October 2024

Oct 17, 2024 New Delhi: Indian Council of Medical Research (ICMR) Director General Dr Rajiv Bahl spoke about new projects and achievements in public health and highlighted a significant advancement in tuberculosis (T B) diagnosis: a new handheld X-ray device developed for screening T B, enhancing early detection and treatment efforts, ultimately improving public health outcomes. Speaking at the 19th International Conference of Drug Regulatory Authorities (ICDRA) INDIA-2024 on Wednesday, ICMR DG Dr Bahi said, “The handheld X-rays are available at a very high cost and now the IIT Kanpur in partnership with ICMR has developed a handheld X-ray indigenously which will be less than half the cost of what the cost of imported handheld X-rays are. This will make sure we can have screening for TB near the homes of patients and even the vulnerable population.” Bahl further said that India has developed three testing kits for Mpox as well. “We have developed three testing kits for Mpox and there are three companies who are manufacturing such kits,” he said. Over a million people are affected in India with sickle cell disease, which is the second largest in the World, last year Prime Minister Narendra Modi also launched the National Sickle Cell Anaemia Elimination Mission to eliminate sickle cell disease as a public health problem by 2047. ICMR is constantly working on this and recently they have conducted a brainstorming session with doctors and scientists all over the country at the New Delhi Head office. According to Dr Rajiv Bahl, India has developed 18 tests with low cost to detect Sickle Cell Anaemia which is a major breakthrough, “Now we have approved 18 tests for Sickle cell Anemia and each test costs rupees 30 which was earlier 400 per test.” India lost several lives due to Dengue but now vaccine for dengue is also expected to be launched soon if data shows efficacy and safety, Dr Bahl said, “We are doing phase three clinical trial of dengue vaccine and we expect the results to come within one year or so and found safety as well as efficacy then India will develop dengue vaccine also.” (ANI) Source: Economic Times

Oct 24, 2024 London: Britain will ban single-use vapes from next year, a government minister said on Thursday, seeking to crack down on the environmental harm and rising usage levels among children. Health authorities have raised concerns about the use of vapes among young adults, with their colourful designs and fruity flavours making them stand out on grocery store shelves. According to a 2024 survey by health charity ASH, about one in five children aged 11-17 said they had tried vaping. It is illegal to sell nicotine-containing e-cigarettes to anyone under the age of 18 or for adults to buy them on behalf of under-18s. The plan to ban disposable vapes was initially set out by the previous Conservative government in January but was not implemented before the July election, which was won by the Labour Party. Labour’s culture minister said that the number of children vaping had tripled in the last three years, and that disposable vapes were causing a lot of problems for the environment. “We have been increasingly concerned,” she told Sky News. “We hope (this) will help to break this cycle where children are getting into the habit of vaping at younger and younger ages.” The government’s Department For Environment, Food, and Rural Affairs (Defra) did not immediately respond to a Reuters’ request for details on the measure. Media reports said the ban was due to come into force in June. A separate study by ASH this year said vapes were the most popular aid to quitting among tobacco smokers, with nearly 3 million people in Britain having quit smoking with a vape in the last 5 years. Source: Economic Times

Oct 23, 2024 New York: Most U.S. states do not currently cover highly sought after weight- loss drugs from Novo Nordisk and Eli Lilly in their Medicaid health programs for low income people, citing cost as a key factor, according to a survey conducted by health research firm KEF. The survey of the 50 states and the District of Columbia found that just 12 Medicaid programs covered the drugs to treat obesity as of July 2024 with some limits on use. Half of the states without coverage said they are considering adding them or evaluating their coverage, it said. The drugs from a class known as GLP-I agonists were initially developed to treat type 2 diabetes but also promote weight loss by suppressing hunger. Novo’s Wegovy and Lilly’s Zepbound list for around $1,000 per month, though most people pay less through health insurance or other drug company discounts. Coverage of the drugs by commercial plans is also limited. The Medicare program for people aged 65 and older has said that GLP-I drugs may be covered for diabetes and cardiovascular disease after studies revealed healt benefits. The survey found that state Medicaid programs expect their health plan spending to increase by 7% in fiscal 2025, slowing from the 19% increase this year as membership decreases. The fiscal year ends for most states in the survey on June 30. The lower spending increase from a year ago follows termination of a policy requiring insurers to keep members enrolled during the COVID-19 pandemic and the expiration of some federal funding. Medicaid costs are paid by states and by the U.S. federal government. Total spending on Medicaid rose 5.5% in fiscal 2024 and is expected to increase 3.9% in fiscal 2025. Medicaid membership re-determinations have decreased enrollment from a peak of 94 million in April of 2023. There were some 71 million on its rolls ahead of the pandemic. As of August, four states were still re- determining Medicaid eligibility. State Medicaid programs expect memberships to decline by around 4.4% in 2025 from a 7.5% decrease in 2024, KFF said. Increased costs of providers, managed care, medical benefits and prescription drugs were key drivers of spending, according to the survey findings. Three quarters ofthe states are exploring at least one new or expanded initiative to contain prescription drug costs in 2024 or 2025, KFF found. (Reporting by Amina Niasse; editing by Caroline Humer and Bill Berkrot) Source: Economic Times

Oct 21, 2024 Wellington: Anyone who has spent time inside a neonatal intensive care unit (NICU) knows it’s intense. For the tiny babies cared for in these wards, any infection could prove fatal. Great care is taken to prevent the spread of pathogens, but outbreaks still occur. Traditionally, detecting outbreaks within a NICU has been reactive – only after multiple babies fall ill at the same time. Our research is advancing the use of whole-genome sequencing technologies to detect outbreaks early and stamp out bacteria before they threaten more babies. From reactive to proactive NICU outbreak surveillance usually involves monitoring rates of illness and identifying spikes and long-term trends that may point to a pathogen circulating on the ward. When a potential outbreak is identified, bacteria may be cultured and retrospectively sequenced to determine if they can be linked to a shared source or transmission on the ward. Wellington Regional Hospital has changed its approach to infection surveillance in the NICU. Rather than waiting for infants to fall ill, they are using the same sequencing technology we developed at the Institute of Environmental Science and Research (ESR) for genomic contact tracking during the COVID pandemic. Infants in the unit have diagnostic swab samples taken as part of routine practice. If any key bacteria are cultured from these samples, they are sequenced promptly to identify possible transmission events in near real time. This allows us to monitor the situation closely and respond quickly to emerging outbreaks. Because not all infants carrying a particular bacterial strain will experience a severe infection, this proactive approach can detect an outbreak before any babies fall ill. And because whole-genome sequencing decodes the entire genetic makeup of bacteria, it also provides the NICU team with information on how pathogens are related to each other. This allows them to differentiate one-off cases imported to the unit from any circulating within it. This level of detail allows for precise infection monitoring and fast, informed decisions on outbreak control. A case study This shift was recently tested when proactive genomic surveillance showed two infants in the NICU had eye infections caused by the same organism, an uncommon strain of methicillin-resistant Staphylococcus aureus (MRSA). MRSA is notorious for its resistance to common antibiotics, making it particularly dangerous in hospitals. The onsite sequencing showed the two cases were likely linked. The priorities were to establish whether other infants were affected and limit the pathogen’s spread as quickly as possible. Screening of infants in the NICU found six more carrying the same strain of MRSA (though none with serious illness). This meant these infants could be isolated rapidly and the outbreak contained before any others developed a significant infection. ESR’s experience as genomic contact tracers helped establish how these infections spread in the unit. An outbreak response takes up resources and involves multiple steps, from the initial confirmation of the infection and its transmission route to communication with parents. This proactive approach to infection surveillance provides an early- warning system. It means the NICU team can be confident an outbreak is underway and act quickly to contain it. MRSA in New Zealand The power of genome sequencing extends beyond immediate outbreak control. By comparing the genomic data generated in the lab to that collected in national surveillance projects, our team was able to show the strain that caused the eye infections may have emerged in the early 1990s. This strain has slowly accumulated the genes required to evade first- choice antibiotics, underpinning the risk of antibiotic-resistant bacteria in Aotearoa New Zealand. We also highlighted the power of genomics to reveal connections when we found the MRSA strain causing illness in the NICU was related to bacteria collected from cattle. This discovery underscores the concept of “One Health” – the idea that human health, animal health and environmental health are inextricably linked. The data suggest bacteria from a cow milk tank and from babies in a hospital may have shared a common ancestor at some point. Future focus As we continue to unravel the complex world of microbes, tools like whole-genome sequencing offer hope in the ongoing battle against infectious diseases. The work at Wellington Regional Hospital’s NICU is just the beginning. From protecting our most vulnerable newborns to uncovering unlikely connections between farm animals and hospital patients, genomic technology is changing how we combat infectious diseases. As this technology continues to evolve, it promises to play an increasingly crucial role in safeguarding public health, one DNA sequence at a time. In the face of growing antibiotic resistance and emerging pathogens, this proactive, genomics-based approach to infection control may well be our best defence. (The Conversation) PY PY Source: Economic Times

Oct 24, 2024 In 1893, the American Journal of the Medical Sciences reported on ten patients whose large and hitherto incurable cancers had been injected with bacteria taken from skin infections. In every case, striking improvement was seen, marking the birth of “cancer immunotherapy” – using the power of the immune system to attack cancer. The immune system is the body’s most powerful weapon against cancer and infection. For a cancer cell, surviving long enough to divide and eventually form a lump or tumour is the result of a brutal Darwinian process. To reach this point, cancer must adapt, hiding from immune detection and co-opting patients’ immune machinery to betray its original programming and instead protect the cancer. Immunotherapy – which really started to take off just over a decade ago – is an attempt to artificially tip the balance back in favour of tumour elimination. Sometimes this can be done by taking off the brakes from immune cells already in the cancer. This works because cancers have fooled the body by using its own natural safety switches, or “checkpoints”, that usually keep our immune systems under control. Blocking these switches using specially chosen antibodies – biological drugs – turns the immune response back on. This approach is called “immune checkpoint blockade”. Mutations are alterations in genetic code that can lead to cancer. All cancers fall on a spectrum, depending on how many mutations the cells have. Typically, cancers caused by exposure to toxic or harmful things have higher numbers of mutations than those which are not – examples include melanoma, a type of skin cancer, and some types of colon cancer. From the perspective of the immune system, the more mutations there are, the “hotter” the cancer is. This may make a cancer more aggressive, but it also increases the chances that the immune system will have detected it and mounted a response. This is why immune checkpoint blockade therapy works well for these high-mutation cancers, but less well for others. The other type of immunotherapy does not rely on the natural activity of the immune system. This approach uses immune machinery that is designed in a laborat01Y, a bit like biological Lego. Scientists take pieces of existing immune mechanisms and combine them to make new ones, which enhance the way the body’s defence system responds. When put into the patient’s T-cells (a type of immune cell that usually fights viruses), this machinery allows them to attack and kill cancer. Called cell therapy, this approach has cured patients with previously incurable leukaemia. The new machinery, called a “chimeric antigen receptor” or “Car”, transforms a diverse Wcell population into Car-T, where the engineered cells all respond to the same cancer-associated marker. Victims of their own success Both types of immunotherapy have been victims of their own success. This has led to the replication of existing technology rather than riskier diversification. Of 11 immune checkpoint blockade treatments approved by American regulators, nine target the same immune interaction. And of the Car-T cell treatments approved in the US since their debut in 2017, all target one of two markers found exclusively on blood cancers. Substantial effort has been spent on iterative developments of the existing Car concept. Examples include changing the target or tuning the signals that stimulate the T-cells. This has yielded important advances, but the saturation of both academic and commercial research space has contributed to a diminishing appetite for funding more cell therapy programmes. Success against solid cancers has also been extremely low. The Darwinian adaptiveness shown by cancer creates a suppressive environment in a cancer lump, where it is hard for Car-T to work properly. So, reliance on a single technology has not delivered on its initial promise. Given that Car-T costs around GBP 282,000 per patient in the UK, and the patient’s disease often worsens in the two-to-three weeks it takes to manufacture them, confidence is waning. This phenomenon is not new. In the 1950s, confidence in chemotherapy was low because single drugs failed to produce lasting cures. But by the 1960s, combination chemotherapy began to deliver durable patient benefit, and multi-drug regimens now form a mainstay of cancer therapy. Immunotherapies that use combination approaches are now emerging. Recent research from University College London demonstrated how engineered immune cells called gamma-delta T-cells could act as delivery vehicles for anti-cancer antibodies. In this approach, not only did the engineered cells kill cancer in mice, they also empowered other cells to join the fight. Also, gamma-delta T- cells can be safely taken from a healthy donor and given to several patients. So there is hope. Cell therapies that can be made beforehand from healthy donor cells and then stored, ready to use, are receiving more interest. For example, the number of trials using gamma delta T-cells doubled between 2022 and 2023, the fastest-growing area of activity. This could remove the waiting time for treatment manufacture, reducing the chance of disease worsening in the interim. A move away from reliance on single-axis immune interventions, such as immune checkpoint blockade or Car-T in isolation, should yield better outcomes. The immune system is highly complex. Our attempts to manipulate it must live up to this complexity if we are to deliver lasting patient benefit. (The Conversation) GRS GRS Source: Economic Times

Oct 24, 2024 New Delhi: A study has uncovered a biological process in which thyroid hormones and proteins in the liver work together to regulate cholesterol, an imbalance of which is considered common in neurodegenerative diseases. Researchers said the “previously unrecognised” process could be targeted to prevent one from developing ageing-related disorders, such as Alzheimer’s and Parkinson’s diseases. The study, led by the University of Houston, US, reviewed previously published research on how thyroid hormones and liver proteins (liver X receptors) function, and found that the two were part of a single process by which the endocrine system balances cholesterol in the brain. Further, a decline in the function of liver proteins crucial to regulating thyroid in the brain was found to lead to ageing-related degeneration in neurons (neurodegeneration). Therefore, the “discovery could fundamentally change how we approach treatment for various neurodegenerative conditions”, said lead author Margaret Warner, a professor at the department of biology and biochemistry, University of Houston. “A review of the literature clearly shows that these two receptors work together to regulate cholesterol homeostasis and dysregulation of cholesterol homeostasis is a common factor in neurodegenerative diseases,” the authors wrote in the study published in the journal Genomic Psychiatry. Alzheimer’s disease treatments aimed at activating liver proteins known to regulate cholesterol and lipid (fat) metabolism could help reduce amyloid plaque formation and improve memory, the researchers proposed. Amyloid plaques are clumps of amyloid proteins in the brain which are considered a hallmark of Alzheimer’s disease and are a common target for developing drugs. The authors said their review revealed a higher prevalence of hypothyroidism in which thyroid is produced in insufficient levels in Alzheimer’s disease, but cautioned that they could not discern if it was a risk factor for or a consequence of the neurodegenerative condition. The team also proposed looking at processes involving liver X receptors for treating Parkinson’s disease because of their protective effect on dopamine-producing neurons. A lack of the brain chemical dopamine is considered to play a key role in causing Parkinson’s disease. The process involving thyroid and liver proteins could also be targeted for treating amyotrophic lateral sclerosis, a progressive disease affecting movement neurons in the brain and spinal cord, and multiple sclerosis, which is an autoimmune condition, the authors suggested. “What’s particularly intriguing is the age-dependent nature of these protective effects. Understanding why certain neurons become vulnerable to degeneration as we age could be key to developing preventive treatments,” said co-author Xiaoyu Song, University of Houston. Source: Economic Times

Oct 24, 2024 New Delhi: It’s terrifying to imagine a scenario where one falls ill but has no effective medication for treatment. While it could seem a little far-fetched in today’s modern, tech- advanced world, this is happening almost daily in hospitals, according to medical experts. Many city-based doctors said antibiotics, which were once effective in treating serious infections, are now failing, leading to higher mortality rates and prolonged and costly treatments for those who survive. “Antimicrobial resistance (AMR) is a reality and is spreading silently across hospitals and communities, putting millions at risk,” says Dr Ajay Shukla, director and medical superintendent, ABVIMS & RML Hospital. AMR occurs when bacteria, viruses, fungi and parasites evolve and become resistant to the medicines used to treat the infections they cause, he said. As a result, antibiotics that once cured serious infections fail to work. Medical experts will discuss AMR in detail at the upcoming session of a scientific programme organised by Doctors Without Borders/Medecins Sans Frontiers (MSF) in collaboration with RML Hospital, scheduled for Friday. A full session, ‘AMR of New Antibiotics and Associated Surveillance Systems: Barriers and Potential Solutions’, has been dedicated to the issue, which has become a major concern for medicos across the globe. Dr Shukla stressed the severity of the situation, stating that minor cuts can become life-threatening and routine surgeries can become high-risk procedures due to the ineffectiveness of antibiotics. “The battle against antimicrobial resistance has already commenced,” he said. Dr Mala Chhabra, senior consultant and associate dean (research), RML Hospital, said many patients often underwent multiple courses of antibiotics, frequently without appropriate medical supervision. These patients harbour drug-resistant infections, complicating treatment efforts. Overcrowded healthcare facilities and inconsistent infection control measures worsen the problem, and delays in accessing effective diagnostic tools further complicate patient care, often resulting in loss of life. Physicians find themselves ill-equipped to combat these infections, not due to a lack of expeltise, but because the available antibiotics are losing their efficacy, the doctor said. A study published in The Lancet in 2022 revealed AMR caused nearly 1.3 million deaths globally in 2019, with the highest burden in low- and middle-income countries, including India. However, these numbers may be just the tip of the iceberg due to underreporting, lack of diagnostic resources and inconsistent data collection. These micro-organisms tend to be more devastating for vulnerable groups, such as newborns, the elderly, and those with underlying chronic medical illnesses, said experts. Dr Sujata E Mathews, professor, department of medicine, RML Hospital, said the rise of AMR is largely man-made, driven by over-the-counter access to antibiotics, improper prescriptions and a lack of stringent antibiotic stewardship. For years, antibiotics were handed out too easily, without sufficient oversight or education about their proper use. To tackle the problem of AMR, several measures must be implemented. Smveillance must be strengthened, with increased reporting of resistant infections and a national-level commitment to enforcing existing AMR policies, said doctors. Global investment in the development of new antibiotics and alternative treatments is essential. Policymakers and pharmaceutical companies must prioritise research and development to identify new antimicrobials. Preventive strategies, such as sanitation, vaccination and equitable access to appropriate treatments, must be expanded, especially in low- and middle-income countries. Source: Economic Times

Oct 23, 2024 New Delhi: Risk of death due to a sudden heart attack could be four times higher for patients of schizophrenia, a new study has found. For those having other types of mental illness such as depression, death risk is still twice as high, regardless of age, suggesting that an 18-year-old could expect to live 10 years fewer, compared to one of same age without mental health issues, researchers have found. The team from the University of Copenhagen, Denmark, said that while having a psychiatric condition is known to heighten death risk due to a sudden cardiac arrest, it is not clear if the risk extends across one’s lifespan. For the study, published in the journal Heart, the researchers looked at deaths in 18-90 year old Danish residents during 2010. Over 45,000 people had died that year, of which 6,002 were classified as sudden cardiac deaths 3,683 in the general population and 2,319 among those with a mental illness. The team found that overall, cases of sudden deaths due to a heart attack were up to 6.5 times more among those having a mental disorder, compared to the general population. Death risk was twice as high in people with depression, 3-fold higher among those with bipolar disorder, and 4.5 times higher risk among those with schizophrenia, the researchers said. Ill mental health was found to be related with a doubling in death risk from a sudden cardiac arrest, regardless of age, sex, and co-existing medical conditions. Further, having a mental health condition was also significantly linked with death due to other causes almost 3 times the risk compared to that in the general population and with a shortened lifespan. The researchers also estimated that a 70-year-old with a mental health condition could expect to live another 10 years, compared with 14 more years that one without such a condition could expect to live for. A sudden death due to a cardiac arrest was also found to explain about 13 per cent of the discrepancy in reduced longevity among people with ill mental health, the team said. While they acknowledged no cause-and-effect links, the researchers proposed that unhealthy lifestyle that people with mental health conditions are likely to follow, along with side-effects of medications, could make such individuals vulnerable to developing metabolic disorders, including high blood pressure and heart disease. Source: Economic Times

Oct 23, 2024 Mumbai: In Maharashtra, where data shows that every fourth child is malnourished, new research has found that the diet of over 80% of children between six and 23 months is poor and lacks “diversity” as defined by World Health Organisation (WHO). According to WHO, children in the six- to 23-month bracket should have minimum dietary diversity (MDD) and consume five out of the eight recommended food groups (see graphic). Children who have less than five of these food groups are considered as minimum dietary diversity failures (MDDF). Over three-quarters of India’s children could be classified as MDDF, according to the study published in The National Medical Journal of India, a publication of the All India Institute of Medical Sciences. “However, there was a slight improvement in MDDF from the National Family Health Survey-3 when 87% of this age group were MDDF to 77% as per the NFHS-5 conducted in 2019-2021,” said author Gaurav Gunnal from the International Institute for Population Sciences, Deonar. Maharashtra, along with seven other states including UP, Rajasthan, and Gujarat, had high MDDF of over 80%. Only 95 districts in the south, east, and the northeast out of India’s 707 districts had a low prevalence of dietary failure at 60% and lower. “Dietary failure was higher among children who were females, from lower socio-economic groups, did not receive food from anganwadi centres, and were born to younger mothers,” said Gunnal and co-author Dhruvi Bagaria from Indian Institute of Public Health in Gandhinagar. Dietary diversity helps combat deficiency of micronutrients that play an important role in development and growth. Poor nutrition increases risks of delayed motor and cognitive development, weak learning, low immunity, poor metabolism, memory, and increased susceptibility to infections. According to NFHS-5, 1 in every 3 children is underweight and stunted, while 1 in every 5 children is wasted in India. Dr Abhay Shukla of Jan Swasthya Abhiyan said Maharashtra ranks lowest among states as far as “wasting” (over 25%) and “severe wasting” (over 10%) is concerned. “These kids are at a high risk of dying due to infections,” he said. Source: Economic Times

Oct 23, 2024 New Delhi: A new study by the Max Institute of Healthcare Management at the Indian School of Business (ISB) identifies critical lacunae in hypertension diagnosis and management by private healthcare providers, particularly in rural and peri-urban India. The findings underscore the need for a more standardised and structured healthcare approach to hypertension, a chronic condition affecting over 220 million Indians and the leading cause of cardi0Nascular diseases. Published in BMC Health Sewices Research, a peer-reviewed journal, the qualitative study titled ‘Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India— a qualitative study’ involved in-depth interviews with over 46 primary healthcare professionals and patients across three districts of Telangana- Warangal Urban, Karimnagar, and Sircilla. Key findings point to inconsistent diagnostic practices, improper follow-up mechanisms and inadequate record-keeping, which hinder effective hypertension management. A concerning revelation of the study is the lack of adherence to routine opportunistic screening protocols as private practitioners measure blood pressure only when patients exhibit explicit symptoms. Additionally, arbitrary’ variation in diagnostic thresholds by private practitioners further delays the diagnosis, leaving the patients devoid of treatment and at a heightened risk of complications. The evident human cost of these lapses underpins the importance of routine monitoring and timely detection. Additionally, the study highlights the lack of consistent f0110VFup routine, pointing out that the high costs of diagnostic tests discourage the patients from seeing a specialist, stressing the need for financial aid to improve sustained long-term management of the disease. Moreover, the lack of monitoring systems, poor record-keeping practices, and the absence of a structured follow-up mechanism hamper regular follow-up regime and treatment adherence, further compounding the crisis. To improve the outcomes, the ISB-MIHM study recommends compliance to standardised screening protocols and targeted educational interventions to address knowledge gaps and attitudinal barriers among private practitioners as well as patient education for enhanced self-management. It also suggests innovative financing models such as insurance or community health funds to lessen the economic burden on patients by minimsing out-of-pocket expenditure. Alongside systematic follow-up mechanisms such as patient outreach, community participation and digital monitoring tools, these measures can augment treatment adherence and overall hypertension management. “Hypertension is often considered a health issue primarily affecting the affluent urban populations, but its prevalence is rising among lower income groups in rural and peri-urban areas, where access to formal healthcare is limited. This makes it crucial to develop public health programmes that engage with the healthcare providers at the local level to improve the quality of care and reduce the risk of complications,” said Professor Sarang Deo, Executive Director, Max Institute of Healthcare Management and one of the co-authors of the study. Source: Economic Times