“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.

Alex Hughes, the son of former Wales and Manchester United footballer Mark Hughes, has died at the age of 38 from Sudden Arrhythmic Death Syndrome (SADS), also known as Sudden Adult Death Syndrome.

Alex Hughes, who served as Grimsby Town's Head of Player Recruitment, was found collapsed on the bedroom floor of his Cheshire home by his two sons at around 7 a.m. on June 19, an inquest at Cheshire Coroner's Court heard.

According to the hearing, Alex's eldest son immediately began CPR before paramedics arrived. Despite prolonged resuscitation efforts, emergency responders were unable to revive him.

Area Coroner Victoria Davies concluded that Hughes died from Sudden Arrhythmic Death Syndrome (SADS), a condition in which a fatal heart rhythm abnormality causes sudden cardiac arrest even though the heart appears structurally normal during a post-mortem examination.

Following his death, Mark Hughes and his wife, Jill, said they were "totally heartbroken by the sudden and unexpected loss of our beloved son."

What Is Sudden Arrhythmic Death Syndrome (SADS)?

SADS refers to a sudden, unexpected death caused by an abnormal heart rhythm in people whose hearts appear structurally normal after death. The condition is most commonly linked to inherited disorders that affect the heart's electrical system, triggering life-threatening irregular heart rhythms (arrhythmias) that can lead to sudden cardiac arrest.

According to the British Heart Foundation, around 500 people die from SADS each year in the UK, with young adults—particularly men—being most commonly affected.

What Causes SADS?

Most cases of SADS are caused by inherited genetic conditions that interfere with the heart's electrical signals. Because these disorders often cause few or no symptoms, many people remain unaware they have them until a cardiac arrest occurs.

Early diagnosis through cardiac evaluation and family screening can help identify those at risk and prevent sudden deaths.

Inherited Conditions Linked to SADS

Several inherited heart rhythm disorders are associated with SADS, including:

• Brugada syndrome: Causes dangerous abnormal rhythms in the heart's lower chambers (ventricles).
• Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): Triggers dangerously fast heart rhythms during exercise or emotional stress.
• Long QT syndrome (LQTS): Delays the heart's electrical recovery between beats, increasing the risk of life-threatening arrhythmias.
• Short QT syndrome (SQTS): Causes the heart to recharge too quickly, raising the risk of atrial fibrillation and ventricular arrhythmias.
• Timothy syndrome: A rare form of Long QT syndrome associated with severe heart rhythm abnormalities.
• Wolff-Parkinson-White (WPW) syndrome: An extra electrical pathway in the heart causes episodes of rapid heartbeat.

Symptoms That May Signal SADS

Many people with inherited heart rhythm disorders experience no warning signs. However, symptoms that warrant medical evaluation include:

• Fainting or seizures, particularly during exercise, excitement or emotional stress.
• Chest pain during physical activity.
• Shortness of breath while exercising.
• Episodes of rapid or irregular heartbeat (palpitations).
• A family history of unexplained sudden cardiac death.

The Ebola outbreak in the Democratic Republic of Congo (DRC) has crossed 4,000 cases, making it the second-largest Ebola epidemic ever recorded after the 2014-2016 West Africa outbreak.

According to the latest Health Ministry situation report, the DRC has recorded 4,053 cases and 1,850 deaths since the outbreak was officially declared in mid-May. Health officials believe transmission may have begun as early as January.

The outbreak is caused by the Bundibugyo strain of the Ebola virus, which has neither a vaccination nor any antiviral. However, two vaccine candidates by Oxford-SII and Moderna have entered clinical trials.

Africa CDC Calls for Intensified Response

Africa's public health agency has said the current response needs to be significantly expanded, announcing plans to shift from traditional contact tracing to an active, community-wide search for cases.

Dr. Wessam Mankoula, Acting Head of Emergency Preparedness and Response at the Africa Centres for Disease Control and Prevention (Africa CDC), said response teams will begin door-to-door case finding.

"I think the time for incremental action is over and we're starting now the phase for scaling up," he said.

He explained that community health workers would move from house to house to identify people showing Ebola symptoms rather than relying solely on contact tracing.

Africa CDC Director General Dr. Jean Kaseya also outlined plans for a village-centered response, with greater community involvement, expanded use of digital surveillance tools, and stronger interventions in camps housing people displaced by conflict.

Second-Largest Ebola Outbreak on Record

The outbreak has spread across 53 health zones in the provinces of Ituri, North Kivu, South Kivu, Haut-Uele and Tshopo.

Ituri, the epicentre of the outbreak, accounts for 86.9% of confirmed cases.

Africa CDC noted that, 11 weeks into the outbreak, the DRC has reported eight times more cases and six times more deaths than were recorded at the same stage of the 2014 West Africa Ebola epidemic, which ultimately infected more than 28,000 people and killed at least 11,000.

Is The Bundibugyo Virus Mutating?

Health officials are now examining whether changes in the virus could be contributing to the unusually severe outbreak.

Speaking at a press briefing, Dr. Jean Kaseya said he had discussed the situation with World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus.

"We plan studies to check if there is no additional issue, or maybe if the virus is not mutating, because the level of severity of this Bundibugyo outbreak is unprecedented," Kaseya said.

He cautioned against assuming scientists fully understand the virus.

"After many Ebola outbreaks, we cannot assume we know everything. In the DRC, we must listen to communities, act on what they tell us and build the trust needed to stop transmission."

Outbreak Shows No Signs Of Slowing

Medical charity Médecins Sans Frontières (MSF) said the response is expanding but is still not reaching communities quickly enough to interrupt transmission, The Guardian reported.

Philippa Boulle, MSF's Deputy Medical Director, warned that the outbreak continues to spread into new areas.

"New suspected cases are being reported almost daily in new locations, outside already identified transmission chains. To prevent further loss of life, the response must outpace the current rate of transmission," Boulle said.

Kaseya also highlighted shortcomings in surveillance, noting that only 10 contacts are being identified per Ebola patient, compared with the approximately 40 contacts typically expected during effective contact tracing.

The US Food and Drug Administration (FDA) has granted accelerated approval to Replimune's Tudriqev for the treatment of advanced refractory melanoma—a deadly form of skin cancer that continues to grow or spread despite treatment with standard immunotherapy drugs such as PD-1 inhibitors.

The approval comes after the FDA rejected the therapy twice over concerns related to the quality of clinical data.

The latest decision was supported by clinical trial results showing that 24% of patients responded to treatment, with responses lasting a median of 14.1 months. The FDA also considered input from clinical experts and patient advocates, who highlighted the urgent need for new treatment options for patients with refractory melanoma.

What Is Tudriqev?

Tudriqev is an oncolytic viral immunotherapy based on a genetically modified herpes simplex virus type 1 (HSV-1). The virus is engineered to selectively infect and destroy cancer cells while stimulating the body's immune system to recognize and attack the tumour.

The therapy is approved in combination with nivolumab for adults with unresectable melanoma that:

• Has spread or cannot be safely removed through surgery.
• Has progressed after treatment with a PD-1-blocking antibody-based regimen.

"For patients with advanced melanoma that has stopped responding to PD-1 blocking therapy, the prognosis is often devastating, and options have been far too limited. Clinicians managing these patients know this urgency firsthand," said Karim Mikhail, Acting Director of the FDA's Center for Biologics Evaluation and Research (CBER).

Also read: Narcolepsy: US FDA Approves First-Ever Pill That Targets Root Cause of Rare Sleep Disorder

How Does Tudriqev Work?

Tudriqev is injected directly into tumours, where the modified virus replicates inside cancer cells, causing them to rupture. At the same time, it activates the immune system to identify and attack cancer cells throughout the body.

When combined with nivolumab, an anti-PD-1 immunotherapy, Tudriqev may help restore an anti-tumour immune response in patients whose melanoma no longer responds to checkpoint inhibitor therapy.

How Is The Treatment Given?

Tudriqev is administered once every two weeks for eight consecutive doses.

• The dose is determined by tumour size.
• A lower concentration is used for the first injection, followed by a higher concentration for the remaining doses.
• Nivolumab is administered intravenously starting in week three of treatment.

Replimune has announced a list price of $450,000 per course of therapy, before rebates and discounts.

Clinical trial results

The FDA based its approval on an open-label, multiregional, single-arm trial involving 140 adults with Stage IIIB, IIIC, or IV unresectable melanoma whose disease progressed after at least eight consecutive weeks of prior anti-PD-1 therapy.

Among the 91 evaluable patients:

• 24% achieved an objective response.
• The median duration of response was 14.1 months.

A confirmatory Phase III study is currently underway to verify the drug's clinical benefit. Replimune expects results in 2030.

Safety and Side Effects

The most common side effects reported in more than 10% of patients included:

• Fatigue
• Fever (pyrexia)
• Infections
• Chills
• Musculoskeletal pain
• Nausea and Vomiting
• Diarrhoea
• Injection-site reactions
• Headache
• Cough
• Influenza-like illness
• Rash
• Shortness of breath (dyspnoea)
• Bleeding (haemorrhage)
• Oedema
• Abdominal pain

The FDA also warned of:

• The risk of accidental transmission of herpes infection to close contacts.
• Development or reactivation of herpes infection in treated patients.
• Injection-related complications.

About melanoma

Melanoma is the deadliest form of skin cancer and the fifth most common cancer in the United States. An estimated 105,000 new cases are expected to be diagnosed in the US in 2025, with the disease causing nearly 8,500 deaths each year.

Immune checkpoint inhibitors are the current standard treatment for advanced melanoma, but about half of patients either do not respond or eventually develop resistance, underscoring the need for new treatment options such as Tudriqev.