WHY DO WE GET GOOSE BUMPS?? EXPLORING THE SCIENCE BEHIND IT!!!

Lots of things can make our hair stand on end, from a cool breeze tickling our neck to a sense of impending danger. We might also experience goosebumps when we hear an inspirational speech or song. Some unrelated events elicit goosebumps. The reason for this is the physiology of emotions!

Centuries ago, people believed that goosebumps made our hair grow faster. Today, we know this is not the case, but goosebumps still hold some mystery.

When we’re cold, or we experience a strong emotion, such as fear, shock, anxiety, sexual arousal or even inspiration, goosebumps can suddenly pop up all over the skin.

Goosebumps occur when the arrector pili muscles cause the hairs to stand up, making the skin look bumpy. The arrector pili are smooth, involuntary muscles that a person cannot voluntarily contract. Hence, people cannot voluntarily cause their goosebumps. When the hairs stand up on the skin, it is known as piloerection. Goosebumps are an involuntary reaction to certain kinds of stimulation.

In a new study, Harvard University scientists have discovered the reason: the cell types that cause goosebumps are also important for regulating the stem cells that regenerate the hair follicle and hair. Underneath the skin, the muscle that contracts to create goosebumps is necessary to bridge the sympathetic nerve's connection to hair follicle stem cells. The sympathetic nerve reacts to cold by contracting the muscle and causing goosebumps in the short term, and by driving hair follicle stem cell activation and new hair growth over the long term.

Published in the journal Cell, these findings in mice give researchers a better understanding of how different cell types interact to link stem cell activity with changes in the outside environment.

These bumps are caused by a contraction of miniature muscles that are attached to each hair. Each contracting muscle creates a shallow depression on the skin surface, which causes the surrounding area to protrude. The contraction also causes the hair to stand up whenever the body feels cold. In animals with a thick hair coat, this rising of hair expands the layer of air that serves as insulation. The thicker the hair layer, the more heat is retained. In people, this reaction is useless because we do not have a hair coat, but goosebumps persist nevertheless.

The medical terms for goosebumps are piloerection, cutis anserina, and horripilation. The term “goosebumps” is most widely used because it’s easy to remember: The little bumps that form on your skin when this phenomenon happens.

The presence of goosebumps with piloerection on the skin tends to suggest that a person is cold, scared, or having an emotionally intense experience. Neurological, endocrine, or other systemic issues may cause this symptom, so people should see a doctor for any unusual or worrisome goosebumps.                  

In addition to cold, the hair will also stand up in many animals when they feel threatened--in a cat being attacked by a dog, for example. The elevated hair, together with the arched back and the sideward position the animal often assumes, makes the cat appear bigger in an attempt to make the dog back off.

People also tend to experience goosebumps during emotional situations, such as walking down the aisle during their wedding, standing on a podium and listening to a national anthem after winning in sports or even just watching horror movies on television. Quite often a person may get goosebumps many years after a significant event, just by thinking about the emotions she once experienced, perhaps while listening to the romantic song to which she danced many years ago with the love of her life.                           

The reason for all these responses is the subconscious release of a stress hormone called adrenaline. Adrenaline, which in humans is produced in two small beanlike glands that sit atop the kidneys, not only causes the contraction of skin muscles but also influences many other body reactions. In animals, this hormone is released when the animal is cold or facing a stressful situation, preparing the animal for a flight-or-fight reaction. In humans, adrenaline is often released when we feel cold or afraid, but also if we are under stress and feel strong emotions, such as anger or excitement. Other signs of adrenaline release include tears, sweaty palms, trembling hands, an increase in blood pressure, a racing heart or the feeling of 'butterflies' in the stomach.

Factors trigger goosebumps

Goosebumps appear when the arrector pili muscles contract, pulling the hairs into an upright position. On areas of the body that do not have much hair or that only have light hair, a person might notice only the erect hair follicle and not the hair itself. Erect hair follicles look swollen and slightly bigger than usual. This enables them to hold the hair upright, and it also causes goosebumps. A number of specific factors can give rise to goosebumps. These include;

Extreme temperatures: Chills and cold: Goosebumps play an essential role in the body’s ability to regulate its temperature. Other mammals, including humans’ primate ancestors, have thick hair that keeps them warm. When the hair stands up, it offers more insulation.

Many people notice goosebumps when they are cold. They may also appear when someone thinks about being cold, such as when they witness a cold scene in a movie. Some people also get goosebumps when they have chills that they associate with an illness or fever. Goosebumps can be experienced in the presence of flash-cold temperatures, for example, being in a cold environment, and the skin being able to re-balance its surface temperature quickly. The stimulus of cold surroundings causes the tiny muscles attached to each hair follicle to contract. This contraction causes the hair strands to stand straight, the purpose of which is to aid in quicker drying via evaporation of water clinging to the hair which is moved upward and away from the skin.

Emotionally intense experiences: Some emotionally intense experiences cause the body to release certain chemicals that can trigger goosebumps.

In an extremely stressful situation, the body can employ the "fight or flight" response. As the body prepares itself for either fighting or running, the sympathetic nervous system floods the blood with adrenaline (epinephrine), a hormone that speeds up heart rate, metabolism, and body temperature in the presence of extreme stress. Then the sympathetic nervous system also causes the piloerection reflex, which makes the muscles attached to the base of each hair follicle contract and forces the hair up. Likewise, intensely pleasurable experiences, such as listening to music or the gentle touch of a loved one, can cause the brain to release dopamine. Dopamine is a chemical that plays a role in motivation, reward, and pleasure. Experiences such as this can also cause goosebumps.

Music: Canadian researchers have suggested that when humans are moved by music their brains behave as if reacting to delicious food, psychoactive drugs, or money. The pleasure experience is driven by the chemical dopamine, which produces physical effects known as "chills" that cause changes in heart rate, breathing, temperature and the skin's electrical conductance. The responses correlate with the degree to which people rate the "pleasurability" of music. Dopamine release is greatest when listeners had a strong emotional response to music. "If music-induced emotional states can lead to dopamine release, as our findings indicate, it may begin to explain why musical experiences are so valued,” wrote the scientists. 

Ingestion: Medications and herbal supplements that affect body temperature and blood flow may cause piloerection. For example, one of the commonly reported side effects of the intake of yohimbine is piloerection.

Drugs: Certain drugs may also cause goosebumps. For example, a 2016 study identified two sisters who experienced goosebumps after taking a medication called milnacipran hydrochloride. Taking drugs that stimulate activity similar to those chemicals in the body that normally cause goosebumps may also trigger the phenomenon. For example, a person experiencing an adrenaline-like rush when using methamphetamine may also have goosebumps. Withdrawal from some drugs, such as opioids, may also cause goosebump.

Opiate withdrawal: Piloerection is one of the signs of opioid withdrawal. The term "cold turkey" meaning an abrupt withdrawal from a drug, may derive from the goosebumps that occur during abrupt withdrawal from opioids; this resembles the skin of a refrigerated plucked turkey.

Voluntary control: Scientists generally agree that, in normal circumstances, goosebumps are involuntary. This is because the arrector pili muscles, which cause goosebumps, are smooth muscles. People cannot typically control smooth muscles, unlike skeletal muscles, which they voluntarily use, for example, to move their legs and flex their arms. However, there is some limited evidence to suggest that a small number of people may be able to exert control over the arrector pili muscles. This enables them to trigger goosebumps voluntarily. A 2018 analysis details a few cases of people who supposedly have control over their goosebump reaction. It seemed that none of the people with this ability learned it via conditioning or training, and doctors do not know what causes it.

Post-mortem goosebumps: After a person dies, the chemical adenosine triphosphate, which provides the energy to cells, depletes, and lactate builds up in the muscles. This process causes the muscles to stiffen, thereby triggering rigour mortis. As part of rigour mortis, the arrector pili muscles also stiffen, giving rise to goosebumps, in most cases, goosebumps are nothing more than a temporary nuisance. However, goosebumps can be a sign of a long-lasting or serious medical condition. For example, goosebumps can also be a sign of:

Keratosis pilaris: A harmless and common skin condition that creates the look of goosebumps on the skin for long periods of time.

Autonomic dysreflexia: An overreaction of the nervous system caused by a spinal cord injury.

Temporal lobe epilepsy: A chronic seizure disorder.

Chills: For example, those associated with fevers caused by influenza.

Goosebumps are not a medical disease. They do not require treatment, and no treatment can completely prevent a person from getting goosebumps. That said, people who feel self-conscious about goosebumps or want to avoid them can reduce their frequency by wearing warm clothing, especially when it is cool outside, avoiding drafts and heavy air conditioning, remaining calm during stressful or emotionally intense situations, avoiding illegal drugs. The right treatment can help manage the symptoms of keratosis pilaris. Some strategies that may help include: regularly moisturizing the skin with thick moisturizing cream, using chemical exfoliators, such as lactic acid or salicylic acid, to remove dead skin, trying laser treatment, if other strategies do not work.

Ms. Aleesha R, M. Pharm, Asst. Professor,

Dept. of Pharmacology, Nirmala College of Pharmacy, Muvattupuzha

ANTIBODY DEPENDENT ENHANCEMENT – WILL IT HAMPER THE COVID – 19 VACCINE DEVELOPMENTS?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a zoonotic the virus in the late 2019 and is the causative agent of COVID-19. Exposure to SARS-CoV-2 can result in a range of clinical outcomes, varying from asymptomatic infection to severe acute respiratory distress and death. SARS-CoV-2 has spread globally and was declared as a pandemic on March 11, 2020, by WHO. As of July 23, 2020, more than 15 million people globally have been infected with more than 6,23,66 deaths. No vaccines have been approved for the prevention of COVID-19. There are currently more than 137 candidates undergoing preclinical development and 23 in early clinical development, according to the WHO. Coronaviruses are enveloped; positive-sense single-stranded RNA viruses with a glycoprotein spike on the surface, which mediates receptor binding and cell entry during infection. The roles of the spike protein in receptor binding and membrane fusion make it an attractive vaccine antigen.

How the coronavirus the
vaccine will work?

Background on Antibody-Dependent Enhancement (ADE)

ADE is also known as immune enhancement or disease enhancement. It involves in the cascade of events whereby viruses may infect susceptible cells via interaction between virions complexed with the antibodies (complement component) and Fc (complement receptors) respectively which leads to the amplification of their replication and increases the infectivity and the virulence.

In the case of ADE, the normal mechanisms of antigen-antibody complex clearance fail and instead it provides an alternative route for host cell infection. ADE has been reported in – vitro in Ebola virus, Zika virus, HIV, SARS and MERS. ADE has been linked to the development of cytokine storm syndrome, which occurs in the most severe cases in the SARS, MERS and the current COVID-19 infections. ADE assays are used as a valuable tool to assess the capacity of antibodies to enhance the secondary infection related to SARS-COV-2 and provide valuable insights into the pathogenesis of the covid-19 infections as well as the vaccine against the coronaviruses.

Viruses can acquire mutations that change the surface proteins, leading to distinct viral serotypes. After getting infected with one viral serotype, the host will produce antibodies to that particular serotype and this protects from the reinfections. The development of antibodies to one serotype doesn’t protect from the second serotype, even if the antibodies produced to the second serotype has the non-neutralizing capacity of the antibodies. Antibodies produced against one viral serotype not only fail to protect against the second viral serotype but actually do harm. These antibodies drive uptake of a newly infecting serotype into immune cells, promoting viral replication and similarly exacerbate the immune response.

ADE and Dengue Virus (DENV)

Dengue is one of the examples of an ADE seen in communities with multiple viral strains circulating. Antibodies developed against the first viral serotype only binds to the next serotype without neutralizing it. DENV can use Fc receptor to infect cells. Immune cells like macrophages dock onto tail ends of the antibodies using the Fc receptor. The antibodies that simply bind to the pathogens will actually end up helping the virus to enter the macrophages to detect the cells.

It was not just the non – neutralizing characteristic of the antibodies but also the neutralizing antibodies which were not numerous enough to block all the key proteins across the virus surface can cause ADE.

ADE and coronavirus           

Coronaviruses mainly infect humans that cause the common cold, so anti–coronavirus antibodies are likely to be present in many people. Several groups have suggested that prior infection with non – SARS coronaviruses promoted severe SARS in 2002–2004. Now the ADE is speculated to be responsible for severe COVID–19. Prior to the infection resulted in a sub–neutralizing level of coronavirus antibodies that enhances SARS–COV–2 replication and promotes the inflammation. It is theoretically possible, but there is little evidence for this so far and in principle, some COVID–19 patients could develop antibodies that don’t neutralize or produce neutralizing ones at insufficient concentrations and then develop severe symptoms if they get re-infected for the second time. But a handful of reported COVID–19 re-infections has found due to flawed tests. In the U.S, patients who received an antibody-containing blood plasma transfusion from COVID-19 survivors, the treatments did not make the situations worse, which is against the ADE.

ADE’s role in vaccine development

Even though it is a theoretical concept, ADE is a possibility that vaccine tested against flu-like infections, peritonitis, and coronavirus disease in cats. The vaccinated kittens died much sooner than the unvaccinated ones. One explanation for this was the proposed ADE; this could have produced antibodies that target parts of the virus without blocking the specific site on its spike proteins which it uses to infect cells – the Receptor Binding Domain (RBD).

The cellular entry of SARS-COV-2 occurs by the interaction between the receptor-binding protein in the spike region (RBD) and the angiotensin-converting enzyme₂ (ACE₂) binding cell receptor. If the immune system gives with the only choice of making an antibody to the RBD, it can drastically limit the possibility of ADE.

ADE is a concern for the monoclonal antibodies (m Abs) too, because the antibodies that fail to neutralize the virus also facilitate the virus entry into the cells. An antibody lacking Fc receptor can’t bind the macrophage and thus can’t cause ADE. That is why some companies are advancing monoclonal antibodies which lack the Fc region. A successful vaccine for prevention of SARS-CoV-2 infection probably needs to incorporate T-cell epitopes to induce a long term memory T-cell immune response to the virus.

The recent Oxford vaccine was found to be safe, tolerated and it produced a humoral immune response to both the spike and the RBD by day 28 of the post-prime and cellular immune response (T-cell) were induced by day 14. Neutralizing antibodies were induced in all participants after the second dose of the vaccine. However, a boost in the cellular responses was not observed following the second dose.

The degree of ADE in coronavirus vaccine is unknown. There are several ongoing clinical trials to check the safety, tolerability and immunogenicity of the coronavirus vaccines. These developing vaccines may give a temporary wave against the SARS-COV-2 as till now there is no study pointing out how long these neutralizing antibodies will be present in our body once we are vaccinated. Neutralizing antibodies from the coronavirus the vaccine will help the host body to develop memory T-cell immune responses which protects from the viral attack of the primary serotype. If in case of an entry of the second viral serotype, the neutralizing antibodies from the vaccine will not be able to produce antibodies against the new antigen from the second viral serotype and hence results in the exacerbated immune responses from the second viral serotype as well as from the neutralizing antibodies of the primary viral serotype. Once the effect of the coronavirus vaccine decreases with the time, the amount of these neutralizing antibodies also gets depleted which point outs the risk for an ADE as well as the re-infection from the second serotype and thus further studies are mandatory to avoid ADE and re-infections. Frequent booster doses of the vaccine can reduce the risk for the re-infections and the ADE as it can boost up the level of the neutralizing antibodies, if so the dose of the booster vaccines and the frequency of administration should be taken into consideration, if not in future if the ADE as well as the re-infection from the coronavirus vaccine can lead to an exacerbated immune response for the vaccinated population than the non-vaccinated ones.

Ms. Helan Kurian, Pharm.D Intern

VIRTUAL TRAVEL: A VIRTUAL REALITY ASSISTED TOOL FOR STRESS RECOVERY

As efforts to contain the effects of COVID 19 crisis ramp up, millions of people across the globe are stuck at their homes. The chaos put forward by COVID 19 has struck the whole idea of ‘travelling’. Countries across the globe have closed their borders to further contain the spread of coronavirus. This unpredicted situation demanded the introduction and adaption of newer technologies to tackle and resume pre-COVID times. 

Researches have proved that travelling results in the so-called ‘Stress Recovery’. Stress recovery refers to the process during which an individual’s functioning returns to its pre-stressor level. Leisure trips of pleasure of travelling can help an individual recover from work stress and hence increase their psychological well-being. None of these principles really could be applied under the current circumstances of COVID 19. But technology has actually paved its way to the solution in VR or virtual reality, by which you can travel across the globe from the comfort of your home or workspace.

 The VR the environment is a fully immersive experience, where the user actually enters a virtual reality room and gets a fully 3-dimensional feeling, where they are free to explore which gives them a strong sense of presence and realism. Studies have proven that the virtual travel experience created through virtual reality can reduce stress and individual well-being, hence better productivity. The pandemic of COVID 19 has drastically digitalised the whole world within the last few months. This rapid digitalisation brought up VR technology as a new tool to resume the concept of travelling, which ultimately is an option for ‘Stress Recovery’.  

The world itself is being pushed to a virtual world, like the virtual classrooms, virtual workspaces, virtual meetings and virtual discussions. A new global concept is on a rise: ‘Virtual is a new reality’. This technology of Virtual reality will help us to presume our travel explorations, which ultimately was one of the best options for Stress recovery. 

Mr Jude James, Pharm.D Intern

HEALTH OUTCOMES RESEARCH: A STRATEGY TO IMPROVE TREATMENT RESULTS

We live in an era where new epidemics and pandemics are emerging along with the pre burden of chronic diseases where hospital admissions are increasing day by day. This has been a challenge to Healthcare organisations and professionals as there has been great pressure on them to provide high-quality care while limiting the cost. Here is where the importance of health outcomes research is understood as it provides a valuable resource to help physicians make better treatment choices which are beneficial and in favour of the patients.

Some of the most effective examples of health outcomes research consider patient-centred outcomes including patient's preferences, lifestyle etc. This also gives a chance for the patients and their caregivers to communicate and state their choices and make informed Healthcare decisions.

The scope of health outcomes research is to be understood and studied very well as when the researchers identify how to implement Health Outcomes Research studies and produce data, the findings could be used in a variety of situations. The biggest role of health outcomes research is in helping physicians to select the most effective treatment options for an individual according to their needs. This, in turn, leads to patient compliance and a safe mode of treatment regimen where the patient's needs are also taken into consideration. But this could only be effective when physicians know and understand how to apply the data on patients. This method comes under another field of research called "implementation science". For example, while clinical trials measure the effectiveness of various clinical approaches, most of the physicians often don't consider various other factors like age, dietary habits etc of an individual which if given a closer look could help alter their treatment approach in a better way.

Looking forward, we expect physicians and other medical professionals to recognize patients as individuals to create a more personalised treatment approach that will likely achieve better results.

Miss Minnu Ann Mohan, III Pharm.D

POST PANDEMIC EFFECTS ON THE INDIAN HEALTHCARE SYSTEM

The COVID-19 pandemic is a watershed moment in the global healthcare landscape. It is straining our health system and revealing how fragile it is, forcing our government to make tough choices keeping in mind the medical accessibility and safety of its citizens.

As goes the maxim, “Necessity is the Mother of Invention”; the healthcare sector, post-COVID-19, is about to undergo transfiguration with a plethora of new ideas.

Focus on the Healthcare System

“The best defence against any outbreak is a strong healthcare system”.The overburdened hospitals need an upgrade on every level from their infrastructures to their processes.

To come up with a successful transformation plan, organizations in the healthcare industry will need to consider a few key points:

Ensuring Regulatory Sync Up and Synergy.
Establishing a new normal through strategic Digital Initiatives

Utilizing Next-Gen adjudication systems.

Impact on Health Care Professionals and Private Health Care Providers:

We can expect our country to re-skill its healthcare workers by implementing training processes and professional education curricula. Post pandemic, due to an unprecedented toll on healthcare workers, there might be an inevitable spike in burnouts among the healthcare staff. More than burnouts, we may see front-liners with symptoms of post-traumatic stress disorder (PTSD).

The private sector had offered the government all the support it needs, be it testing support, preparing isolation beds for patients or deploying equipment and staff. However, this sector is bound to experience a sharp drop in OP footfalls, IP treatment, elective surgeries and International patients.

Impact on Medical devices Industry

The medical devices industry has also taken a hit. Our country imports consumables, disposables and capital equipment including orthopaedic implants, gloves, syringes, CT and MRI devices from China. Due to the current crisis, medical device manufacturers across the country are finding it difficult to source raw materials and electronic components from the Chinese factories. This can also put upward pressure on the prices of medical devices in the short term.

Focus on TeleHealth

The Government of India has been leveraging the potential of digital health care and initiated its journey by introducing the Aarogya Setu app, revising the telemedicine practice guidelines, and promoting both the National eHealth Authority and e-Sanjeevani. Factors such as increased Internet penetration, DISHA (Digital Information Security in Healthcare Act) and Ayushman Bharat are expected to promote a digital health revolution in India.

Artificial Intelligence-Powered Customer Support

The number of telehealth consults has risen exponentially during this pandemic and it will multiply manifolds post- COVID-19. During this outbreak, with an increase in queries and lack of live agents, AI-powered customer support can be used as the first line of communication.
Healthcare professionals are also opting for chatbots for checking symptoms  and accordingly suggest remedies or schedule appointments. 

The COVID-19 pandemic has had a favourable impact on ePharmacies. Continued operations during the lockdowns, coupled with a high demand for medicines, drove positive consumer behaviour. The companies would need to strengthen their supply chain and form a new integrated model for ePharma.

Diagnostics Industry

There is an expectation of phenomenal growth for the diagnostics industry. One of the key challenges while treating patients through telemedicine is of monitoring patients vitals such as BP, heart rate variability etc. Lack of equipment and facilities at home will strengthen the adoption of wearables and diagnostics through remote/contactless care.

Focus on Sustainable Solutions

We all had to experiment with digital solutions, be it virtual meetings for work, online classes for students and virtual events instead of in-person conferences. These proved not only to be effective but also an environmentally-friendly way to operate in a connected world.
The outbreak has laid bare the deficiencies in our health system which heralds the onset of clear and irreversible changes to come.

India is one of the biggest markets for healthcare services consumption. Our population coupled with our industry capabilities is likely to ensure a more robust ‘Make in India’ initiative in the years to come. Healthcare is a necessity and not a luxury, this segment is likely to show exponential growth.

COVID-19 offers a silver lining for eHealth platforms -to embrace change, join forces, and to innovate, creating real value in the healthcare ecosystem.The COVID-19 saga will come to an end without a doubt. However, post-pandemic, life will be significantly different. Thermal sensors will be incorporated in our daily life & digital transformation will be prevalent leading to a healthcare industry equipped with rapid management crisis capabilities. The urgent steps that have been taken to make the health care system more flexible and innovative during the COVID-19 pandemic should not be forgotten once the crisis is over. Many of these steps need to become central features of the health care system to ensure that if such a situation knocks our door again, we will be all set to sail through the storm.

Miss Christy Sojan, II Pharm.D