedly first used in May 2020 as a hashtag on Twitter by Elisa Perego, an archaeologist at University College London.

Long COVID has no single, strict definition. It is normal and expected that people who experience severe symptoms or complications such as post-intensive care syndrome or secondary infections will naturally take longer to recover than people who had mild illness and no such complications.

One rule of thumb is that long COVID represents symptoms that have been present for longer than two months, though there is no reason to believe that this choice of cutoff is specific to infection with the SARS-CoV-2 virus.

Most people who catch COVID-19 won’t become severely ill and get better relatively quickly. But significant numbers have had long-term problems after recovering from the original infection — even if they weren’t very ill in the first place.

Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions.

These conditions can have different types and combinations of health problems for different lengths of time.

According to Centers for Disease Control and Prevention (CDC), some people are experiencing a range of new or ongoing symptoms that can last weeks or months after first being infected with the virus that causes COVID-19.

Unlike some of the other types of post-COVID conditions that only tend to occur in people who have had a severe illness, these symptoms can happen to anyone who has had COVID-19, even if the illness was mild, or if they had no initial symptoms.

People commonly report experiencing different combinations of the following symptoms:

  • Difficulty breathing or shortness of breath
  • Tiredness or fatigue
  • Symptoms that get worse after physical or mental activities
  • Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
  • Cough
  • Chest or stomach pain
  • Headache
  • Fast-beating or pounding heart (also known as heart palpitations)
  • Joint or muscle pain
  • Pins-and-needles feeling
  • Diarrhoea
  • Sleep problems
  • Fever
  • Dizziness on standing (lightheadedness)
  • Rash
  • Mood changes
  • Change in smell or taste
  • Changes in period cycles

The respiratory tract is the site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry and infection; however, COVID-19 is a complex systemic disease, affecting the cardiovascular, renal, hematologic, gastrointestinal and central nervous systems. As evidence emerges of predominantly lasting impairment of lung function related to fibrosis, more data on the long-term effects of COVID-19 on other organs are required.

Researchers don’t know why symptoms linger but believe some symptoms reflect lung scarring or damage to other organs from severe initial infections. Another theory suggests that the virus may linger in the body and trigger an immune response that leads to the symptoms.

Multi-organ effects can affect most, if not all, body systems, including heart, lung, kidney, skin, and brain functions. Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) or tissue damage in the affected parts of the body.

There is currently no test – instead, it is currently a “diagnosis of exclusion” with doctors first ruling out other possible causes. After a year and a half, the risk of long COVID is one of the pandemic’s biggest and least-addressed unknowns.

Some estimates indicate about 30% of unvaccinated COVID-19 patients develop long-term symptoms, including shortness of breath, fatigue, difficulty concentrating, insomnia and brain fog. Similar symptoms can develop after other viral infections, too.

The best way to prevent COVID is by getting vaccinated against COVID-19 as soon as you can. Avoid physical contact and don’t forget to use masks in public places.

Roughly half of the people with long COVID reported an improvement in their symptoms after being jabbed – possibly by resetting their immune response or helping the body attack any remaining fragments of the virus, say experts.

Vaccination can also help prevent people from contracting the virus and developing long COVID in the first place. Using masks in public places are to be continued as a practice even after vaccination. We need to continue to follow the COVID appropriate behaviour.

Past pandemics have led to changes in the way we live that we’ve come to accept as normal. Screens on our doors and windows helped keep out mosquitos that carried yellow fever and malaria. Sewer systems and access to clean water helped eliminate typhoid and cholera epidemics. Perhaps the lessons learned from COVID-19 might yield similar long-term improvements in our health system.

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Awareness Means Life | Life is Precious

It was in the year 2018 when I just completed my MBBS internship and had the honour to be invited to a National Seminar held on Hemorrhagic and Ischemic stroke on the campus of Sikkim Manipal Institute of Medical Sciences (SMIMS) in Gangtok, Sikkim by the chief organizer of the event – Dr. Gorkhi Medhi, MD, DM, Interventional Radiology and Neuroimaging, Assistant Professor Radiology, SMIMS on April 13, 2018.

The seminar started with the lighting of the ceremonial lamps and Saraswati Vandana. Dr. Sharath K.G.G., MD, DM, Consultant Diagnostic and Interventional Neuroradiologist, Apollo Hospitals mentioned about the basics of stroke in his introductory speech.

A stroke is a condition of short supply of blood to a part of brain, which could be due to hemorrhage or blockage.

The speakers started deliberating on how the stroke happens in many people with different reasons and with unpredictable signs and symptoms based on their experiences with their patients. The latest advancement the Specialists made in managing the patients were discussed.

Traditionally, such cases were managed by neurosurgeons by opening the skull — craniotomy. Since the nineties, interventional radiologists have developed an innovative method by puncturing a single hole in a deep vein (most preferably – Femoral) a.k.a. catheterization and completing the entire procedure guided by Computerised Tomography (CT) inside a catheterization laboratory or cath lab. The new procedure is faster, less pain-inflicting, cost-effective and with quicker recovery time.

The seminar ended with discussions on lack of knowledge about the stroke among the population and therefore it’s quite important to create general awareness among the patients and their kith and kin so that the patients could be diagnosed and treated in time with least or no irreversible damage.

Patients who arrive at the emergency room within 3 hours of their first symptoms often have less disability 3 months after a stroke than those who received delayed care.

There is an effective way that non-medical associated people should follow for any High-risk patients (as listed below) — commonly called: F.A.S.T. The FAST was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel, and an emergency room physician.

Face – To check for any drooping of the face
Arms – To check for any weakness in arms
Speech – To check for any slurring of speech
Time – If any/all symptoms are present in the patient then its time to call emergency

High-risk patients: Patients with

  • Old age
  • Hypertension
  • Diabetes
  • Hyperlipidemia, or high cholesterol
  • Long-standing unattended Deep Vein Thrombosis
  • History of Embolism
  • History of Loss of consciousness
  • History of previous occurrences
  • History of atherosclerosis

Regardless of your age or family history, a stroke doesn’t have to be inevitable. Stroke is a medical emergency. Let’s spread the message: Think FAST. Act Fast.