“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

In a groundbreaking move, the US Food and Drug Administration has approved the first-ever dual adeno-associated virus (AAV) vector-based gene therapy to treat hearing loss.

AAV-based gene therapy offers potential treatment for patients with OTOF gene-associated severe-to-profound hearing loss.

Developed by American Biotechnology company Regeneron, Otarmeni has been approved for the treatment of pediatric and adult patients with severe-to-profound and profound sensorineural hearing loss (any frequency more than 90 dB HL) associated with molecularly confirmed biallelic variants in the OTOF gene.

To date, no disease-modifying treatments exist for OTOF-related deafness.

“Today’s approval is a significant milestone in the treatment of genetic hearing loss,” said FDA Commissioner Marty Makary, in a statement.

“Through the national priority voucher pilot program, the agency is accelerating therapies for rare diseases with unmet medical needs while proving we can successfully review even the most complex submissions—such as novel dual vector gene therapies and combination products requiring coordination across multiple offices and centers—in significantly shortened timeframes,” Markary added.

Importantly, the company has announced that it will offer the therapy free of cost to qualifying individuals, at least during the initial rollout phase. The company cited its commitment to accessibility and patient impact as key reasons behind the decision.

How Otarmeni Works

Hearing loss affects over 430 million people worldwide, with a significant portion caused by genetic mutations. Genetic mutations cause about half of congenital hearing loss. Variants in the OTOF gene account for 2 per cent to 8 per cent of inherited, non-syndromic cases.

Until now, treatment options have largely been limited to hearing aids or cochlear implants, which assist hearing but do not address the underlying cause.

Genetic mutations cause about half of congenital hearing loss. Variants in the OTOF gene account for 2 per cent to 8 per cent of inherited, non-syndromic cases.

The OTOF gene is responsible for producing otoferlin, a protein essential for transmitting sound signals from the inner ear to the brain. Without it, sound cannot be processed, resulting in profound deafness.

Otarmeni is for patients with preserved outer hair cell function and no prior cochlear implant in the same ear.

Otarmeni includes a dual adeno-associated virus serotype 1 (AAV1) vector gene therapy administered as a single dose per ear surgically into the cochlea via a syringe and catheter provided in the Administration Kit and connected to an infusion pump.

The therapy delivers a functional copy of the OTOF gene to inner hair cells to restore otoferlin production and auditory signaling.

Are There Any Side Effects

The FDA noted that the common side effects included middle ear infection, nausea, dizziness, and procedural pain. Providers should monitor for surgical complications. It noted that the therapy is not recommended for patients with anatomy that prevents safe access to the inner ear.

The FDA approval comes after a landmark study, published in the New England Journal of Medicine, showed the benefits of hearing restoration. In trials, 80% of children aged 10 months to 16 years showed real improvement in just 24 weeks. This is not expected in the natural history of the disease without intervention.

For the past two days, Delhi locals have been waking up to extreme heatwave conditions. The India Meteorological Department (IMD) issued a warning of an extreme heatwave for Friday and Saturday, and we are now on day 2. On Friday, temperatures in the national capital were recorded at 43.1 degrees Celsius and 41.9 degrees Celsius. At the Ridge station and Lodhi Road, a high of 41.8 degrees was recorded, which met the criteria for heatwave conditions. Citing this, the IMD issued a yellow alert for Saturday, forecasting isolated heatwave conditions in the city. With this comes an increased risk of heat stress.

What is heat stress?

Heat stress refers to a state wherein the body absorbs more heat from the environment or produces heat through exertion that overwhelms the body's natural cooling system. This is caused by humidity, high temperatures, or exercise, leading to symptoms like headaches, dizziness, and, in extreme cases, heatstroke.

Heat stress occurs when the body is exposed to radiant heat, high air temperature, physical exertion, high humidity, or low air movement. It harms the body's ability to maintain a normal core temperature, thereby resulting in dehydration and cardiovascular strain. It is advised to wear protective clothing and drink plenty of water to stay hydrated.

What are the signs of heat stress?

Dr Anirban Chattopadhyay, Senior Consultant, Critical Care Medicine, CK Birla Hospitals, CMRI, in an interaction with Health and Me, spoke about the symptoms of heat stress. The expert said, “As the summer season begins and the sunlight is now scorching, heat and related symptoms increase. One of the early symptoms of heat exhaustion is headache, light-headedness, dizziness, and brain fog. This happens because the brain is temperature-sensitive. That is why patients often experience a headache when temperatures rise. This occurs due to vasoconstriction. One may experience dizziness and brain fog because the brain cannot withstand high levels of heat. These are the early symptoms of heat stress.”

When heat stress or prolonged heat exposure continues, it can progress to a more serious condition. This may even lead to a comatose state, known as heatstroke. Therefore, avoid direct sunlight exposure. If possible, stay indoors during peak hours, from 12 pm to 3 pm. Drink plenty of water to keep yourself hydrated, and consume electrolyte-containing fluids to maintain balance. When going out, use umbrellas and sunglasses, and wear breathable fabrics like cotton.

Heatwave across Central and North India

The heatwave is not restricted to the national capital—it is currently affecting northern and central states such as Madhya Pradesh, Rajasthan, Bihar, Chhattisgarh, Chandigarh, and Haryana. The conditions are likely to continue until April 27, with low chances of relief in the coming week.

World Malaria Day is observed on April 25 every year - on this day, experts spread awareness about malaria, an infection caused by the bite of the female Anopheles mosquito. Its symptoms include extremely high fever, headaches, chills, and fatigue. However, ahead of or during the monsoon season, people often get confused between viral fever and malaria due to similar symptoms. As a result, the infection is diagnosed late. On this occasion, Health and Me interacted with experts to learn more about the tests that one must take for malaria diagnosis.

An increase in the number of patients presenting at diagnostic centres with very high fevers has been attributed to people assuming they have a seasonal virus; however, when these patients present later, they often have life-threatening complications. According to the World Health Organization, over 280 million cases of viral infections worldwide were reported last year, making the clinical distinction between malaria and viral diseases increasingly deceptive.

Which tests to take for malaria diagnosis?

Dr Divya C, Microbiologist at Neuberg Anand Reference Laboratory, said, “Diagnostic testing has also transformed from the traditional microscope to more advanced diagnostic techniques, such as dual-target RDT (rapid diagnostic test), which detects HRP2 and Pf-LDH antigens. The RDT may not be able to detect some infections with lower numbers of malaria parasites circulating in the patient’s bloodstream. Therefore, all negative RDTs must be followed by microscopy to confirm the result.”

The expert went on to say that molecular PCR tests are now the preferred tests for cases with low parasite density or asymptomatic carriers, as they can detect fewer than 10 parasites per microlitre of blood with high levels of sensitivity. Some leading laboratories that perform PCR testing are also including AI-assisted digital microscopy as a supplement to the process, reducing human fatigue and providing significantly more precise results than a manual smear could.

What happens when malaria is diagnosed late?

The risk of “waiting to see” if malaria develops after the initial temperature spike is that, unlike most other viral fevers, malaria infects human red blood cells; the consequence of waiting can be organ failure or cerebral complications within 48–72 hours after the initial symptomatic temperature spike.

It is recommended that any patient with cyclic chills, excessive sweating, or fatigue should be tested based on differential diagnosis, as India moves towards becoming malaria-free by 2027. There is a short 15-minute diagnostic window to determine whether a patient can be treated without complications or is at risk of dying from malaria if it is missed.

Dr Praveen K Bharti (Scientist G), Director, ICMR–National Institute of Research in Tribal Health (NIRTH), Jabalpur, said, “We need testing to catch malaria early, but we also need the right kind of tests. Traditional tests often miss low-density, mixed, and asymptomatic infections. These are not minor gaps. As India advances towards its malaria elimination goals by 2030, point-of-care molecular tests for malaria diagnosis that can detect low-density, hidden reservoirs of infection will prove to be the key differentiator.”