If hand sanitisers kill 99.99% of germs, then who are those 0.01% who survive? There are three major kinds of germs which remain active even when you have used your sanitiser.

Norovirus

Among them, is the norovirus that causes diarrhoea and vomiting outbreaks in places like cruise ships and schools. It is superior to many other viruses because it has a protein capsid, which is resistant to the effects of alcohol.

Norovirus is a group of viruses that causes common illnesses and is also very contagious. It is especially active in the colder month and comes back seasonally. The first norovirus outbreak occurred in Norwalk, Ohio, USA, in a school in 1968, this is where it gets it name from.

Enterococcus faecium

The next on the list is enterococcus faecium, and it lives in the gut. As per a 2024 study titled Enterococcus faecium: evolution, adaptation, pathogenesis and emerging therapeutics, published in Nature journal, it is a Gram-positive bacterium that is a core member of the intestinal microbiota of humans and animals and an opportunistic pathogen that causes life-threatening infections, particularly among hospitalized patients. It mutates in a way that it absorbs carbohydrates and forms a gooey, slime-like substance called the biofilm, which makes it resistant to alcohol.

Clostridium Difficile

Another one is clostridium difficile. This is responsible for causing horrendous diarrhoea and vomiting in hospitalised patients. It also has a remarkable ability to respond to environmental stressors including alcohol gel by going to sleep. It produces spores and allows all metabolic activity.

Clostridium difficile (C. diff) is a type of bacteria that can cause colitis, a serious inflammation of the colon. Infections from C. diff often start after you've been taking antibiotics. It can sometimes be life-threatening.

Why Do You Label Read 99.99%?

Apart from the germs and pathogens, another reason why your label reads that it kills 99.99% is to avoid any legal hassles. If someone uses a specific product and falls sick, then the person cannot sue the company as the company did not give a 100% safety guarantee against the germs.

A better way to be healthy is always to clean your hands with soap and water and wear gloves wherever is possible.

Alzheimer's disease is one of the most prevalent types of dementia, and one of the biggest challenges is that the disease can begin many years before symptoms such as memory loss, confusion, or difficulty performing daily activities become noticeable. By the time these signs appear, important changes may have already occurred in the brain.

New hope comes from recent advances in diagnostic technologies. Scientists are developing specialized brain imaging techniques that can detect changes associated with Alzheimer's disease long before symptoms develop. These scans can identify abnormal protein deposits, such as amyloid and tau, which are known to play a key role in the disease process. Early identification of these changes may help doctors monitor individuals more closely and initiate timely interventions.

In addition to brain imaging, blood-based biomarkers are emerging as a promising tool for Alzheimer's screening. Recent research has shown that certain proteins linked to Alzheimer's disease can be detected through simple blood tests. While these tests are not yet a replacement for comprehensive evaluation, they may help identify individuals who require further assessment and could make early screening more accessible and affordable in the future.

These advanced tests are not currently recommended as routine screening for everyone, but they represent a significant step forward in early diagnosis and personalized care. Early detection may allow individuals to make informed life decisions, manage risk factors such as diabetes, hypertension, high cholesterol, and obesity, and potentially benefit from newer treatments that are most effective in the early stages before significant brain damage occurs.

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Prevention, early detection, and timely intervention are the keys to the future of Alzheimer's care. As science advances, innovative imaging techniques and blood-based tests could help shift the focus from managing symptoms to identifying risk earlier and preserving quality of life. Early awareness and proactive brain health management remain our strongest tools in the fight against Alzheimer's disease.

Dr. Aparna Gupta, Director, Neurology, ISIC Multispeciality Hospital

Vitiligo is an acquired disorder of depigmentation characterized by white patches on the body. It affects all races. There is a lot of stigma associated with the disease due to disfigurement. The affected persons suffer from psychological distress, low self-esteem, and social neglect. Inadequate knowledge and age-old misconceptions are the key reasons for this undue apprehension associated with this condition.

Common Myths About Vitiligo

There is a misconception that vitiligo can spread by contact. However, vitiligo is non-contagious and does not spread by contact.

Another misconception is that sour food causes vitiligo, which is not scientifically proven. It cannot be transmitted through contact, shared items, or proximity. It is not caused by bacterial, viral, or other infectious agents. It tends to be more noticeable in people with darker skin, due to higher contrast between affected and unaffected areas.

There is no significant variation in people of different races, religions, and socio-economic status for predisposition to vitiligo. There is another myth that vitiligo and leprosy are the same, as both present with white skin.

What Causes Vitiligo?

The exact cause is multifactorial, with hypotheses based on genetic—autoimmune, neural, and biochemical theories. There is a role of acquired factors like stress and infections in its clinical expression. It is associated with other autoimmune disorders like diabetes mellitus, alopecia areata, Addison's disease, and thyroid disorders.

The course of the disease is unpredictable. If you notice any skin discoloration, reach out to a dermatologist for early diagnosis and treatment.

What You Can Safely Do Around Someone With Vitiligo

Bust the myths about vitiligo with proper information regarding the condition.

• You can safely touch or hug someone with vitiligo
• You can share food, drinks, or utensils.
• Use the same towels, clothes, or bedding
• Swim in the same pool
• Live, work, or study in close quarters
• There is zero risk of transmission.

By proper public awareness, the social stigma associated with the condition can be debunked. A qualified dermatologist can diagnose the condition with medical history, Wood's lamp examination, and blood tests to rule out other autoimmune diseases.

There is no cure for vitiligo, but treatment to restore pigmentation and to prevent progression of the disease can be done. Counseling and support groups to help patients with this disorder can make a meaningful difference.

(Dr. Saji Firoz, Consultant, Dermatology & Cosmetology, KIMSHEALTH, Thiruvananthapuram)

Fentanyl is an FDA-approved, quick-acting narcotic painkiller that is nearly 100 times more potent than morphine and 50 times stronger than heroin. While it has important medical uses, widespread illicit use has created a public health crisis, with researchers now warning that commonly used addiction treatments are struggling to keep pace.

A study by researchers at the University of California, Los Angeles, found that people who regularly use illicit fentanyl consume opioid doses equivalent to morphine levels hundreds of times higher than the fentanyl doses used in hospitals—far beyond what current addiction treatment protocols were designed to address.

Published in the journal Drug and Alcohol Dependence, the findings suggest these extreme exposure levels contribute to high opioid tolerance, making medications for opioid use disorder (MOUD) less effective and increasing overdose risk.

Although methadone and buprenorphine remain highly effective at reducing overdose deaths, many patients have struggled to start and remain on treatment since fentanyl replaced heroin as the dominant illicit opioid in the US because of the severity of fentanyl withdrawal, the team said.

Daily Intake Far Exceeds Treatment Protocols

The researchers estimated fentanyl exposure using morphine milligram equivalence (MME), a standardized measure that compares the potency of different opioids.

The analysis combined purity data from more than 500 fentanyl samples collected by Drug Checking Los Angeles between September 2023 and January 2026 with surveys of 47 people who regularly used fentanyl.

The researchers estimated that participants consumed an average of 8,887 MME per day.

According to the US Centers for Disease Control and Prevention (CDC), just 2 mg of fentanyl can be lethal for an opioid-naïve person. The study found that the average fentanyl user in Los Angeles consumes roughly 60 times that amount each day.

Tolerance develops not only to the drug's intoxicating effects but also to the respiratory depression that causes overdose, said Dr. Chelsea Shover, associate professor in the Department of Health Policy and Management.

"Now, we find that people are regularly exposed to doses of opioids that would have seemed impossible to me before I started this work," Shover said.

"To put it in perspective, in hospital settings, fentanyl is often dosed in 100-microgram vials. One gram of average-purity fentanyl that we tested had a dose equivalent to more than 1,200 of these vials. So people are getting daily doses that are on par with injecting hundreds of the hospital vials or taking 440 Percocet pills."

Why It Matters for Addiction Treatment

According to the researchers, the potency and variability of illicit fentanyl mean that people are consuming opioid doses far beyond what existing treatment protocols were designed to manage.

"Of course, starting MOUD is going to be harder for fentanyl than it is for heroin," Shover said.

"This study is a great example of where our science was directly informed by lived experience. It is a call to take withdrawal management seriously, with adjuvant therapies, and compassionate approaches."

As a fully synthetic drug, fentanyl is cheaper and easier to produce than heroin. Its high potency also increases the risk of unintentionally consuming dangerous amounts, raising the likelihood of overdose.

"It's no longer, 'how do we treat someone who smokes a gram of fentanyl per day,' it's 'how do we treat someone using thousands of MMEs of oral morphine in fentanyl per day?' That question and its answers feel more accessible, less abstract to clinicians," Shover said.

Standard Treatment Guidelines May Need Updating

The study reinforces concerns among addiction experts that standard treatment regimens for opioid addiction may no longer adequately address patients with extremely high fentanyl tolerance.

Current doses of medications such as buprenorphine and methadone were originally developed to treat heroin and prescription opioid addiction. The findings add to growing calls from clinicians to update treatment guidelines to reflect today's illicit fentanyl market.

"When patients say their withdrawal is not being treated well, it's important to listen," Shover said.