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Organic Chemistry

Swimming against the tide: Technocrat Ashwin Desai’s journey to the billionaires club – Forbes India

Ashwin Desai, Founding Promoter and Managing Director, Aether IndustriesImage: Mexy Xavier

Ashwin Desai loves swimming, especially against the tide. Make no mistake, he is no daredevil. In his own words, the 72-year-old is an ordinary family man who enjoys the little joys of lifewhether it is going on long bike rides with his wife or taking a nine-day long walk from Surat to Shirdi or occasionally starting his day by swimming in the Tapi river, followed by surti sev khamani for breakfast.

But look closely into his journey into Forbess billionaire club and Desais life appears rather tumultuous, involving walking away from his family business after his fathers demise to trading his familys upmarket and swanky bungalow for a one-bedroom house before giving up control of a company he built from scratch.

Desai is the founding promoter and managing director of Surat-based Aether Industries, a publicly traded specialty chemical company that manufactures active ingredients for sectors as diverse as pharmaceuticals, agriculture, and oil and gas. It is also a provider of contract research and manufacturing services (CRAMS) to numerous multinationals. I never thought I would be a billionaire, says Desai. Because, at heart, Im still a core engineer or a technician. Maybe you can label me a technocrat.

Desai took Aether public in June 2022, almost a decade after he started the company, raising 808 crore from the capital markets. The companys shares were listed at a 10 percent premium, rallying over 42 percent in the last nine months, and are today valued at 11,200 crore. The company posted annual revenues of nearly 600 crore last year with profits of 108 crore. Desai and family own 87 percent stake in Aether, whose clients range from Saudi Aramco to Dr Reddys and United Phosphorus Limited, among 200 others.

About half of the companys revenues come from the pharmaceutical business while one-third from supplying products for the agrochemical industry. The remaining comes from material science, photography and coatings, among others. Aether primarily operates its business under three business models that involve large-scale manufacturing of its own intermediates and specialty chemicals, followed by CRAMS and exclusive contract manufacturing.

Of this, the company is the lone maker of some specialty chemicals in India, including 4MEP, MMBC and DVL. 4MEP is used in the pharmaceutical sector, MMBC is used in the agrochemical sector and DVL as a coating additive.

When we started Aether, we wanted the company to be based on chemistry and technology, Desai says. Chemistry is obvious. But technology is something the industry doesnt adopt much. So, we thought that we will encompass chemistry with technology, and that will be our driving force rather than one particular product.

That also meant setting up a pilot plant, where the company experiments with products and makes them in small batches, before large-scale productiona practice not prevalent in the country, according to Desai. The company claims to have one of the largest pilot plants in the world with 106 reactors installed; it helps to generate critical scale-up data in the transition from R&D to manufacturing while also helping to manufacture low-volume, high-value products.

Aethers strength lies in the large pilot plant (for complex chemistries) backed by a strong R&D team, scale-up facilities and long-term engagement with marquee clients, Ranvir Singh, a research analyst with Edelweiss Wealth Research, said in a report last year. Our quick estimates suggest the companys earnings would more than double in the next three years. The company cherry-picks products having more than 25 percent margin for development.

Also read: Inside the shaken house of Adani

Desai grew up in Indore, in a large bungalow, with his parents and four sisters. His father, who Desai says started from nothing, had an umbrella manufacturing business in the city. Desai, however, wasnt fascinated by that world. Instead, he wanted to study chemical engineering and enrolled at the Institute of Chemical Technology (ICT), formerly the University Department of Chemical Technology, in Mumbai.

I had the marks to take admission in any college of my choice, Desai says. But I chose chemical engineering, and the dilemma was that none of my family or even distant family was in chemicals. My father was amused, as I was the only son. But I was passionate about pursuing my dream in the chemical field and he graciously let me do that.

While in college, Desais father passed away and he soon had to decide between staying on with the family business, where his uncle was partner, or stepping away. Again, I chose my path, Desai says. His uncle, meanwhile, retained him in the umbrella business till he finished college.

By 1976, after a few years of working various jobs, Desai moved with his mother to Surat, where his brother-in-law lived, determined to start something of his own. We started from scratch because he (brother-in-law) was also not aware of anything in the chemical sector, Desai says. While staying in a one-bedroom apartment in Surat, Desai rented a small farm with a well, far from the city, to manufacture sulfuryl chloride, an inorganic compound that was being imported in the country, and among the most dangerous chemicals. The chemical is used in dyes and the pharmaceutical sector.

Ashwin Desai (right) started Aether in 2013 with wife Purnima and sons Aman (extreme left) and Rohan Desai as whole-time directors

We developed a new type of catalyst and succeeded in it, and my whole capital cost at that time fell from 2.5 lakh to 50,000, says Desai, who, with his brother-in-law, soon started Anupam Rasayan Limited, with the idea of manufacturing sulfuryl chloride. We went on adding products and developed every product for the first time in India, says Desai.

Much of his success with Anupam Rasayan, Desai reckons, was because of his focus on research and development, with a keen understanding of the market where the company manufactured products that werent available in the country then. By 2013, some 36 years after he started Anupam Rasayan, Desai stepped away as chairman and managing director, leaving it to his nephew and their family.

I had to take a decision, Desai says. Either I had to retain the company or leave it. Because my nephew was prepared on both fronts. Coincidentally, Anupam Rasayan went public a few months before Aether hit the bourses.

Very few people can let go and thats often a limiting factor, says Aman Desai, wholetime director at Aether, and Desais younger son. Its not easy to find someone in India who has built up two specialty chemical companies from scratch and made them successful. He had spent his lifetime building Anupam, and its not easy to step out of your comfort zone at 62 to build something from scratch again. That ability to let go, especially for someone from that era, and free up his mind is what makes him strong.

Desai, Aman says, had the option of retaining Anupam but decided to build something new with his sons. He said he wanted to spend the next 10 years of his productive life doing something he was passionate about, says Rohan Desai, wholetime director at Aether and Desais elder son. We did have the option of a private equity while at Anupam to retain control, but he was of the firm belief that he didnt want to leave any liabilities for us. Thats also why, at Aether, we skipped private equity.

Aman, like his father, holds a bachelors degree in chemical technology from ICT, and a PhD in organic chemistry, while Rohan looks after the commercial side of the business. The four of us started on slate zero, with no person from Anupam, and no product from Anupam, Desai says. This time, Desai says, he wanted to pay more attention to technology alongside chemicals, which led them to set up their pilot plant.

We chose to have a business model based on a pilot plant, Desai says. In the Indian chemical industry, there arent pilot plants. They have a lab and then they go straight to production. That was one of the most unique concepts we had.

They spent the initial three years setting up the R&D facility and the pilot plant, and began manufacturing on a large scale in 2016. In 2015, the company acquired land to set up two production facilities, and also chose to begin commercial production of its flagship product, 4MEP.

Like a true technocrat, I didnt transfer the money (from his Anupam Rasayan stint) to mutual funds, shares, gold or any farmhouse, Desai says. I am a typical technocrat, whos happy to follow my passion than focus on status.

The company also identified some 20 products that were not being produced in India before it finalised 10. It also helped that the Chinese chemical industry was in the midst of some turbulence. In 2016, when we entered the market with our product, the Chinese downturn had started because of issues relating to pollution and safety, Desai says. There were shutdowns, and we had a red carpet welcome with all our customers. That was our luck.

Indias share in the global chemicals sector could triple to 10 to 12 percent by 2040, creating an additional $700 billion market value, over and above the current contribution of $170-180 billion, according to a report by McKinsey in March. The specialty chemicals segment is likely to be a key driver of this growth. It has the potential to contribute more than $20 billion to Indias net exports by 2040, a 10x jump from the current total of $2 billion, the report says.

Today, Aether is the largest global manufacturer of products such as NODG, 4MEP, T2E and HEEP, and remains their sole manufacturer in India. Along the way, Desai reckons he has taken the fight to the Chinese, especially on the cost front. We are now exporting products to China, he says.

Also read: Dasari Uday Kumar Reddythe billionaire founder who swears by his 4 am regime

In March, Aether signed a pact with Saudi Aramco Technologies Company to exclusively manufacture and commercialise the converge polyols technology and product line. Before that, Aether had worked with Aramco on a contract research and manufacturing model business model.

One of Aethers main focus areas is to convert R&D (CRAMS) opportunities provided by its clients into large-scale/contract manufacturing projects, HDFC Securities said in a report in April. The company does so by offering value engineering, developing innovative processes and undertaking its core competency chemistries in the companys contract manufacturing/exclusive manufacturing operations. This allows the company to enter into long-term contracts with its customers that provide assured product offtake and better margins, thereby helping improve Aethers profitability.

Its partnerships, especially with over 200 customers across 18 countries, has helped improve the companys expertise, giving it enough ammunition to build a wide array of products. We have worked with hundreds of thousands of products in the last 10 years, and that knowledge has enriched us in a very big way, Desai says. We are one of the few companies that can give a gram-level product to our customer, or at a tonne level, or even at 1,000 tonnes.

It also helped that Chinas supply chain issues have pushed global companies to seek out Indias specialty chemicals sector in recent times. India is cost-competitive in several chemical segments due to low capital and operating expenses such as labour, utility and overhead expenses etc, McKinsey adds in its report. Coupled with the promoters focus on high profitability and a culture of process innovation, Indian chemical companies generate one of the highest Ebitda per unit of investment in fixed assets. The future of the Indian chemical sector looks promising, and the country could potentially become the driving force of the demand and supply of the world chemical market.

For now, Desai has serious ambitions for Aether. The company has procured 31 acres of land, where it says it will be adding more production capacity over the next decade in addition to launching new products. The company is also looking at acquisition opportunities in the US and Europe for R&D and manufacturing assets. We have a good reason to grow, Desai says.

Desai now has two more years to part with 13 percent of his stake in the company in line with market norms capping promoter stakes. That also means more money in store for further expansion. At the same time, whatever we are accruing in our profit is being put back into the system, Desai says. We want to grow in a structured manner, and at the same time come up with something unique that we will be known for.

We may be small compared to many global companies, says Aman. But we have only been manufacturing for 10 years. While import substitution, pharmaceuticals and agrochemicals are part of our focus area, its the non-pharma, non-agro part of business where there is significant potential, and we have become pioneers there. We are in a golden era for Indian specialty chemicals, because people have severely burnt their fingers in the China basket and the West cannot manufacture.

That means Desai, who still puts in 10 hours at work, knows very well that his 10-year-old company is only getting started. He has now handed over the active running of the business to his sons, while he plans the direction of the company.

If you are free, if you are open, then you get a lot of good ideas, Desai says. So, I believe that my job is to create ideas and give direction to the company.

So, what would he tell the young boy who left his parents and family in his quest to study chemical engineering? If you believe in something, you must never worry about it, Desai says. You can succeed only when you are totally involved in it. And as for his billionaire tag, he likes to reiterate. These figures are all fun. I dont take them seriously.

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Swimming against the tide: Technocrat Ashwin Desai's journey to the billionaires club - Forbes India

Endocrinology

Save Your Heart, Save Your Life – University of New Mexico

The most important reason that I appreciate this award is that it gives me an opportunity to talk to many people that I normally never talk to and tell them that theres no reason to die of a heart attack, Schade said. I can theoretically save a few lives by getting people to understand that they can do something about it.

Schade, who serves as chief of the Division of Endocrinology & Metabolism, has been at UNM since the 1970s and has been the principal investigator on multiple large multicenter clinical studies involving diabetes and cardiovascular research. He has nearly 700 peer-reviewed publications.

In recent years, he has focused on the direct connection between diabetes and heart disease.

The problem with diabetes is not everybody is in good glucose control, Schade says. In those cases, elevated blood sugar damages the nerves, kidneys and lining of the blood vessels including those supplying the heart. The talk will really be about preventing heart disease in everybody, and particularly in diabetic patients, he says.

Schade cited four major risk factors for heart disease: diabetes, smoking, hypertension and high cholesterol. Some diabetic patients have all four, and of course they die at an early age, he says. Meanwhile, the societal costs of heart disease are staggering, claiming nearly 600,000 lives in the U.S. every year.

If you have a heart attack and you pay for all the nurses and all the doctors and all the medications and then you follow the patient, its $100,000, he says. In New Mexico, there are 6,000 calls to the emergency med service every month for chest pain.

With emeritus professor R. Philip Eaton, MD, Schade helped persuade the New Mexico Legislature in 2021 to mandate that health insurance plans cover the cost of coronary artery calcium scans, which cost about $150.

The non-invasive CT scan accurately predicts a persons risk of suffering a heart attack by identifying the presence of calcium-containing plaques in the inner lining of the blood vessels.

Weve sent a letter to Washington to try to get Medicare to cover the cost of a calcium scan, Schade says. Medicare doesnt cover it, even though Medicaid does.

Should a coronary artery calcium scan detect evidence of silent heart disease, lifestyle changes coupled with medication therapy can actually reverse the damage in the arteries, he says. Im trying to get the message out that you can do something to prevent it.

Schade is hoping for a big audience with whom to share his message of health empowerment.

This is a talk for everybody and everybody will enjoy it, Schade says. It will mean something to everybody, because everybody has a heart.

Continued here:

Save Your Heart, Save Your Life - University of New Mexico

Endocrinology

Working to fill the gaps in transgender health care – The Boston Globe

CONCORD, N.H. Health care for transgender people has become a hot button political issue, and providers in New England say the political debate around gender-affirming care makes their jobs harder.

Dr. Frances Lim-Liberty, a pediatric endocrinologist, and Jessica Smith, an endocrinology nurse practitioner and program coordinator for the states only pediatric and adolescent trans health program at Dartmouth Health, spoke with the Globe about the care they provide. The program has grown steadily since it began in 2014, and now serves about 500 young people from New Hampshire, Vermont, and Northern Massachusetts.

Lim-Liberty and Smith addressed the most-common myths surrounding trans health care, how this care helps young people, and how terrified patients are of losing access to it.

Q: You say theres no lower age limit about when youll start seeing patients at the clinics. When it comes to families with younger children, why are they seeking care?

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Lim-Liberty: Many have questions. They want to know how to support their kids. They are seeking therapists and mental health specialists who understand childhood and gender identity development.

We spend a lot of time counseling. The biggest gender affirming medical care we provide is guiding the family to resources, answering questions about puberty, where to find gender neutral clothing, where to find an understanding hairdresser. We have support groups, and a library with books and educational guides. Were trying to fill the gaps.

Q: What kinds of medical care do you offer?

Smith: If someone is thinking about medical affirmation, they first meet with a social worker, a psychologist, an endocrine provider, and therapists. Theres a team ready before we start.

Lim-Liberty: We are really careful in our approach. By the time were ready to start a puberty blocker or estradiol or testosterone, weve had many conversations and discussions.

Q: How do you talk to parents who might not understand gender affirming health care?

Smith: Usually those kids are really hurting by the time they see us. We try to engage parents by bringing in the mental health team and talking about the importance of treatment and what thats going to look like. When we have a young person struggling with distress related to gender dysphoria, we have to treat that in the same way we treat any other medical diagnosis. Outcomes are good.

Lim-Liberty: The most important part is sorting out the myths theyve heard, and the biases that they hold.

Q: What are some of the most common myths you encounter?

Lim-Liberty: That gender is a binary. Were all raised in a binary world. We have them start to think about gender as a spectrum and talk about what its like to have aspects of both masculinity and femininity.

Smith: We spend a lot of time talking about the fact that gender identity isnt easily influenced. Its normal that their teenager is hanging out with other trans kids. They find each other naturally, in the way athletes find each other and become friends.

Q: Theres a lot of talk about puberty blockers. What are they and when are they used?

Smith: Theres a big spread of disinformation about puberty blockers. Folks who have an anti-trans agenda are trying to use this as a scare tactic to say we are harming young people and thats absolutely false.

Puberty blockers have been used in pediatric endocrinology for decades to treat precocious puberty so there is a very good amount of data demonstrating safety and efficacy. We use puberty blockers to pause puberty for young people who are exploring their gender identity.

These are completely reversible medications. If a young person wants to stop the blocker and go through their natal puberty, we can do that safely with no bad outcomes. If somebody decides to transition from a puberty blocker to gender affirming hormone therapy, we can also do that.

Lim-Liberty: Theres lots of studies showing positive impacts on mental health: dropping depression rates, dropping suicidality and suicidal ideation. Jess and I experience that every day when were in the transgender clinic. We see these kids change, we see them blossom, we see them become the people that they talk about wanting to become at that first visit. We see them go from being reserved and quiet to being interested in activities or opening up about something they really like.

Q: The New Hampshire legislature considered a bill this session that would restrict the kind of care you can provide. Whats it like to be doing this work now given the political climate?

Lim-Liberty: Its very hard to be told that your work is wrong. Its very hard to be told that the trans kids you take care of every day shouldnt exist. Never have I, in any of the other endocrine conditions or diseases, had to defend someone for being who they are.

I dont like fighting legislation. Thats not not my training. Thats not something that I learned in medical school. While Im honored to do that, its also robbing me of the clinical work I need to be doing here. Its not fair to our kids.

We want our program to grow, and when we dont have the time and the resources to do that because were in Concord explaining that what were doing is best practice medicine, its I dont even have the right word: maddening, frustrating, unfair.

Smith: Gender affirming care is life saving work, And to have folks without an ounce of medical training saying we are harming children certainly that impacts us, but it has an incredible impact on our patients who are already marginalized and at risk. Theyre terrified they are going to lose care: What happens if New Hampshire bans gender affirming care? Where do we go? What do we do? We have to realize the impact this has on the trans community.

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Working to fill the gaps in transgender health care - The Boston Globe

Endocrinology

Obesity is gateway to fatal diseases: Chandigarh hosts discussion on diabetes, endocrinology – The Indian Express

Obesity is not just a cosmetic disorder; it has its roots in the bodys endocrinological system. If ignored, it becomes the reason for many other irreversible health problems.

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This was one of the main issues discussed in a two-day continuing medical education (CME) that began in Chandigarh Saturday (April 15) on various aspects of diabetes and endocrinology. Sweet Diabetes Foundation is organising the CME to empower doctors by keeping them aware of international trends in treating advanced diabetes. More than 400 experts are participating in the CME and 25 doctors and health experts took part in the keynote session.

Dr Sachin Mittal, one of the leading endocrinologists of India and founder of Sweet Diabetes Foundation, spoke in detail about the lethal combination of diabetes and obesity, which he terms diabesity.

Diabetes, obesity, and heart disease have become common problems, even among the young. As per International Diabetes Federation, in India, 7.7 lakh people above 18 have diabetes, and the numbers are rising rapidly. Obesity is also increasing alarmingly across all age groups, including children and young adults. Chandigarh is fast emerging as the obesity capital of India, and its high time we focus on diet and healthy lifestyle to address the issue of childhood obesity, said Dr Mittal.

As per the Indian Council for Medical Research, Chandigarh (13.6 per cent) has the highest prevalence of obesity (among adults) compared to the rest of the country (11.8 per cent). Besides Indians being a high-risk group, a sedentary lifestyle and bad dietary habits are the major factors behind this rise.

Noted speakers also included Dr Saptarishi Bhattacharya, who talked about new-age treatments for obesity while talking about healthy diet parameters. Olympic gold medallist Abhinav Bindra will join the CME as the chief guest on the concluding day, April 16.

First published on: 16-04-2023 at 13:08 IST

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Obesity is gateway to fatal diseases: Chandigarh hosts discussion on diabetes, endocrinology - The Indian Express

Endocrinology

expert reaction to study looking at disturbed sleep and … – Science Media Centre

April 15, 2023

A study published in the Lancet Respiratory Medicine and presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) looks at sleep disturbance, dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK.

Dr Ivana Rosenzweig, Clinical Reader in the Neuroscience of Sleep, Kings College London, said:

Does the press release accurately reflect the science?

The study is a well-designed prospective multicentre cohort substudy that investigated the effects of sleep disturbance on recovery after COVID-19 in a cohort of adult participants, who were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Based on their findings, the authors of the study (justifiably) speculate, that sleep disruption may be a major drive of breathlessness in these patients. However, it remains unclear to which extent this is further affected/moderated by the associated reduced muscle function and increased anxiety, both also recognised causes of breathlessness.

Is this good quality research? Are the conclusions backed up by solid data?

I agree that major strengths of the study include its size, multicentre nature, and the use of different complementary assessment measures to evaluate sleep disturbance. The findings and the authors conclusions are also further supported by the replicated and consistent clinical associations across each evaluation method.

Have the authors accounted for confounders? Are there important limitations to be aware of?

This is a substudy of a larger study, and thus, it is impossible to exclude that there are other potentially unaccounted for confounders. However, the authors were frank that only associations and learned conclusions can be done in clinical research, this is sometimes as good, and as close as we can get in uncovering the underlying mechanisms, and the authors have done their best to declare all possible limitations and to exclude or account for all known confounders.

What are the implications in the real world? Is there any overspeculation?

It will be now really interesting to see if interventions targeting sleep disturbance can improve daytime breathlessness too.

Dr Richard Russell, Clinical Reader in Respiratory Medicine at King College London, said:

This is an important study in that it sheds light into the nature of Long-Covid, its impact on those living with it and also a new focus for treatment. This nation-wide study was performed by an expert group who have looked at Long-Covid in a robust manner. This study has generated new evidence on this condition and also confirmed the importance of sleep to human well-being.

Sleep quality is not just about quantity; too little is not good for health as is too much. Quality is important. The finding that sleep disturbance occurs in people living with Long-Covid and that this is linked to symptoms is important as there are effective strategies to improve sleep quality that will hopefully impact the burden of this disease and improve the lives of those living with it.

Prof David Ray, Professor of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Diabetes; and Sir Jules Thorn Sleep and Circadian Neuroscience Institute, University of Oxford, said:

This is an observational cohort study. People hospitalised with Covid, after discharge were invited to take part, and about 50% of those approached did so. Observational data can identify associations, and here breathlessness was associated with poor sleep. It could be that breathlessness leads to poor sleep, the other way around, or something else e.g. anxiety could lead to both. The authors acknowledge the limitations of the study design, and attempt to control for them. However, it is clear that poor sleep and poor quality of life are closely linked, and so attention to improving sleep may be a low risk, and high gain approach to help people suffering with long covid. That would require a proper interventional trial, and that may be hard to do as the covid waves are now subsiding.

Prof Nicholas Hart, Professor of Respiratory and Critical Care Medicine, Kings College London, said:

This important study provides further insights into physical and mental health impact following hospitalisation as a consequence of COVID-19 infection. This study has shown that sleep disturbance, anxiety and dyspnoea (breathlessness) were more prevalent in hospitalised COVID-19 survivors following discharge. Of particular interest, these patients showed greater rest time and less efficient sleep during recovery. The next step is to confirm or exclude sleep disordered breathing or other sleep disorders, such as periodic limb movement disorder, so that we can apply interventions to improve sleep quality and assess the impact on breathlessness and anxiety.

Dr Julie Darbyshire, Senior Researcher, University of Oxford, said:

Patients rarely sleep well in hospital and poor sleep following hospital admission is common. Feeling breathless, especially overnight, is distressing and this study demonstrates how this is associated with disturbed sleep.

This study assessed sleep using validated methods which ensures quality of recording and comparison with other similar sleep assessment studies.

It is important to note that this study asked people to recall their sleep before they were hospitalised which is an unreliable measure. Comparisons between sleep before and after hospitalisation are therefore less reliable than comparisons between measures reported in real-time. This should not detract from the wider message that sleep quality after hospitalisation with COVID-19 is poor and is also associated with lower measures of health.

The statistical analysis in the article provides compelling evidence for the association between sleep and breathlessness, muscle weakness, and anxiety after hospitalisation for COVID-19. The press release suggests that sleep disruption might cause breathlessness (dyspnoea) whereas the article itself reports an association between the two without attributing a causal pathway. The press release does not mention the other primary associations with greatest sleep irregularity which include a lower deprivation index, smoking, existing depression or anxiety, diabetes, high blood pressure, and kidney disease.

Although we cant be sure from this study, it is plausible that targeting sleep disruption following admission to hospital for Covid may improve general health and recovery in some people, including muscle strength, anxiety, and breathlessness. In general I would say that for any patient struggling to sleep, regardless of why they were admitted to hospital, addressing this is likely to have an effect on their recovery.

Prof Amitava Banerjee, Professor of Clinical Data Science and Honorary Consultant Cardiologist, Institute of Health Informatics, UCL, said:

This is a detailed and very interesting analysis using novel methods, showing that sleep disturbance is common in patients hospitalised with COVID, even 5-8 months following hospital admission, and the sleep quality seems to be worse, even when compared with control groups in UK Biobank, both hospitalised and non-hospitalised. The authors found associations with multiple symptoms, especially shortness of breath, anxiety and muscle weakness.

However, there are some limitations. First, as the accompanying editorial notes, there may be biases in the patients who had sleep monitoring, compared to the overall population of people hospitalised with Covid. Second, this study only concerns hospitalised post- Covid individuals. The majority of people with Long Covid were not hospitalised for Covid so the results may not be generalisable to this larger group. Third, this study only shows correlation and does not show that sleep disturbance causes the symptoms of long Covid. For example, the sleep disturbances could well be an effect rather than a cause of symptoms like breathlessness and anxiety.

Good quality sleep is important for health and reduces risk of chronic diseases, such that it is included in the American Heart Associations Lifes Essential 8 health behaviour recommendations (https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8). Quality of sleep is therefore likely to be important for those with Long Covid in reducing their risk of chronic disease, but the role of sleep in the mechanism of Long Covid needs further research.

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study by Callum Jackson et al. was published in the Lancet Respiratory Medicine at 23:30 UK time on Saturday 15 April 2023.

DOI: 10.1016/S2213-2600(23)00124-8

Declared interests

Dr Ivana Rosenzweig: No COIs.

Prof David Ray: No conflicts.

Prof Nicholas Hart: I am part of PHOSP but not part of this study. No other conflicts relating to this work.

Dr Julie Darbyshire: I have no conflicts of interest to declare. I was the Chief Investigator for the NIHR funded SILENCE study which investigated the relationship between sound levels, sleep, and delirium in the intensive care unit, and Im currently working alongside patients with long covid to understand how long covid clinics can best support their recovery.

Prof Amitava Banerjeeis the chief investigator of STIMULATE-ICP, an NIHR-funded study in non-hospitalised individuals with Long Covid. He has also received research funding from Astra Zeneca unrelated to Covid or Long Covid.

For all other experts, no reply to our request for DOIs was received.

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expert reaction to study looking at disturbed sleep and ... - Science Media Centre

Endocrinology

Do You Have an Under-active Thyroid? This 90-Second Quiz Helps … – The Healthy

If youve ever suspected that your metabolism is a little sluggish, you might also wonder whether you have an under-active thyroid. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), around 5% of Americans aged 12 years or older have an underactive thyroid, or hypothyroidism. Thyroid experts like Dr. David S. Cooper, MD, MACP, with the division of endocrinology, diabetes, and metabolism at the Johns Hopkins University School of Medicine, suggest that the number of American adults experiencing mild hypothyroidism may be even higherpossibly closer to 10%.

Symptoms of an underactive thyroidcan be vague, and many hypothyroid symptoms can be confused with other medical conditions. So while the most reliable method of diagnosing an under-active thyroid is to see a licensed healthcare provider who runs lab workmaybe repeatedlysigns of hypothyroidism can start with a few main clues.

And note how important this can be. An under-active thyroid doesnt just cause frustrating questions about whether your body is utilizing calories as efficiently as it could. More severe cases of hypothyroidism can cause frustrating symptoms and pose health risks, in particular for cardiovascular health. Depending on how low your thyroid hormone levels are, medical treatment might be called for.

The Healthy @Readers Digest partnered with endocrinologists to develop a quiz that will help you determine whether its time to talk to your doctor about getting tested for hypothyroidism.

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Dr. Cooper says that in general, if you experience several of the symptoms we asked about that can be linked with hypothyroidism, speak with your licensed doctor. In most cases, your doctor can determine whether you have hypothyroidism using a routine blood test that measures levels of thyroid stimulating hormone (TSH).

That said, Dr. Cooper says its important to remember that many of the symptoms that can be associated with hypothyroidism can be caused by other conditions. Many of these symptoms are also experienced by people who are perfectly healthy, he adds. Dry skin is one example. Also according to Dr. Cooper, severe hypothyroidism tends to be fairly rare in the United States.

Dr. Cooper says that if your TSH levels are only a little higher than normal, and youre not experiencing any troublesome or severe symptoms, you may not need to start taking thyroid hormone replacement medications. But medically speaking, he says healthy levels of TSH tend to sit between 0.5 and 4, and people that have TSH levels of 10 or higher typically require treatment.

According to the experts, most health risks associated with hypothyroidism are related to severe or prolonged hypothyroidism, not mild cases. But Dr. Desai explains, untreated hypothyroidism can have long-term effects, ranging from mild conditions to life-threatening conditions.Hypothyroidism has been linked to infertility [and an] increased risk of miscarriages, she says. It has been associated with birth defects, including impaired mental development.

Dr. Desai adds that hypothyroidism can also cause elevated cholesterol levels, which can increase your risk of heart disease. She further explains that hypothyroidism can impact mental health, as it can lead to depression and can cause cognitive slowing. Hypothyroidism can also cause your thyroid gland to grow in size, which leads to the formation of a goiter, or enlarged thyroid gland.

Dr. Desai concludes by saying that in very severe cases of long untreated hypothyroidism, you can experience myxedema coma, which is a life-threatening condition that requires hospitalization.

Sources

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Endocrinology

Science Update: Children born to women with COVID-19 could be at … – National Institute of Child Health and Human Development

Infants born in 2020 through mid-2021 to women with COVID-19 weighed less at birth, but grew at a faster rate than a comparable group born to women who did not have COVID-19, according to a study funded by the National Institutes of Health. Previous studies have found that preterm infants and other infants who are small or underweight at birth and who undergo catch-up growth in the first year are at higher risk for later life obesity, heart disease, high blood pressure and diabetes, compared to infants born at normal weight. The authors called for additional studies of infants whose mothers had COVID-19 during pregnancy to learn if they have increased health risks later in life.

The study was conducted by Andrea Edlow, M.D., and Lindsay Fourman, M.D., of Massachusetts General Hospital, and colleagues. It appears in The Journal of Clinical Endocrinology and Metabolism. NIH funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with additional support from the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of Allergy and Infectious Diseases.

According to the U.S. Centers for Disease Control and Prevention, in 2020, pregnant women comprised 9% of reproductive aged women with COVID-19. Compared to nonpregnant females of similar age, pregnant people with COVID-19 are more likely to experience severe disease, more likely to be admitted to an intensive care unit, and more likely to need mechanical ventilation to help them breathe. Mothers with COVID-19 are more likely than those without the infection to give birth preterm and to have hypertensive disorders of pregnancy. Moreover, placentas from pregnancies complicated by COVID-19 are often inflamed at the junction between the maternal and fetal parts of the placenta and contain higher amounts of immune cells from mother and fetus.

Despite these ill effects, pregnant people with COVID-19 are unlikely to pass the virus on to their babies. However, few studies have been conducted on the potential long-term effects that may be experienced by children born to mothers with COVID-19 during pregnancy.

For the current study, researchers compared weight, length, and body mass index (BMI) at birth, 2 months, 6 months, and 12 months of 149 babies born to mothers with COVID-19 during pregnancy to those of 127 babies born to mothers without any symptoms of COVID-19. For each infant, researchers calculated a z-score for each of the three measures. Z-scores are a comparison measure of an individual to a formal standardin this case, average weight, length, and body measurements compiled as growth charts by the World Health Organization.

At birth, infants born to mothers with COVID-19 and those born to mothers without COVID-19 did not differ in average z-scores for length. However, those exposed to COVID-19 during pregnancy had an average birth weight z-score that was 30% lower than those not exposed and a BMI z-score that was 35% lower than that of the unexposed infants. By 12 months, infants exposed to COVID-19 in the uterus had a 53% greater gain in BMI z-score than the infants not exposed to COVID-19.

Although preterm infants often have a similar pattern of accelerated growth in comparison to term infants, the authors did not find preterm birth to be the cause of the rapid growth they saw in their study, as the z-scores considered gestational age at birth, and the study did not include enough preterm infants to account for the difference.

In fact, the difference between the two groups persisted, even after researchers statistically compensated for factors known to influence infant size, such as the mothers age and BMI.

The pattern of catch-up growth seen in infants exposed to COVID-19 during pregnancy may place them at risk for heart disease and other obesity-related illnesses later in life. The findings underscore the need to prevent COVID-19 in pregnant people using such protective measures as vaccination and wearing masks indoors, before and during pregnancy.

Ockene, MW, et al. Accelerated longitudinal weight gain among infants with in utero COVID-19 exposure. The Journal of Clinical Endocrinology & Metabolism. 2023.

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Science Update: Children born to women with COVID-19 could be at ... - National Institute of Child Health and Human Development