Metabolic Consequences of Insufficient Sleep.


A small, randomized, controlled crossover study demonstrates changes in a critical insulin-signaling pathway in peripheral tissue.

Small experimental studies have revealed adverse effects of reduced sleep duration on glucose tolerance and insulin sensitivity. To explore the effects of sleep restriction on metabolic activity in peripheral tissue, investigators randomized seven lean, healthy young adults (aged 18–30) to undergo 4 weeks each of normal and restricted sleep (8.5 and 4.5 hours, respectively), in random order and under controlled conditions, 4 weeks apart. The primary endpoint was change in levels of phosphorylated Akt — an important step in the insulin-signaling pathway — in abdominal subcutaneous adipocytes.

Phosphorylation of Akt was 30% lower after restricted sleep than after normal sleep (P=0.01). This reduction coincided with a 16% reduction in total-body insulin sensitivity, as measured by frequently sampled intravenous glucose tolerance tests.

Comment: We know that partial sleep restriction is associated with marked adverse changes in insulin sensitivity and glucose tolerance; now, this small study shows a correlation between sleep restriction and significant changes in molecular metabolic pathways in subcutaneous abdominal fat. I wonder if this line of research will lead us to recognize sleep deprivation as a precursor risk factor for metabolic abnormalities that lead to vascular disease — and whether we might eventually prescribe more sleep to our high-risk patients.

Source: Journal Watch Cardiology

Update on the Outbreak of Fungal Meningitis Associated with Contaminated Methylprednisolone.


The index case that led to the recognition of the outbreak is described, and what is currently known about the outbreak is detailed in a preliminary report.

A new report provides details on the index case in the recent outbreak of fungal meningitis associated with contaminated methylprednisolone injections.

An immunocompetent man in his 50s presented with headache and neck pain; 4 weeks earlier, he had received a lumbar epidural injection of methylprednisolone. Although computed tomography of the head was unrevealing, cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis and marked hypoglycorrhachia. One of several CSF samples grew Aspergillus fumigatus. Despite antifungal therapy, the patient developed seizures, and his mental status declined. Further neuroimaging revealed evidence of a mycotic aneurysm and cerebral and cerebellar infarcts. The patient died on hospital day 22, after discontinuation of life support. Autopsy revealed branching hyphae consistent with Aspergillus in the lumbar epidural region as well as within the wall of a cerebellar artery aneurysm. CSF analysis revealed high levels of Aspergillus antigen, but Aspergillus did not grow in cultures of samples collected postmortem.

Comment: This case led to the identification of a multistate outbreak of fungal meningitis associated with epidural injections of methylprednisolone. As Kauffman and colleagues point out, what is interesting is that another fungus, Exserohilum rostratum, appears to be the culprit in most of the 200-plus other cases so far identified. As of October 22, 2012, this mold had been cultured or identified by polymerase chain reaction in the CSF of 52 patients and has been detected in unopened vials from implicated lots of methylprednisolone.

More than 14,000 persons may have been exposed to contaminated drug injections. Persistent headache, CSF neutrophil predominance, and posterior circulation stroke are common presentations. The incubation period has usually been 1 to 4 weeks, but the maximum is unknown. Currently, voriconazole alone — or, in patients with severe or refractory central nervous system disease, combined with intravenous liposomal amphotericin B — for at least 3 months is recommended.

Source: Journal Watch Infectious Diseases

 

Novartis drug Votubia® approved in the EU as first medication to treat patients with non-cancerous kidney tumors associated with TSC.


  • Prior to this approval, surgical intervention was the only option in Europe for these tuberous sclerosis complex (TSC) patients[1],[2]
  • Kidney tumors, or renal angiomyolipomas, affect up to 80% of patients with TSC and growing tumors may lead to life-threatening complications[1],[3]
  • Approval marks the second TSC-related indication for Votubia in the EU, where it is also approved to treat a non-cancerous brain tumor associated with TSC[2]

 

Novartis received approval from the European Commission (EC) for Votubia® (everolimus) tablets* for the treatment of adult patients with renal angiomyolipoma associated with tuberous sclerosis complex (TSC) who are at risk of complications (based on factors such as tumor size or presence of aneurysm, or presence of multiple or bilateral tumors) but who do not require immediate surgery[2]. This marks the first approval of a medical treatment in this patient population in Europe[1],[2].

 

“Renal angiomyolipomas affect the vast majority of patients with TSC and over time can cause debilitating symptoms, a decline in renal function, and possibly even the need for kidney transplant or dialysis,” said Dr. Chris Kingswood, Royal Sussex County Hospital, Brighton, United Kingdom. “This approval represents a major advance in the treatment of the disease in Europe, giving clinicians a non-surgical option to manage TSC kidney tumors.”

 

This approval is based on data from the Phase III EXIST-2 (EXamining everolimus In a Study of TSC) trial, which found that 42% of patients taking everolimus experienced an angiomyolipoma response versus 0% of patients in the placebo arm (p<0.0001). The evidence is based on analysis of the change in the sum of the angiomyolipoma volume. Median time to angiomyolipoma progression was 11.4 months in the placebo arm and was not reached in the everolimus arm (p<0.0001)[2].

 

“For the first time, European patients living with renal angiomyolipoma associated with TSC now have an effective non-surgical option,” said Hervé Hoppenot, President, Novartis Oncology. “This approval reinforces the potential of Votubia to treat a wide range of manifestations associated with TSC, a debilitating, lifelong disease where there remains critical unmet need.”

 

Up to 80% of patients with TSC, a genetic disorder that may cause non-cancerous tumors to form in vital organs, develop renal angiomyolipomas. Typical onset occurs between the ages of 15 and 30 and prevalence increases with age[3]. Over time, these kidney tumors may grow large enough to cause severe internal bleeding, require emergency surgical interventions, such as embolization and nephrectomy, and lead to kidney failure or cardiovascular diseases[1],[3],[4]. The tumors can be difficult to manage as they may be numerous and often form in both kidneys[3]. In the EU, approximately 7,000 TSC patients have large growing renal tumors (>3 cm) at risk of bleeding[5],[6],[7].

 

Everolimus works by inhibiting mTOR, a protein implicated in many tumor-causing pathways[2],[8]. TSC is caused by defects in the TSC1 and/or TSC2 genes[2]. When these genes are defective, mTOR activity is increased and can cause uncontrolled tumor cell growth and proliferation, blood vessel growth and altered cellular metabolism[8],[9]. According to preclinical studies, by inhibiting mTOR activity in this signaling pathway, everolimus reduces cell proliferation and blood vessel growth[8].

 

This EC approval follows a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) adopted for Votubia in September 2012 for the treatment of renal angiomyolipoma associated with TSC and applies to all 27 EU member states, plus Iceland and Norway.

 

About EXIST-2

EXIST-2 is the first double-blind, randomized, placebo-controlled, international, multicenter Phase III study for the treatment of patients with renal angiomyolipoma associated with TSC. Trial patients (median age=31, range 18-61) were randomized 2:1 to receive either everolimus (n=79) or placebo (n=39) at a daily dose of 10 mg. The median duration of blinded study treatment was 48 weeks in the everolimus arm and 45 weeks in the placebo arm[2].

 

In the study, 42% of patients on everolimus (33 of 79; 95% confidence interval [CI] 30.8-53.4) experienced an angiomyolipoma response versus 0% on placebo (0 of 39; 95% CI 0.0-9.0; p<0.0001), defined as a 50% or greater reduction in the sum of angiomyolipoma volume relative to baseline, the absence of new tumor growth at least 1 cm in longest diameter, absence of kidney volume increase of 20% or greater and no renal angiomyolipoma-related bleeding of Grade 2 or higher[2].

 

Everolimus demonstrated improvement when compared to placebo for both key secondary endpoints measured: time to angiomyolipoma progression and skin lesion response rate. There were three patients in the everolimus arm and eight patients in the placebo arm with documented angiomyolipoma progression by central radiologic review. The time to angiomyolipoma progression was longer in patients on everolimus (hazard ratio [HR] 0.08, 95% CI 0.02-0.37; p<0.0001). Skin lesion response rate was higher in the everolimus arm. A partial clinical response in skin lesions (corresponding to a 50% or greater improvement) was observed by Physician Global Assessment in 26% of patients on everolimus, compared with 0% of patients on placebo (p=0.0011). No complete responses were observed[2].

 

The most common adverse reactions reported in the everolimus arm during the double-blind period (with an incidence at least 15%) included stomatitis, hypercholesterolemia, aphthous stomatitis, mouth ulceration and acne. The most common Grade 3 adverse reactions in the everolimus arm (with an incidence of at least 2%) were amenorrhea, aphthous stomatitis and mouth ulceration. The most common laboratory abnormalities (incidence >= 50%) were hypercholesterolemia, hypertriglyceridemia and anemia. The most common Grade 3-4 laboratory abnormality (incidence >= 3%) was hypophosphatemia[2].

 

About everolimus

Everolimus is now approved in the European Union (EU) as Votubia® (everolimus) tablets for the treatment of adult patients with renal angiomyolipoma associated with tuberous sclerosis complex (TSC) who are at risk of complications (based on factors such as tumor size or presence of aneurysm, or presence of multiple or bilateral tumors) but who do not require immediate surgery. The evidence is based on analysis of change in sum of angiomyolipoma volume. Everolimus is also approved in the United States (US) as Afinitor® (everolimus) tablets for the treatment of adult patients with renal angiomyolipomas and TSC, who do not require immediate surgery. The effectiveness of Votubia in treatment of renal angiomyolipoma is based on an analysis of durable objective responses in patients treated for a median of 8.3 months. Further follow-up of patients is required to determine long-term outcomes.

 

Everolimus is also approved in the EU as Votubia for the treatment of patients aged 3 years and older with subependymal giant cell astrocytoma (SEGA) associated with TSC, who require therapeutic intervention but are not amenable to surgery. The evidence is based on analysis of change in SEGA volume. Further clinical benefit, such as improvement in disease-related symptoms, has not been demonstrated. In the US, everolimus is approved as Afinitor and Afinitor Disperz(TM) in pediatric and adult patients with TSC for the treatment of SEGA that requires therapeutic intervention but cannot be curatively resected. The effectiveness is based on demonstration of durable objective response, as evidenced by reduction in SEGA tumor volume. Improvement in disease-related symptoms and overall survival in patients with SEGA and TSC have not been demonstrated.

 

Everolimus is also available from Novartis as Afinitor for use in oncology settings and for use in other non-oncology patient populations under the brand names Certican® and Zortress® and is exclusively licensed to Abbott and sublicensed to Boston Scientific for use in drug-eluting stents.

 

Indications vary by country and not all indications are available in every country.

 

Important Safety Information about Votubia/Afinitor

Votubia/Afinitor can cause serious side effects including lung or breathing problems, infections and renal failure which can lead to death. Mouth ulcers and mouth sores are common side effects. Votubia/Afinitor can affect blood cell counts, kidney and liver function, and blood sugar and cholesterol levels. Votubia/Afinitor may cause fetal harm in pregnant women. Highly effective contraception is recommended for women of child-bearing potential while receiving Afinitor and for up to 8 weeks after ending treatment. Women taking Votubia/Afinitor should not breast feed.

 

The most common adverse drug reactions (incidence >=15%) are mouth ulcers, diarrhea, feeling weak or tired, skin problems (such as rash or acne), infections, nausea, swelling of extremities or other parts of the body, loss of appetite, headache, inflammation of lung tissue, abnormal taste, nose bleeds, inflammation of the lining of the digestive system, weight decreased and vomiting. The most common Grade 3-4 adverse drug reactions (incidence >=2%) are mouth ulcers, feeling tired, low white blood cells (a type of blood cell that fights infection), diarrhea, infections, inflammation of lung tissue, diabetes and amenorrhea. Cases of hepatitis B reactivation and blood clot in the lung and leg have been reported.

Source: Novartis newsletter

 

 

CABG Again Outperforms PCI in Patients with Diabetes.


In patients with diabetes and heart disease, coronary artery bypass grafting reduces cardiovascular events more effectively than PCI with drug-eluting stents, according to a study presented at the American Heart Association meeting and published in the New England Journal of Medicine.

Some 1900 diabetic patients with multivessel disease were randomized either to undergo PCI with drug-eluting stents or CABG.

During roughly 4 years’ follow-up, the primary composite outcome — death from any cause, nonfatal MI, and nonfatal stroke — occurred more often with PCI than with CABG (5-year event rate: 27% vs. 19%). In particular, death and MI were more common with PCI, while stroke was more common with CABG.

In Journal Watch Cardiology, Harlan M. Krumholz calls the observed superiority of CABG a “blockbuster result.” He adds: “The excess risk for stroke, however, may give some people pause. The issue is ripe for shared decision making; these findings will greatly benefit patients and their doctors working together to make well-informed choices.”

Source:NEJM

 

Vegetable caterpillar.


Caterpillar fungus, Vegetable Caterpillar or Yarsagumba is a Chinese medicine product that is a result of a parasitic relationship between a fungus and a caterpillar, found in southwestern mountains of China. As the fungi invades, it grows off larvae and the end result is desiccated caterpillar shell, with a fungal fruiting body attached. It is known in the West primarily from its use in Traditional Chinese medicine, where it is a prized ingredient.

Names

In it is known as Yartsa Gunbu , source of Nepali:????????????, Yarshagumba, Yarchagumba.
It is also known as ”keera jhar” or ”keeda ghas” in India. Its name in Chinese “dong chong xia cao” means “winter worm, summer grass” . The Chinese name is a literal translation of the original Tibetan name, which was first recorded in the 15th Century by the Tibetan doctor Zurkhar Namnyi Dorje in his text: Man ngag bye ba ring bsrel .

The name ‘vegetable caterpillar’ is a clear misnomer. Caterpillar fungus is a preferable term.

In traditional Chinese medicine, its name is often abbreviated as “chong cao”, a name that also applies to other ”Cordyceps” species, such as ”C. militaris”.

Strangely, sometimes in Chinese English language text Cordyceps sinensis is referred to as ‘Aweto’, which is the Maori name for a different Cordyceps species from New Zealand. In Japanese it is known as tochukaso/tohchukaso.

Natural history

The caterpillar prone to infection by the fungus lives underground in alpine grass and shrublands on the Tibetan Plateau and the Himalayas at an altitude between 3000m and 5000m. Spending up to five years underground before pupating, the caterpillar is attacked while feeding on roots. The fungus invades the body of the ”Thitarodes” caterpillars, filling its entire body cavity with mycelium and eventually killing and mummifying it. The caterpillars die near the tops of their burrows. The dark brown to black fruiting body emerges from the ground in spring or early summer, always growing out of the forehead of the caterpillar. The long, usually columnar fruiting body reaches 5-15 cm above the surface and releases spores.

In Nepal caterpillar fungus is found on the subalpine pastures in Dolpo in Karnali Zone and Darchula in mahakali zone. It is also common in Bhutan and India’s Himachal Pradesh. Reports from distribution outside of High Asia are probably erroneous and relate to other species of ”Cordyceps”, e.g. ”Cordyceps militaris”.

It is not certain how the fungus infects the caterpillar; possibly by ingesting a fungal spore or by the fungus mycelium invading the insect through one of its breathing pores.

It is also found in Nandadevi centuary in Uttarakhand Himalayas of India. In the onset of Summer grasslands of Delisera, Dharansi, Malari are populated by the local people, who can be seen crouching on the ground and looking for the “Kira Jari” or the caterpillar root. The locals clean this fungus, dry it and sell it at 100 – 150 rupees each.

Because of its rarity and value, inter-village conflicts over the grasslands has become a headache of the local governing bodies.

Use in Medicine

Traditional Chinese medicine

The first mention of ”Cordyceps sinensis” in traditional Chinese Medicine was in the 18th Century.

The entire fungus-caterpillar combination is hand-collected for medicinal use.

The fungus is highly prized by practitioners of Tibetan medicine, Chinese medicine and traditional herbal Folk medicines, in which it is used as an aphrodisiac and as a treatment for a variety of ailments from to cancer. It is regarded as having an excellent balance of yin and yang as it is apparently both animal and vegetable . Assays have found that Cordyceps species produce many pharmacologically active substances. They are now cultivated on an industrial scale for their medicinal value.

The popularity of this fungus recently grew because two female Chinese athletes, Wang Junxia and Qu Yunxia, who beat the world records for 1500, 3000 and 10,000 meters in 1993 in Stuttgart, were reported to have used Cordyceps at the recommendation of their coach. However, this version of the events that lead to the extraordinary records of the Chinese women’s team was regarded as a smoke screen by many doping experts. The records might have been spurred by steroid use. Interestingly, the Chinese athletes could not repeat their performance in the following years, indicating further that illegal doping might have been involved.

According to Bensky , laboratory-grown ”C. sinensis” mycelium has similar clinical efficacy and less associated toxicity. He notes a toxicity case of constipation, abdominal distension, and decreased peristalsis, two cases of irregular menstruation, and one case report of amenorrhea following ingestion of tablets or capsules containing ”C. sinensis”. In Chinese medicine ”C. sinensis” is considered sweet and warm, it enters the Lung and Kidney channels; the typical dosage is 3-9 grams.

Treatment of radiation poisoning

Some work has been published in which Cordyceps sinensis has been used to protect the bone marrow and digestive systems of mice from whole body irradiation.

Economics and impact

Its value gave it a role in the Nepalese Civil War, as the and government forces fought for control of the lucrative export trade during the June – July harvest season. Collecting yarchagumba in Nepal had only been legalised in 2001, and now demand is highest in countries such as China, Thailand, Korea and Japan. By 2002, the herb was valued at R 105,000 per kilogram, allowing the government to charge a royalty of R 20,000 per kilogram.

In Tibet, Yartsa Gunbu developed to become the most important source of cash income in rural Tibet. Prices are increasing continuously, especially since the late 1990s. In 2007, one kg traded for US$3000 to over US$15,000 .

The search for ”Cordyceps sinensis” is often perceived to pose a threat for the environment of the Tibetan Plateau where it grows. However, it has been collected for centuries and is still common in such collection areas. However, current collection rates are much higher than in historical times.

Cordyceps producers like to perpetuate the story that unscrupulous harvesters insert twigs into the stromata of wild ”C. sinensis” to increase the weight and therefore the price paid. Tiny twigs are only used when the stromata is broken from the caterpillar, and has nothing to do with weight increases. Supposedly at some point in the past, someone has inserted lead wires with which to increase weight, however, each year hundreds of millions of specimens are harvested and this appears to have been a one time occurrence.

Cultivated ”C. sinensis” mycelium is a sustainable alternative to wild-harvested ”C. sinensis”, and producers claim it may offer improved consistency. Artificial culture of ”C. sinensis” is typically by growth of the pure mycelium in liquid culture or on grains . Stromata are not produced apart from the insect host.

Pradaxa Does Not Pose Higher Risk for Serious Bleeding .


New patients taking dabigatran (Pradaxa) don’t have higher rates of bleeding than those on warfarin, according to the results of an FDA investigation. Despite that reassurance, patients may ask about a story in the New York Times about the bleeding risks associated with the drug.

The findings of the agency’s safety evaluation are consistent with those from the clinical trial used to approve the drug, says the FDA. However, this may do little to reassure critics who point out that, unlike warfarin, there is no way to reverse dabigatran’s anticoagulant effects. The Times reports that the drug has been linked to over 500 deaths in the U.S.

The FDA says it will continue evaluating “multiple sources of data” as part of an ongoing safety review. In the meantime, dosing recommendations should be carefully followed to reduce the risk for bleeding, especially in patients with renal impairment.

Source: FDA MedWatch safety alert

Low-Dose Aspirin Doesn’t Prevent VTE Recurrence But Does Reduce Vascular Events .


Aspirin maintenance therapy after venous thromboembolism — although not better than placebo at preventing recurrence — does reduce risks for major vascular events, according to a study presented at the American Heart Association meeting and published in the New England Journal of Medicine.

Researchers randomized some 800 patients with first episodes of unprovoked VTE to 100 mg of aspirin or placebo daily. All had completed therapy with anticoagulants.

During a median follow-up of roughly 3 years, VTE recurrence (the primary outcome) did not differ significantly between the groups. However, composite outcomes that included VTE, MI, stroke, major bleeding, and death (secondary endpoints) were reduced by about one third with aspirin.

Allan S. Brett writes in Journal Watch General Medicine: “After completing initial courses of anticoagulation, patients with unprovoked VTE are at high risk for recurrence. Indefinite continuation of warfarin lowers that risk substantially but confers considerable ongoing bleeding risk. Aspirin offers a reasonable compromise for such patients.”

Source: NEJM

Papaya leaf juice helps fight dengue fever.


With the rising number of people catching dengue fever, the demand for papaya leaf juice has soared. The extract of raw papaya leaf helps boost platelets, also known as thrombocytes.

Dengue is transmitted by mosquitoes and can be fatal. Common symptoms include fever with headache, severe muscle pain, joint pain and rashes on the body. There is no effective medicine for dengue.

Traditionally, the juice of papaya leaf has been found to be useful in the treatment of dengue fever. Few recent studies have shown the effect of papaya leaf juice in curing dengue fever. A recent study done on five dengue patients by Indian Institute of Forest Management has shown some interesting observations.

Among five patients, papaya leaf juice was found to be effective in curing dengue.

The number of platelets increased in all five patients within 24 hours of drinking the juice, with all patients reporting significant improvement in their health. It seems that this bitter green juice is promising without posing any serious ill-effects. As a result, pharmaceutical and nutraceutical companies are already formulating papaya leaf extract preparations.

Interestingly, papaya leaf has also been found to possess powerful anti-malarial and anti-cancer properties. Papaya leaf extract has been used in some parts of the world as a prophylactic to prevent malaria in endemic regions. According to research published in the Journal of Ethnopharmacology published in 2010, doctors and researchers from US and Japan have discovered that enzymes found in papaya leaf have cancer fighting properties and are known to work against cervix, breast, liver, lung and pancreatic cancers. According to the study, papaya leaves are not known to have toxic effects and their consumption does not have side effects. Some doctors are beginning to recommend papaya leaf tea as part of chemotherapy.

These benefits may not be surprising as a study by Purdue University in United States showed that papaya leaf consists of over 50 active ingredients found to kill fungi, worms, parasites, bacteria and many forms of cancer cells. Papaya leaves contain important nutrients that support the immune system, including vitamins A, C, and E.

For dengue fever it is suggested that the juice is extracted by crushing fresh leaves of papaya. One leaf of papaya gives about one tablespoon of juice. Two tablespoons of papaya leaf juice are given to dengue patient three times a day — once every six hours.

Remember, this is not a substitute for medical advice.

Source: http://www.indianexpress.com

 

 

 

 

 

 

 

 

The ‘Viagra’ transforming local economies in India.


A rare fungus some are calling Indian Viagra is starting to transform local economies in the Himalayas. But some of those harvesting it are now having to arm themselves to protect what has become a valuable cash crop.

There is a fungus that attacks caterpillars in the Indian Himalayas. People in north India call it kira jari. In neighbouring Tibet it is known as yarsagumba.

The fungus mummifies its prey and then grows out of the top of the dead caterpillar’s head. It appears above ground just as the snow melts in May or June.

In China, kira jari is used as an aphrodisiac. Athletes have used it as a performance-enhancing drug. For villagers in the Indian Himalayas it is a source of income.

During the last five years they have begun to collect the caterpillar fungus and sell it to local traders. These middlemen, in turn, sell the fungi to businesspeople in Delhi and it travels on from there to Nepal and China.

When sold in the village, a single fungus fetches 150 Indian rupees (about £2 or $3) – more than the daily wage of a manual labourer.

Some people are able to collect 40 in a single day. So the search for caterpillar fungus has come to resemble a type of Himalayan gold rush.

I have spent the past few months in the Indian Himalayas doing research on youth and social change. I lived in the village of Bemni, located at about 10,000 feet (3,000m) near the Indian border with Tibet.

Much of our time was spent trying to understand the changing economy of the village, and kira jari featured heavily in our interviews.

Take Prem Singh, a 24-year-old man in the village known for his restless energy and appetite for hard work.

Prem spent the first two weeks of May in high altitude snowfields collecting kira jari. He went on his own, carrying rice, wheat and daal on his back, camping in a cave on the way, and eventually pitching camp 5,000 metres up. He found nothing during the first three days.

But then his luck changed. He returned to Bemni with 200 fungi stuffed into old sweet jars. He is using his earnings to construct a new house, an impressive two-storey structure built out of local stone.

Kira jari, and the money it earns, is big news for Bemni. Young men have generally been looking outside the village for opportunities to make money in cities down in the plains. They have worked in hotels, in the army, and in some of the new service industries emerging in urban India.

Kira jari is reversing this process somewhat. Since 2007, when villagers learnt about the fungus, vast numbers now head not to the big cities but to the high altitude meadows.

People joke that the meadows – formerly the preserve of intrepid goatherds – have become small towns of tents, stoves, and clothes’ lines. As Prem told us, “Why would I migrate to Delhi to work in a hotel when I can earn in two weeks what I’d make in Delhi in two years?”

But there is a dark side to fungus collection, too.

Some villagers return with nothing to show for their weeks in high altitude snow fields. Many fall ill. Searching for the fungus involves lying on your front, elbows dug into the scree and snow, scouring the ground in front of you for nothing larger than the stalk of an apple. It is freezing cold, there is a howling wind, and your lungs ache.

People often return to the village with snow-blindness, painful joints, and problems breathing. One person died recently as a result of the altitude. Another man fell into an ice crevasse and was only rescued by villagers 13 days later – he had lived on drips from the glacier. (Apparently he is back collecting kira jari this year).

Continue reading the main story

“Start Quote

You have got your risky work and your safe work – kira jari is the risk”

Prem Singh

The fungus business is also generating rivalries. There are two villages that are at loggerheads over access to a high-altitude meadow where kira jari is especially abundant. They have to carry guns on their trips for the fungus.

There are other risks, too. It is legal to collect the fungus but not legal to sell it.

Two years ago, a confidence trickster arrived in Bemni and promised people he could get a very good price for their crop. He disappeared with people’s fungi and has never returned. Because kira jari is part of the black market, the villagers could not complain.

Last year young men from the village tried to sell their fungi in a local town. Someone in the village tipped off the local police who intercepted the young men on the road and seized the entire fungus crop.

Imagine the heartbreak as they trooped back to the village. The men had nothing to show for weeks in the bitter cold, while the police no doubt profited from their booty.

But people seem to take these risks in their stride. As Prem said to us, “You have got your risky work and your safe work. Kira jari is the risk, local manual labour is the safe option.”

For the time being, India’s home-grown version of Viagra has become a decent gamble.

And no, I haven’t tried it.

Source: BBC