Dr. Hanjabam Barun, Medical-Clinical & Interventional Physiologist

04/12/2025

Diabetes has long been associated with dementia, which is a disease of brain energetics and inflammation. Epidemiological studies show that better cardiovascular health is associated with improved cognitive health, and new research indicates that it offsets dementia risk in people with type 2 diabetes. https://newsroom.heart.org/news/optimal-cardiovascular-health-among-people-with-type-2-diabetes-may-offset-dementia-risk

03/12/2025

🧠 𝙀𝙭𝙚𝙧𝙘𝙞𝙨𝙚 𝙄𝙣𝙩𝙚𝙣𝙨𝙞𝙩𝙮 𝙈𝙖𝙩𝙩𝙚𝙧𝙨: 𝙁𝙞𝙣𝙙𝙞𝙣𝙜 𝙩𝙝𝙚 𝙊𝙥𝙩𝙞𝙢𝙖𝙡 𝘿𝙤𝙨𝙚 𝙛𝙤𝙧 𝘽𝙧𝙖𝙞𝙣 𝙃𝙚𝙖𝙡𝙩𝙝

▪️ Aerobic exercise is a recognized medical intervention effective in preventing and managing chronic conditions, including dementia, by protecting against age-related brain atrophy and cognitive decline.
▪️ The key molecular link mediating this neuroprotective effect is muscle–brain crosstalk, facilitated by factors released from skeletal muscle during contraction, known as myokines.

💬 𝗠𝘆𝗼𝗸𝗶𝗻𝗲𝘀: 𝗠𝗼𝗹𝗲𝗰𝘂𝗹𝗮𝗿 𝗠𝗲𝘀𝘀𝗲𝗻𝗴𝗲𝗿𝘀

▪️ Neuroprotective myokines—including FNDC5/Irisin, Cathepsin B (CTSB), and Vascular Endothelial Growth Factor (VEGF), along with metabolites in the kynurenine pathway—are upregulated during exercise.
▪️ These factors ultimately enhance the expression of Brain-Derived Neurotrophic Factor (BDNF), a pivotal neurotrophin crucial for neurogenesis, synaptic plasticity, learning, and memory, predominantly expressed in the hippocampus.

⚡𝗧𝗵𝗲 𝗖𝗲𝗻𝘁𝗿𝗮𝗹 𝗤𝘂𝗲𝘀𝘁𝗶𝗼𝗻 𝗼𝗳 𝗜𝗻𝘁𝗲𝗻𝘀𝗶𝘁𝘆

▪️ While the neuroprotective effects of exercise are clear, the most effective “dose” of aerobic exercise to promote beneficial changes in these myokine pathways is currently unknown.
▪️ Most existing evidence stems from moderate-intensity exercise studies, and research on high-intensity exercise (like High-Intensity Interval Training or HIIT) is scarce.
▪️ The review emphasizes that intensity matters, highlighting the need for standardized intensity classifications (e.g., Low, Moderate, High, based on metabolic thresholds) to effectively compare research findings.

🔬 𝗜𝗻𝘁𝗲𝗻𝘀𝗶𝘁𝘆 𝗮𝗻𝗱 𝗞𝗲𝘆 𝗣𝗮𝘁𝗵𝘄𝗮𝘆𝘀: 𝗪𝗵𝗮𝘁 𝘁𝗵𝗲 𝗘𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝗦𝗵𝗼𝘄𝘀

▪️ FNDC5/Irisin: There is emerging evidence suggesting that high-intensity exercise may have a superior impact on circulating Irisin levels compared to lower intensities.
▪️ Moderate- to high-intensity training has also been shown to be superior (≈ 2-fold) to low-intensity training in increasing FNDC5 protein levels in rodent skeletal muscle.

▪️ CTSB: This protease promotes adult hippocampal neurogenesis (AHN) and neural debris clearance.
▪️ Moderate-intensity exercise increases CTSB in muscle and plasma, but research on high-intensity exercise effects is lacking.

▪️ Kynurenine Metabolites: The balance between neuroprotective Kynurenic Acid (KA) and neurotoxic Quinolinic Acid (QA) is critical.
▪️ High-intensity training is hypothesized to be superior in promoting neuroprotective metabolites (via PGC-1α activation), but current human studies show no difference in key metabolite levels between low- and high-intensity exercise.

▪️ Adult Hippocampal Neurogenesis (AHN): In contrast to myokine upregulation, low- to moderate-intensity training appears to be the strongest stimulus to enhance AHN (cell proliferation and maturation) in rodents, often improving AHN to a greater extent than high-intensity training.

🎯 𝘾𝙤𝙣𝙘𝙡𝙪𝙨𝙞𝙤𝙣 𝙖𝙣𝙙 𝙁𝙪𝙩𝙪𝙧𝙚 𝘿𝙞𝙧𝙚𝙘𝙩𝙞𝙤𝙣

▪️ The current evidence is insufficient to draw definitive conclusions on the optimal intensity for maximizing neuroprotective myokine benefits.
▪️ Future research must utilize well-controlled studies, such as work-matched training interventions, and standardize intensity definitions to accurately determine the optimal exercise dose.
▪️ Understanding how exercise intensity regulates myokines holds significant promise in offering therapeutic avenues to alleviate the burden of neurodegenerative conditions like dementia.

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

03/12/2025

📌 𝗧𝗵𝗲 𝗧𝗵𝗿𝗲𝗲 𝗦𝘁𝗮𝗴𝗲𝘀 𝗼𝗳 𝗧𝗲𝗻𝗱𝗼𝗻 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝘆

▪️ Tendinopathy is a prevalent tendon disorder causing persistent, localized pain, and loss of strength and function.
▪️ These common musculoskeletal injuries result from factors like overuse or excessive mechanical loading, which push the tissue beyond its physiological threshold and lead to an insufficient healing response.
▪️ Tendon pathology is generally understood to progress through a three-stage continuum: reactive tendinopathy, tendon disrepair, and degenerative tendinopathy.
▪️ Recognizing these stages is crucial, as the severity of the injury and the likelihood of successful repair are often dependent on the stage of progression.

🔵 𝙎𝙩𝙖𝙜𝙚 1: 𝙍𝙚𝙖𝙘𝙩𝙞𝙫𝙚 𝙏𝙚𝙣𝙙𝙞𝙣𝙤𝙥𝙖𝙩𝙝𝙮

▪️ This is the initial stage following an acute injury.
▪️ Key Features: Inflammatory responses begin immediately.
▪️ Tissue Changes: The tendon displays minimal collagen damage. This stage is characterized by the release of pro-inflammatory cytokines, increased fluid in the extracellular matrix (ECM), altered tenocyte shape, and de-tensioned collagen.
▪️ Reversibility: If treated within this first stage, the process is generally reversible.

🟡𝙎𝙩𝙖𝙜𝙚 2: 𝙏𝙚𝙣𝙙𝙤𝙣 𝘿𝙞𝙨𝙧𝙚𝙥𝙖𝙞𝙧

▪️ If the pathology progresses, the tendon enters the disrepair stage.
▪️ Key Features: This stage is characterized by the proliferation of abnormal tenocytes.
▪️ Tissue Changes: Features include collagen splitting and neovascularization (the formation of new blood vessels, often indicated by grouped endothelial cells). There is also an increase in type III collagen production.
▪️ Reversibility: The process is still generally reversible if treated during this stage.

🔴 𝙎𝙩𝙖𝙜𝙚 3: 𝘿𝙚𝙜𝙚𝙣𝙚𝙧𝙖𝙩𝙞𝙫𝙚 𝙏𝙚𝙣𝙙𝙞𝙣𝙤𝙥𝙖𝙩𝙝𝙮

▪️ This is considered the final or terminal stage of tendon pathology.
▪️ Key Features: This stage marks the most severe damage.
▪️ Tissue Changes: There is further disruption of collagen fibers, diffused cell death, and permanent ECM disorganization. Stage 3 also shows further increases in type III collagen production.
▪️ Treatment Outlook: Treatment becomes challenging in this terminal stage.

🧩 𝗧𝗵𝗲 𝗕𝗶𝗴𝗴𝗲𝗿 𝗣𝗶𝗰𝘁𝘂𝗿𝗲

▪️ Throughout these stages, the tendon fibers become de-tensioned (represented via thinning and looser organization of fibrils).
▪️ The progression involves the aggregation of endothelial cells, continuous inflammation, and a sustained increase in type III collagen.
▪️ It is important to note that Type I collagen constitutes more than 85% of the dry weight of a normal tendon.
▪️ Therefore, the progressive alterations in collagen phenotype (such as the increase in Type III collagen) are critical factors in determining the severity of the injury and the likelihood of successful repair.
▪️ Early detection and treatment of tendinopathies are challenging partly because of a prolonged asymptomatic phase during which ECM disorganization occurs.

03/12/2025

Astaxanthin is one of the only known dietary antioxidants that spans the entire cell membrane (and thus, provides end-to-end protection) like this - i.e., protecting both surfaces and the vulnerable fatty-acid core.

03/12/2025

Relative value of novel systemic immune-inflammatory indices and classical hematological parameters in predicting depression, su***de attempts and treatment response

https://www.nature.com/articles/s41598-024-70097-z #:~:text=Systemic%20immune%2Dinflammation%20index%20(SII,an%20increased%20risk%20of%20depression.

This study compared the power of the novel inflammatory markers systemic immune inflammation index (SII) and the system inflammation response index (SIRI) versus the classical hematological indices neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and platelet counts in distinguishing between major depressive disorder (MDD) with and without su***de attempts and distinguishing the non-response to selective serotonin reuptake inhibitor (SSRI) treatment. A total of 139 young adult MDD patients and 54 healthy controls (HC) were included. We found that, in comparison to HC, baseline NLR, PLR, SII, and SIRI were significantly higher in MDD patients, but only NLR and SII had area under the ROC curve (AUC) values greater than 0.7. MDD patients with su***de attempts (SA) showed significantly higher baseline MLR and SIRI, and a tendency to increase NLR compared to those without SA. In terms of AUC, sensitivity, and specificity, NLR was better than MLR, SIRI, SII, and PLR in distinguishing SA. Non-responders to SSRI treatment showed a significant increase in baseline platelet count and PLR compared to responders with an AUC greater than 0.7. These findings highlight the potential benefit of combining novel and classical hematological indices in predicting depression, su***de attempts and treatment response.

".....Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) are two novel inflammatory indexes and convenient measurements based on peripheral blood neutrophils, monocyte counts, platelet counts, and lymphocyte counts. The SII (calculated as neutrophil count × platelet count/lymphocyte count) was first proposed as a powerful prognostic indicator of poor outcome in patients with hepatocellular carcinoma in 2014 by Hu et al. 23. Similarly, SIRI (calculated as neutrophil count × monocyte count/lymphocyte) was first described by Qi et al.24. Given that SII brings together three inflammatory peripheral cell counts, including neutrophil, platelet, and lymphocyte counts, into an equation and SIRI incorporates neutrophil, monocyte, and lymphocyte counts into an equation, they should offer a more comprehensive reflection of the inflammatory state.

Several studies confirmed that a higher SII was significantly associated with an increased risk for depression in patients with diabetes mellitus25, stroke26, and tuberculosis27. In addition, a study by Li et al.28 demonstrated that high levels of SII and SIRI were associated with an increased risk of depression...."

This study compared the power of the novel inflammatory markers systemic immune inflammation index (SII) and the system inflammation response index (SIRI) versus the classical hematological indices neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio...

25/11/2025

Conditions that alter repolarization of myocytes and result in ST-segment and T-wave abnormalities

1. Digoxin → “D” for Down-sloping
• Scooped ST depression
• PR slightly prolonged

2. Hyperkalemia → “High K = High T”
• Tall peaked T waves
• Severe:
• P wave disappears (flattened P)
• Widened QRS → sine wave (late stage)

3. Hypokalemia → “Low K = Low T, Big U”
• Flattened T wave
• ST depression
• Prominent U wave (hallmark)

4. Hypercalcemia → “High Ca = Short QT”
• Shortened QT interval

5. Hypocalcemia → “Low Ca = Long QT”
• Prolonged QT interval

25/11/2025

A new study indicates that there is an increased risk for cerebral microbleeds among adults who have moderate to severe obstructive sleep apnea, which could increase the risk of stroke and dementia.

25/11/2025

📢 **Announcement**

The *Indian Society of Sports and Exercise Medicine (ISSEM)* is delighted to announce its upcoming free Webinar on 25th November 2025; 15:00 IST on the *Topic: Sports Medicine Training Programme and Curriculum Development in the United Kingdom* .

The speaker is a well known specialist in the field: *Professor (Dr) Dane Vishnubala*, MBBS MSc (Med Ed) FRCGP FFSEM MSc (SEM) DipSEM (UK) PGCert MSKUS SFHEA PhD; Professor and Consultant Physician of Sport and Exercise Medicine | Uni of Leeds Clinical Lead for MSc in SEM | Non Executive Director and Charity Trustee.

This webinar will be followed by the the signing of a *Memorandum of Understanding (MoU)* with the *Sri Lanka Sports Medicine Association (SLSMA)*

This strategic collaboration will symbolize a significant step toward fostering *academic cooperation, research partnerships, and professional development* in the field of *Sports and Exercise Medicine (SEM)* in particular and *Sports and Exercise Sciences (SES)* in general across South East Asia.

Through this MoU, both organizations will work together to:
🔹 Facilitate joint research, scientific and clinical skills exchange
🔹 Promote educational and training programs for the professionals of Sports-Exercise Medicine and Sciences.
🔹 Strengthen regional networks to enhance Athletic Performance, Overall Health, Fitness and Wellness.

This partnership will underscore our shared commitment to advancing the science and practice of Sports & Exercise Medicine for the benefit of athletes, clinicians, researchers and general public alike.

Together, ISSEM and SLSMA look forward to a future of *mutual learning, innovation, and regional excellence* in Sports-Exercise Medicine and Sciences.

*Youtube Link*: https://www.youtube.com/live/styyfzi4FQI?si=GyZloHwEQ3qez0pO

*The registration for the online event is free, but mandatory. The registration link is*:
https://forms.gle/wFgGT1Tht8AaCSBK7

https://www.facebook.com/share/p/16aN1Nn9R9/

( https://whatsapp.com/channel/0029VaZVXs60VycBK7pu3P29 )

www.issem.in

The Indian Society of Sports and Exercise Medicine (ISSEM) is delighted to announce its upcoming free Webinar on 25th November 2025; 15:00 IST on the Topic, ...

23/11/2025

In recent years, Sweden has begun a remarkable shift in its education system: after a period of intense digitization in classrooms, the country is rediscovering the value of physical books, traditional reading, and handwriting.

The change doesn't mean eliminating screens entirely, but rather balancing their use and reducing their presence in the earliest years, where specialists have expressed concern about the impact on reading comprehension, attention span, and the development of basic skills.

The Swedish government has allocated funds for schools to purchase more textbooks and printed materials, while also promoting more reading time and less screen time. Many teachers have begun limiting tablet use and reintroducing activities such as handwritten notes, working with notebooks, and consulting encyclopedias and physical texts. This decision is supported by studies suggesting that children understand information better when they read it on paper, and by signs that rapid digitization has not always yielded the expected results.

Although technology still has a place in Swedish education, the country is moving towards a more balanced model, where digital tools are complementary rather than the central focus of learning.

Source:

- "Sweden Education Shift: From Digital Learning to Pen and Paper", The Think Academy