Klaus Hergersheimer
Prince
so what cleared up my congestion when I used nyquil?
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Newsworthy Science
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The alcohol? Maybe the flavoring or the good nights sleep. Nyquil has always worked for me. Yum!
Placebo effect?
Releasing diseased mosquitoes can reduce mosquito born disease
Dengue rates drop after release of modified mosquitoes in Colombia
Three cities in Colombia saw a dramatic fall in the incidence of dengue in the years following the introduction of mosquitoes carrying Wolbachia, a bacterium that prevents the insect from transmitting viruses. In neighbourhoods where the Wolbachia mosquitoes were well established, dengue incidence dropped by 94–97%.
The Aedes aegypti mosquitoes were released by the World Mosquito Program (WMP), a non-profit organization that has been conducting similar experiments in Australia, Brazil, Indonesia and Vietnam, among other countries. In Colombia, the modified mosquitoes were released in one of the country’s most populous regions. “That’s the largest continuous releases of Wolbachia [mosquitoes] globally so far, in terms of the population covered and the area,” says Katie Anders, an epidemiologist at the WMP and Monash University in Melbourne, Australia.
When infected with Wolbachia, the mosquitoes are much less likely to transmit diseases such as dengue and Zika, because the bacteria compete with these viruses. The insects also pass the bacteria on to their offspring. Researchers hope that the modified mosquitoes will interbreed with the wild population wherever they are released, and that the number of mosquitoes with Wolbachia will eventually surpass that of mosquitoes without it.
Dengue rates drop after release of modified mosquitoes in Colombia
Three cities in Colombia saw a dramatic fall in the incidence of dengue in the years following the introduction of mosquitoes carrying Wolbachia, a bacterium that prevents the insect from transmitting viruses. In neighbourhoods where the Wolbachia mosquitoes were well established, dengue incidence dropped by 94–97%.
The Aedes aegypti mosquitoes were released by the World Mosquito Program (WMP), a non-profit organization that has been conducting similar experiments in Australia, Brazil, Indonesia and Vietnam, among other countries. In Colombia, the modified mosquitoes were released in one of the country’s most populous regions. “That’s the largest continuous releases of Wolbachia [mosquitoes] globally so far, in terms of the population covered and the area,” says Katie Anders, an epidemiologist at the WMP and Monash University in Melbourne, Australia.
When infected with Wolbachia, the mosquitoes are much less likely to transmit diseases such as dengue and Zika, because the bacteria compete with these viruses. The insects also pass the bacteria on to their offspring. Researchers hope that the modified mosquitoes will interbreed with the wild population wherever they are released, and that the number of mosquitoes with Wolbachia will eventually surpass that of mosquitoes without it.
I would love to know if this is really true, or if it is just usual US federal anti-drug FUD. Phenylephrine is basically weak speed, right? And speed definitely clears out your sinuses if you use enough of it. My suspicion, based on nothing but the US governments history in this area, is they tested some really low dose that definitely does not have a psychoactive effect, and that is not enough to detect a decongestant effect. I wonder if the result would be different if they gave people good concentrated stuff, let them take as much as they want and see if they feel better.
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It is hard to say what actually caused the change. My experience with Nyquil is so good that I will still use it if it stays available. If not I guess I'll take a shot of Kalua before bed.....
Honey and brandy is my go to medicinal. 1 heaped teaspoon of honey in ~25ml brandy. Set honey gives it a lovely smooth consistency. The honey is shown to be curative, at least for coughs. Both have antibacterial action.
MrCynical
Deity
It's been fairly common knowledge among those in the industry for years that phenylephrine does practically nothing. Derek Lowe over at the excellent "In the Pipeline" blog gave a pretty good summary of this over a year ago, and even then it was a case of "seriously, how long is it going to take to admit this?"
If it does have any effect, you'd need orders of magnitude more phenylephrine than you'd get from any of the formulations on the market to realistically see any benefit. As to why your congestion cleared up, it's the same reason that people's colds clear up after taking various "cold treatments" or home remedies. These are self limiting conditions that usually clear up fairly quickly anyway. Treatments that reduce the recovery time from 3 days to 72 hours, as they say.
So from wiki:
Phenylephrine is a sympathomimetic drug, which means that it mimics the actions of epinephrine (commonly known as adrenaline) or norepinephrine. Phenylephrine selectively binds to alpha-1 receptors which causes venous and arterial vasoconstriction.
Whereas pseudoephedrine causes both vasoconstriction and increase of mucociliary clearance through its nonspecific adrenergic activity, phenylephrine's selective α-adrenergic agonism causes vasoconstriction alone, creating a difference in their methods of action.
So the thing is it is too selective for the α adrenergic receptor. Are they letting them have a less selective drug instead if that would be better?
NICE, the UK org that says what drugs are good, does not even mention its decongestant activety.
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Menopausal chimpanzees deepen the mystery of why women stop reproducing
The females in a group of wild chimpanzees (Pan troglodytes) are the first non-human primates to be documented experiencing menopause. The finding, published today in Science, deepens the mystery of why a handful of mammals — including humans and toothed whales (odontocetes) — evolved extended female lifespans beyond their reproductive years.
“There’s so many species who just more or less reproduce until they keel over,” says Tobias Deschner, a primatologist at Osnabrück University in Germany. The riddle, he says, is why a select few buck this trend, ceasing reproduction long before they die.
Researchers followed 185 female members of the Ngogo community of chimpanzees in Kibale National Park, Uganda from 1995 to 2016. The data revealed that, in a pattern similar to that in other chimpanzees and humans, the number of births declined after 30 years old, and ceased altogether by age 50.
Yet, several female chimpanzees continued to live post-reproductive lives, sometimes well into their 60s. Ngogo females spend around one-fifth of their adult lives in this post-reproductive period, roughly half as long as that of hunter-gatherer humans. That number was much larger than the team expected, says Brian Wood, an anthropologist at the University of California, Los Angeles.
The female chimpanzees experience a hormonal transition similar to that seen in humans. Scientists doggedly followed post-reproductive Ngogo females to collect samples of urine as it showered from the trees. The team found a decline in oestrogens and progestins levels, paired with heightened levels of follicle-stimulating hormone and luteinizing hormone in those females — hormones that control ovulation and renewal of the uterine lining after menstruation.
So far, a long post-reproductive life in wild mammals has only been recorded in five other mammals: orcas (Orcinus orca), short-finned pilot whales (Globicephala macrorhynchus), narwhals (Monodon monoceros), beluga whales (Delphinapterus leucas) and false killer whales (Pseudorca crassidens).
One hypothesis for the evolution of life beyond reproduction — rather than menopause per se — is called the grandmother hypothesis. This suggests that older females could boost their genetic legacy by helping their daughters in raising their offspring. But the hypothesis doesn’t work in chimpanzees, says Wood, because young females leave their family group to mate, and are therefore separated from their mother.
An alternative evolutionary explanation that could explain menopause in Ngogo chimps is the reproductive-conflict hypothesis, which suggests that, within a group, older females stop reproducing to prevent reproductive competition with younger females, who, over time, are increasingly likely to be their granddaughters or another close relation.
But not all biologists agree that menopause is an evolutionary adaption. “There’s even the question of whether this has been at all selected for, or if it’s a byproduct” of other processes, says Goncalves.
Pat Monaghan, an evolutionary ecologist at the University of Glasgow, UK, argues that menopause has evolutionary origins, but not because of social factors. She says that animals need to ensure that their eggs are furnished with high-quality mitochondria, the energy-producing structures inside cells. Good-quality mitochondria are especially important to brain cells of large-brained mammals, such as humans. By middle-age, females, who are born with their full complement of eggs, simply run out of eggs with good mitochondria. Men do not pass their mitochondria onto their offspring, and so their reproductive lives are not limited.
Langergraber says that in humans, the fact that the timing of a woman’s menopause is inherited suggests that it is an adaptive trait that has been selected for over evolutionary time, rather than a biological quirk that is neither beneficial nor harmful. Because it is heritable, “that means that selection could move it much later”, he says. But that hasn’t happened, so there must be an evolutionary pressure keeping it at around age 50 in humans, he says.
Paper Writeup
Old chimps
The females in a group of wild chimpanzees (Pan troglodytes) are the first non-human primates to be documented experiencing menopause. The finding, published today in Science, deepens the mystery of why a handful of mammals — including humans and toothed whales (odontocetes) — evolved extended female lifespans beyond their reproductive years.
“There’s so many species who just more or less reproduce until they keel over,” says Tobias Deschner, a primatologist at Osnabrück University in Germany. The riddle, he says, is why a select few buck this trend, ceasing reproduction long before they die.
Researchers followed 185 female members of the Ngogo community of chimpanzees in Kibale National Park, Uganda from 1995 to 2016. The data revealed that, in a pattern similar to that in other chimpanzees and humans, the number of births declined after 30 years old, and ceased altogether by age 50.
Yet, several female chimpanzees continued to live post-reproductive lives, sometimes well into their 60s. Ngogo females spend around one-fifth of their adult lives in this post-reproductive period, roughly half as long as that of hunter-gatherer humans. That number was much larger than the team expected, says Brian Wood, an anthropologist at the University of California, Los Angeles.
The female chimpanzees experience a hormonal transition similar to that seen in humans. Scientists doggedly followed post-reproductive Ngogo females to collect samples of urine as it showered from the trees. The team found a decline in oestrogens and progestins levels, paired with heightened levels of follicle-stimulating hormone and luteinizing hormone in those females — hormones that control ovulation and renewal of the uterine lining after menstruation.
So far, a long post-reproductive life in wild mammals has only been recorded in five other mammals: orcas (Orcinus orca), short-finned pilot whales (Globicephala macrorhynchus), narwhals (Monodon monoceros), beluga whales (Delphinapterus leucas) and false killer whales (Pseudorca crassidens).
One hypothesis for the evolution of life beyond reproduction — rather than menopause per se — is called the grandmother hypothesis. This suggests that older females could boost their genetic legacy by helping their daughters in raising their offspring. But the hypothesis doesn’t work in chimpanzees, says Wood, because young females leave their family group to mate, and are therefore separated from their mother.
An alternative evolutionary explanation that could explain menopause in Ngogo chimps is the reproductive-conflict hypothesis, which suggests that, within a group, older females stop reproducing to prevent reproductive competition with younger females, who, over time, are increasingly likely to be their granddaughters or another close relation.
But not all biologists agree that menopause is an evolutionary adaption. “There’s even the question of whether this has been at all selected for, or if it’s a byproduct” of other processes, says Goncalves.
Pat Monaghan, an evolutionary ecologist at the University of Glasgow, UK, argues that menopause has evolutionary origins, but not because of social factors. She says that animals need to ensure that their eggs are furnished with high-quality mitochondria, the energy-producing structures inside cells. Good-quality mitochondria are especially important to brain cells of large-brained mammals, such as humans. By middle-age, females, who are born with their full complement of eggs, simply run out of eggs with good mitochondria. Men do not pass their mitochondria onto their offspring, and so their reproductive lives are not limited.
Langergraber says that in humans, the fact that the timing of a woman’s menopause is inherited suggests that it is an adaptive trait that has been selected for over evolutionary time, rather than a biological quirk that is neither beneficial nor harmful. Because it is heritable, “that means that selection could move it much later”, he says. But that hasn’t happened, so there must be an evolutionary pressure keeping it at around age 50 in humans, he says.
Paper Writeup
Old chimps
Spoiler Legend :
Pretty interesting find. I was a bit amazed when I first read about it. Collecting urine data.....
Which won't happen in the United States.
Did dust from the Chicxulub asteroid impact kill the dinosaurs?
Dust might have been responsible for the deadly dinosaur-killing global winter that came after an asteroid slammed into Earth 66 million years ago, finds a study published on 30 October in Nature Geoscience.
A team of geoscientists led by Cem Berk Senel at the Royal Observatory of Belgium in Brussels reinvestigated the aftermath of the impact that formed Mexico’s Chicxulub crater — a collision that wiped out the non-avian dinosaurs and much of life on Earth.
The researchers looked at a well-preserved sample of rock formed at the time of extinction event in what is now North Dakota. Such rocks contain traces that geoscientists use to mark the change from the Cretaceous period to the Palaeogene period in Earth’s history. They looked at the amounts of sulfur, soot and minerals called silicates in the sample, and found that the sample contained many more small, fine particles of silicate dust — ranging from about 0.8 to 8.0 micrometres in diameter — than expected.
Senel’s team thinks that the asteroid impact threw up clouds of these tiny particles that blocked out the Sun and could have prevented plants from photosynthesizing for up to two years after the impact. As a consequence, vegetation would have died off, resulting in the starvation of many herbivorous species, including some dinosaurs. This could have helped to kick off a catastrophic mass-extinction event.
Or was it the stones
The Late Heavy Bombardment was followed a few billion years later by the Comparatively Light but Oddly Specific Bombardment.
Dust might have been responsible for the deadly dinosaur-killing global winter that came after an asteroid slammed into Earth 66 million years ago, finds a study published on 30 October in Nature Geoscience.
A team of geoscientists led by Cem Berk Senel at the Royal Observatory of Belgium in Brussels reinvestigated the aftermath of the impact that formed Mexico’s Chicxulub crater — a collision that wiped out the non-avian dinosaurs and much of life on Earth.
The researchers looked at a well-preserved sample of rock formed at the time of extinction event in what is now North Dakota. Such rocks contain traces that geoscientists use to mark the change from the Cretaceous period to the Palaeogene period in Earth’s history. They looked at the amounts of sulfur, soot and minerals called silicates in the sample, and found that the sample contained many more small, fine particles of silicate dust — ranging from about 0.8 to 8.0 micrometres in diameter — than expected.
Senel’s team thinks that the asteroid impact threw up clouds of these tiny particles that blocked out the Sun and could have prevented plants from photosynthesizing for up to two years after the impact. As a consequence, vegetation would have died off, resulting in the starvation of many herbivorous species, including some dinosaurs. This could have helped to kick off a catastrophic mass-extinction event.
Or was it the stones
The Late Heavy Bombardment was followed a few billion years later by the Comparatively Light but Oddly Specific Bombardment.
It must be the stones. The proof is that all dinosaur fossils are surrounded by rocks.
What causes fainting? Scientists finally have an answer
Whether as a result of heat, hunger, standing for too long, or merely at the sight of blood or needles, 40% of people faint at least once in their lifetime.
But exactly what causes these brief losses of consciousness — which researchers call ‘syncope’ — has remained a mystery for cardiologists and neuroscientists for a long time.
Now, researchers have discovered a neural pathway, which involves a previously undiscovered group of sensory neurons that connect the heart to the brainstem. The study, published in Nature on 1 November1, shows that activating these neurons made mice became immobile almost immediately while displaying symptoms such as rapid pupil dilation and the classic eye-roll observed during human syncope.
The authors suggest that this neural pathway holds the key to understanding fainting, beyond the long-standing observation that it results from reduced blood flow in the brain. “There is blood flow reduction, but at the same time there are dedicated circuits in the brain which manipulate this,” says study co-author Vineet Augustine, a neuroscientist at the University of California, San Diego.
“The study of these pathways could inspire new treatment approaches for cardiac causes of syncope,” says Kalyanam Shivkumar, a cardiologist at the University of California, Los Angeles.
Whether as a result of heat, hunger, standing for too long, or merely at the sight of blood or needles, 40% of people faint at least once in their lifetime.
But exactly what causes these brief losses of consciousness — which researchers call ‘syncope’ — has remained a mystery for cardiologists and neuroscientists for a long time.
Now, researchers have discovered a neural pathway, which involves a previously undiscovered group of sensory neurons that connect the heart to the brainstem. The study, published in Nature on 1 November1, shows that activating these neurons made mice became immobile almost immediately while displaying symptoms such as rapid pupil dilation and the classic eye-roll observed during human syncope.
The authors suggest that this neural pathway holds the key to understanding fainting, beyond the long-standing observation that it results from reduced blood flow in the brain. “There is blood flow reduction, but at the same time there are dedicated circuits in the brain which manipulate this,” says study co-author Vineet Augustine, a neuroscientist at the University of California, San Diego.
“The study of these pathways could inspire new treatment approaches for cardiac causes of syncope,” says Kalyanam Shivkumar, a cardiologist at the University of California, Los Angeles.
Spoiler Legend :
Cancer trial results show power of weaponized antibodies
It’s rare to get a standing ovation at a scientific conference. But on 22 October, cancer researcher Thomas Powles received two.
The first came in the middle of his talk, after he announced that a combination of treatments cut the risk of death in people with advanced bladder cancer by more than half — an unprecedented result in a cancer for which survival rates have been almost unchanged since the 1980s.
Powles, who works at St Bartholomew’s Hospital in London, says he was surprised by the response, and stumbled through to the end of his presentation, at which point he was met with another ovation. “People were just glad that I finished.”
Powles was not the only person to present promising data for a class of cancer treatments called antibody–drug conjugates (ADCs) at the European Society for Medical Oncology Congress, held in Madrid on 20–24 October. Further data from trials in breast cancer and other types of tumour added to the momentum of the technology, which uses cancer-targeting antibodies to deliver toxic agents to tumours.
The combination of drugs used in the bladder cancer study was approved by the US Food and Drug Administration earlier this year. But the data underlying that approval came from a trial of only about 120 people who received the two drugs — the ADC enfortumab vedotin (marketed as Padcev) with pembrolizumab (Keytruda) — so it was unclear how the treatment would perform in a larger trial, says Powles.
Pembrolizumab blocks a protein that hinders the immune system, allowing the body to launch a more effective attack against tumours. Enfortumab vedotin consists of an antibody that targets a protein called nectin-4, which is expressed at higher levels in some types of cancer cell than in non-cancerous cells. Attached to this antibody is a chemical that disrupts cell division.
The aim of ADCs such as enfortumab vedotin is to provide a way to deliver chemotherapies that target dividing cells directly to tumours, rather than administering them throughout the body, where they can damage other tissues. Several ADCs are already marketed against various forms of cancer, but researchers are still working to find the best way to design them and put them to use in the clinic.
In Madrid, Powles reported that his team’s drug cocktail nearly doubled the median length of time that people with advanced bladder cancer survived after their treatment, from about 16 months to 31.5 months, compared with conventional chemotherapy. The study tracked more than 880 people who had been randomly assigned to one of the two treatments.
Such large benefits are rarely seen in cancer research, where months of added survival are often celebrated as a breakthrough. That’s true especially of advanced bladder cancer, for which decades of research had consistently failed to improve survival times substantially. “We kind of knocked it out of the park,” says Powles.
Other results presented at the meeting are poised to expand the use of ADCs in advanced breast cancer, says Meric-Bernstam. One group reported that an ADC called datopotamab deruxtecan slowed tumour growth, with recipients lasting two months longer than those who received conventional chemotherapy before their tumours started to expand again. Another showed that an ADC called trastuzumab deruxtecan, which targets the tumour protein HER2, improved survival in people with advanced breast cancer — even those whose tumours produced low levels of HER2.
A cell from a bladder tumour, because fluorescent imaging is cool
It’s rare to get a standing ovation at a scientific conference. But on 22 October, cancer researcher Thomas Powles received two.
The first came in the middle of his talk, after he announced that a combination of treatments cut the risk of death in people with advanced bladder cancer by more than half — an unprecedented result in a cancer for which survival rates have been almost unchanged since the 1980s.
Powles, who works at St Bartholomew’s Hospital in London, says he was surprised by the response, and stumbled through to the end of his presentation, at which point he was met with another ovation. “People were just glad that I finished.”
Powles was not the only person to present promising data for a class of cancer treatments called antibody–drug conjugates (ADCs) at the European Society for Medical Oncology Congress, held in Madrid on 20–24 October. Further data from trials in breast cancer and other types of tumour added to the momentum of the technology, which uses cancer-targeting antibodies to deliver toxic agents to tumours.
The combination of drugs used in the bladder cancer study was approved by the US Food and Drug Administration earlier this year. But the data underlying that approval came from a trial of only about 120 people who received the two drugs — the ADC enfortumab vedotin (marketed as Padcev) with pembrolizumab (Keytruda) — so it was unclear how the treatment would perform in a larger trial, says Powles.
Pembrolizumab blocks a protein that hinders the immune system, allowing the body to launch a more effective attack against tumours. Enfortumab vedotin consists of an antibody that targets a protein called nectin-4, which is expressed at higher levels in some types of cancer cell than in non-cancerous cells. Attached to this antibody is a chemical that disrupts cell division.
The aim of ADCs such as enfortumab vedotin is to provide a way to deliver chemotherapies that target dividing cells directly to tumours, rather than administering them throughout the body, where they can damage other tissues. Several ADCs are already marketed against various forms of cancer, but researchers are still working to find the best way to design them and put them to use in the clinic.
In Madrid, Powles reported that his team’s drug cocktail nearly doubled the median length of time that people with advanced bladder cancer survived after their treatment, from about 16 months to 31.5 months, compared with conventional chemotherapy. The study tracked more than 880 people who had been randomly assigned to one of the two treatments.
Such large benefits are rarely seen in cancer research, where months of added survival are often celebrated as a breakthrough. That’s true especially of advanced bladder cancer, for which decades of research had consistently failed to improve survival times substantially. “We kind of knocked it out of the park,” says Powles.
Other results presented at the meeting are poised to expand the use of ADCs in advanced breast cancer, says Meric-Bernstam. One group reported that an ADC called datopotamab deruxtecan slowed tumour growth, with recipients lasting two months longer than those who received conventional chemotherapy before their tumours started to expand again. Another showed that an ADC called trastuzumab deruxtecan, which targets the tumour protein HER2, improved survival in people with advanced breast cancer — even those whose tumours produced low levels of HER2.
A cell from a bladder tumour, because fluorescent imaging is cool
Scientists have succeeded at creating facial ID software for geese.
97% is pretty good.
97% is pretty good.
Now they can easily keep track of the storylines.
Seals Show Scientists an Unknown Antarctic Canyon
Charting the seafloor with deep-diving animals can help scientists predict glacial and ice-sheet-melting physics
Scientists have been placing trackers on Elephant Seals and Weddell Seals around Antarctica for years, gathering data on ocean temperature and salinity. For a new study, the researchers compared these dives' location and depth data with some of the less detailed seafloor maps. They spotted places where the seals dove deeper than should have been possible according to the maps—meaning the existing depth estimates were inaccurate.
In eastern Antarctica's Vincennes Bay, the diving seals helped the scientists find a large, hidden underwater canyon plunging to depths of more than a mile. An Australian research ship called the RSV Nuyina later measured the canyon's exact depth using sonar, and the researchers have proposed naming their find the Mirounga-Nuyina Canyon—honoring both the ship and the involved Elephant Seals, genus Mirounga.
A Southern Elephant Seal not in a canyon
Charting the seafloor with deep-diving animals can help scientists predict glacial and ice-sheet-melting physics
Scientists have been placing trackers on Elephant Seals and Weddell Seals around Antarctica for years, gathering data on ocean temperature and salinity. For a new study, the researchers compared these dives' location and depth data with some of the less detailed seafloor maps. They spotted places where the seals dove deeper than should have been possible according to the maps—meaning the existing depth estimates were inaccurate.
In eastern Antarctica's Vincennes Bay, the diving seals helped the scientists find a large, hidden underwater canyon plunging to depths of more than a mile. An Australian research ship called the RSV Nuyina later measured the canyon's exact depth using sonar, and the researchers have proposed naming their find the Mirounga-Nuyina Canyon—honoring both the ship and the involved Elephant Seals, genus Mirounga.
A Southern Elephant Seal not in a canyon
This one could have been in the weird news thread.
Are these moths blinding children?
September is typically the end of the monsoon season in Nepal — and the time of year when eye clinicians begin to worry. A mysterious and debilitating eye infection, known as seasonal hyperacute panuveitis (SHAPU), starts afflicting people, mainly children, in some parts of the country. Symptoms typically start with a painless reddening and loss of pressure in one eye. If the condition is not treated within 24 to 48 hours, the children are at risk of losing their eyesight.
But in 2023, researchers in Nepal are more committed and better equipped than ever before to determine the cause of this puzzling condition. For the first time, they have environmental surveys, genomic sequencing and a reporting system in place to track down its source. However, they are up against major funding challenges, and this year, reports of the disease have changed. “The cases have come from previously unreported territories and the severity of symptoms has also become quite unpredictable,” says Ranju Kharel (Sitaula), an ophthalmologist at the Institute of Medicine at Tribhuvan University in Kathmandu.
Every two years
The disease itself is not new. Back in 1979, ophthalmologist Madan P. Upadhyay, now chair emeritus at the BP Eye Foundation in Kathmandu, was woken by the sound of his doorbell. Outside was a man clutching his three-year-old daughter, her right eye inflamed. The scene was familiar, matching cases Upadhyay had seen before — first in 1975, and again in 1977. Upadhyay named the mysterious illness SHAPU, and noted that, inexplicably, cases seemed to spike every two years.
The condition turned out to be more serious that doctors had first realized. “Initially, we thought that the condition was just an inflammation but it would shrink the whole eyeball, and treatment options couldn’t save the vision in kids,” says Anu Manandhar, an uveitis specialist at the Tilganga Institute of Ophthalmology in Kathmandu.
The cause remains unknown, meaning that clinicians are left frantically trying various treatment options, including antibiotics, steroids and other eye medications — with no guarantee of success. Sometimes the drugs work; in other cases the same combination of treatments has little effect.
Until 2021, SHAPU had limited recognition, and only a few cases each year were documented in hospital records and scientific journals. However, in 2021, the country faced a particularly large outbreak, with more than 150 cases. This drew considerable attention from the local media. As a result, clinicians were better prepared for 2023.
This year, doctors have a system for timely reporting of cases across the country. This has already helped them to better understand the geography of the disease. “We used to assume that SHAPU cases were confined to the mid-hill terrain of western Nepal. Now, we are seeing cases reported in central Nepal, including Kathmandu, and even in the eastern highlands, including the Everest region,” Kharel says.
The reporting system has also shown that the outbreak in 2023 has been particularly bad. “In the past two months, we have registered nearly 100 cases of SHAPU,” says Kharel.
Scientists had hoped that a simple laboratory culture from the infected eye would reveal the cause of the infection. But the results weren’t clear-cut. The tests detected various microorganisms, including Staphylococcus and Streptococcus bacteria. “Other culture studies have even revealed the presence of viruses such as human anelloviridae and varicella-zoster virus, and even some fungi,” Kharel says.
However, researchers noticed that many people anecdotally mentioned that they had been in direct or indirect contact with a ‘white moth’ before the onset of the illness. In a survey2 first published online in 2020, Kharel and her team found that the only statistically significant difference between people with SHAPU and a control group was that the individuals with SHAPU were nearly seven times more likely than the control individuals to report having had contact with butterflies or white moths. White moths of the genus Gazalina are known to swarm through Nepal at the end of the monsoon season. The results of Kharel and colleagues’ survey, along with the timing of Gazalina moth hatching, “present a strong case for the link with the Gazaline moth”, says Daya Ram Bhusal, an entomologist at Tribhuvan University.
Following this lead, for the past couple of months, Bhusal and his team have been surveying major districts of western Nepal that have had repeated outbreaks of SHAPU in the past. They are collecting data from places where moths have been recorded, and examining ecological factors including temperature, humidity, vegetation type and altitude.
"We also need to confirm the moth’s taxonomic classification,” Bhusal adds. He says that three species of moth from the Gazalina genus are recorded in Nepal, and all are white. Any or all of the species could be associated with the disease, he says. His team also plans to conduct biochemical analyses comparing the vitreous fluid from an infected eye with compounds from moth hairs to determine whether a specific toxin found in moths is driving the inflammation.
Genetic material
It’s not clear why the disease infects some people but not others. To try to resolve this question, Kharel and her team are collecting samples from the affected and unaffected eyes of people with SHAPU, and from family members. They will screen these samples for genetic material from bacteria and viruses to determine whether there is a culprit microorganism.
Although researchers are making progress on SHAPU, they don’t have the funds to do everything that is needed. Using advanced DNA sequencing allows researchers to look for genetic material in a sample to shed light on the types of microorganisms that are present. However, Nepal doesn’t have a metagenomic sequencing laboratory, so samples often have to be shipped to the United States and other countries for analysis. This is expensive and takes time. The Nepalese government has increased its support in recent years, but the project is still chronically short of funds.
Kharel says that research initiatives are heading in the right direction, but that the changing geographical distribution of the disease and the range of symptoms reported “keep making SHAPU more mysterious”. Hara Maya Gurung, an ophthalmologist at the Himalaya Eye Hospital, in Pokhara in central Nepal, has diagnosed about 30 people with SHAPU so far this season. “This year’s cases seem so weird as no patient mentioned coming into direct contact with the white moth,” Gurung says. And this year, individuals often presented with complications in the cornea, iris and sclera (the white of the eye), which are very unusual for SHAPU, she adds.
Kharel hopes that a solution to this long-standing enigma is on the horizon. But for the time being, it seems that Nepal will continue to grapple with these tragic biennial outbreaks.
Evidence for the moth:
We identified 35 cases and 105 controls; 71.4% were children≤16 years (38-day infant to 50-year-old). All were immunocompetent individuals, males were 57.1% and females 42.9%. Potential risks such as visible moths/butterfly activity, contact with livestock, and attending mass gatherings of people were not reported more frequently in cases vs controls in univariate analyses. Differences in possibly protective factors such as self-reported mosquito net use, light off at night while sleeping, and habit of hands/face washing after physical contact/touch with any insects/butterflies/birds were not statistically significant between both groups. In multivariate model, SHAPU cases were significantly more likely than controls to report physical contact with butterflies/white moths (Adjusted OR:6.89; CI:2.79–17.01,p < .001).
Are these moths blinding children?
September is typically the end of the monsoon season in Nepal — and the time of year when eye clinicians begin to worry. A mysterious and debilitating eye infection, known as seasonal hyperacute panuveitis (SHAPU), starts afflicting people, mainly children, in some parts of the country. Symptoms typically start with a painless reddening and loss of pressure in one eye. If the condition is not treated within 24 to 48 hours, the children are at risk of losing their eyesight.
But in 2023, researchers in Nepal are more committed and better equipped than ever before to determine the cause of this puzzling condition. For the first time, they have environmental surveys, genomic sequencing and a reporting system in place to track down its source. However, they are up against major funding challenges, and this year, reports of the disease have changed. “The cases have come from previously unreported territories and the severity of symptoms has also become quite unpredictable,” says Ranju Kharel (Sitaula), an ophthalmologist at the Institute of Medicine at Tribhuvan University in Kathmandu.
Every two years
The disease itself is not new. Back in 1979, ophthalmologist Madan P. Upadhyay, now chair emeritus at the BP Eye Foundation in Kathmandu, was woken by the sound of his doorbell. Outside was a man clutching his three-year-old daughter, her right eye inflamed. The scene was familiar, matching cases Upadhyay had seen before — first in 1975, and again in 1977. Upadhyay named the mysterious illness SHAPU, and noted that, inexplicably, cases seemed to spike every two years.
The condition turned out to be more serious that doctors had first realized. “Initially, we thought that the condition was just an inflammation but it would shrink the whole eyeball, and treatment options couldn’t save the vision in kids,” says Anu Manandhar, an uveitis specialist at the Tilganga Institute of Ophthalmology in Kathmandu.
The cause remains unknown, meaning that clinicians are left frantically trying various treatment options, including antibiotics, steroids and other eye medications — with no guarantee of success. Sometimes the drugs work; in other cases the same combination of treatments has little effect.
Until 2021, SHAPU had limited recognition, and only a few cases each year were documented in hospital records and scientific journals. However, in 2021, the country faced a particularly large outbreak, with more than 150 cases. This drew considerable attention from the local media. As a result, clinicians were better prepared for 2023.
This year, doctors have a system for timely reporting of cases across the country. This has already helped them to better understand the geography of the disease. “We used to assume that SHAPU cases were confined to the mid-hill terrain of western Nepal. Now, we are seeing cases reported in central Nepal, including Kathmandu, and even in the eastern highlands, including the Everest region,” Kharel says.
The reporting system has also shown that the outbreak in 2023 has been particularly bad. “In the past two months, we have registered nearly 100 cases of SHAPU,” says Kharel.
Scientists had hoped that a simple laboratory culture from the infected eye would reveal the cause of the infection. But the results weren’t clear-cut. The tests detected various microorganisms, including Staphylococcus and Streptococcus bacteria. “Other culture studies have even revealed the presence of viruses such as human anelloviridae and varicella-zoster virus, and even some fungi,” Kharel says.
However, researchers noticed that many people anecdotally mentioned that they had been in direct or indirect contact with a ‘white moth’ before the onset of the illness. In a survey2 first published online in 2020, Kharel and her team found that the only statistically significant difference between people with SHAPU and a control group was that the individuals with SHAPU were nearly seven times more likely than the control individuals to report having had contact with butterflies or white moths. White moths of the genus Gazalina are known to swarm through Nepal at the end of the monsoon season. The results of Kharel and colleagues’ survey, along with the timing of Gazalina moth hatching, “present a strong case for the link with the Gazaline moth”, says Daya Ram Bhusal, an entomologist at Tribhuvan University.
Following this lead, for the past couple of months, Bhusal and his team have been surveying major districts of western Nepal that have had repeated outbreaks of SHAPU in the past. They are collecting data from places where moths have been recorded, and examining ecological factors including temperature, humidity, vegetation type and altitude.
"We also need to confirm the moth’s taxonomic classification,” Bhusal adds. He says that three species of moth from the Gazalina genus are recorded in Nepal, and all are white. Any or all of the species could be associated with the disease, he says. His team also plans to conduct biochemical analyses comparing the vitreous fluid from an infected eye with compounds from moth hairs to determine whether a specific toxin found in moths is driving the inflammation.
Genetic material
It’s not clear why the disease infects some people but not others. To try to resolve this question, Kharel and her team are collecting samples from the affected and unaffected eyes of people with SHAPU, and from family members. They will screen these samples for genetic material from bacteria and viruses to determine whether there is a culprit microorganism.
Although researchers are making progress on SHAPU, they don’t have the funds to do everything that is needed. Using advanced DNA sequencing allows researchers to look for genetic material in a sample to shed light on the types of microorganisms that are present. However, Nepal doesn’t have a metagenomic sequencing laboratory, so samples often have to be shipped to the United States and other countries for analysis. This is expensive and takes time. The Nepalese government has increased its support in recent years, but the project is still chronically short of funds.
Kharel says that research initiatives are heading in the right direction, but that the changing geographical distribution of the disease and the range of symptoms reported “keep making SHAPU more mysterious”. Hara Maya Gurung, an ophthalmologist at the Himalaya Eye Hospital, in Pokhara in central Nepal, has diagnosed about 30 people with SHAPU so far this season. “This year’s cases seem so weird as no patient mentioned coming into direct contact with the white moth,” Gurung says. And this year, individuals often presented with complications in the cornea, iris and sclera (the white of the eye), which are very unusual for SHAPU, she adds.
Kharel hopes that a solution to this long-standing enigma is on the horizon. But for the time being, it seems that Nepal will continue to grapple with these tragic biennial outbreaks.
Evidence for the moth:
We identified 35 cases and 105 controls; 71.4% were children≤16 years (38-day infant to 50-year-old). All were immunocompetent individuals, males were 57.1% and females 42.9%. Potential risks such as visible moths/butterfly activity, contact with livestock, and attending mass gatherings of people were not reported more frequently in cases vs controls in univariate analyses. Differences in possibly protective factors such as self-reported mosquito net use, light off at night while sleeping, and habit of hands/face washing after physical contact/touch with any insects/butterflies/birds were not statistically significant between both groups. In multivariate model, SHAPU cases were significantly more likely than controls to report physical contact with butterflies/white moths (Adjusted OR:6.89; CI:2.79–17.01,p < .001).
