https://biospectrumindia.com/rssfeed/bio-interactions/blogs blogs https://biospectrumindia.com/views/21/28650/one-science-three-regulators-what-the-metabolite-turn-means-for-microbial-products.html https://biospectrumindia.com/views/21/28650/one-science-three-regulators-what-the-metabolite-turn-means-for-microbial-products.html Wed, 14 Oct 2026 13:54:30 +0530 The same microbial preparation can reach an Indian consumer as a food, as a nutraceutical, or as an investigational medicine. The science underneath does not change. What changes is the evidence asked of it, the authority that asks, and the claims the label is then permitted to carry. For most of the past decade that was tolerable. Probiotics were live organisms sold as supplements, medicines were medicines, and the ground between them was wide enough that few products had to stand in it. Then the field moved, and it moved in a particular direction. The turn from organism to metabolite Much of what the microbiome does for its host, it does chemically. Bacteria ferment what we cannot digest and release compounds the host then uses, and those compounds are increasingly understood to be where the physiology actually sits. Butyrate is the best characterised of them. It is a short-chain fatty acid the human body does not synthesise, produced by colonic fermentation of dietary fibre, and it is the principal energy substrate of the colonocyte, a role Roediger described in 1980. It supports tight junction assembly, modulates histone deacetylase activity and regulatory T-cell differentiation, and acts on the free fatty acid receptors FFAR2 and FFAR3 on enteroendocrine cells, where it influences incretin secretion. A single bacterial metabolite, carrying a substantial share of what we attribute to a healthy gut. Once that is understood, an obvious question follows. If the metabolite is doing the work, why supply the organism and hope it is produced? That question has produced a generation of products built on microbial metabolites directly, and it is the reason our categories no longer hold. Where the categories stopped being distinct A probiotic is a live organism administered in adequate amounts to confer a health benefit. A postbiotic, under the 2021 consensus, is a preparation of inanimate microorganisms or their components. A synbiotic combines organism and substrate. A live biotherapeutic product is, in regulatory terms, a medicine made of bacteria. As a list, four tidy categories. In a development laboratory they are points on a continuum, with products at every position along it. Heat-treated strains. Cell-free supernatants. Defined consortia selected for one physiological effect. And purified metabolites with no cellular material in them at all, including butyrate delivered as tributyrin, a triglyceride prodrug cleaved by lipases along the gut rather than absorbed as a salt in the proximal intestine. A formulator moving along that continuum is making a scientific decision about mechanism. They are also, often without intending to, deciding which authority will govern the product and what it will cost to prove anything about it. Definitions written for an earlier generation The consensus definitions are good documents, carefully argued and widely adopted. They were also written to describe the products that existed when they were drafted. The postbiotic definition shows this most clearly. It requires inanimate microbial cells or their components, and deliberately excludes purified metabolites containing no cellular biomass. That exclusion was reasonable and remains defensible. It also means that products built on precisely the molecules through which the microbiome is now understood to act fall outside the term most commonly used to market them. This is not pedantry. A definition determines which literature a company may cite, which pathway it enters, and what a regulator will accept as evidence. Where a product sits outside every available definition, those questions have no settled answer, and the answer tends to be supplied by whoever is most confident rather than whoever is most correct. The real cost is to the standard of proof When a category’s boundaries are unsettled, the evidence bar attached to it drifts downward. A company that commissions a registered, prospectively declared trial competes on the same shelf as one that cited an ingredient supplier’s literature and called the matter settled. Both may use the same category word. Nothing on the label distinguishes them. Three things would help, none of them requiring a regulator to move first. Describe products by what they contain rather than by the category word that sells best; a purified metabolite is a purified metabolite. Register trials prospectively, including small ones, and publish them including the ones that disappoint. And settle measurement before settling claims, because for metabolite-based products our endpoints are presently weaker than our chemistry. India has the clinical infrastructure, the manufacturing base and the research capacity to lead this category. What it does not yet have is agreement on what the category is. That is worth settling ourselves, and soon.   Dr V. Ariarasudhan, Scientific Director & Co-Founder, Thirdbiome ]]> https://biospectrumindia.com/views/21/28615/beyond-pink-ribbon-tokenism-survivorship-advocacy-policy-in-indian-oncology.html https://biospectrumindia.com/views/21/28615/beyond-pink-ribbon-tokenism-survivorship-advocacy-policy-in-indian-oncology.html Wed, 07 Oct 2026 21:21:13 +0530 Each October, Breast Cancer Awareness Month unleashes commemorative banners, webinars, and survivor testimonials, celebrating patients across public forums as enduring symbols of courage. Yet once marketing concludes, structural deficits across India’s cancer care continuum remain unaddressed: acute survivorship care gaps and the precarious status of independent advocates within healthcare governance. Transforming performative awareness into measurable outcomes requires concrete policy execution: defining independent research advocacy, integrating structured survivorship navigation to alleviate clinical overload, and institutionalising Fair Market Value (FMV) compensation for lived-experience consulting. Acute Eradication vs. Functional Preservation ICMR and GLOBOCAN data record over 200,000 annual breast cancer cases in India—representing 28% of female malignancies. While India’s five-year relative survival rate of 66.4% lags behind Western benchmarks due to late-stage presentation, multimodal care transitions over 100,000 women into survivorship annually. Crucially, a substantial proportion are diagnosed under age 50, entering remission with decades of productive professional and family life ahead. This reality underscores a fundamental distinction: an active patient requires acute disease eradication, whereas a survivor requires long-term functional preservation. The Survivorship-Prevention Paradox Tertiary oncology centres are optimised almost exclusively for acute care: surgery, cytotoxic chemotherapy, and radiotherapy. Under heavy outpatient throughput, follow-ups focus strictly on recurrence surveillance. This pressure fuels the Survivorship-Prevention Paradox: acute interventions achieve disease-free survival, yet systems disengage from chronic toxicities. Adjuvant endocrine therapies, premature ovarian failure, secondary lymphedema, joint arthralgia, and chronic autonomic fatigue receive little structured management once active hospital protocols conclude. Treatment adherence breaks down not from patient apathy, but because clinical delivery lacks formal bridges between acute intervention and multi-year maintenance. The Oncofertility Blind Spot With hormone receptor–positive (HR+) tumours accounting for 50% to 60% of diagnoses in India, precision endocrine regimens and targeted biologics make the disease highly manageable. Yet manageability is not finality; it mandates 5 to 10 years of endocrine blockade, ovarian suppression, and chronic toxicities. For younger premenopausal women, chemotherapy and ovarian suppression routinely induce premature ovarian insufficiency, terminating reproductive potential. While international guidelines (such as ASCO and ESMO) mandate upfront fertility preservation counselling, heavy clinical workloads and socio-cultural barriers leave it largely unaddressed in high-volume clinics. Genuine survivorship requires institutional frameworks balancing multi-year disease control with reproductive autonomy. Defining the Independent Research Advocate In India, the term "patient advocate" is often conflated across distinct functions. Industry relations leads manage corporate stakeholder partnerships, while clinicians advocate for diagnostic and therapy access. Neither replaces the independent patient voice. An Independent Lived-Experience Research Advocate is an autonomous expert with personal treatment navigation who has developed formal literacy in clinical trial design, bioethics, and regulatory guidelines. Operating free from corporate obligations, they evaluate protocol feasibility, assess participant burden, review informed consent clarity, and identify real-world adherence barriers. Regulatory Precedents and Fair Market Value Under ICMR National Ethical Guidelines and the New Drugs and Clinical Trials Rules (NDCTR 2019), patient and community representatives hold statutory seats on Institutional Ethics Committees (IECs). Globally, premier bodies—including Susan G. Komen, ESMO, and AACR—routinely integrate research advocates into grant reviews, steering committees, and trial co-design. Complementing these standards, international initiatives by WECAN and PFMD have formalised Fair Market Value (FMV) models. These frameworks recognise specialized advocacy as technical consulting rather than discretionary volunteerism, setting standardised remuneration schedules for advisory boards and protocol reviews. Establishing FMV benchmarks alongside formal training is essential to institutionalizing an accredited cadre of independent oncology consultants. Strategic Policy Recommendations To transition from tokenism to technical integration, sponsors, CROs, and healthcare institutions should implement three operational steps: Standardise FMV Guidelines: Introduce formal consulting agreements and structured remuneration for independent advocates advising on trial protocols, steering committees, and patient-reported outcome (PRO) endpoints. Differentiate Stakeholder Roles: Clearly demarcate pharmaceutical industry liaisons, hospital provider advocates, and independent lived-experience consultants across ethics panels to eliminate conflicts of interest. Institutionalise Task-Shifted Peer Navigation: India’s oncologist-to-patient ratio forces clinicians to prioritize acute cytotoxic care, leaving long-term toxicities, lymphedema, oncofertility, and endocrine adherence unaddressed. Task-shifting non-oncologic survivorship navigation to accredited peer advocates protects clinical bandwidth, reduces informational burden, and curbs avoidable treatment discontinuation. To execute this equitably, the ecosystem must establish safeguards: third-party blind-pool funding models to protect advocate autonomy, ring-fenced public trial grant allocations so academic research is not priced out, and regional-language training pathways to prevent urban exclusivity. Ultimately, supported survivorship generates a self-reinforcing flywheel. When survivorship is visible and supported, it directly dismantles the fear and fatalism deterring timely screening. Thriving survivors prove early detection secures not merely temporary survival, but a full, productive life.   About the author- Sarika Rana serves as a global patient advocate across Susan G. Komen, ESMO, and AACR. She is the founder of Anandi Sheroes. ]]> https://biospectrumindia.com/views/21/28586/from-compliance-to-clinical-excellence-how-governance-is-redefining-modern-hospitals.html https://biospectrumindia.com/views/21/28586/from-compliance-to-clinical-excellence-how-governance-is-redefining-modern-hospitals.html Thu, 01 Oct 2026 13:30:39 +0530   The journey toward structured healthcare quality began in the Western world, where health systems gradually realized that systematic monitoring of clinical outcomes and infection control practices was essential to reducing morbidity and surgical complications. This realisation spurred the creation of formal quality standards, independent accreditation bodies, and public data-reporting frameworks, such as the Leapfrog Group and public hospital scorecards—which made clinical performance transparent and accountable. In contrast, India's healthcare system remains largely focused on point-in-time accreditation, where compliance checklists often overshadow continuous oversight. To truly elevate patient safety and care standards, Indian healthcare must now move beyond basic accreditation toward dynamic, real-time clinical governance. While regulatory and licensing bodies set baseline standards, a significant gap remains between point-in-time compliance and continuous oversight. Complication rates, procedure volumes, and protocol adherence need to be monitored in real time rather than reviewed after an incident or during periodic audits. As hospital networks grow larger and more complex, clinical governance must evolve from a static compliance exercise into a dynamic framework for continuous quality improvement. Shifting from Retrospective Reviews to Real-Time Support For decades, quality management relied on retrospective reviews such as periodic paper audits, late incident reports, and monthly peer evaluations that identified gaps weeks after care was delivered. While these tools still matter, modern healthcare demands prospective intelligence. Clinical Decision Support Systems (CDSS) now embed governance directly into clinical workflows. Rather than discovering errors retroactively, clinicians receive evidence-based guidance at the point of care, evaluating differential diagnoses, checking drug interactions, and identifying appropriate care pathways. Multi-step artificial intelligence models can further assist by cross-referencing recommendations against validated medical literature. Crucially, AI serves to strengthen clinical judgment rather than replace it. This transition relies on non-punitive feedback loops. Converting unstructured medical records into structured data allows health systems to spot protocol variations while encouraging clinicians to document context-specific decisions. Governance thus shifts from identifying fault to driving continuous systemic improvement. Building a Continuous Oversight Ecosystem Scaling governance across multi-site hospital networks requires structured, longitudinal tracking. Key pillars of a modern oversight framework include: Dynamic Physician Profiling: Tracking credentials, active privileges, continuing education, and case logbooks dynamically. Balanced Clinical Scorecards: Synthesizing procedure volumes, complication rates, patient feedback, and guideline adherence. Longitudinal Outcome Audits: Evaluating Patient-Reported Outcome Measures (PROMs) and 30-day readmissions after discharge. Continuous data streams reveal subtle procedural trends such as infection variances or unexpected surgical durations, allowing leaders to intervene before issues become systemic. Aligning Governance with Value-Based Care Digital governance is essential as healthcare shifts toward value-based care models, where success is measured by delivering optimal care while managing total health costs. Real-time prompts help prevent unnecessary investigations, unwarranted surgeries, and avoidable admissions. Post-discharge platforms ensure rehabilitation and chronic care management continue seamlessly. Evolving accreditation frameworks, such as the NABH 6th Edition, mirror this transition by emphasising measurable outcomes like unplanned readmissions and surgical site infections, over paperwork alone. The goal for expanding hospital systems is not to build rigid bureaucracy, but to establish a digital central nervous system that monitors care quality continuously. By uniting digital technology with clinical governance, future-ready hospitals ensure clinical excellence is measurable, physician decision-making is supported, and patient safety remains central to healthcare delivery.   Dr Chandrika Kambam, Group Medical Director, Even Hospitals ]]> https://biospectrumindia.com/news/21/28537/innovation-in-car-t-cell-therapy-making-treatment-faster-and-more-accessible.html https://biospectrumindia.com/news/21/28537/innovation-in-car-t-cell-therapy-making-treatment-faster-and-more-accessible.html Thu, 24 Sep 2026 00:00:00 +0530 The science behind car t-cell therapy has already been proven. What's harder now is the logistics side of things; actually getting this treatment to more patients, faster, without the process turning into a barrier of its own. A lot of the newest work in the field is focused right there. The Manufacturing Bottleneck Traditionally, this kind of therapy has meant a pretty involved process. A patient's T-cells get collected, shipped to a specialized facility, genetically modified, grown in large enough numbers, then shipped back to be infused into the patient. The whole cycle can take a few weeks, sometimes longer if anything gets delayed along the way. For patients, that wait isn't just an inconvenience. Aggressive cancers don't always allow for that kind of timeline, and some people need bridging treatments just to hold steady while their cells are being prepared somewhere else entirely. It's one of the most practical hurdles the field has been trying to work around. Point-of-Care Production: A Different Approach One of the more interesting shifts happening now is the move toward point-of-care manufacturing. Rather than sending cells across the country, or overseas, to a centralized lab, some hospitals are building out the ability to modify and grow T-cells on site, right where the patient is being treated. It's not just a convenience thing either. When cells don't have to travel as far, there's less chance for delays, shipping costs drop, and patients who don't have weeks to spare may get their treatment sooner. It also means smaller or more remote medical centers could eventually offer this kind of care without leaning entirely on a handful of centralized hubs somewhere else. This approach is still fairly new in a lot of places, and setting up the infrastructure and training staff isn't a small task. But more centers are exploring it each year, and the direction things are heading is pretty clear. Making the Process Faster Beyond where manufacturing happens, there's work being done on how long it actually takes. Researchers have been testing streamlined protocols that shorten the time cells spend growing in the lab, and some newer techniques suggest a faster production window doesn't necessarily mean a weaker end product. Automation is playing a role too. Manual steps used to slow things down and left more room for inconsistency between batches. Automating parts of that process is helping things run more consistently, and it's also a piece of what's needed to scale up production as more patients seek out this treatment. Why Accessibility Matters So Much Here None of this innovation counts for much if patients still can't get the treatment. Cost, geography, and the general complexity of coordinating care have all limited access in different ways, which is a big reason so much current research is focused on simplifying the process itself, not just improving it in a lab somewhere. As manufacturing gets faster, more localized, and less reliant on shipping cells long distances, the hope is that more patients, in more places, will be able to access this treatment when they actually need it. It's not a solved problem yet, but it's moving in a more practical, more accessible direction than it was even a few years back.   ]]> https://biospectrumindia.com/views/21/28525/building-indias-bio-ai-workforce-requires-a-three-way-compact.html https://biospectrumindia.com/views/21/28525/building-indias-bio-ai-workforce-requires-a-three-way-compact.html Wed, 23 Sep 2026 11:09:42 +0530 Artificial intelligence (AI) is changing life sciences from drug discovery and clinical development to manufacturing, diagnostics and drug-safety monitoring. Yet the sector’s workforce challenge will not be solved simply by adding a generic AI course to a science degree. Life-sciences professionals need dual fluency: enough biology and regulatory understanding to frame the right problem, and enough data and AI literacy to evaluate whether a system is reliable, safe and useful. This matters because life-sciences AI operates in regulated settings, where errors can affect patients, product quality, scientific integrity, commercial decisions and public confidence at scale. India already has building blocks. The IndiaAI Mission’s FutureSkills programme is expanding AI education, fellowships and training infrastructure beyond metropolitan centres. The BioE3 policy proposes Bio-AI hubs across academia and industry, while government skilling programmes now include AI-enabled roles in life sciences. The missing element is an operating model that connects these initiatives to real scientific and industrial work. The government should provide the common rails. This means financing compute, secure data environments and teaching laboratories; defining portable competency standards; and supporting paid apprenticeships rather than measuring success only through enrolments or certificates. A national skills map, refreshed with employers and universities, should identify demand across roles such as bioinformatics, computational chemistry, digital pathology, bioprocess optimisation and regulatory analytics. Public funding should reward programmes for demonstrated competence, placement, progression and regional inclusion. Academia should redesign learning around problems, not departments. A biotechnology student need not become a software engineer, but should be able to work with data, question model outputs and understand validation. A computer-science student entering healthcare must learn experimental design, biological variability, privacy, research ethics and regulation. Universities can create shared modules taught jointly by life-science, engineering, statistics and ethics faculty. Faculty also need industry residencies so curricula follow changing practice rather than yesterday’s tools. Industry’s contribution must go beyond guest lectures. Companies should publish skill requirements, provide anonymised or synthetic datasets, supply mentors and offer paid project placements. They can help universities build realistic assignments: predicting process deviations, improving trial recruitment, analysing microscopy images or monitoring drug safety. In return, firms gain a talent pipeline whose capabilities have been tested in relevant settings. Smaller biotechnology companies should participate through consortia, since few can build training programmes alone. The partnership should be organised through regional Bio-AI skills hubs linked to universities, hospitals, research institutes, manufacturers and startups. Each hub could run short, stackable credentials for students and working professionals; shared capstone projects; faculty immersion; and apprenticeships. Credentials should record what a learner can do, the datasets and tools used, and the level of supervision required—not merely hours completed. Responsible use must be part of competence, not a separate compliance lecture. Learners should practise recording where data came from, testing performance across populations, protecting confidential information, detecting when performance deteriorates and knowing when human review is essential. In life sciences, an impressive model can still fail because the data are unrepresentative or the biological question is poorly framed. Finally, the three partners need shared accountability. The government should publish outcomes; academia should track whether training improves employability and research quality; industry should report apprenticeship conversion and emerging skill needs. An independent advisory group could review curricula annually and retire credentials that no longer match practice.  The aim is not to produce a generation of scientists who merely use AI tools. It is to build teams capable of combining biological judgment, computational skill and public responsibility.  The government can create access and standards, academia can build durable understanding, and industry can supply real problems and pathways into work. Their strongest contribution will come from designing the system together.   Chintan Dave, Chief of Staff, Indian AI Research Organisation (IAIRO) ]]> https://biospectrumindia.com/views/21/28489/from-college-labs-to-clinic-indias-quiet-student-led-healthcare-research-movement.html https://biospectrumindia.com/views/21/28489/from-college-labs-to-clinic-indias-quiet-student-led-healthcare-research-movement.html Tue, 15 Sep 2026 22:34:11 +0530 Something meaningful is shifting in where healthcare research in India begins. Not dramatically, but steadily, and in a direction the pharmaceutical and healthtech industry would do well to notice. Across undergraduate and postgraduate programmes in medicine, life sciences, and biomedical engineering, a growing number of students are attempting to tackle problems with immediate diagnostic, therapeutic, and public-health relevance. What distinguishes their work is a quality that corporate R&D pipelines- optimised, rightly, for regulatory timelines and commercial return are rarely structured to produce: it is grounded in the day-to-day constraints of community health, and approached without the assumptions that settle in over years inside any established institution. Yet this momentum reveals a stark institutional asymmetry. Today, the structured opportunity to conduct formal health research remains heavily concentrated inside a privileged tier: apex institutes like AIIMS and the IITs, premier central universities, and well-endowed private medical campuses. For students inside these enclaves, institutional ethics committees, funded faculty supervisors, and well-equipped wet labs are standard operating environments. For the majority of India's higher-education cohort- enrolled in the country's 45,000-plus affiliated colleges, six in ten of which are in rural areas, and in the newer government medical colleges attached to district hospitals- the picture is completely different. They sit in closest geographic proximity to the primary health centres and district hospitals where India's healthcare delivery is most severely tested. They have no shortage of pressing questions, but almost no institutional rails to test them. The clearest sign that student-led health innovation is a genuine national impulse comes from the platforms that track it. The Indian Council of Medical Research's Short Term Studentship has for decades provided structured grants to MBBS and BDS students. BIRAC's SITARE-GYTI awards, run with SRISTI, surfaced student biotech prototypes from 96 institutions across 23 states in a single cycle. And the Smart India Hackathon (SIH) drew over 8,000 finalist students to its 2025 grand finale, with MedTech/BioTech/HealthTech a standing theme- close to 20 of the 226 problem statements in the 2026 catalogue already. A look through the SIH problem-statement repository shows what these students are actually being asked to build: explainable AI for diabetic retinopathy screening in rural India, community early-warning systems for water-borne disease in the North-East, telemedicine access for villages without a nearby doctor, and low-cost prosthetic and orthotic devices. These are pragmatic attempts to build against real resource constraints- intermittent electricity, erratic connectivity, and non-specialist frontline health workers. For pharma and healthtech leaders, this distinction matters. These students are designing for the exact clinical environments where scalable public-health impact must occur. But while their talent is distributed nationwide, research infrastructure is not. India has constructed a respectable post-graduation stack- BIRAC's BIG grant, NIDHI-PRAYAS, a growing network of medtech incubators- but almost all of it assumes a registered company or an incubator seat. What remains missing is a pathway that begins at the undergraduate project stage and is funded against verifiable milestones, with no company required. Between an early laboratory hypothesis and an incubator-ready device sits a perilous gap. Crossing it typically requires small amounts of capital- Rs 50,000 to a few lakhs- alongside early alignment with institutional ethics committees and, for devices, the CDSCO pathway. When students in non-elite colleges hit this wall, their work stalls. Promising diagnostics are abandoned on lab benches because no mechanism exists to fund the proof. This is precisely where the pharmaceutical and healthtech sectors can intervene with strategic foresight. Milestone-based project support- wherein an enterprise backs defined student research in its own focus areas and releases capital against verified bench milestones- surfaces early-stage innovation long before it enters a crowded venture pipeline. It is also a defensible application of CSR capital under the healthcare and education heads of Schedule VII, delivered through a non-profit implementing partner. The motivation behind building DreamXec stems directly from this gap. Whether a viable clinical idea survives should not depend on whether a student secured a seat at an elite metro institution. The strategic question for the healthcare industry is whether it will continue waiting for mature ventures to emerge from the top campuses, or build the rails to engage student researchers while they are still in the lab.   Ashish Trivedi, Founder, DreamXec  ]]> https://biospectrumindia.com/views/21/28398/why-indias-real-overdose-emergency-isnt-the-drug-but-the-delay.html https://biospectrumindia.com/views/21/28398/why-indias-real-overdose-emergency-isnt-the-drug-but-the-delay.html Sat, 29 Aug 2026 21:32:17 +0530 Ahead of International Overdose Awareness Day on August 31, most conversations turn to numbers: how many deaths, how many adm issions, how the figures have climbed year on year. Those numbers matter. But inside an emergency room, the number that actually decides whether a patient walks out or doesn’t is not any statistic; but the minutes. In overdose medicine, there is a narrow window between when breathing starts to fail and when it stops altogether. What happens in that window, who notices, how fast they act, and how quickly the patient reaches a hospital equipped to manage it, matters more than the substance that was involved. This is the part of the overdose crisis that almost never makes it into public conversation. It plays out quietly, in homes, hostels, and cars on the way to a hospital, long before a patient is even counted. What Actually Kills, and How Fast Most fatal overdoses, whether from a sedative, an opioid painkiller, or an unknown substance picked up at a party, follow a similar physiological path. The central nervous system, which controls breathing and heart rate, slows down. Breathing becomes shallow, then irregular, and then stops. The heart can continue beating for several minutes after that, which means there is often a survivable window if oxygen can be restored in time. However, that gap is short. Depending on the substance and the person’s health, permanent brain injury from lack of oxygen can begin as soon as four to six minutes after breathing stops. In a hospital ICU, we can manage this: airway support, ventilation, monitoring, and reversal agents where applicable. Outside the hospital, in the time before help arrives, almost none of that is available unless someone nearby recognises what is happening and acts fast. This is where India’s overdose problem becomes a community one. The Recognition Gap In practical experience of overdose cases, where the condition is identified very late, there always seems to be a similar trend where the individuals surrounding the person do not know what to do because the signs of an overdose only become apparent after many crucial moments have passed. Breathing difficulties are thought to be either drunkenness or blocked nose. Confusion and difficulty speaking are overlooked because they are immediate signs of visible pain. Unlike heart attacks or an injury, an overdose may appear harmless at first glance. Most often, there is no collapse involved, no fight involved. The individual may lie dying in a bed while people around think the person just needs some rest. That is the one mistake deadlier than the substance, which can even result in death. The Transport Gap Even when an overdose is recognised in time, what happens next in most parts of India is inconsistent. In large cities with reasonable ambulance access, patients can reach a capable emergency department within a workable window. In smaller towns, or even in parts of large cities with heavy traffic, transport delays can erase the advantage of early recognition entirely. Clinicians also see a hesitation factor: families delay calling for help or bringing a patient in because of the stigma attached to drug use, whether it involves an illegal substance or a misused prescription medicine. Fear of judgement, fear of legal trouble, or just embarrassment can add minutes to respiratory failure. What Actually Moves the Needle Overdose management does not really require a new drug or advanced medical technology. The interventions that save lives are almost entirely awareness and speed. Here’s how you can recognise some of the warning signs: Unusually slow or shallow breathing Bluish lips or fingertips Unresponsiveness to voice or touch Extreme agitation, a racing heartbeat, or seizures depending on the substance involved. Treat any of these as a medical emergency rather than wait-and-watch approach, regardless of what was taken or how it was obtained. Removing any and all hesitation to call for help, and dial for emergency help or try to rush the person to the nearest healthcare centre. A hospital’s role is to stabilise the patient, and not to judge how they got there. Basic bystander training, such as the kind already used for choking or cardiac arrest, must be extended to cover overdose recognition, even in non-medical settings like colleges, hostels, and workplaces. Reframing the Day International Overdose Awareness Day is usually framed around loss, and rightly so. But from where emergency medicine sits, it is also a reminder that the difference between life and death is often what happens before the patient reaches a doctor. India does not yet have a real-time system to track overdose response, community case mapping, or a mechanism to prevent prescription overdosing. What is within the reach of the healthcare system, that too at zero cost and one that could change outcomes immediately, is to teach people what an overdose looks like, what steps they should take as bystanders, and make it easier for them to ask for help the moment they recognise the quiet symptoms.   Dr Arjun Alva, Senior Consultant, Director, Adult Intensive Care and Emergency Medicine, Narayana Health ]]> https://biospectrumindia.com/views/21/28298/indias-next-leap-powering-a-rising-nation-through-research-and-innovation.html https://biospectrumindia.com/views/21/28298/indias-next-leap-powering-a-rising-nation-through-research-and-innovation.html Wed, 12 Aug 2026 16:56:42 +0530 For most of the last three decades, India competed on scale. A young workforce, a fast-growing entrepreneurial base and an ability to execute at volume turned the country into the world's back office, a manufacturing destination, and one of the fastest growing large economies. That approach worked well, and it is still working. But it is no longer enough on its own. The next round of global competition will be decided less by who can build more and faster, and more by who discovers something first, patents it first, and gets it to market faster. Artificial intelligence, biotechnology, quantum computing and clean energy are changing what counts as economic leadership. Scientific capability now matters as much as industrial capacity, and that is the shift India has to make. There is no shortage of intent from the government. The Anusandhan National Research Foundation, the Research, Development and Innovation Scheme, the IndiaAI Mission, the National Quantum Mission, BioE3 and the India Semiconductor Mission all say the same thing: research is no longer treated as an academic pursuit, it is treated as an economic one. That is a genuine shift in how the state sees science. Where things get harder is after the policy is announced. A mission or a fund can put money into a lab. It cannot, by itself, decide whether that lab's work ever becomes a product, a company or a patent that means anything commercially. That conversion, from research to enterprise, is where most of India's effort is still thin. The spending gap gets too much attention India's gross expenditure on research and development has more than doubled over the last decade, moving from about Rs 60,000 crore in 2010-11 to close to Rs 1.27 lakh crore in 2020-21. Recent budgets have added significantly more on top of that, alongside new schemes meant to bring private capital into research funding for the first time. Even with that growth, India's R&D spending sits around 0.64% of GDP, well below countries like China, South Korea or Israel. It is easy to look at that number and conclude the problem is simply underfunding. The more useful question is what each rupee of that spending actually produces. Papers published and patents filed are simple to count, and simple to inflate, but they tell you very little about whether an idea ever turned into a working technology or a functioning business. Judged against that standard, the funding gap looks more like a symptom of a system that has not yet learned to convert research into value, rather than the root cause itself. Talent is not the constraint By almost any measure, India's scientific talent base is remarkable. Millions of STEM graduates enter the workforce every year, and the country produces one of the largest cohorts of doctoral researchers in the world. India also does better than most economies on gender representation in STEM with women comprising roughly 43% of its total STEM graduate pool, which deserves more credit than it usually gets. The problem shows up after graduation. Good research often stays inside academic journals because industry keeps funding incremental improvements instead of taking bigger bets on unproven ideas. Plenty of capable researchers still choose to build their careers abroad, and it is rarely because India lacks potential. It is usually because other countries offer steadier funding, better infrastructure and a clearer route from lab to market. So the real issue is not that talented people leave India. It is that India has not yet built enough places where staying is the more rewarding choice. A few institutions already show what works There are working examples of this done right. IISc, the IITs, CSIR laboratories, BIRAC and C-CAMP have all demonstrated that when a research institution builds a genuine working relationship with industry, science actually crosses over into commercial products. The task now is not inventing a new model. It is expanding what already works in a handful of institutions until it becomes how the whole system operates. You can already see the early signs of this in specific sectors. India built its global reputation in healthcare as the pharmacy of the world through generics, and it is now trying to move further up the chain into biologics, genomics and personalized medicine, which means inventing new therapies rather than manufacturing cheaper versions of old ones. In artificial intelligence, the combination of digital public infrastructure and growing compute capacity under the IndiaAI Mission gives the country a real shot at building its own capability instead of importing someone else's models. Semiconductors, electric mobility and green hydrogen carry the same logic. The goal in each case is to help set the direction of these technologies early, rather than adopting them years after other countries have already defined the standards. Private capital has to show up None of this happens quickly, and that is exactly why private industry needs to take on a bigger share of the burden. In the economies that actually lead on innovation, businesses fund most of the research because they see it as a long term competitive advantage rather than a cost to be trimmed whenever budgets tighten. Indian industry has not made that shift yet, and until it does, public money will keep carrying weight that should belong to the market. Access to research infrastructure also needs to stop being concentrated in a handful of cities. I-STEM has made real progress giving researchers and startups shared access to expensive scientific equipment, but most of the country's serious research capacity is still sitting in a small number of metros. The talent in Tier-II and Tier-III India is real. What is missing is the lab access to actually put it to work. And the pipeline needs to start earlier than graduate school. Undergraduate research opportunities, interdisciplinary programs, and classrooms built around solving problems rather than memorizing answers are what eventually produce people capable of doing any of the rest of this. What 2047 will actually measure India has set 2047, a century after independence, as the year it becomes a developed nation. Whether that happens will depend less on the headline GDP growth rate and more on something harder to put a number on: whether India starts building technologies the rest of the world adopts, instead of products the rest of the world simply buys. History has a habit of remembering countries not for how efficiently they manufactured someone else's ideas, but for the ideas they had first. India already knows how to build at scale. What it has not yet proven is that it can turn scientific discovery into enterprise consistently, not just inside a few standout labs but across the system as a whole. The talent is there. The policy intent is there. What remains is whether the country can bring the two together into something that actually functions as one ecosystem, rather than a set of good ideas running in parallel.   Dr Ravindra Vikram Singh, Director and Head- R&D, Technology and Innovation at Merck  ]]> https://biospectrumindia.com/views/21/28257/the-hidden-cost-of-being-the-fifth-entrant.html https://biospectrumindia.com/views/21/28257/the-hidden-cost-of-being-the-fifth-entrant.html Wed, 05 Aug 2026 17:50:12 +0530 First-mover advantage gets studied to death in pharma strategy. Almost nobody studies the other end of the queue- what it actually costs to be approval number five into an already-crowded molecule. In India's generics and specialty-generics landscape, that number is where a lot of investment cases quietly stop making sense, well before anyone updates the model to say so. The market doesn't split five ways- it splits after four price cuts Each new approval into a molecule doesn't just add a competitor to divide the pie- it resets the price floor for everyone entering after it. By the time a molecule reaches its fifth entrant, average selling price has typically fallen well below whatever the pre-launch model assumed at position one or two. The fifth entrant doesn't inherit a fifth of the category average; it inherits whatever floor the first four have already carved out. The go/no-go question worth asking isn't what the category is worth today- it's what realistic entry price looks like specifically at position five, not position one. The US FDA has also measured this trend directly, across its entire generics market. Its own pricing analysis found that with a single generic competitor, prices average 39% below the pre-competition brand price. With two competitors, that reaches 54% lower. With four, 79% lower. With six or more, prices fall by more than 95%. Each additional entrant keeps moving the floor, not just the first few ones- which is precisely why treating ‘generic entry’ as a single event, rather than a sequence with a measurable price attached to each position in the queue, misses where the actual commercial risk sits. India's 2026 semaglutide market shows this dynamic playing out in real time and even faster. When the drug's patent expired in March 2026, more than 30 generic entrants rushed in within weeks. Novo Nordisk's own branded price had stood around ₹8,800–10,000 a month; the first wave of generics launched at ₹3,400–4,200, and within the same window, later entrants were already undercutting them further, down to ₹1,290–1,760. By the time a dozen-plus companies were competing for the same molecule, the ‘market’ wasn't one price point anymore- it was a race to whichever floor the most recent entrant had just set. Another well documented example is India’s hepatitis C market. Gilead licensed seven Indian manufacturers to produce sofosbuvir in September 2014, a number that grew to eleven within about two years as more companies entered. The drug launched in India in late 2015 at roughly $1,000 for a full 12-week course. Within that same year, as additional manufacturers entered the field, on-the-ground pricing had already fallen to around $483 a course, and a multi-manufacturer price survey conducted around the same period found courses ranging anywhere from $161 to $312 depending on which licensed generic was dispensed. By 2016–17, once state governments began procuring the drug through tenders, prices had collapsed further still: Haryana's state tender secured a 12-week combination course for roughly ₹5,250 (about $80 at the time), and Punjab's for around ₹7,200 (about $110). Every additional entrant after the first movers wasn't dividing a stable market- it was competing into a floor that kept dropping under it, year over year, tender by tender. In tender markets, the fifth bidder isn't competing on quality anymore Institutional and government procurement channels award almost entirely on L1- lowest price. Every additional approved entrant adds one more bidder willing to go lower, and by the time a molecule has five approved players, margins at the winning bid are frequently sitting at or below the point where fulfilling the contract still makes commercial sense. Winning the tender and the contract being worth having are two different outcomes, and it's worth checking which one a fifth-entrant bid actually delivers before treating a tender win as a commercial success in itself. The sofosbuvir tenders case reinforce this: once enough manufacturers were competing for the same state contracts, winning L1 bids landed at $80–$110 a course- a fraction of the roughly $1,000 launch price just a year or two earlier, and a level that left little room above raw production cost for whichever manufacturer actually won. That's the real mechanics of a tender-driven market: it isn't a fixed prize divided among bidders, it's a floor that gets renegotiated downward with every additional company willing to bid for it. Entering a tender-heavy molecule at position five means underwriting a business case against a price that hasn't been set yet- it's set by whoever bids lowest on the day, and that number tends to fall, not hold, as more approved competitors enter the pool. More formulators chasing the same molecule doesn't lower API cost- it raises it When five or more companies are competing for the same active ingredient from the same two or three approved sources, procurement leverage shifts to the supplier, not the buyer. Earlier entrants typically lock in volume commitments and preferential terms first; the fifth entrant is usually left negotiating from a weaker position, often the least favorable pricing and the shortest supply security in the group. The real diligence question at that point isn't whether the molecule is attractive- it's who actually controls upstream supply once five buyers are chasing the same two or three sources; unless the sources increase. This isn't a hypothetical risk. China currently supplies an estimated 70–80% of the world's antibiotic API production and roughly 80% of the intermediates used to manufacture APIs globally- and for specific inputs, the concentration is tighter still: five Chinese manufacturers alone control more than four-fifths of global production of 6-APA, the key starting material behind penicillin-class antibiotics. When that many downstream formulators are drawing on that few upstream sources, a late entrant isn't negotiating a commodity price- it's negotiating access to a chokepoint, and the negotiating leverage sits entirely on the other side of the table. By the time approval five clears the queue, the opportunity it was built for has often closed Regulatory review timelines create their own timing trap. A filing decision made when only two competitors existed in a category can result in a launch landing into a market that now has four. The competitive landscape that justified the original investment case rarely still exists by the time the approval actually lands- which means the question that matters isn't what the market looks like on the filing date, but what it will look like on the approval date. Being early isn't the goal- being early enough to still matter is The right strategic question isn't ‘should we enter this molecule.’ It's ‘at what entrant position does this stop being worth entering- and where do we actually sit relative to that number today.’ That threshold moves with every molecule, every market, and every cost structure involved, and it's rarely sitting where the original go/no-go call assumed it would be. Treating entrant position as a footnote, rather than the central variable in the decision, is how a defensible business case at the modeling stage turns into a fifth-entrant margin problem at launch.   Karishma Shah, Director and Founder, PharmAnalytica ]]> https://biospectrumindia.com/views/21/28234/hospitals-to-strengthen-mechanical-electrical-plumbing-and-fire-protection-systems.html https://biospectrumindia.com/views/21/28234/hospitals-to-strengthen-mechanical-electrical-plumbing-and-fire-protection-systems.html Wed, 29 Jul 2026 18:07:58 +0530 The COVID-19 pandemic was an unprecedented stress test for hospital infrastructure. As hospitals rapidly expanded intensive care capacity, accommodated surging oxygen demand and created isolation facilities, many building services were pushed beyond their intended limits. By exposing critical weaknesses in the Mechanical, Electrical, Plumbing and Fire Protection (MEPF) systems that underpin modern healthcare, the pandemic demonstrated that resilient healthcare depends not only on clinical expertise but also on engineering systems that are flexible, reliable and capable of responding to public health emergencies. Engineering the Future of Healthcare Replacing hospitals is rarely practical or economical, whereas modernising existing healthcare facilities by upgrading MEPF systems offers a cost-effective way to improve resilience, infection control and operational efficiency. Modern hospitals must be designed with the flexibility to adapt clinical spaces, increase critical care capacity and maintain uninterrupted services during emergencies. Hospital engineering systems cannot be upgraded in isolation; mechanical, electrical, plumbing and digital systems are closely interconnected, with each influencing the performance of the others. An integrated MEPF strategy therefore is essential to build futureproof healthcare systems. Electrical Resilience Reliable electrical infrastructure is fundamental to hospital operations, supporting life-support equipment, intensive care units, operating theatres and diagnostic services. The emphasis should be on resilience rather than simply increasing capacity. Existing hospitals should strengthen their UPS systems, emergency generators, power distribution networks and critical electrical infrastructure to ensure continuity during outages. Flexible electrical layouts, combined with Building Management Systems (BMS) and digital power monitoring, enable wards to be rapidly converted into higher-acuity spaces while supporting proactive maintenance and fault detection. HVAC Systems and Airborne Infection Control The pandemic established ventilation as a critical component of infection prevention. Modern healthcare HVAC systems should prioritise high indoor air quality, pressure control and operational flexibility through dedicated air-handling units, HEPA filtration where required, negative-pressure isolation rooms, independent exhaust systems and continuous pressure monitoring. Well-designed treated fresh air systems dilute airborne contaminants, while effective humidity control supports both patient comfort and infection prevention. Together, these measures create safer healthcare environments and strengthen hospitals' preparedness for future infectious disease outbreaks. Oxygen and Medical Gas Systems With hospitals experiencing unprecedented oxygen demand during peak COVID-19 admissions, many facilities struggled with existing storage capacity, distribution networks and pipeline pressures. Hospitals should therefore focus on strengthening oxygen resilience through increased storage capacity, redundant supply systems, expanded pipeline networks and continuous monitoring. Medical gas systems should also be designed with sufficient flexibility to support the rapid conversion of general wards into intensive care units during future emergencies. Plumbing and Public Health Engineering Public Health Engineering (PHE) systems are fundamental to infection prevention and hospital resilience. Safe water supply, wastewater management, drainage and firefighting infrastructure must continue to operate reliably during periods of increased clinical demand. Hospitals should prioritise touch-free plumbing fixtures, improved water quality management, robust drainage systems and wastewater treatment that complies with current environmental and public health regulations. Modifications should be carefully integrated with existing infrastructure to minimise disruption while enhancing operational reliability. Smarter and more sustainable Digital technologies are transforming hospital operations by enabling real-time monitoring and proactive management of critical infrastructure. Building Management Systems (BMS), energy management platforms and smart sensors provide continuous oversight of electrical systems, HVAC performance, indoor air quality, pressure differentials and medical gas networks. Predictive maintenance, automated alarms and remote monitoring improve operational efficiency, reduce downtime and enable facilities teams to respond rapidly during emergencies. At the same time, sustainability has increasingly become a complementary objective for hospitals – modern hospital upgrades should incorporate energy-efficient HVAC systems, LED lighting, renewable energy where feasible, water conservation measures and heat recovery technologies. These interventions reduce operational costs, lower carbon emissions and strengthen the long-term resilience of healthcare facilities without compromising patient safety or clinical performance. Looking ahead Healthcare facilities must be primed to handle not only everyday operations but also exceptional events. Upgrading existing hospitals through an integrated MEPF strategy that combines resilient electrical systems, advanced ventilation, robust medical gas infrastructure, effective public health engineering, digital building management and sustainable design, will create healthcare environments that are safer, more adaptable and better prepared for future public health emergencies.   Firoj Jena, CEO of Clancy Global (Mumbai) ]]> https://biospectrumindia.com/views/21/28123/drug-names-a-matter-of-trademarks-or-patient-trust.html https://biospectrumindia.com/views/21/28123/drug-names-a-matter-of-trademarks-or-patient-trust.html Tue, 14 Jul 2026 19:28:39 +0530 A case study by the Indian Institute of Management Ahmedabad highlighted how the advertisement of a mother caring for her sick child by applying Vicks turned the brand into a cultural icon of caregiving. This is how medicine names acquire trust and reliance over time. In this backdrop, the Central Drugs Standard Control Organisation's (CDSCO) circular proposing to regulate the use of similar brand names for medicines containing different active pharmaceutical ingredients and serving distinct therapeutic purposes warrants attention. It recognises that confusion between medicines cannot be treated merely as an intellectual property dispute. It is equally a question of patient safety. However, as the regulator tightens pharmaceutical nomenclature, it also needs to decide if it will employ trademark law principles to adjudge similarity, or it needs to develop additional framework rooted in medication safety?   Formula of Medicines Nomenclature Pharmaceutical manufacturers name brands through a painstaking process. They hire linguists, lawyers and market researchers who test the pronunciation, trademark registrability, and memorability of numerous proposed names. The objective is to generate brand recognition and patient trust. Many a times drug names differ by a syllable, prefix or suffix despite serving different therapeutic purposes. These are called look-alike and sound-alike (LASA) drug names. Their similarity can confuse not only patients, but also trained doctors and pharmacists who work under severe time pressures.   Prescribing the Problem The risks posed by LASA drug names are magnified by the realities of India's healthcare system. A Comptroller and Auditor General report on government hospitals in Uttar Pradesh found that outpatient consultations commonly lasted for two minutes. Doctors often write hurried prescriptions and have little time to explain the medicines to patients. Pharmacists operate under similar pressures. Another CAG audit of Delhi hospitals found that each pharmacist routinely attended to over 200 patients, while deciphering illegible prescriptions and managing staff shortages. Patients increasingly navigate healthcare by themselves. A recent survey found that 8 out of 10 patients in Delhi NCR searched online after consulting a doctor because they remained unclear about their medicines. Many depend on remembered brand names and self-medication. This convoluted ecosystem demands regulation before harm occurs.   Reactive Trademark Law Confusing pharmaceutical names are traditionally regulated through trademark law. Sections 9(2)(a) and 11 of the Trade Marks Act, 1999 prohibit the registration of marks that are likely to cause confusion or are deceptively similar to an earlier trademark. In Cadila Health Care Ltd. v. Cadila Pharmaceuticals Ltd., where the similarity between the marks of two drugs was being disputed, The Supreme Court observed that medicines are a different class of goods. This is because confusing one medicine for another may result in therapeutic failure. Accordingly, the Court held that instead of focusing only on visual or phonetic similarity, courts must also consider the nature of the medicines, their therapeutic use, the class of purchasers, and the mode of purchase. Trademark litigation however cannot be a one-stop for drug regulation, as litigation is inherently reactive, and it is initiated by private manufacturers to secure their good will and commercial interests. Preventing errors resulting from LASA drug names requires a regulatory intervention before a proprietary name is introduced into clinical practice.   Sluggish Regulation As per section 17B of the Drugs and Cosmetics Act, 1940, a drug that has a name similar to another drug and is likely to confuse, is considered a spurious drug. Although the provision partially captures the problem of resemblance and confusion. It does not prescribe the standards for adjudging similarity. Relying on it, the Court in Cadila suggested that regulators could require applicants to check for likelihood of confusion before proposing names. Eventually, it directed the Ministry of Health and Family Welfare (MoHFW) to develop a framework to curb the menace of LASA drugs. The Delhi High Court in Curewell Drugs & Pharmaceuticals Pvt. Ltd. v. Ridley Life Science Pvt. Ltd. Echoed this sentiment. Thereafter, the 59th report of the Parliamentary Standing Committee on Health and Family Welfare also reemphasised the judicial directives. After a long vacuum, the MoHFW introduced the Drugs and Cosmetics Amendment Rules, 2019 requiring companies to self-certify that their proposed names are unlikely to cause confusion, and to upload the proposed names on the database hosted by CDSCO’s SUGAM portal. But this reform papered over. A survey of 137 postgraduate residents at a tertiary hospital showed that 39% of medical errors continued to be a result of LASA drug names. While the SUGAM database was made publicly searchable only in 2024, after the Drugs Consultative Committee reiterated the suggestion. Even now this portal only enables browsing across existing drug names, it does not offer any standards for determining similarity. Courts and regulators have recognised that LASA drug names need to be curbed in unison. But no one has clarified the methodology for doing so.   Call for Proactive Regulation International experience demonstrates that LASA assessments require structured methodologies. The United States Food and Drug Administration evaluates proposed proprietary names through phonetic and orthographic analysis, wherein it is determined if two drug names sound or appear similar when they are spoken or written. It also conducts simulated prescribing and dispensing tests, to see if healthcare professionals are likely to confuse the names while reading handwritten prescriptions or selecting medicines from a pharmacy shelf. Similarly, health Canada focuses on factors like visual and sound similarity and the clinical context of prescription and dispensation. CDSCO must adapt these international methodologies to India’s multilingual prescribing environment. A predictable set of standards need to define how similar is too similar, in what all conditions should a name sound and appear to be similar, to which stakeholders should it seem similar. This would provide greater certainty to manufacturers and assist doctors and pharmacists in identifying potential risks. A medicine name is not merely a commercial identity, but a constituent element of the patient safety architecture. Hence, its regulation cannot be ex-post. While the CDSCO collects inputs from the industry, a significant regulatory decision awaits it- whether LASA drug names should be regulated through trademark or patient safety principles or both. The answer is not easy, but it nevertheless has to be excavated.   Anchal Bhatheja, a Delhi-based lawyer, currently pursuing LLM at Harvard Law School ]]> https://biospectrumindia.com/views/21/28074/how-international-exposure-and-collaborations-are-reshaping-pharmacy-education-in-india.html https://biospectrumindia.com/views/21/28074/how-international-exposure-and-collaborations-are-reshaping-pharmacy-education-in-india.html Mon, 06 Jul 2026 10:16:27 +0530 A pharmacist's role has evolved substantially in the last few decades. It extends far beyond the conventional image of dispensing medicines, and has incorporated many more responsibilities. Pharmacists have emerged as integral members of multi-functional healthcare teams, with contributions to drug discovery, clinical research, regulatory science, pharmacovigilance, and public health. Healthcare is becoming increasingly interconnected, and thus, preparing pharmacists to address global challenges requires an education that reaches beyond borders. The pharmaceutical industry mandates a global outlook. Medicines developed in one country may be manufactured in another, assessed through multinational clinical trials, and regulated under international standards, before reaching patients worldwide. Pharmacy graduates, therefore, must be equipped not only with the technical know-how, but also with a comprehensive understanding of global healthcare systems, continuously evolving regulatory frameworks, and collaborative research practices. The advent of AI necessitates students to be well-versed in digital technologies. International exposure empowers students to hone their skills in these varied domains, while acquiring the confidence to work across borders. Globally, leading pharmacy schools are calling for international collaborations through student exchange programmes, joint research initiatives, and collaborative publications. These partnerships consolidate conceptual understanding among students by encouraging them to think of multiple approaches to the pharmaceutical sciences, clinical practice, innovation, and healthcare delivery. Moreover, students become capable of deriving knowledge from various disciplines, including biotechnology, biomedical engineering, and data science, to solve prevailing challenges in healthcare. India, having cemented its position as the ‘Pharmacy of the World’, is at the forefront of contributing to this ecosystem. Our nation possesses one of the world's largest pharmaceutical industries, a competent workforce, and an ever-expanding research landscape, driven by pioneering initiatives in domains such as biologics and novel medical devices. Recent reforms introduced by the Pharmacy Council of India under the National Education Policy 2020 framework are a significant step forward towards progress. These reforms incorporate artificial intelligence, machine learning, digital health, innovation, and entrepreneurship into the existing curriculum, thus preparing graduates for a dynamic healthcare landscape and enhancing their global competitiveness. For international collaborations to be meaningful, they must go beyond formal agreements. Sustained academic collaboration is the need of the hour. Student exchanges, collaborative research, knowledge-sharing initiatives, and interactions with global experts provide valuable opportunities to broaden perspectives, encourage innovation, and strengthen academic excellence. Such initiatives foster the exchange of ideas across borders, enabling learners to develop a deeper understanding of healthcare systems and pharmaceutical sciences from a global perspective. Such collaborations are in tandem with initiatives that are being taken by global organisations. The International Pharmaceutical Federation (FIP), the worldwide body that represents pharmacy practice, education, and science, is actively involved in measures to tackle the problem of antimicrobial resistance. It coordinates its work through an AMR Commission and the 2025 Copenhagen Declaration, signed by 82 member organisations to strengthen international partnerships and antimicrobial stewardship. FIP has also worked to rectify gender-based imbalances in healthcare through FIPWiSE, its initiative supporting women in science and pharmacy education. An international perspective and the exchange of ideas across the world have the potential to empower pharmacists to better understand the ground realities of India's healthcare systems. Affordability and accessibility remain key issues in India's healthcare landscape. Such global partnerships signal wide-reaching policy changes, which will positively impact patients and healthcare providers alike in the decades to come.   Dr Supriya Shidhaye, Principal, Vivekanand Education Society, College of Pharmacy ]]> https://biospectrumindia.com/views/21/28076/nutritional-interventions-to-address-the-growing-liver-crisis.html https://biospectrumindia.com/views/21/28076/nutritional-interventions-to-address-the-growing-liver-crisis.html Mon, 06 Jul 2026 11:23:16 +0530 Acting as the body’s primary "fat traffic controller," the liver drives glucose and fatty acid metabolism. When compromised, it directly triggers lipid accumulation, obesity, type 2 diabetes, and cardiovascular disease. At the cellular level, this dysfunction is born in the mitochondria—the powerhouse fueling over 500 vital hepatic functions via Adenosine Triphosphate (ATP) production. Sugar, fructose, and environmental toxins disrupt the mitochondrial electron transport chain of liver cells, depleting ATP while spiking cell-damaging reactive oxygen species (ROS). This blog deconstructs the precise biological mechanisms behind liver failure and reveals targeted therapeutics interventions to eliminate toxins, activate detoxification pathways, and restore metabolic health from the inside out.  The liver conundrum Weighing roughly 3 pounds, the liver is the cornerstone of metabolic health, executing over 500 biochemical functions—including glucose and fatty acid metabolism, cholesterol biosynthesis, ketone production, and homocysteine regulation. To sustain this massive workload, liver mitochondria must operate at peak capacity to generate ATP. While sugar and fructose dominate popular liver health discussions, mitochondrial disruption and liver dysfunction are frequently triggered by deeper cellular interactions, including the oral-gut-liver axis and environmental toxins. Starting with inflammation, liver diseases pass through four different stages before the unimaginable liver failure happens. Chronic inflammation: Consuming rancid seed oils high in polyunsaturated fatty acids destabilizes liver cell membranes, making them highly susceptible to oxidation. This cellular fragility allows an influx of both environmental and microbial toxins—including microplastics, glyphosates, mycotoxins, and gut- or oral-derived Lipopolysaccharides (LPS) and proteases. Inside the liver, these toxins break down energetic processes of mitochondria, generating massive reactive oxygen species (ROS) and launching an inflammatory cascade driven by NF-κB, TNF-α, and IL-6. This chronic, silent inflammation causes hepatic swelling and cellular damage that typically remains asymptomatic until flagged on routine blood panels. Fibrosis: Continued inflammation leads to formation of scar tissue which impairs the blood flow. This could be reversed if the underlying cause is treated. Cirrhosis: Extensive scar tissue replaces healthy cells, severely impairing the organ's ability to function and regenerate. This damage triggers symptoms like fatigue and abdominal swelling, alongside elevated homocysteine levels—affecting over 50% of patients. Furthermore, because the scarred liver cannot efficiently process glucose or clear insulin, up to 80% of patients experience glucose intolerance, with 30% to 60% developing "hepatogenous diabetes”. Routine blood tests typically capture this dysfunction through abnormal liver function tests and elevated ALT and AST enzymes. End stage liver disease(ESLD): The liver is so scarred that it  shuts down and complications like internal bleeding, kidney impairment show up. Precision therapeutics approach to liver disease prevention Modern liver disease treatments rely on generic lifestyle changes and pharmaceuticals, yielding poor results. Instead, precision therapeutics targeting mitochondrial energy and trans-organ inflammation can restore liver function and lower metabolic syndrome risk. This approach centers on optimizing cell membrane fluid dynamics, regulating the mitochondrial electron transport chain, suppressing inflammation, and accelerating detox pathways. Some of these therapeutic and cellular and mitochondria support molecules include Phospholipids: Phosphatidylcholine (PC) is a vital phospholipid made of choline and essential fatty acids (saturated, Omega-3, and Omega-6). By maintaining cell membrane structure and fluidity, PC drives crucial cellular communication. It also accelerates detoxification—repairing liver cells and flushing out toxin-laden fats through bile. Some of the food having Phosphatidylcholine includes lecithin in egg yolks, sunflower seeds, cheese and even soy based lecithin. Supplements such as soy lecithin and phosphatidylcholine enhance cellular integrity and detoxification, provided the lecithin is free of seed and vegetable oil carriers. TUDCA: The liver secretes primary bile acids, which gut microbes synthesize into the secondary bile acid Ursodeoxycholic acid (UDCA). When conjugated with taurine, it becomes TUDCA (Tauroursodeoxycholic acid). Key Benefits of TUDCA Supplementation Detoxification and Inflammation Control: Downregulates oxidative stress markers and key inflammatory molecules (such as NF-κB, IL-1β, and TNF-α). Cellular Stress Relief: Acts as a chemical chaperone to relieve endoplasmic reticulum (ER) stress, reducing cellular strain in liver cirrhosis patients. Enzyme and Scar Reduction: Lowers ALT and AST liver enzymes and helps reverse liver scarring (fibrosis). Metabolic Support: Improves insulin sensitivity, counteracting the insulin resistance typically caused by liver cirrhosis. Ginger: Ginger is an excellent herb for the liver. It contains 6-Gingerol and shogaols. These phenolic compounds reduce oxidative stress by neutralising reactive oxygen species produced by mitochondria of liver cells, thereby lowering lipid peroxidation. These compounds also suppress inflammatory pathways such as NF-κB and decrease the accumulation of triglycerides in the liver. Curcumin + Black Pepper: This potent combination is the key to regulate liver health and downregulate ALT and AST liver enzymes. While curcumin is poorly absorbed in our body, combining curcumin with piperine in black pepper suppresses inflammatory cytokines such as NF-κB, IL-1β, and TNF-α. This combination also boosts production of superoxide dismutase (SOD) that can neutralise reactive oxygen species and reinstate functions of mitochondria of liver cells. N-Acetyl-Cysteine (NAC): This molecule converts to L-cysteine to synthesize glutathione. Driven by gut-derived butyrate, a specific transporter moves glutathione into the mitochondria, where it neutralises reactive oxygen species and protects liver cells from oxidative damage. Liver health is a key driver of metabolic health. Injury to hepatocytes and their mitochondria caused by inflammation, oxidative stress and exposure to toxins could drive metabolic syndrome including obesity type 2 diabetes, fatty liver disease and  cardiovascular disease. Adopting a non-toxic therapeutics and precision nutrition approach can support liver cells in driving essential biochemical functions while also clearing toxins from the cells to reinstate metabolic homeostasis.   Sushant Kumar, Founder, Genefitletics ]]> https://biospectrumindia.com/views/21/28004/india-is-building-world-class-hospitals-who-is-training-people-to-run-them.html https://biospectrumindia.com/views/21/28004/india-is-building-world-class-hospitals-who-is-training-people-to-run-them.html Mon, 22 Jun 2026 19:50:23 +0530 In my 40 years of professional journey, I have seen the remarkable growth in the hospital sector and paradigm shift in the last five decades, starting from doctor-led nursing homes to charitable hospitals to professionally managed and now in the present context, investor-backed, technology-heavy, and multi-location healthcare enterprises. This is indeed a remarkable journey by all means. Consumerism in healthcare has increased, thanks to Google for generating awareness, and now AI tools like Cloude, ChatGPT and Gemini and others are educating them a lot, and this journey is not to end here, as Indian being a big and attractive market, we have a lot of FII/FPI participation in major visible hospital chains like Apollo, Max Healthcare, Narayana, Aster DM. In shaping the hospital industry, Private Equity funding has played a pivotal role. In the growth of the hospital industry, the role and support of the Pharma Industry also cannot be undermined, be it Clinical practice and treatment protocols or clinical trials, knowledge diffusion or Hospital pharmacy.   The ratio 1:811that makes us feel good about the problem actually, we haven’t solved: Thanks to our Medical universities ( Govt. and Private both), our Doctor to population ratio has improved: 1:811 (at the aggregate level), but this statistic does not convey anything about the geographical dispersion and concentration, registration vs practice gap and then the distribution by speciality-wise. A district in Bihar or rural Rajasthan could have ratios many multiples worse than 1:811, while the Metros like Delhi/Mumbai might be pulling back the average up. These statistics do not throw any light in context to the operational unpreparedness esp. in the context of a high-tech health system, it does not convey anything about nurses, allied health workers, technicians, or workers, and it conveys nothing about whether those Doctors have the digital, managerial or systems skills! Thus, this ratio 1:811 (a misleading number) conveys to us “how many”, but it does not convey anything about whether they are “equipped” for the system being built. Hence, in my opinion, even if every gap in that ratio is filled, it will be solving our yesterday's problem and not today’s problem, as the workforce India needs today is not just larger but the one that is ready to keep learning even after the degree is over.   Your degree has an expiry date -and most Clinicians don’t know it has already passed In today’s content, one must be continuously in the process of Learnè Unlearnè Relearn. I have rarely seen any “learning ecology” in the organisations which can equip /support the healthcare workers in their productivity or career progression. What I tell a classroom is true – but what happens when an entire institution never relearns is no longer a classroom problem. It is certainly the board-level problem that they inherit without ever being told.   Organisations promote their best clinicians and then abandon them there During my interactions with the various CEO’s/board members, I often ask,” What is the criteria for promotion is your business organisation? Is it tenure or clinical expertise? Across all the levels, I call this systemic leadership capability a “Board level risk”, as here in this transition, particularly, the leadership capability is assumed; it is not developed. The strategic decisions are driven by clinical or technical bias, which is further compounded by weak financial and people decisions esp. at the senior level. Thus, this lack of leadership quality directly impacts governance, compliance and outcomes. Thus, the ritual announcement of the promotion is there, but actually, no transition exists; they are still doing the same job with the added responsibility of a new one, whereas the Management Board yardstick still remains the same; it never changes. The organisational systems have everything to measure, but I fail to understand why they cannot measure this visible systemic gap. This failure has only one exit- and it’s silent. I have seen management agonise over who to promote into the Management.   Task-Shifting: A Strategic Enabler The same institution cannot ask/fail to ask the right question- right now, who is there on the floor doing more than their designation and can still be asked safely to do more? So, this risk compounds further when the board member looks only for the upward solutions -i.e. hiring better leaders, building competent pipelines, while at the same time, there is a second, larger source of capability just one level down, already trained, competent, willing, but largely untapped. This is probably the systemic failure. To overcome this, a better and safer option is “task shifting” in place of “shortage management”, irrespective of the fact that whether a hospital has adequate staffing, having a specialist to do that work that a trained nurse or qualified technician can perform equally well, is certainly a misallocation of the most expensive resource in that organisation. This is proved in various scientific studies, too, such as the landmark IMAPCT Diabetes study. Punjab’s I-TREC model further augments and adds credibility to the task-shifting concept. If task-shifting is carried out in a programmed manner with shared decision making, clear process outcomes, adequate training and competency building, it becomes a strategic enabler. Without these, it becomes a liability.   Rural Posting: Career Death Sentence or Opportunity? In a low-resource setting like India, this task -shifting as a redesign has emerged as a potential strategic enabler, but unfortunately, its value is not evenly distributed, as the problem in rural India starts even one step earlier -retention, as the rural posting is considered a Career Death Sentence. For the last three decades, unfortunately, organisations/governments have mismanaged the rural placements as they have failed to provide proper infrastructure, incentives and desired support, thus making workers feel neglected, isolated, punished and forgotten. In today’s context, the current generation views rural posting as a punishment and not as an opportunity. The career ladder path has not been designed to pass through rural India. The saddest part in this context is that rural postings are considered a transaction and not a relationship.   Three Transformative Decisions: A forward-looking actionable framework Every problem shared above has a common root cause – capability (pl read this as capacity +ability) -and that too at every level -from the board room to the village clinic. The question here is not whether it can be “fixed”, but what “fixing” it actually requires. My forty years of professional experience have helped me to see these gaps from both ends – navigating them as a pharmaceutical professional and later in my academic tenure, teaching the students how to navigate. So, what follows is not theory; rather, this is what I believe needs to change, starting with the three decisions any healthcare institution can make today: Building and then further strengthening the CPD (Continuous Professional Development). The professional development should be continuous and not episodic training. The organisations should not consider this as an expenditure, but rather it should be considered as an investment in the most precious resources of the organisation- human resources (aka work force). Treat this workforce capability as an “infrastructure”. The organisations can plan it tier wise facilities by linking them/aligning them with their workflows. The leadership transition should be a “design process” with full accountability at the Board level. There should be structure on-boarding, mentoring, coaching, and cohort support for clinicians moving into management. Like all other audit processes in the organisation, there should be a “leadership pipeline readiness” process with a proper audit process in place with accountability at the board level. It’s high time to incentivise task-shifting and rural retention. The organisations should not only identify and formalise the scope of work and practices along with the desired /customised training pathways esp. in the context of the frontline, as they need to be strengthened. The most often overlooked, neglected and ignored but very important pathways are Rural Career pathways; it needs to be rebuilt or rechristened in such a way that it offers not only willingness but also a potential source of opportunity for career progression and advancement. And this is precisely the model we are testing as an organisation at HMX (Centre of Health Management Excellence).   Dr Sandeep Narula -Professor and Centre Head, Centre of Health Management Excellence, HMX, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur ]]> https://biospectrumindia.com/views/21/27976/how-cyberknife-is-revolutionising-radiation-oncology.html https://biospectrumindia.com/views/21/27976/how-cyberknife-is-revolutionising-radiation-oncology.html Tue, 16 Jun 2026 17:03:18 +0530 Radiation therapy has long been an effective and valuable modality for fighting cancer, but recent advances have taken its benefits to a whole new level. What we are talking about here is CyberKnife - a highly precise and non-invasive robotic radiosurgery system used to treat cancerous and non-cancerous tumours. Unlike in conventional radiation therapy, where radiation is typically delivered over several weeks and may require larger treatment margins to account for patient movement, robotic stereotactic radiation systems are designed to deliver highly precise radiation doses directly to the target area while minimising exposure to surrounding healthy tissues, which can significantly change the treatment journey for many patients. Precision Like Never Before One of the biggest challenges in radiation therapy has always been ensuring that the radiation reaches the tumour accurately, while sparing nearby organs and critical structures. This becomes especially important when treating tumours located close to sensitive areas such as the brain, spine, lungs, liver, pancreas, or prostate. A robotic radiation system uses advanced imaging and real-time tracking to continuously monitor the tumour's position during treatment, and adjusts the radiation beams automatically when the target moves due to breathing or other natural body movements. As a result, treatment can be delivered with exceptional precision, reducing the risk of treatment-related complications. A Non-Invasive Alternative Many cancerous tumours required surgery as the primary treatment approach. However, not every patient is a suitable surgical candidate due to factors such as old age, underlying health conditions, tumour location, or personal preferences. A highly focused stereotactic radiation therapy offers a non-invasive treatment option for selected patients. In most cases, the procedure does not require incisions, anaesthesia, or hospitalisation, and patients can return to their normal activities shortly after treatment. Fewer Treatment Sessions Conventional radiation therapy often involves multiple sessions scheduled over several weeks. While effective, this schedule can be physically and emotionally tiring for patients and caregivers. A robotic stereotactic radiation system, on the other hand, allows oncologists to deliver very high doses of radiation with remarkable accuracy, which means fewer sessions (1 to 5), depending on the type, size, and location of the tumour. Expanding Applications While the robotic radiosurgery system was initially developed for treating certain brain lesions, it is now being used for a wide range of cancers and non-cancerous conditions, including tumours of the lung, liver, pancreas, prostate, spine, and other challenging locations. The technology has also expanded treatment possibilities for patients with recurrent tumours or limited metastatic disease, where precise targeting is essential. In many cases, it can be used in conjunction with surgery, chemotherapy, immunotherapy, and other cancer treatments as part of a multidisciplinary treatment plan. Improving Quality of Life Beyond tumour control, modern cancer care increasingly focuses on preserving quality of life. By reducing radiation exposure to healthy tissues, advanced stereotactic radiation from a robotic radiosurgery system may help minimise side-effects and support faster recovery compared to traditional approaches. Patients often experience fewer interruptions to their daily routines, and the non-invasive nature of treatment can reduce help anxiety. While outcomes vary depending on the individual diagnosis and treatment plan, the ability to deliver highly targeted therapy is indeed an important step toward more personalised cancer care. The Future of Radiation Oncology As cancer treatment continues to evolve, precision medicine is becoming central to improving outcomes and patient experiences. Robotic stereotactic radiation systems exemplify this shift by combining advanced imaging, artificial intelligence-driven tracking, and highly accurate radiation delivery into a single treatment approach. While not suitable for every patient or every cancer type, their ability to provide precise, non-invasive, and efficient treatment make them one of the most significant recent innovations in radiation oncology.   Dr Munish Gairola, Director, Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC), Delhi ]]> https://biospectrumindia.com/views/21/27951/biotech-trends-driving-innovation-in-diagnostics-and-disease-management-in-india.html https://biospectrumindia.com/views/21/27951/biotech-trends-driving-innovation-in-diagnostics-and-disease-management-in-india.html Fri, 12 Jun 2026 19:26:23 +0530 With chronic diseases, infectious diseases and the aeging population posing an increasing threat to India, it is becoming ever more important to diagnose correctly and manage diseases efficiently. Biotechnology developments are playing a very important part in this and developing how healthcare will be. The Growing Importance of Biotechnology in Healthcare The discipline of biotechnology uses biological science combined with modern technology to solve the world's needs for health care, agriculture, and industry. Biotechnology has played a critical role in the development of solutions to health care concerns including disease diagnostics and treatments and customized medical care. Supported by government policy, rising private funding and the emergence of a robust ecosystem of research organisations and startups, India is at the fore of advancements in the field of biotechnology research. Now it is expected that the tools and treatment methods in diagnostics can extend to a wide variety of healthcare institutions instead of being restricted to specialised institutions. Biotechnology is driving innovation in the medical sector of India as the health systems mature.   Molecular Diagnostics Is Transforming Disease Detection One of the most significant biotechnology trends in India is the rapid adoption of molecular diagnostics. Traditional diagnostic methods often rely on symptoms and laboratory testing that can take time to deliver results. Molecular diagnostics allows healthcare professionals to detect diseases at the genetic and molecular level with greater accuracy. By employing techniques like Polymerase chain reaction (PCR), nucleic acid testing and other modern methods for advanced biomarkers diagnosis infectious diseases, genetic diseases and many different types of cancers are being diagnosed more rapidly and appropriately. The earlier and more accurate diagnosis allow healthcare workers to start treatment earlier and provides a better result for the patients. In 2025, Bengaluru-based Biopeak launched its first longevity clinic combining molecular diagnostics, advanced imaging, and AI-driven health assessments, while also securing $3.5 million in seed funding to expand its diagnostic platform and clinic network. This reflects growing investor confidence in next-generation diagnostic technologies. Genomics and Personalised Medicine Are Gaining Momentum Genomics is an emerging field in managing diseases in India. Information on the genome of an individual enables a healthcare provider to acquire more understanding on an individual's susceptibility to a certain disease, response to treatments, and likelihood of the treatment outcome. The growing adoption of genomics and advanced diagnostic technologies is also reflected in market trends. As per Consegic Business Intelligence, the global biomarkers market is projected to grow at a CAGR of 10.9% through 2031, driven by increasing demand for early disease detection, personalized medicine, and advanced diagnostic solutions. Personalised medicine takes this genetic information and develops an individual specific therapy based on an individual's unique characteristics, thus moving away from a one-size fits all approach in medicine. It uses an individual's genetic profile to select the therapy more likely to work on them. This new trend of using genomics in disease management is more prevalent than in other areas, such as oncology, where precise drug therapies have been developed to more accurately target cancer. It is predicted that the role of personalised medicine will continue to grow as genomic testing decreases in cost and increases in availability. Artificial Intelligence (AI) Is Enhancing Diagnostic Accuracy AI is also used in the diagnostic field in integration with biotechnology. It is able to analyse lab results, patient's records and medical images faster than any manual system. In the diagnostic lab, an AI algorithm can recognise trends and anomalies that might hint a disease. This technology assists healthcare workers by providing quicker and more precise findings and lessening the chance for human mistakes. In the prediction and risk assessment field, AI can help healthcare providers recognize any developing health problem earlier and then establish some preventative care programs that will help long-term results. AI-driven diagnostics continue to attract significant investment and commercialization. In 2025, Indian health-tech company Dectrocel raised Rs 4 crore to expand its AI-powered diagnostic solutions for respiratory and hepato-pancreatico-biliary diseases. The company also commercialised DecXpert, one of the few CDSCO-approved AI diagnostic tools currently available for clinical use in India. Advancements in Point-of-Care Diagnostics The accessibility of healthcare is an issue in several parts of India, especially in rural and isolated areas. Point of care diagnostics is reducing the gaps by bringing the testing close to the patient. Point of care diagnostic devices deliver results instantly without specialszed lab equipment. These methods are especially useful for screening and detecting infections, monitoring patients for chronic disease, and assisting in emergency situations. Biotechnology companies are creating innovative test platforms that are cheap, user-friendly and can be adapted to many health care settings. This helps the patients to be able to receive immediate medical diagnoses and recommendations regardless of where they live. Point-of-care diagnostics have received increased industry support through strategic investments. In 2024, Cipla announced an additional investment of up to Rs 26 crore in Achira Labs, a Bengaluru-based company developing microfluidics-based point-of-care diagnostic kits. The investment is expected to accelerate the commercialization of rapid testing solutions designed for decentralized healthcare settings.   Biotechnology Is Strengthening Disease Management Disease management extends beyond diagnosis. Effective healthcare requires continuous monitoring, treatment optimisation, and patient engagement. Biotechnology is supporting these goals through innovative monitoring technologies and advanced therapeutic solutions. Through wearable health devices, connected monitoring systems, and biomarker tests, healthcare providers are better able to monitor the health of their patients. These devices are producing new data which can aid treatment and disease management. For chronic illnesses such as diabetes, cardiovascular diseases and respiratory conditions ongoing monitoring enables healthcare team to recognise and address changes in a timely fashion.   Growth of Biopharmaceutical Research Besides all the developments that the biotech sector is doing, India's growing biotechnological sector is enhancing human health by developing advanced biopharmaceutical products. With a variety of new biologics, biosimilars, and targeted therapies being produced, patients suffering with complex conditions will be offered more treatment options. These biopharmaceutical products are crucial in curing diseases such as cancer, autoimmune diseases, and rare disease, more so than old fashioned medicines. Compared with previous treatments, these new biologic medicines are more specific, will help to optimize the response rates and patient prognosis, but also reduce adverse effects. In 2025, Biocon launched Liraglutide in the UK market, marking its entry into the fast-growing GLP-1 therapy segment. The company also launched Yesintek in the United States and continued expanding its biosimilar portfolio globally. These developments highlight India's growing capabilities in advanced biologics and biosimilar innovation.   Digital Health Integration Is Accelerating Innovation This convergence of biotechnology and digital health has opened up new frontiers in healthcare delivery. Tools such as electronic health records, telemedicine technologies and data analysis systems have enabled clinicians to make better informed decisions in all aspects of health. Diagnosis data is being used in conjunction with medical histories and other clinical information, providing a complete picture of an individual's health and leading to improved diagnoses and treatment plans. It also facilitates greater interaction between patients and physicians, and an increased efficiency in the management of the disease. Digital health and biotechnology are increasingly converging through AI-enabled healthcare platforms. In 2025, AI-driven clinical research company Pi Health expanded its presence in India by deploying AI technologies to streamline clinical trial management and accelerate drug development processes. Such innovations demonstrate how digital platforms are improving healthcare efficiency while supporting biotechnology research and disease management.   Challenges and Opportunities Ahead Although there are considerable advancements, there are still challenges faced. Adoption of cutting-edge biotechnology solutions might not be uniform across various geographies, and it will be imperative that the healthcare professionals address the cost issues so that technology is within reach of a larger population. Infrastructure, human capital, and the regulatory regime will be critical to the long-term growth sustainability within the biotechnology sector and further development will still depend on sustained R&D for its momentum and future progress. However, India’s sizable patient pool, increasing healthcare needs and burgeoning biotechnology domain do provide considerable scope for growth. Conclusion Overall, biotechnology is revolutionising the diagnosis and treatment of various diseases in India. Through advances in molecular diagnostics, genomics, artificial intelligence, point of care tests and development of bio-pharmaceutical drugs, healthcare is becoming increasingly effective, affordable and accessible. The applications of biotechnology in healthcare will continue to grow with emerging technologies, helping to solve current healthcare issues and facilitating the move towards a more personalised and data-driven model of healthcare delivery. Due to investment in the technology, infrastructure and research it is highly likely that in years to come India will become a global force in biotechnology-based solutions.   Aditi Jaiswal is a Content Writer at Consegic Business Intelligence ]]> https://biospectrumindia.com/views/21/27933/medical-significance-of-renaming-pcos-as-pmos.html https://biospectrumindia.com/views/21/27933/medical-significance-of-renaming-pcos-as-pmos.html Tue, 09 Jun 2026 22:50:51 +0530 For years, I have seen women walk into clinics carrying the weight of confusion, shame, and misinformation around PCOS. Many come to believe they only have a “period problem.” Others think they cannot have PCOS because their scans did not show ovarian cysts. Some only discover the condition when they struggle with weight gain, acne, infertility, anxiety, or difficulty conceiving. That is exactly why the recent global move to rename PCOS as PMOS (Polyendocrine Metabolic Ovarian Syndrome) is medically significant.   Polycystic Ovary Syndrome, commonly known as PCOS, is now increasingly being referred to as Polyendocrine Metabolic Ovarian Syndrome (PMOS). The change comes after years of discussion among endocrinologists, reproductive health specialists, researchers, and patient advocacy groups worldwide. And honestly, I believe this shift was long overdue.     Why The Name “PCOS” Was Incomplete   One of the biggest misconceptions around PCOS has always been the word “polycystic ovary.” In reality, many women diagnosed with PCOS do not even have ovarian cysts. The condition is much more complex than what the old name suggested.   As doctors, we have known for years that PCOS is not just an ovarian disorder. It affects the entire hormonal and metabolic system of the body.Renaming PCOS as PMOS is more than a cosmetic change in medical terminology. For years, many women misunderstood the condition because the word ‘polycystic ovary’ made them believe it was only related to ovarian cysts or fertility. In reality, this condition affects the entire hormonal and metabolic system of the body.   The term PMOS better reflects what we see clinically today, women struggling not only with irregular periods and ovulation issues, but also insulin resistance, inflammation, weight fluctuations, stress-related hormonal imbalance, anxiety, poor sleep, and long-term metabolic risks. I believe this shift will help create broader awareness that hormonal health is deeply connected to overall wellbeing, not just reproduction. That is why the term PMOS feels more medically accurate.   The new name highlights the three major systems involved:   Polyendocrine- Meaning multiple hormonal systems are affected simultaneously.   Metabolic- Meaning the condition is strongly linked to insulin resistance, weight gain, inflammation, diabetes risk, and metabolic dysfunction.   Ovarian- Because ovulation, menstrual cycles, and fertility are still central aspects of the condition.   In simple words, PMOS acknowledges that this is a full-body hormonal and metabolic disorder, not merely a reproductive issue.   What concerns me deeply is how early these metabolic disturbances are now appearing. A decade ago, we commonly diagnosed PCOS in women in their late twenties or early thirties. Today, many girls in their late teens and early twenties already show symptoms like: Irregular periods, Acne and facial hair growth, Rapid weight gain, Hair thinning, Fatigue and poor sleep, Insulin resistance also anxiety and emotional burnout In my clinical practice, I often tell patients that PMOS is no longer just a fertility diagnosis. It has become a lifestyle-linked metabolic condition.   Modern urban lifestyles are contributing significantly to this rise. Sedentary routines, chronic stress, poor sleep, processed food consumption, excessive screen exposure, and hormonal dysregulation are all playing a role and the numbers reflect this shift.   Several Indian studies estimate that PCOS affects anywhere between 1 in 5 to 1 in 10 women depending on the region and diagnostic criteria used. Research has also shown that Indian women with PCOS are developing metabolic complications much earlier than previously expected.     PMOS Is Not Only About Fertility   One of the biggest problems with the older terminology was that many women only associated PCOS with pregnancy difficulties. But the condition goes far beyond fertility. Women with PMOS may also face increased long-term risks of: Type 2 diabetes, High cholesterol, Fatty liver disease, Hypertension, Sleep disturbances, Anxiety and depression and cardiovascular complications   In fact, studies have shown strong associations between PMOS, insulin resistance, chronic inflammation, and mental health disorders. This is why I strongly believe women need earlier diagnosis, better education, and more holistic treatment approaches.   One thing that often gets ignored in hormonal health conversations is the emotional burden women silently carry. Women with PMOS frequently struggle with body image issues, weight fluctuations, acne, infertility anxiety, social pressure, and emotional exhaustion. Many feel frustrated because they are blamed for symptoms they cannot fully control. Hormonal imbalance affects emotional wellbeing. And emotional stress further worsens hormonal imbalance. It becomes a cycle. This is why treatment cannot remain limited to medications alone. Women need compassionate, long-term support systems that focus on physical health, emotional wellbeing, sleep quality, stress regulation, nutrition, and metabolic care together.     So What Changes Now?   The diagnostic process remains largely the same. Women may still be evaluated based on menstrual irregularity, androgen excess, ovulation issues, metabolic markers, and ultrasound findings. But what changes is the way we understand the condition.   The term PMOS encourages both doctors and patients to move beyond the narrow idea of “ovarian cysts” and recognise the broader metabolic and endocrine impact of the disorder. And that shift matters. Because when women understand that their symptoms are connected, they stop blaming themselves and start seeking comprehensive care earlier.   If you have irregular periods, unexplained weight changes, acne, facial hair growth, fatigue, sleep disturbances, or difficulty conceiving, please do not ignore these signals. Hormonal health is not superficial. It affects every aspect of wellbeing, from metabolism and fertility to emotional health and long-term disease risk. Most importantly, PMOS is manageable with the right support. Lifestyle changes, proper sleep, regular movement, balanced nutrition, stress regulation, and personalised medical care can make a significant difference when started early.   Women deserve to know that this condition is not their fault and certainly not something they should feel ashamed of. The body is not working against them. It is asking for attention, regulation, and care.     Dr Snehal Kohale, a consultant Fertility Specialist & Gynaecologist  ]]> https://biospectrumindia.com/views/21/27913/protecting-indias-healthcare-workers.html https://biospectrumindia.com/views/21/27913/protecting-indias-healthcare-workers.html Thu, 04 Jun 2026 22:38:25 +0530 India’s healthcare system serves a vast and diverse population of over 1.4 billion people, making it one of the largest and most complex healthcare ecosystems globally. One of the key focus areas for healthcare institutions has been the occupational safety of healthcare workers (HCWs), as they are the backbone of the healthcare system and are exposed to several occupational hazards, including blood‑borne infections such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV), as well as exposure to cytotoxic drugs. Among the various occupational health hazards, needlestick injuries (NSIs), which can lead to blood‑borne infections, are a major concern in hospital settings. The cost of inaction includes increased treatment costs, workforce loss, and absenteeism. India’s nurse to population ratio of 1.7 per 1,000 is below WHO norms of 3 nurses per 1,000 population underscores the need for a proactive safety culture. We must transition to an integrated safety approach that addresses mechanical, chemical, and systemic risks simultaneously. Scale of the Problem India’s hospital-based studies suggest that NSIs are common (often affecting ~30–60% of healthcare workers (HCWs) annually in facility-level reports) and are significantly underreported, making them a major yet preventable occupational safety concern. In India, it is estimated that around 20,000 NSI incidents occur annually, as reported by the ICMR. NSIs remain one of the most pervasive threats to healthcare workers. Studies indicate that 11.7% of HCWs in a hospital in Lucknow experienced an NSI within one year, while 79.5% of HCWs in Delhi reported experiencing at least one NSI during their careers. Globally, the prevalence of NSIs is approximately 44.5%. Underreporting remains a critical issue, with only 30 – 70% of incidents being reported, leaving a substantial number of cases unaddressed and unmanaged. Device and Transmission Risks In a study conducted at a tertiary care center, needlestick injuries (NSIs) were most commonly associated with blood sample collection (42.86%), making it the leading cause. This was followed by IV cannulation (36.90%), which also contributed significantly. In comparison, surgical procedures accounted for a smaller proportion (13.09%), while needle detachment after use (7.14%) was the least common cause. Overall, the majority of NSIs were linked to routine bedside procedures rather than surgical activities. These injuries carry a risk of transmission of HIV (0.3%), Hepatitis C (1.8%), and Hepatitis B (6–30% in non‑immunised individuals). Despite >95% vaccine protection against HBV, timely intervention remains critical, including adherence to the 72‑hour window for HIV post‑exposure prophylaxis (PEP). The Critical Gap: Adoption of Safety-Engineered Devices Safety-engineered devices are proven to reduce injuries and are globally recommended, yet adoption in India remains inconsistent due to cost and regulatory gaps. The cost of inaction, however, far exceeds upfront investment. Only about 68% of healthcare workers receive post-exposure prophylaxis after reported injuries, as limited awareness, delayed access, stigma, and underreporting persist, while rising cytotoxic exposure amid cancer cases projected to exceed 1.5 million annually underscores the need for safety infrastructure and improved biomedical waste handling. India’s nurse ratio remains below WHO standards and 30 to 50% of trained nurses migrate overseas. Fatigue from long shifts increases injury risk, with 58% of workers feeling unsafe and 63% citing inadequate safety protocols. Prevention Pathways Clinical studies have shown that safety‑engineered devices can prevent up to two‑thirds of needlestick injuries (NSIs), with the greatest benefit seen in IV safety technologies. NSI prevention requires the use of safety‑engineered devices, adherence to safe practices (such as avoiding recapping and ensuring immediate disposal), and the implementation of robust training and reporting systems. It also involves promoting the use of personal protective equipment (PPE), vaccination, and prompt post‑exposure care to reduce injury risk and protect healthcare workers. Strengthening universal Hepatitis B vaccination, ensuring 24/7 access to post‑exposure prophylaxis, and fostering non‑punitive reporting systems are critical to closing existing gaps, as protecting healthcare workers is essential for building a resilient healthcare system in India. Conclusion Strengthening safety measures through proper training, availability of personal protective equipment (PPE), adherence to infection control practices, use of safety‑engineered devices, and supportive institutional policies is essential to safeguard healthcare workers and ensure quality patient care. As India’s healthcare system continues to advance, protecting healthcare workers from preventable occupational injuries must remain a commensurate priority. Investing in safety‑engineered devices, implementing evidence‑based practices, and prioritizing worker well‑being are not optional—they are essential for building a sustainable and resilient healthcare system. The use of safety‑engineered devices can also generate cost savings for hospitals while helping achieve healthcare worker safety goals.   Atul Grover, ASSOCHAM Chairman of Medtech Council and Managing Director, BD India ]]> https://biospectrumindia.com/views/21/27897/beyond-antibiotics-how-phage-therapy-is-fighting-the-superbug-crisis.html https://biospectrumindia.com/views/21/27897/beyond-antibiotics-how-phage-therapy-is-fighting-the-superbug-crisis.html Tue, 02 Jun 2026 18:25:08 +0530 Every year, drug-resistant bacteria kill over a million people worldwide and the numbers are increasing. Antibiotics, the drugs we have relied on since the 1940s, are becoming increasingly ineffective. The answer, it turns out, has existed for billions of years bacteriophages, viruses that specifically infect and lyse bacterial cells. Scientists are now racing to harness their therapeutic potential, and emerging evidence suggests they could redefine our approach to infectious disease management. The Antibiotic Resistance Crisis: Why We Need Alternatives The golden age of antibiotic discovery, which once yielded over 40 distinct classes, has stalled. Today, the pipeline faces severe bottlenecks; out of thousands of preclinical molecules, fewer than five typically achieve regulatory approval. This high attrition rate, combined with rapid resistance, makes capital investment commercially unviable for pharmaceutical companies. While development stagnates, the threat accelerates. The evolution of multidrug-resistant (MDR) and pan-drug-resistant (PDR) pathogens notably the WHO’s high-priority ESKAPE group consistently outpaces new drugs. Left unaddressed, this will precipitate a post-antibiotic era where routine infections become lethal, necessitating an immediate shift toward alternatives like bacteriophage therapy. What Are Bacteriophages? Nature's Original Bacteria Killers Bacteriophages are viruses that target and destroy bacterial cells without affecting mammalian tissue. Unlike broad-spectrum antibiotics, which act as blunt chemical agents causing collateral damage to the host microbiome, phages are highly specific obligate parasites. They bind to precise surface receptors on Gram-positive or Gram-negative bacterial walls in a conserved receptor-mediated adsorption. Once attached, a lytic phage ejects its genetic material into the host cell, hijacking its metabolic machinery to manufacture viral progeny. Because phages reproduce exponentially at the infection site, they offer a self-limiting dosage; the treatment multiplies where bacteria are present and clears out once the host population is gone. Furthermore, unlike static drugs, phages possess an evolutionary capacity to mutate alongside the host when a bacterium alters its receptors to develop resistance. However, therapy must strictly utilise obligate lytic phages. Temperate phages risk lysogenic conversion, where integrated prophages transfer virulence factors or resistance genes to the host genome. Properly screened lytic phages can degrade biofilms and work synergistically with the immune system to fight pan-drug-resistant infections. How Phage Therapy Works: The Lytic Life  The therapeutic success of bacteriophage treatment relies entirely on the strictly lytic replication cycle, which systematically destroys target bacteria from within. The process begins with phage adsorption, where viral tail structures bind to specific receptors on the bacterial surface. Upon attachment, the tail tube penetrates the cell envelope to eject genomic DNA directly into the host cytoplasm. Once inside, the viral genome hijacks the cell’s framework, forcing the bacterium to stop its own synthesis and manufacture viral structural proteins and new phage genomes instead. To release these newly assembled particles, the virus must break through the durable bacterial cell envelope. This destruction is driven by two main types of phage-encoded proteins: polysaccharide depolymerases and virion-associated peptidoglycan hydrolases (VAPGH). The depolymerases degrade the outer protective capsule and extracellular matrix of biofilms, while the hydrolases directly break down the internal peptidoglycan layer. This coordinated enzymatic attack destabilises the cell wall, inducing osmotic lysis. The bacterium bursts, releasing hundreds of progeny virions into the immediate microenvironment to infect neighboring pathogens. Phages vs Antibiotics: Key Differences  Unlike systemic, broad-spectrum antibiotics that eliminate beneficial gut microbiota alongside pathogens, phages are precise biological entities targeting only the specific bacterial strain causing infection.This live nature completely changes dosing; while chemical drugs break down over time, phages multiply exponentially at the infection site, creating a natural feedback loop that scales up during infection and fades once it clears. Most importantly, if a bacterium alters its surface receptors to escape, phages can naturally mutate alongside it to maintain the attack and evolutionary flexibility a fixed chemical drug simply cannot match. Concluding Remarks and Future Outlook The looming threat of antibiotic resistance is a current medical emergency requiring an immediate expansion of our antimicrobial toolkit. As traditional drug pipelines dry up, bacteriophage therapy stands out as a biologically adaptive strategy, though moving it to standard clinical care brings real-world hurdles. Because wild phages are naturally occurring organisms, they cannot be patented, disrupting the standard pharmaceutical business model and forcing intellectual property to focus on engineering or processing techniques instead. Additionally, regulatory bodies are still establishing frameworks for a treatment that is dynamic and custom-tailored to individuals, though recent trials confirm that safety and treatment outcome remains positive. Despite these complexities, scaling phage therapy offers massive clinical returns, creating specialised biotechnology jobs and serving as a vital line of defense through phage-antibiotic synergy. Sneha Salunke, Freelancer ]]> https://biospectrumindia.com/views/21/27880/india-witnessing-expansion-of-ai-powered-lung-cancer-screening-in-public-hospitals.html https://biospectrumindia.com/views/21/27880/india-witnessing-expansion-of-ai-powered-lung-cancer-screening-in-public-hospitals.html Fri, 29 May 2026 19:20:43 +0530 India is making a giant leap forward in revolutionising cancer diagnosis through the application of artificial intelligence (AI) for lung screening in public hospitals. Given that lung cancer is among the most common cancers causing deaths, and it is usually diagnosed at a very late stage, the purpose of this innovation is to detect cancer early and treat it. This innovative technology relies on the power of AI to examine chest X-rays and CT scans. Through machine learning, AI tools are able to scan millions of medical images and spot any slight signs like tiny nodules and unusual tissue formations.  The technical side of such solutions is based on a combination of AI algorithms and deep learning approaches such as Convolutional Neural Networks (CNNs) that try to replicate human capabilities of analysing visual input data. As a result of constant learning from new samples, these systems become better and better at making distinctions between benign tumors and those that pose potential risks for patients' health. In addition to disease recognition, the introduction of AI in healthcare allows making advances in epidemiological studies and obtaining insights into factors affecting cancer development (including pollution). This means that the collected data might prove useful for policy-makers and allow developing preventive measures for the future. For instance, Goa is the first state in India to implement an AI-enabled lung cancer screening pilot. The government has proposed making AI-assisted screening a standard alongside chest x-rays in all government hospitals, so early detection is available to everyone. The initiative is being implemented under a public-private partnership with AstraZeneca and Qure.ai.  In April 2026, AstraZeneca Pharma India signed a Memorandum of Understanding (MoU) with the Government of Telangana to introduce AI-enabled lung cancer screening across public healthcare facilities in the state. The collaboration aims to strengthen early detection and improve outcomes for patients in both urban and rural areas. Several hospitals and institutions have also launched independent AI-driven initiatives. SSO Cancer Hospital recently announced the introduction of AI-powered diagnostic systems to improve cancer detection and patient care efficiency; Yashoda Hospital, Hitech City, has collaborated with Qure.ai to establish an AI-enabled Lung Nodule Clinic focused on identifying suspicious nodules earlier and ensuring faster clinical intervention; Kamala Nehru Hospital has partnered with IIT Kanpur to unveil an AI-powered lung cancer screening device designed to support accessible and affordable early detection, especially in resource-constrained healthcare settings. With AI implementation in public health facilities, India is creating a benchmark for the application of new technology to solve the problems of inequality in healthcare.   Somya Jain, Freelancer ]]> https://biospectrumindia.com/views/21/27869/india-2030-what-will-define-leadership-in-global-medical-tourism.html https://biospectrumindia.com/views/21/27869/india-2030-what-will-define-leadership-in-global-medical-tourism.html Thu, 28 May 2026 13:08:24 +0530 India’s leadership in global medical value travel by 2030 will not be defined by affordability alone. That advantage helped India earn global attention, but it will not be enough to secure long-term leadership in a far more competitive, better connected, and more demanding healthcare landscape. The next phase will be shaped by three things: how effectively India builds clinical corridors across markets, how well it strengthens cross-border healthcare capacity, and how reliably it delivers continuity of care across the full patient journey. That is where real leadership in medical value travel will now be determined. The scale of the opportunity is already clear. India’s medical tourism market is expected to nearly double from $8.7 billion in 2025 to $16.2 billion by 2030. At the same time, the global Medical Value Travel market is projected to reach nearly $286 billion by 2030, underscoring the scale and intensity of the opportunity ahead. India is not approaching this opportunity from the sidelines. It is already part of the global healthcare conversation. The question now is what kind of leadership it wants to build within it. Leadership Will Depend on Clinical Corridors, Not Just Clinical Reputation India already has strong clinical depth in high-demand specialties such as cardiology, oncology, orthopaedics, fertility treatment, organ transplants, and other complex procedures. Patients from the Middle East, Africa, South Asia, and parts of Europe are increasingly choosing India for exactly these areas of care. But in the next phase of medical value travel, strong hospitals and specialist doctors alone will not define leadership. What will matter more is whether that clinical strength is supported by structured pathways that connect source markets to destination providers more intelligently. This is where clinical corridors become critical. A mature medical value travel ecosystem is no longer built around isolated hospital referrals. It is built around trusted clinical pathways that connect hospitals, consultants, clinicians, ministries, public institutions, and post-treatment pathways into a more reliable system of healthcare access. That is how patient movement becomes scalable, trust becomes institutional rather than transactional, and cross-border care begins to move with more consistency. The Future Will Belong to Consultants Who Can Shape the Patient Journey The role of healthcare consultants is also changing. It is no longer limited to helping patients identify a hospital or coordinate treatment logistics. Today’s international patient expects a far more connected experience, one that includes second opinions, treatment planning, travel coordination, teleconsultation, recovery management, and continuity of care beyond discharge. That is why the next phase of leadership will belong to consultants who can do more than guide patient movement. They will need to help shape the patient journey itself. This includes enabling smoother care pathways, strengthening hospital partnerships, supporting quality alignment, and reducing fragmentation between diagnosis, treatment, recovery, and follow-up. In a sector where trust is everything, continuity is no longer an added layer of service. It is becoming one of the core markers of quality. Cross-Border Capacity Will Define the Next Decade India’s opportunity is also tied to how it contributes to healthcare capacity beyond its own borders. The future of medical value travel will not be built by one country scaling inward while the rest of the ecosystem remains uneven. It will be built through more coordinated healthcare development across regions, particularly in high-growth markets across Asia, the Middle East, and Africa. In that context, capacity building must be understood not just as infrastructure expansion, but as the strengthening of clinician capability, quality systems, hospital management, specialty programmes, and connected healthcare ecosystems across geographies. This is where consultants will play a wider strategic role. They can help hospitals align with global quality expectations, strengthen clinician training, and build more integrated systems of care. The draft already points to the growing importance of digital health platforms, telemedicine, artificial intelligence in diagnosis, remote monitoring, and global patient management. But these tools matter not simply because they make care more efficient. They matter because they make cross-border care more connected, more responsive, and more scalable. India’s Edge Will Come From a More Connected Care Model India’s healthcare infrastructure is also evolving rapidly to support this demand. The focus on Heal in India, medical visas, regional medical hubs, and AYUSH integration is helping strengthen the country’s positioning as both a treatment and wellness destination. The draft notes that India recorded 9.15 million foreign tourist arrivals in 2025, of which over five lakh visitors travelled specifically for medical treatment, accounting for approximately 5.5 per cent of total foreign tourist arrivals. These are not small signals. They show that India is already operating at a meaningful international scale. But 2030 leadership will not come from volume alone. It will come from integration. It will depend on how well India can bring together clinical excellence, wellness recovery, digital health, consultant-led coordination, and continuity-led patient journeys into one coherent global care model. That is also where India’s distinctiveness lies. The combination of advanced clinical treatment with preventive wellness, rehabilitation, Ayurveda, and yoga gives the country a broader care proposition than many competing destinations can offer. Leadership Will Belong to Ecosystems, Not Isolated Providers By 2030, the real leaders in medical value travel will not simply be those who attract more patients. They will be those who build stronger healthcare ecosystems around those patients. For India, that means moving from a destination-led model to a corridor-led model, from episodic treatment access to end-to-end patient journeys, and from transactional referrals to consultant-driven global healthcare networks. India’s next phase of leadership in medical value travel will be defined not only by clinical excellence, but by how well it can build connected patient journeys across borders. The real differentiator will lie in creating trusted clinical corridors, stronger hospital partnerships, and more coordinated care pathways that make access to quality care more seamless for international patients. In that sense, the future belongs not only to providers, but to ecosystems that can deliver continuity of care across the full patient journey, from treatment planning and travel readiness to recovery and follow-up. That is the shift that will define the next decade, and that is where India’s leadership opportunity truly lies.   Rajeev Taneja, Founder & CEO, GlobalCare Health ]]> https://biospectrumindia.com/views/21/27798/up-to-30-of-procurement-value-lost-before-impact-new-insights-highlight-gaps-in-healthcare-and-pharma.html https://biospectrumindia.com/views/21/27798/up-to-30-of-procurement-value-lost-before-impact-new-insights-highlight-gaps-in-healthcare-and-pharma.html Tue, 12 May 2026 14:51:35 +0530 A growing gap between negotiated savings and realized value is emerging as a critical concern in healthcare and pharmaceutical procurement. According to industry observations 20–30% of contracted value is lost before it reaches the bottom line, indicating a deeper operational inefficiency beyond sourcing. Most procurement leaders in healthcare and pharma know their savings figures, but few can quantify missed savings or explain the reasons. This gap reveals a deep rooted problem in procurement operations. Procurement quality is often mislabeled as a sourcing issue, with the core focus on improving RFPs, negotiations, and vendor selection. Yet top-performing teams routinely lose 20–30% of contracted value before it hits the bottom line. The real issues occur before and after sourcing. By the time procurement receives a requirement, key decisions are often predetermined. Vendors may be informally chosen, specifications may favor certain suppliers, or time schedules may limit competition. This intake issue is alarmingly widespread in healthcare and pharma. Immediate action is needed: procurement must engage earlier in budgeting and planning. Relying on improved forms alone will worsen outcomes. In regulated industries, contracts are often seen as legal endpoints instead of valuable commercial tools. After signing, reviews rarely occur until disputes or renewals force a response, dangerously delaying oversight. Because of this, the value found in contracts, like service levels, rebates, and volume commitments, often goes unrealized. This problem doesn’t stem from poor negotiation; it comes from a lack of active management. While individual tail spend transactions are low in value, their total impact is significant. In many healthcare organizations, tail spend makes up to 20–25% of procurement activity. Uncontrolled tail spend increases supplier fragmentation, obscures visibility and magnifies compliance risks especially in clinical settings where supplier control is important. Procurement data is quite frequently segmented across misaligned systems. As a result, teams receive delayed, reconciled reports that are useful for reporting yet limited for prompt decision-making. In healthcare and pharma, delayed procurement decisions directly threaten operations and patient safety. Relying on outdated data increases risk. Leading organisations are not only improving sourcing but also transforming procurement operations. They engage earlier, manage contracts proactively, and raise visibility throughout the procurement lifecycle. The shift toward strategic procurement has been discussed for years. In healthcare and pharma, it is now essential. Looking ahead, procurement must create value by operating more intelligently and doing so urgently. Success will not come from harder negotiation alone.   Arjit Agarwal, Principal Consultant, Business Consulting, Nexdigm ]]> https://biospectrumindia.com/views/21/27777/harnessing-ai-for-drug-discovery-positioning-indian-pharma-as-global-innovation-powerhouse.html https://biospectrumindia.com/views/21/27777/harnessing-ai-for-drug-discovery-positioning-indian-pharma-as-global-innovation-powerhouse.html Fri, 08 May 2026 13:13:47 +0530 India's pharmaceutical sector stands at a defining crossroads. The country supplies 20% of global generic drug demand and ranks as the third-largest exporter by volume. This is a remarkable achievement for a nation that built its pharmaceutical backbone on cost-efficient manufacturing. Yet, volume leadership has not translated into commensurate value: India ranks only 11th globally in export value. That gap tells the real story. To close it, India must move from being the world's pharmacy to becoming the world's pharmaceutical innovator. It demands a structural reset, one that repositions India higher in the global pharmaceutical value chain, from molecule synthesis to drug discovery itself - and artificial intelligence-based ecosystem is the engine that can drive that transition. From Volume to Value: The Agentic AI Ecosystem Dividend The economics of drug development have long been daunting. Traditional pipelines span 10 to15 years and consume enormous R&D budgets, with much of that time and money lost to sequential, siloed workflows. AI and automation are already beginning to compress those timelines to 9 to 13 years, while R&D-to-launch costs have declined from the 20–30% range to 15–25% as AI frees research teams from routine analytical tasks. The deeper transformation, however, is architectural and systemic. AI enables a shift from linear handoffs where discovery, chemistry, manufacturing and controls (CMC), and clinical workstreams pass the baton one at a time  to integrated platforms.  These disciplines can run in a hub and spoke model based on self-organizing agentic architectures. Teams can self-organize in a dynamic manner around specific business and scientific goals, e.g., novel targets and molecules, new market launch, regulatory approvals, etc. There is a need for building a collaborative ecosystem where multiple pharma companies contribute based on pre-determined incentive structures to minimize risk for the individual organization and improve the chances of success at the systemic or national level. The ability to develop and share AI-based assets such as Small Language Models (SLMs), Knowledge Graph (KGs), Agentic Skills and Agents in a collaborative architecture is key to the success of this effort. Precision Assets for Drug Discovery: SLMs, KGs, Agentic Skills and Agents For the specific, high-stakes demands of drug discovery, Small Language Models (SLMs) combined with Knowledge Graphs (KGs) represent a far more precise and practical toolkit. SLMs are trained on curated, drug-discovery specific datasets making them better calibrated for scientific and clinical contexts. Knowledge Graphs complement SLMs by providing structured, query-able representations of biological and chemical relationships. They can be bootstrapped from publicly available ontologies and taxonomies, then iteratively enriched with proprietary institutional data. When SLMs reason over KGs, the combination delivers explainable outputs grounded in enterprise-specific knowledge — dramatically reducing the hallucinations that make general-purpose AI unsuitable for regulated scientific environments. The ability to encapsulate common drug discovery related tasks and capabilities into agentic skills and agents enable the ability for multiple pharma organizations to collaborate with each other by leveraging an agentic architecture. This will enable the Indian pharma ecosystem to come together to collaborate and share assets with each other to de-risk and increase the chances of success. The CQuRATE Framework: Six Pillars for Global Leadership Technology alone does not build global leadership. India's path to becoming a biopharmaceutical powerhouse requires coordinated action across six strategic pillars, captured in the CQuRATE framework. Collaborative Ecosystem is critical to for Indian pharma to assume risk and make progress in becoming the drug discovery destination. An agent-based collaborative ecosystem will enable creation of cross-organizational dynamic teams – leading to risk reduction and increasing the chances of success. Quality remains the foundation. India has made measurable progress — the share of US-FDA inspections resulting in Official Action Indicated (OAI) findings fell from 19% in 2013 to 9% in 2023. Closing the remaining gap with the global average of 4% will require AI-assisted quality management systems that catch deviations before they become violations. Regulation is the next frontier. AI can significantly accelerate regulatory authoring, helping Indian companies reduce submission timelines and navigate complex multi-market requirements with greater consistency. Access must remain central to India's pharma identity. Innovations that are affordable, scalable, and patient-centric are not only a moral imperative — they are a competitive differentiator in high-growth emerging markets. Talent is perhaps India's most under appreciated asset in this context. With over 2.5 million STEM graduates annually, the country has the raw human capital to lead AI-driven R&D. The priority now is directing that talent pipeline toward pharmaceutical science and AI applications. Entrepreneurial Innovation must be institutionalised through sustained policy support. Schemes like Biopharma Shakti, with a Rs 10,000 crore outlay, and the Production-linked Research and Innovation Program (PRIP) signal the right intent. The Moment to Act The ultimate value of SLM, KGs, Agentic Skills and Agents does not lie in replacing scientific and clinical judgment. It lies in augmenting it by improving workflow efficiency, safety adherence and the cross-pollination of ideas across research disciplines and  organizations. For India, the technology is ready. The talent is available. The policy architecture is forming. What remains is the will to move beyond experimentation to cross-organisational collaboration and industrial-scale AI deployment and in doing so, claim a far larger share of the global pharmaceutical value pie.   Vipul Kashyap, Advisor, Indian AI Research Organization (IAIRO) and CEO MedHive.AI and Dr Amit Sheth, Founding Director, IAIRO ]]> https://biospectrumindia.com/features/21/27762/how-glass-weight-operated-pressure-relief-valves-protect-corrosive-chemical-processes.html https://biospectrumindia.com/features/21/27762/how-glass-weight-operated-pressure-relief-valves-protect-corrosive-chemical-processes.html Wed, 06 May 2026 00:00:00 +0530 Maintaining safe pressure levels is critical to protecting equipment, ensuring worker safety, and maintaining process continuity. A glass weight-operated pressure relief valve plays an essential role in safeguarding glass process systems by providing reliable and controlled pressure release. In corrosive environments where metal components may fail, industrial glass control valves offer a dependable and chemically resistant solution. The Pressure Challenges of Corrosive Processing Environments Chemical reactions, solvent recovery, distillation, and evaporation processes naturally generate pressure. If not managed properly, pressure buildup can compromise equipment and disrupt operations. Common risks include: Sudden equipment failure Leakage or contamination Process instability Increased downtime and maintenance Corrosive chemicals further increase these risks by gradually degrading metal components. This creates a strong need for pressure control devices that can withstand aggressive chemical exposure without compromising performance. What Makes Weight-Operated Relief Valves Different A glass weight-operated pressure relief valve releases excess pressure using a simple and dependable mechanical design. Instead of springs or complex internal components, calibrated weights determine the opening pressure, ensuring predictable and stable operation. This approach reduces the risk of mechanical failure and supports consistent performance in corrosive environments. When system pressure rises above the preset limit, the valve lifts automatically to release pressure and reseals once safe conditions return, maintaining continuous and reliable process protection. Why Glass Construction Is Critical for Corrosive Media Material compatibility is a key factor in chemical process safety. Glass offers properties that make it highly suitable for aggressive chemical environments. Chemical Stability: Borosilicate and quartz glass resist most acids, solvents, and reactive compounds. Process Purity: Non-reactive surfaces help maintain contamination-free processing. Thermal Resistance: Glass tolerates high temperatures and thermal cycling. Operational Visibility: Transparent construction allows real-time monitoring of system behaviour. These characteristics make industrial glass control valves ideal for demanding laboratory and industrial applications. Built-In Safety for Glass Reactors and Process Systems Pressure relief valves are essential components within glass reactors and processing assemblies. Their role extends beyond safety to overall system reliability. They help to: Prevent overpressure damage Protect glass reactors and vessels Maintain process stability Support safe, continuous operation Such as integrated glass reactors and distillation assemblies, pressure protection devices are key elements in complete glass process systems manufactured by providers like Goel Scientific Glass Works Ltd. Reliable Performance with Minimal Maintenance Weight-operated relief valves offer practical advantages compared to spring-loaded alternatives. Fewer moving parts reduce wear and mechanical fatigue. Simple design improves long-term reliability. Reduced maintenance lowers operational costs. Consistent pressure response ensures predictable system behaviour. These benefits are especially valuable in facilities operating continuously under demanding conditions. Where These Valves Are Commonly Used Glass pressure relief valves are used across industries that require corrosion resistance and high-purity processing. Chemical Manufacturing: Used in reactors, distillation systems, and evaporation units. Pharmaceutical Production: Supports sterile and contamination-free processes. Pilot Plants and R&D Facilities: Provide safe pressure control during experimental operations. Speciality Chemical Production: Ensures safe handling of aggressive chemicals. To support such applications, manufacturers such as Goel Scientific Glass Works Ltd. develop custom glass process equipment designed for specialised industrial needs. Integration Within Custom Glass Process Assemblies Modern facilities often require complete glass systems rather than standalone components. Pressure relief valves are designed to integrate seamlessly into: Glass reactors Distillation columns Evaporation systems Chemical processing assemblies Integrated solutions from Goel Scientific Glass Works Ltd., such as customised glass process systems and industrial technical packages, help maintain safe operating conditions in complex workflows. Importance of Custom Engineering for Pressure Control Standard components may not always meet specialised process requirements. Custom fabrication ensures compatibility with: Specific pressure ranges Unique system configurations Specialised chemical processes High-temperature operations Custom engineering allows laboratories and industrial facilities to achieve reliable and efficient pressure management. Supporting Long-Term Process Safety and Efficiency Effective pressure control plays a key role in maintaining safe and efficient plant operations over the long term. By managing excess pressure in a controlled manner, facilities can reduce the risk of equipment damage, limit unplanned downtime, and maintain stable processing conditions. This also supports safer working environments and more consistent production performance. Glass weight-operated pressure relief valves help laboratories and industrial facilities achieve dependable, corrosion-resistant pressure protection across demanding applications. Conclusion A glass-weight-operated pressure relief valve plays a vital role in protecting corrosive chemical processes. By offering dependable pressure control, chemical resistance, and simplified maintenance, these valves help ensure safe and consistent operations. Selecting high-quality industrial glass control valves and custom-engineered glass process equipment supports long-term efficiency, reliability, and safety across demanding laboratory and industrial applications.   ]]> https://biospectrumindia.com/views/21/27719/how-digital-dentistry-and-radiology-are-transforming-oral-healthcare.html https://biospectrumindia.com/views/21/27719/how-digital-dentistry-and-radiology-are-transforming-oral-healthcare.html Fri, 24 Apr 2026 00:00:00 +0530 Oral health care is undergoing a remarkable transformation, fueled by the rapid integration of advanced technologies. At the forefront of this evolution is digital dentistry, which refers to the use of digital tools and techniques in modern dental practice. This shift is redefining how dental care is delivered, making processes more streamlined and precise. From early diagnostics to detailed treatment planning and improved patient care, technology-driven dentistry is setting new standards in efficiency, accuracy, and overall patient. For over a century, dentistry relied heavily on manual techniques and analogue tools. Traditional practices involved physical impressions, conventional X-rays, and hand-operated instruments. While effective for their time, these methods were often associated with discomfort, inconvenience, and occasional inaccuracies. Procedures such as crowns and bridges were particularly time-consuming, frequently requiring multiple appointments to complete. However, the advent of the intraoral scanner, digital radiography, CAD/CAM, 3D printers have revolutionized the field of dentistry as we know it today. In the realm of radiology, digital radiography has considerably reduced patient exposure in image generation time for 2D imaging. Conventional procedures like developing, fixing which are time consuming are avoided and images are seen in seconds. This accelerates decision making and treatment planning. With evolution of 3D imaging in form of CBCT i.e cone beam computed tomography, digital dentistry reached new horizons. 3D imaging of the structures was possible. It enabled accurate planning with more predictable treatment outcomes. CBCT brings specific and unique diagnostic benefits in orthodontics, endodontics, oral surgery fields. Fabrication of virtual models with the use of CBCT and intraoral scanning is possible to help clinicians plan the surgery beforehand. Traditionally with the help of IOPAs it was difficult to identify crack lines or fractures in the tooth but now with the advent of CBCT, even minor cracks can be identified easily with a quick scan which ultimately gives us the prognosis of the tooth, thereby reducing frequent patient visits and follow ups. Teleradiology has opened up unprecedented possibilities for accurate and timely diagnosis. High quality radiographic images using 3D technologies like CBCT images can now be transmitted an interpreted remotely which accelerates the diagnostic process ad helps clinician to make their treatment plans. CBCT plays a pivotal role in giving clinicians the precise and detailed images of the teeth and surrounding tissues as it gives sub-millimeter resolution. One of the most significant advantages of digital dentistry is the high level of accuracy it offers. It has enhanced patient experience by eliminating the need for messy impressions, offering a quicker, cleaner, and more comfortable experience for patients. 3D printing has taken implantology to new heights with the introduction of surgical guides. The accuracy of the surgical guides has led to less implant failures and increased its’ longevity. Flapless Guided surgery with the help of CBCT superimposition offer advantages like no cuts, no sutures, reduced intraoperative bleeding and reduced postoperative trauma due to the precision of implant placement and shorter surgical time increasing patient comfort.                    Dr Vinayak Shirsekar, Director, Fredna Dental Systems  ]]> https://biospectrumindia.com/views/21/27678/decoding-your-dna-a-beginners-guide-to-genetic-testing.html https://biospectrumindia.com/views/21/27678/decoding-your-dna-a-beginners-guide-to-genetic-testing.html Sat, 18 Apr 2026 00:00:00 +0530 Genetic testing is a way of reading parts of your DNA, the unique biological code that makes you who you are. This code influences not only visible traits like height or eye color but also how your body functions internally, like how you process food, respond to medication, or even your likelihood of developing certain health conditions. Think of your DNA as a blueprint. It doesn’t dictate your entire future, but it provides important clues. Genetic testing helps interpret those clues, turning complex data into insights that can support better health decisions. Today, advanced genetic testing has evolved significantly. Some of the most comprehensive approaches combine whole-exome sequencing with SNP microarray technology to analyze over 194,515 genetic variants associated with more than 14,155 diseases and conditions. Unlike basic SNP panels, this allows for deeper analysis of the coding regions of DNA, where actual biological function is determined, ensuring that insights are not just broad indicators, but clinically relevant and aligned with global standards such as ACMG, CPIC, and PharmGKB.   Why Are People Turning to It Now? There was a time when genetic testing was limited to specialised medical cases. Today, it is becoming part of a broader conversation around preventive healthcare. Many of us have grown up hearing phrases like “it runs in the family” without fully understanding what that means. Genetic testing offers a way to explore those inherited patterns with more clarity. For some, it’s about understanding a family history of chronic conditions. For others, it’s curiosity. And increasingly, it’s about taking control and making informed choices rather than reactive ones. What has truly accelerated this shift is the move from static reports to actionable intelligence, where people can see not just their risks, but how those risks translate into everyday decisions. What Does the Process Feel Like? Contrary to what many imagine, genetic testing is usually straightforward. It may involve giving a small blood or saliva sample, which is then analyzed in a lab using advanced tools. The results are not delivered as raw data but as a structured report. This is where the experience becomes personal. People often pause at certain sections, reflecting on what the information means for their lives and habits. That’s why guidance matters. Genetic counselling helps translate technical findings into meaningful understanding. In more advanced formats, these reports are designed as structured, multi-layered documents, sometimes extending to detailed formats, divided into modules like genetic disorders, chronic disease risks, pharmacogenomics, nutrigenomics, and physical endurance. What Can You Learn About Yourself? The insights from genetic testing can feel surprisingly relatable, often answering questions people didn’t even realize they had. It can explain why certain diets work for some but not for you, why your body reacts differently to medications, or whether you may be at higher risk for certain conditions. From disease susceptibility to nutrient metabolism and drug response, the information is both practical and eye-opening. But these are indicators, not conclusions. They highlight tendencies, not certainties. What makes this truly valuable is how these insights translate into everyday actions. Instead of generic advice, individuals can receive a personalised weekly diet planner with clearly defined “foods to include” and “foods to avoid”, aligned with their genetics and real dietary habits. Supplement recommendations become more precise, forming a roadmap based on how the body metabolizes nutrients. One of the most impactful layers is pharmacogenomics, where genetic insights help map how the body responds to medications, indicating whether a drug is standard, requires adjustment, or should be avoided across categories like diabetes, cardiovascular care, pain management, antibiotics, and mental health treatments. The Emotional Side of Knowing While science is fascinating, the emotional aspect of genetic testing is equally important. Learning about potential risks can bring clarity, concern, and empowerment all at once. For some, it offers relief. For others, it raises new questions. But perspective matters. Knowing your genetic tendencies is not about fear, it is about preparedness. It allows you to ask better questions, have more informed conversations with doctors, and make decisions aligned with your body’s needs. When these insights are visualised clearly, such as through organ-level risk indicators across cardiovascular, neurological, renal, or metabolic systems, it becomes easier to prioritize what truly needs attention. Where Lifestyle Still Leads the Way Two people with similar genetic risks can have very different health outcomes depending on their lifestyle. Diet, exercise, sleep, stress, and environment play a significant role in shaping how genetic tendencies unfold. Genetic testing does not replace healthy habits, it reinforces them. It adds a layer of understanding that helps personalize choices. When insights translate into actionable outputs like diet plans, supplement strategies, and fitness alignment, the gap between knowing and doing starts to close. Points to Consider Before Taking a Test Like any health decision, genetic testing requires thoughtful consideration. Questions about data privacy, accuracy, and interpretation are important. Choosing credible providers and ensuring confidentiality should be a priority. It’s also worth asking what you hope to learn and how you will use the information. The goal is not just information, but insight that leads to action. A Glimpse into the Future As science advances, genetic testing is moving closer to everyday healthcare. What was once a specialized tool may soon become a routine part of understanding personal health. The direction is clear, from information to interpretation to action, where one test can continue guiding decisions across different stages of life. Conclusion Decoding your DNA is not about predicting your future, it is about understanding your starting point. For beginners, genetic testing may feel unfamiliar. Yet at its core, it is simply a way of getting to know yourself better, scientifically and meaningfully. In a world full of general advice, that kind of personal insight can be both grounding and empowering. Because when health becomes personalized, decisions become clearer, actions become sharper, and outcomes become more predictable. And that is where genetic testing, when done right, truly becomes a lifetime advantage.   Sudhakar Kancharla, Founder, Mr. Yoda ]]> https://biospectrumindia.com/views/21/27628/differentiating-epileptic-and-nonepileptic-events-using-video-eeg.html https://biospectrumindia.com/views/21/27628/differentiating-epileptic-and-nonepileptic-events-using-video-eeg.html Wed, 08 Apr 2026 00:00:00 +0530 Seizure-like episodes can arise from multiple underlying causes, not all of which are epileptic in origin. A range of medical, neurological, and psychological conditions can cause symptoms that look like epileptic seizures, making accurate diagnosis clinically difficult. Individuals with recurrent seizure-like episodes are ultimately found not to have epilepsy. Instead, they are diagnosed with non-epileptic events (NEE) also known as psychogenic non-epileptic seizures (PNES) or functional seizures. While these episodes may look like epileptic seizures, they differ fundamentally in their underlying mechanisms. This overlap in clinical presentation, combined with specific biological causes, creates a key diagnostic challenge: Distinguishing epileptic seizures from non-epileptic events to ensure appropriate and effective treatment. Understanding the Difference: Epileptic Seizures VS Non-Epileptic Events Epileptic seizures are episodes caused by abnormal electrical discharges in the brain. These electrical discharges occur abruptly, affecting normal brain activities, which may lead to convulsion, unawareness, staring, confusion, and odd movements. Non-epileptic seizures are those events that appear to be like Seizures but are not true seizures. They are not caused due to the abnormal brain electricity. Non-epileptic seizures occur due to psychological or emotional upsets. The psychological or emotional distress are expressed through the symptoms that appear to be like the symptoms experienced during epileptic seizures. Since both can present with shaking, collapse, unresponsiveness, and confusion, clinical appearance alone is often misleading. The Hidden Burden of Misdiagnosis When there is confusion between epileptic and non-epileptic seizures, outcomes can be severe. If patients do not have epilepsy, they might be treated with anti-epileptic medications, which they do not need. These may result in unnecessary side effects at times. Conversely, patients who suffer from real epilepsy may receive delayed appropriate care because of misdiagnosis or incorrect identification of their condition. This, in turn, can lead to various problems, ranging from uncontrolled seizures, possible injuries and accidents, and untold suffering for the patients and their families. Why Clinical Observation Alone Is Not Enough Traditional diagnosis relies on patient history and clinical examination. While essential, these methods are limited in nature. Many seizure-like conditions show similar physical signs, making visual evaluation ineffective and unreliable. This creates a need for a diagnostic tool that directly connects physical symptoms with real-time brain activity. How Video EEG Transforms Diagnosis Video Electroencephalography (Video EEG) brings together continuous video monitoring of a patient with simultaneous recording of the brain’s electrical activity (EEG). Patients are observed in a controlled environment until their typical episodes occur. This allows doctors to directly match what the body is doing with what the brain is doing at the exact same moment: In epileptic seizures, the EEG shows abnormal electrical discharges that matches with the physical seizure activity seen on video. In non-epileptic events, the patient may show physical symptoms, but the EEG remains normal. This direct correlation makes Video EEG the gold standard of differentiating epileptic seizures from non-epileptic events. Why Accurate Diagnosis Changes Everything For patients with epilepsy, proper diagnosis allows for proper planning of medication and treatment strategies followed by timely referral of patients to advanced therapy when needed. It creates the door for patients with nonepileptic events to have proper psychotherapy and treatment to support healing and wellness. Restoring Clarity, Confidence, and Hope For patients and families living with unexplained seizure-like episodes, uncertainty can be overwhelming. A clear diagnosis gives trust, direction, and emotional stability. It replaces fear with understanding and confusion with clarity. In modern neurological care, Video EEG is more than a diagnostic tool. It is a bridge between symptoms and truth, appearance and cause, fear and reassurance. By allowing differentiation between epileptic and non-epileptic events, it ensures patients receive the right diagnosis, the right treatment, and the right support at absolutely the right time.   Dr Lakshmi Priya. L, Consultant Neurologist, Department of Neurology, Ramaiah Memorial Hospital, Bengaluru ]]> https://biospectrumindia.com/views/21/27625/nanoparticles-in-vaccine-delivery-the-tiny-transporters.html https://biospectrumindia.com/views/21/27625/nanoparticles-in-vaccine-delivery-the-tiny-transporters.html Tue, 07 Apr 2026 00:00:00 +0530 Vaccines represent one of the most significant advancements in public health. While conventional vaccines have been highly successful, global health scenario demands more efficient and safer vaccine platforms. In this context, nanoparticles (NPs) have emerged as transformative players in vaccine delivery, acting as “tiny transporters” that enhance immune responses and ensure targeted delivery. A wide range of nanoparticles have been designed to address the specific challenges of vaccines namely antigen stability, cellular uptake, immune activation, and manufacturing scalability. As a result, some of the world’s biggest pharmaceutical companies and research institutes are shaping these tiny transporters in vaccines. For instance, Moderna and BioNTech/Pfizer used the lipid nanoparticle technology to develop the COVID-19 mRNA vaccines, proving that these nanocarriers can deliver fragile genetic material safely and effectively. GlaxoSmithKline (GSK) has used liposome-based platforms in vaccines such as Mosquirix for malaria, while Merck has deployed the virus-like particles (VLPs) for HPV and hepatitis B vaccines. Moderna and BioNTech are also using nanoparticle-based vaccine technology for several infectious diseases including respiratory syncytial virus (RSV), Zika virus, rabies, and herpes simplex virus. On the other hand, Altamira Therapeutics is collaborating with Univercells Group to test its SemaPhore nanoparticle platform designed to deliver RNA safely and effectively. Next generation lipid particles developed by researchers at the Massachusetts Institute of Technology (MIT) have achieved similar antibody responses in animal studies using one-hundredth of the conventional dose that would lower the cost and toxicity. Hopewell Therapeutics and Foxcroft Therapeutics are evaluating tissue-targeting lipid nanoparticles for cancer vaccines.  Scientists at the National Center for Nanoscience and Technology in China have used artificial intelligence (AI) to develop an ionizable lipid based on three-dimensional shape that showed markedly higher mRNA delivery efficiency and prominent anti-tumour effects in preclinical models. Self-assembling polymer nanoparticles that form at room temperature designed by researchers at the University of Chicago Pritzker School of Molecular Engineering can simplify manufacturing and improve protein vaccine delivery. Nanoparticles are also being investigated in therapeutic cancer vaccines. For example, nanoparticle formulation of doxorubicin (Doxil by Janssen Pharmaceuticals) is being used for ovarian cancer, Kaposi sarcoma, and multiple myeloma. It allows preferential accumulation in tumour cells allowing enhanced efficacy and reducing cardiotoxicity. mRNA cancer vaccines (e.g. mRNA-4157 by Moderna and Merck & Co.) have also been used in melanoma immunotherapy where lipid nanoparticles are used to deliver tumours specific antigens. Although large-scale manufacturing, long-term stability, regulatory approval, and cost of nanoparticles pose significant challenges, nanoparticles mark a paradigm shift in vaccine delivery. With continued research and innovation, nanoparticles can play a crucial role in shaping preventive medicine.   Navya Mrig, Freelancer ]]> https://biospectrumindia.com/views/21/27561/why-boutique-hospitals-are-gaining-ground-.html https://biospectrumindia.com/views/21/27561/why-boutique-hospitals-are-gaining-ground-.html Wed, 25 Mar 2026 00:00:00 +0530   India’s healthcare sector is entering a new phase of expansion, but this phase may look very different from the large multi-specialty facilities that defined the last two decades. Across Tier 2 and Tier 3 cities, a quieter yet significant trend is emerging: the rise of compact, well-designed boutique hospitals that deliver high-quality care without the scale or cost burden of large tertiary centres. The Shift Beyond Metros India’s demand for healthcare infrastructure continues to outpace supply, particularly outside the major metropolitan centres. While large tertiary hospitals remain essential for highly complex treatments, many regional markets require hospitals that can provide reliable secondary and selective tertiary care closer to where patients live. Importantly, much of the next wave of expansion is shifting beyond metropolitan markets. Industry estimates suggest that nearly 40% of new hospital capacity planned over the next five years will be in Tier-2 and Tier-3 cities, reflecting both rising demand and the growing economic potential of these regions. Boutique hospitals are increasingly filling this gap. Typically designed with around 80-120 beds and a built-up area of roughly 70,000 to 90,000 square feet, these hospitals are significantly smaller than traditional corporate facilities. Yet their scale allows promoters to create clinically robust institutions with modern infrastructure, efficient workflows, and a strong focus on patient experience. The Rise of Specialised Care Alongside the geographic shift, there is also a structural change in how healthcare services are delivered. Rising disease burdens and increasing awareness are driving demand for specialised care in areas such as oncology, fertility treatment, orthopaedics, cardiology, and minimally invasive day-care surgeries. Instead of offering every possible specialty under one roof, many new hospitals are choosing to focus on a few high-demand disciplines where they can build clinical depth and reputation. This shift has given rise to a new generation of specialty hospitals that combine focused expertise with operational efficiency. A Sustainable Model for Hospital Promoters From the perspective of hospital promoters and investors, the economics of boutique hospitals are also compelling. Large tertiary hospitals often require significant capital investment, long gestation periods, and complex operational structures. In contrast, boutique hospitals can be developed with relatively lower capital expenditure while still maintaining strong clinical capabilities in selected areas. Lower fixed costs, optimised staffing models, and efficient utilisation of infrastructure allow these hospitals to achieve healthier operating margins. More importantly, their manageable scale enables promoters to maintain tighter control over quality, patient satisfaction, and clinical governance. Emerging Examples Across India Several hospitals across India illustrate how this model is gaining traction. In Nagpur, Viveka Hospital has been developed as a focused Super-specialty hospital built around operational efficiency and patient-centric design. Ashoka Hospitals in Nashik demonstrates how a regional healthcare brand can scale sustainably by constructing a Built To Suit hospital with an O&M parther like Medicover and Cancer Centre of America without over-expanding into an unwieldy corporate structure. Similarly, TriStar Hospital in Surat and Tricolor Hospital in Vadodara represents a compact hospital model optimized for streamlined clinical workflows and patient experience. Facilities such as HCG Cancer Centre, which focuses exclusively on oncology care, and Nova IVF Fertility, a dedicated fertility care network, demonstrate how specialised hospitals can build strong clinical reputations while operating with more focused infrastructure and service offerings. Building Smarter Healthcare Infrastructure As India continues to expand its healthcare capacity, boutique hospitals are likely to play a crucial role in bridging the infrastructure gap, particularly in emerging urban centres. By combining focused clinical services, efficient design, and sustainable economics, these hospitals are redefining how quality healthcare can be delivered beyond the country’s largest cities.   Dr Vivek Desai, Founder & Managing Director, HOSMAC   ]]> https://biospectrumindia.com/views/21/27533/clouded-mind-understanding-brain-fog.html https://biospectrumindia.com/views/21/27533/clouded-mind-understanding-brain-fog.html Sun, 22 Mar 2026 00:00:00 +0530 Brain Fog is a collection of symptoms. Many people experience symptoms such as forgetfulness, poor attention span, and mental fatigue. Long sleepless nights and prolonged screen exposure often lead to this feeling. What Screens Do to Your Brain Modern life and screens are inseparable. Our lives revolve around TV, laptops, smartphones, and tablets. The constant use of screens for work and personal life forces the brain to continuously process visual information. This constant digital exposure reshapes attention, memory, and focus. Melatonin secretion is increased at night, but using late-night screens interferes with its production, leading to poor-quality sleep and, sometimes, insomnia. Sleep: Brain’s Natural Reset An adequate, undisturbed sleep of 7-8 hours is essential for our body to function in a healthy, coordinated manner. During sleep, the body detoxifies its metabolic state, regains energy, supports emotional regulation, and stabilizes and strengthens memory, thereby preparing the body for the next day’s adventure.  Not only does the duration of sleep matter, but so does its quality. Even short-term disturbed sleep affects memory and focus and can cause irritability. Poor sleep patterns not only cause these symptoms but also affect the body’s Balance and Orientation, bringing the inner ear into play. The Inner Ear: Body’s Hidden Navigator Besides hearing, the primary function of the ear is to maintain the body's balance. The inner ear houses the vestibular system, responsible for maintaining the body’s position, orientation, and motion. This system works with the brain, which interprets signals to keep us steady and grounded. Due to disturbed sleep, the brain and the vestibular system become exhausted and work even harder to keep the body upright and interpret the surroundings. This extra work causes mental exhaustion, difficulty concentrating, and brain fog. In simple terms, an exhausted brain sends confused balance signals and struggles to focus.  Why Your Brain Struggles In A Screen-Filled World Minimal head movement is observed when the person is glued to the screen. Prolonged sitting in front of a screen causes a mismatch between visual and vestibular input. The eyes report visual movement of scrolling, while the head and body remain stationary. Over time, it leads to dizziness, disorientation, and foggy thinking. Why Some People Are More Affected People who have a history of migraine, vestibular disorder, neck strain, and anxiety are more prone to vestibular stress. A little stress to the vestibular system can alleviate these symptoms, especially when sleep deprivation and digital overload are combined. From Fog to Focus: Everyday Fixes Brain fog can be fixed by taking baby steps. Give your eyes and brain regular breaks while using screens—about every 20 minutes, pause briefly and focus on something in the distance for a few moments. Try to switch off digital devices at least an hour before going to bed, allowing your mind to slow down naturally. Keep your sleep routine steady by going to bed and waking up at roughly the same time each day. Add gentle movement into your day, such as short walks, light stretches, yoga, or simple balance-based activities, to keep sensory systems engaged. Be mindful of how you hold your head and neck, especially when using a phone or laptop, and avoid prolonged slouching. If mental cloudiness persists and is accompanied by dizziness or visual strain, seek advice from a vestibular specialist. Listening to the Fog Brain fog is not just “all in the mind.” It reflects how modern habits, such as prolonged screen use and binge-watching, disrupt sleep and how reduced physical movement interacts with brain systems. Acknowledging the role of the inner ear helps us understand why mental clarity depends not only on rest and focus, but also on balance.   Dr Anita Bhandari, Director of NeuroEquilibrium and Dr Anushka Bhandari, Head of R&D at NeuroEquilibrium ]]> https://biospectrumindia.com/views/21/27623/longevity-a-matter-of-time-.html https://biospectrumindia.com/views/21/27623/longevity-a-matter-of-time-.html Fri, 13 Mar 2026 00:00:00 +0530 Not simply chronological age, and not only the presence or absence of disease; but how biological systems change, adapt, and eventually fail across time. Most conventional healthcare engages the human body relatively late along this continuum. Imaging and diagnosis often occur when organ-level dysfunction has already become established. Imaging remains an essential tool, but it represents a late snapshot in a much longer biological process. The more relevant question for longevity-focused medicine is not just what is visible today, but when the underlying process began and at what level of biology it first emerged. Longevity, in this sense, is not primarily a measurement problem, but a decision problem. Biological data becomes meaningful only when it informs what to change, when to intervene, and how to evaluate impact over time. Without this decision layer, even sophisticated diagnostics remain observational rather than actionable.   An organ was once a tissue A tissue was once a collection of cells. Cells themselves are composed of organelles responding continuously to metabolic, inflammatory, and environmental signals. By the time structural change becomes visible at the organ level, cellular and subcellular adaptations have often been underway for years. Extending healthspan therefore requires shifting attention earlier in the biological timeline.   Biology Operates on a Continuum Human biology does not transition abruptly from health to disease. It moves along a spectrum; from resilience to compensation, and eventually to dysfunction. Where an individual sits on this continuum determines which forms of detection are meaningful. In chronically ill individuals, biomarkers often reflect late-stage adaptations or depleted reserves. In contrast, in individuals who appear healthy, biomarkers may reveal early inefficiencies, compensatory patterns, or emerging imbalances that precede clinical disease. Each biomarker represents a snapshot in time, a reflection of current biological state rather than a definitive diagnosis. When viewed in isolation, these snapshots are limited. When interpreted longitudinally and in context, they become informative. At Biopeak, biomarkers are therefore treated not as endpoints, but as temporal signals; indicators of where a person is on their biological trajectory.   The Organism in Its Environment An organism is not a closed system. It exists continuously within an environment, interacting with nutritional inputs, physical activity, psychological stress, light exposure, toxins, and social context. These exposures influence biological function through the epigenome, shaping gene expression and metabolic behavior over time. Importantly, environmental effects are rarely acute. Most act through small, repeated signals that accumulate gradually. Longevity-oriented care must therefore account not only for biological measurements, but for the context in which those measurements arise. This perspective shifts the focus from reactive treatment to understanding exposure, adaptation, and timing.   Detection Depends on the Lens No single test or modality can fully describe biological health. Detection is inherently perspective-based. Imaging, blood biomarkers, functional assessments, movement analysis, autonomic measures, and behavioral data each capture different aspects of physiology. Each provides a partial view. At Biopeak, detection is deliberately multi-dimensional. Data is evaluated through multiple lenses to reduce blind spots and overinterpretation. This layered approach allows patterns to emerge that may not be visible through any single modality.   Experts in the Loop Equally important is how data is interpreted. decision-making at Biopeak is not automated or siloed. Clinicians, physiotherapists, systems biology specialists, and AI-supported analytics function together as complementary lenses. Each brings a different training framework and mode of pattern recognition. Our AI is used to integrate scale and complexity, but human expertise remains central, particularly in contextual interpretation and clinical judgment. The objective is not to replace expertise, but to connect it.   From Detection to Direction Detection without context can generate unnecessary concern. Detection without timing can lead to overtreatment. Detection without expertise risks misinterpretation. The goal of longevity-focused medicine is not the early discovery of disease, but earlier understanding of biological trajectory. By identifying patterns upstream, before structural damage or clinical decline—interventions can be more precise, less aggressive, and more sustainable. Longevity, in this sense, is not about extending life at its end, but about preserving function, adaptability, and resilience across time. That is the approach Biopeak is designed to support. In the Indian context, this shift is especially significant. Chronic and lifestyle-related conditions are still detected late and managed through fragmented care pathways. The constraint is not clinical capability, but the absence of systems that interpret biological signals early and longitudinally. Biopeak is working to help build this layer of the healthcare ecosystem by bringing together multi-dimensional diagnostics, proprietary AI, expert-led interpretation, and continuous monitoring, all with the aim of shaping how longevity care is practised in India. Longevity, ultimately, is not about doing more, rather about choosing better, earlier, with clearer signals, and with the ability to measure what actually changes.   Shiva Subramanian, Co-Founder and CIO of Biopeak ]]> https://biospectrumindia.com/views/21/27463/from-margins-to-mainstream-mental-health-re-forms-public-health.html https://biospectrumindia.com/views/21/27463/from-margins-to-mainstream-mental-health-re-forms-public-health.html Tue, 10 Mar 2026 00:00:00 +0530 Compared to other major economies, India holds immense potential in its “demographic dividend”— a large working-age population, estimated at ~68% within 15-64 years of age (source: UNFPA), that can drive economic growth. By including mental health as an obvious constituent of public health and prioritizing the development of infrastructure and human resource around it, the Union Budget 2026-27 marks a consequential shift, recognising human capital and health as key drivers of economic growth and productivity, that is especially relevant for India in achieving the mission of Viksit Bharat. Beyond incremental increases in allocations, the budget signals a structural reorientation: a decisive expansion of emergency and trauma systems, renewed investment in neuro-specialty capacity, and the announcement of a second national institute for mental health and neurosciences — NIMHANS 2.0, along with the upgradation of central institutes, CIP, Ranchi and LGB, Tezpur. This is a welcome move in acknowledging mental health as fundamental to individual and societal growth and efficiency. It is also aptly timed, with the National Mental Health Survey (NMHS)-II currently underway and expected to illuminate gaps in the country’s mental healthcare framework. NMHS-II expands upon the NMHS-I conducted in 2015-16 across 12 states, by covering all states and union territories, targeting adolescents (13- 17 years) and all adults of age >18 across all states, with a special focus on vulnerable populations. Based on the previous survey, prevalence rates varied with geographic, socioeconomic or sex differences. 10.6% of Indian adults were reported to suffer from mental disorders with urban metros residents having greater prevalence (13.5%) than those in rural areas (6.9%) across various mental disorders; and persons from lower income quintiles were more affected. While a country of 1.4 billion are served only by 47 government mental health hospitals, the significant burden is carried by a large network of primary health care centres; however, the workforce shortage is dire, with 0.75 psychiatrists per 100,00 people, compared to the WHO recommended number of 3. India notoriously ranks the highest on suicide rates (21.1 in 100,000); numbers amongst the youth are ever-rising. In fact, the Tele-MANAS 24/7 helpline, set up in 2022, has since served ~24 lakh people, among whom, ~70% are between 18-45 years, and primarily students. All this paints a rather sombre picture of India’s mental health status amongst the country’s primary workforce, and demands operational measures to value young lives as positive economic assets. Another significant finding from the NMHS-I is that the massive treatment gap for mental disorders ranging between 70-92%. Dr. B.N. Gangadhar, Director of NIMHANS at the time, cited in the NMHS report, that “while, nearly 150 million Indians need mental health care services, less than 30 million are seeking care; the mental health systems assessment indicates not just a lack of public health strategy but also several under-performing components.” For decades, India’s healthcare architecture has struggled with fragmentation: uneven distribution and underdevelopment of emergency services, and neuropsychiatric services concentrated in a handful of apex institutions. Efficient emergency medicine, often the backbone of resilient health systems can significantly reduce mortality from accidents, violence, acute medical events, but also prompt interventions for psychiatric episodes. It therefore intersects directly with neurology and psychiatry, and emergency infrastructure with parallel neuro and mental health capacity would alleviate upstream bottlenecks at higher-order facilities. That the Budget recognises this systems-level interdependence is a crucial advancement of mental health care and delivery systems. In parallel to strengthening primary and emergency or trauma-related health care services, an effective healthcare strategy demands advanced clinical capacity for complex neurological or psychiatric conditions through translational research and workforce development. NIMHANS 2.0 — modelled on the NIMHANS, Bangalore — is a move to decentralise excellence. If designed carefully, NIMHANS 2.0 can serve as a nationally important apex referral that is capable of dramatically scaling up advanced clinical health care delivery, specialist and allied workforce training, and most importantly, anchoring research programs on mental illness that re-evaluates and influences locally relevant mental health policy. These, along with the upgraded regional apex centres at Ranchi and Tezpur should function, not as isolated centres, but as hubs in a networked model spanning the country, supervising state and district level healthcare strategies.   The true measure of this Budget’s ambition however, will lie in integration. The linkage of emergency departments to district mental health programmes, tele-health platforms, and referral pathways to tertiary centres, as well as services for rehabilitation and psychosocial support will be foundational components for a reliable mental health care system. The economic case for this expansion is compelling—road traffic injuries and neuropsychiatric disorders in the form of untreated depression, substance-use and cognitive impairments, account for a significant share of disability-adjusted life years (DALYs) in India. They not only erode workforce participation, and therefore productivity and economic growth at a population-level, but also impose catastrophic expenditure on households. Investments in emergency systems and neuro-mental health infrastructure are therefore productivity investments with long-term benefits, a healthy, sustainable workforce.   Yet, caution is warranted. Capital expenditure must be matched with sustained operational funding that drives faculty recruitment, curriculum development, research grants, community outreach and integration with international mental health systems to create an exceptional and transformative framework of mental health care in India. Definitive and transparent timelines and effective state and federal coordination, and accountability will determine whether NIMHANS 2.0, and all that the Budget promises, becomes a generational turning point for India’s public health system or a protracted construction project. The Budget has also sent an important social signal by including mental health into the fold of the public health and policy rhetoric, and reframing them as core public goods, not optional add-ons. This matters in a country where stigma, underfunding, and professional shortages have historically impeded progress. The Union Budget 2026–27 offers an opportunity to reimagine India’s health system around urgency, equity, and neurological well-being. The challenge now is execution — converting announcements into integrated, accessible, and humane systems of care.   About the authors- Shriya Palchaudhuri, Associate Director (External Engagements), Rohini Nilekani Centre for Brain and Mind at NCBS and Imroze Khan, Assistant Dean, Research, Director, Centre for Climate Change and Sustainability and Associate Professor of Biology, Ashoka University, Delhi-NCR ]]> https://biospectrumindia.com/views/21/27384/healthcare-sector-key-announcements-and-implications-union-budget-202627.html https://biospectrumindia.com/views/21/27384/healthcare-sector-key-announcements-and-implications-union-budget-202627.html Tue, 24 Feb 2026 00:00:00 +0530 Union Finance Minister Nirmala Sitharaman presented the Union Budget 2026–27 with a strong focus on strengthening India’s healthcare ecosystem. The announcements emphasise biopharma manufacturing, medical and allied health education, regional access to care, traditional medicine systems, and mental health as an emerging national priority. Key Announcements Biopharma Shakti Initiative: An outlay of Rs 10,000 crore over five years has been proposed to position India as a global biopharma manufacturing hub. The initiative aims to accelerate domestic capabilities in biologics, biosimilars, and advanced pharmaceutical production, reinforcing supply resilience and global competitiveness. Biopharma-Focused Institutional Strengthening: Three new National Institutes of Pharmaceutical Education and Research (NIPERs) will be established and seven existing ones upgraded to support biologics production, pharmaceutical research, and regulatory capacity. Expansion of Allied Health Education: Institutions for allied health professionals (AHPs) will be upgraded and expanded across ten disciplines, including optometry, radiology, anaesthesia, and applied psychology. The target is to train one lakh AHPs over five years to address systemic workforce gaps. Regional Medical Hubs: Five regional medical hubs will be developed in partnership with states to improve access to advanced healthcare infrastructure and reduce geographic disparities. Strengthening Traditional Medicine Systems: The government announced three new All India Institutes of Ayurveda, upgrades to Ayush pharmacies and drug testing laboratories, and continued support for the WHO Global Traditional Medicine Centre in Jamnagar. Mental Health as a National Priority: A new National Mental Health Institute, “NIMHANS 2,” will be established to address evolving mental health challenges, including those faced by digital professionals and content creators. Implications for the Healthcare Sector The Biopharma Shakti initiative marks a strategic push toward self-reliance in high-value pharmaceutical manufacturing, with potential to improve affordability and availability of advanced therapies, particularly in oncology, immunology, and rare diseases. Expansion of NIPERs strengthens India’s pharmaceutical research and talent pipeline. Its long-term success will depend on effective industry collaboration, curriculum modernisation, and regulatory alignment. Investment in allied health capacity addresses critical non-physician workforce shortages, improving hospital efficiency, diagnostics, surgical support, and mental healthcare delivery. Regional medical hubs can ease pressure on metropolitan tertiary centres and strengthen secondary care systems, provided implementation and financing frameworks are robust. The expansion of traditional medicine infrastructure signals continued policy commitment, though evidence generation and regulatory harmonisation remain essential for global credibility. Finally, elevating mental health through institutional expansion reflects growing recognition of digital-era psychological stressors and the need for accessible, stigma-free care within India’s broader public health framework.   Dr Puneet Khanduja- Health & Nutrition Lead, MicroSave Consulting (MSC)    ]]> https://biospectrumindia.com/views/21/27278/cervical-cancer-in-india-why-awareness-alone-isnt-enough.html https://biospectrumindia.com/views/21/27278/cervical-cancer-in-india-why-awareness-alone-isnt-enough.html Wed, 04 Feb 2026 00:00:00 +0530 Cervical cancer is one of the most preventable cancers, yet it remains a leading cause of cancer-related deaths among Indian women. The estimated number of deaths due to cervical cancer in the country in 2023 was 35,691, according to the Indian Council of Medical Research-National Cancer Registry Programme's (ICMR-NCRP) data. Over the last decade, India has made significant progress in building awareness around cervical cancer. Public health campaigns, clinician outreach, and growing media attention have helped normalise conversations around Human Papilloma Virus (HPV) screening and prevention. Yet, despite this momentum, cervical cancer continues to be one of the leading causes of cancer-related mortality among Indian women. The central challenge today is no longer a lack of knowledge, but a failure of execution. The Awareness–Action Gap: Real Numbers, Real Lives According to the Ministry of Health and Family Welfare, as of July 2025, over 10.18 crore women have been screened for cervical cancer. This sounds very promising until one realises that this still represents only a fraction of the eligible population of women aged 30–65 years nationwide. According to the National Family Health Survey-5, the overall screening coverage remains under 5% in many regions, and the rate of follow-up after a positive screen is even lower. A similar pattern is visible in the uptake of vaccination against HPV. Awareness of the vaccine has improved, particularly in urban and semi-urban India. Yet vaccine completion rates remain low. In the private healthcare market, HPV vaccines continue to cost several thousand rupees per dose, placing full vaccination beyond the reach of a large segment of the population. Awareness, in this context, does not equate to access. Why Awareness Isn’t Enough to Mitigate the On-Ground Barriers Clinical data consistently point to three structural barriers that awareness alone cannot overcome: Financial Exposure: Preventive care is often deprioritised when households face competing demands on limited income. Uneven access: Screening facilities and trained specialists remain concentrated in urban centres. For women in rural and semi-urban areas, the distance to care, limited appointment availability, and lack of follow-up support translate into delayed or foregone prevention. Fragmented care pathways: Preventive healthcare requires continuity. Screening without timely results, counselling, referral, and treatment coordination does not reduce disease burden. In many cases, the absence of integrated systems means that early warning signals are missed. Overlaying these structural challenges are deeply entrenched social and cultural factors. Reproductive health continues to carry stigma. Preventive care is often postponed in favour of other responsibilities. Fear of diagnosis and treatment further delays action. These realities cannot be addressed by awareness messaging alone. The cost of delay The consequences of this gap are reflected in national disease outcomes. Cervical cancer remains one of the most common cancers among Indian women, with thousands of deaths each year. Many of these cases are diagnosed at advanced stages, when treatment is more complex, outcomes are poorer, and financial strain on families is significantly higher. This is particularly troubling because cervical cancer is considered highly preventable. Robust evidence demonstrates that timely screening and HPV vaccination can dramatically reduce incidence and mortality. Insurance as a catalyst for prevention Health insurance providers increasingly recognise that critical illness prevention aligns both with improved health outcomes and long-term risk optimisation. Early screening and vaccination reduce the likelihood of late-stage diagnosis, which is associated with higher treatment costs, prolonged hospitalisation, and poorer outcomes. As a result, insurers are progressively: Embedding preventive screenings into policy benefits, reducing or eliminating out-of-pocket costs for eligible women Promoting wellness and preventive health programmes that actively nudge policyholders toward timely screening When preventive care is financially protected and operationally supported, participation improves. Insurance, in this context, converts awareness into action by lowering friction at the point of care. The role of employers and group insurance Employer-sponsored health plans represent another powerful lever. Corporate wellness programmes that include cervical cancer screening, on-site camps, and vaccination support help overcome both financial and logistical barriers. They also normalise preventive healthcare within working populations, increasing participation across age groups. From awareness to outcomes India has reached a pivotal moment in its cervical cancer journey. Awareness has established intent. Science has provided solutions. What is now required is systemic integration, where public health initiatives, insurance coverage, and employer participation operate in concert. From an insurance perspective, the pathway forward is clear. Prevention must be financed, facilitated, and followed through. Only then can awareness translate into measurable reductions in disease burden, claims severity, and most importantly, the preventable loss of life.   Dr Puneet Biblani, Head – Claim, ManipalCigna Health Insurance ]]> https://biospectrumindia.com/news/21/16888/ai-based-clinic-and-hospital-healthcare-motivation-poster-design.html https://biospectrumindia.com/news/21/16888/ai-based-clinic-and-hospital-healthcare-motivation-poster-design.html Fri, 30 Jan 2026 00:00:00 +0530   There will be inspirational phrases on the walls, the appointment schedule will be put by the main entrance, and wellness charts will be placed near the consultation rooms. It is not merely decorations but rather an inspiration to patients and staff since the very beginning to take their wellness process and stay dedicated to improving their health. At this point, clinic managers and healthcare professionals are capable of generate posters as quickly and simply as ever, without employing designers or using complicated programs. The blog goes into detail on why AI-assisted poster design is just the right extension of both the hospital, whether it is the bustling emergency room or the comfortable local clinic, and demonstrates precisely how to draw images that encourage and educate when working with patients in their daily routine. Why Healthcare Visuals Matter More Than You Think Healthcare posters are much more than mere background decorations. They are silent wellness coaches that assist in the creation of a good attitude and healthy habits during the treatment process. Patients and staff are attracted to these visual messages even in those silent intervals between appointments. Good healthcare posters can be divided into the following pragmatic groups:   Inspirational quotes on perseverance, stability, and establishing confidence with the patient. The appointment schedules can be read even when one is sitting on the other side of the room. Progress or recovery milestones, wellness goal charts.   Educational messages, such as cleanliness techniques or pre-visit preparation. AI design tools are customizable to fit a wide range of vibes of different brands: professional and reassuring or light and inviting. From Empty Walls to High-Impact Wellness Zones There are so many of these blank wall spaces in so many healthcare facilities eager to see what can fill them--hallways, waiting areas, recovery lounges, or even areas around diagnostic equipment. These are the best places to use subtle visual cues that would softly persuade people to behave in a better way.   The development of posters using AI can assist clinicians and facility managers in large extent since they can:   Make a matching style with the medical equipment, lighting, and materials to give a smooth appearance. Increase the intensity of color to make everything stand out in clinical lighting. Scale works to the smallest notices, to enormous murals. You are not just left with templates that are ordinary, but, on the contrary, you have graphics that belong to your clinic. Posters that Speak to Different Patient Personalities Not all patients relate to the same message. Others are energized by empowering recovery phrases that get them going, whereas others rejoice in mild encouragement regarding progress and general equilibrium. In the AI-enabled design, it is easy to change visuals, and you do not have to create something new every time.   The following are some of the poster themes that are popular among healthcare spots:   Motivational phrases to boost vigorous therapy and rehabilitation units. Relaxing and calming texts are suitable for anaesthetics or for having a recovery room. Clean and well-organized weekly appointment schedules. Basic goal trackers that are customized to wellness program habits. Such diversity ensures that the space remains new and welcoming without putting off patients or visitors. Dreamina Steps: Turning Healthcare Ideas into Wall-Ready Visuals Step 1: Compose your healthcare poster prompt Launch Dreamina and go directly into the Canvas section by the image generator. This is where the vision of your clinic begins to be realized. Write an elaborate text prompt that accomplishes the mood, purpose, and setting of your poster.   As an example: Major healthcare inspirational wall art on a gentle clinical backdrop, massive white writing with a cheerful message regarding wellness consistency, detailed medical texture, high-contrast illumination, and professional healthcare ambiance.   Considerable questions guide Dreamina's nail to the point of knowing where it will be hung and how it will be useful to patient visits. Step 2: Tune settings and create You are ready. With your prompt, make the settings just right. Select a model that is excellent to produce striking graphics, select the aspect ratio depending on the space you have on your wall (tall when using pillars, wide when covering a big area), and select the resolution to 1K to preview a picture indoors, or 2K to produce a large print. When everything is satisfactory, just press generate in Dreamina and see your healthcare vision transformed into a draft poster ready to use. Step 3: Customize and save Once it is produced, sharpen it using the AI tools of Dreamina. Inpainting can be used to enhance the important details, eliminate edges to create quacky wall designs, or clean interiors to shine in clinical lighting. On a happy day, you can just download to get your work of art. Refining Healthcare Visuals Without Starting Over In healthcare facilities, branding is often updated, new services are being offered, or seasonal changes, and thus posters may only require slight changes and not complete re-designs. The AI image editor provided by Dreamina allows making it easy to modify colors, font boldness,s or layout changes without messing everything up with your changing objectives. The appearance of your facility remains unified throughout all the rooms and surfaces. Combining Motivation with Communication in Healthcare Good healthcare posters do not merely inspire but lead people as well. With AI, it is easy to inject inspirational aspects of a design with practical information, avoiding the cluttering of the design.   Most facilities make posters that include: The inspirational quote and the recovery challenge. Service icons were superimposed onto appointment schedules. Health objectives, targets, and motivating messages. The method keeps the patients informed and presents their progress on a moderate scale. Keeping Posters Crisp Across Print and Digital Displays Nowadays, the medical premises are filled with printed posters and digital screens. It is important to keep everything sharp in both. Depending on where you are, it may require a fast contrast enhancement or sharpening. A photo enhancer enables clinicians to ensure that the text is readable and images shine, either on large prints or tiny waiting areas. Inference: better visuals, better training culture Not only does the word of the clinicians give you motivation, but the whole surrounding environment. In Dreamina, the walls of your healthcare establishment, whether in a clinic or a hospital, would become active components of wellness paths. Imagine tailor-made quotes, schedules, and progress charts, which are AI-driven.   The patients feel there is consistent support as soon as they enter, and the philosophy of care comes in tandem with the sight. Dreamina enables the designer of a space that feels welcoming for your team. ]]> https://biospectrumindia.com/views/21/27221/combining-pocd-tools-with-indias-digital-health-platforms-and-national-registries.html https://biospectrumindia.com/views/21/27221/combining-pocd-tools-with-indias-digital-health-platforms-and-national-registries.html Fri, 23 Jan 2026 00:00:00 +0530 India’s healthcare system continues to face rising disease burdens alongside limited access to timely diagnostic services. In many rural and peri-urban communities, people wait far too long for a diagnosis.Point-of-care diagnostic tools, or POCDs, provide a practical way to move testing from distant laboratories directly into the community settings where clinical decisions are made. POCDs are diagnostic tests conducted at or near the site where the patient is receiving care and can deliver results within minutes or hours instead of days. Research summarized by Pai and colleagues shows that POCDs reduce the time between the onset of symptoms, diagnosis, and the start of treatment, enabling faster and more effective patient care. This closes one of the biggest gaps in healthcare delivery. According to IMARC Group's industry analysis, the global market for point-of-care diagnostics was worth around $53 billion in 2024 and is expected to quadruple in the next ten years. This is mostly due to the use of these tests in infectious diseases and the growth of digital connection. The value of POCD in India goes beyond just business growth numbers. It has the ability to fix a long-standing systemic inequity where reliable diagnostics are still only available in certain areas and for certain people. Konwar and Borse's study of the Indian healthcare system says that those who live far from metropolitan laboratories have to wait longer for or miss diagnoses of tuberculosis, maternity difficulties, and common non-communicable diseases because they have to rely on transportation and reporting lag. POCD devices fix this problem by making testing available at health sub-centers, mobile clinics, and village outreach initiatives. The Value Of Public Health Goes Beyond Just Testing Individuals From a public health perspective, POCD tools serve as instruments for population disease management rather than as standalone clinical equipment. The World Health Organization's global health estimates show that infectious diseases are still one of the top causes of illness and death in low- and middle-income nations. Quick diagnosis is important not only for the recovery of each person but also to stop the spread of the disease in the community. Hospitals benefit as a whole when diagnostic decentralization moves screening volumes away from tertiary hospitals. According to study by Varghese and colleagues on the use of POCD in Indian public programs, huge groups of low-risk patients are well cared for in primary care systems, which keeps them from having to go to the hospital and frees up space for specialized care. Making Decisions At The Front Line Of Care One of POCD's best contributions to making healthcare more efficient is allowing local decision-making. Healthcare professionals utilizing rapid testing equipment can take action at the same patient visit instead of waiting for lab results to come back days later. Uses in National Health Priorities India has included POCD in its main programs for controlling diseases and improving the health of mothers. Molecular platforms are used in tuberculosis programs to find cases in the community. According to studies using the AideSmart platform, maternal and lactation support programs use multiplex POCD to test for HIV, hepatitis B, hepatitis C, syphilis, trichomoniasis, and anemia. Accredited Social Health Activist personnel are in charge of running things. According to evidence from Raghu and colleagues' cardiovascular risk screening campaigns, smartphone-based POCD solutions let ASHAs collect clinical information during home visits, do tests on the spot, and submit results right away. These platforms combine direct outreach with referral decision pathways, making it easier for groups of people who have not always had access to institutional healthcare to get the care they need. POCD has grown beyond managing infectious diseases to managing diseases that don't spread from person to person. Thodika and colleagues have shown that mobile diagnostic clinics that include POCD testing for blood glucose, hemoglobin, and cardiovascular risk can be used for large-scale, low-cost community screening. These mobile machines connect testing with instant counseling, which cuts down on the time it takes to find out if you have a disease that is usually only found in clinics. Validation, Precision, and Functional Dependability POCD's quickness is its best feature, but precision is what keeps it real. Regulatory standards in health systems around the world call for multi-layered validation to make sure that decentralized operations don't affect reliability. Heidt and his colleagues say that validation includes checking for analytical accuracy, assessing clinical performance in real-world situations, and checking how easy it is for people to use the product. In India, where tests are generally done by nurses, ASHA workers, or the patients themselves instead of professional laboratory technologists, human-factors validation is very important. Regulatory guidance from device oversight agencies stresses the need for training and simulated-use testing to cut down on operator mistakes. The Real World of Regulation in India Even though more pilots are being used, national rules for POCD procurement, validation, training, and scale-up are still not standardised. Agencies all across the world stress post-market surveillance, ongoing quality monitoring, and performance reporting. India's rules for medical devices include some parts of these frameworks, however there are still not enough national rules on how to integrate POCD into public health workflows. Engel and colleagues found that when there are no nationally standardized certification procedures, clinicians do not trust each other since they are not sure how reliable the tests are. When gadget branding changes without similar quality standards, public trust also goes down. Official Use in National Programmes According to national operational standards, Ayushman Bharat's Health and Wellness Centres, also known as Ayushman Arogya Mandirs, clearly endorse the use of POCD for primary-level diagnostic services. More and more, testing for tuberculosis, anemia, diabetes, cardiovascular disease risk, and prenatal infections is done through POCD-supported workflows. Land and colleagues' global response evaluations show that the widespread use of POCD antigen and molecular tests during the COVID-19 pandemic proved that decentralized countrywide testing strategies are possible. Emergency certification procedures enabled community clinics and residential users to conduct testing at an unparalleled scale. This experience made POCD an essential tool for being ready for an outbreak. Decentralized diagnostics are increasingly a big part of emergency response planning frameworks. Challenges Even while POCD is becoming more legitimate, it still has operational problems that will not go away. In rural areas, infrastructure problems are the most common. Neogi and Engel's field tests show that deploying advanced devices is hard because of power outages, lack of room, and lack of storage. Diagnostic routes continue to be disjointed. Engel's research showed that there are problems with the connections between screening, laboratory confirmation, referral, and starting therapy. These problems make it hard for POCD integration to reach its full potential. Patients frequently obtain favorable results without structured referral follow-up. Cost limits make it even harder to grow. According to reviews by Thodika and Varghese, procurement costs, cartridge replacement costs, continuing maintenance, and calibration are all financial problems for basic health centers that don't have enough money. Trust problems are still deeply rooted. Health workers often worry about the stability of calibration and the accuracy of results in devices that don't have recognized certification labels. When different brands of devices are used without consistent quality endorsements, community trust likewise goes up and down. Proof of Public Health Impact Field experience in India shows that it can lead to important results. Pant Pai's reviews of antenatal programs show that AideSmart-enabled POCD screening had a testing completion rate of over ninety percent and was accepted by everyone in the community. This made it possible to start treatment and referrals quickly. Thodika's mobile POCD clinic model proved that it was possible to do mass screening in areas that didn't have enough resources and that it was cost-effective. These projects show that community diagnostics can help tertiary hospitals by doing a lot of early screening in primary care and saving specialist resources for more advanced illness management. Policy Guidance Meeting these goals will require sustained, coordinated action by the government at the national level. Policy reviews led by Pai and fellow researchers point to the need for standardized validation systems that clearly define procurement requirements, training protocols, post-market monitoring, and performance certification. Without these shared benchmarks, the reliability and quality of point-of-care testing remain uneven. Equally important are investments in basic infrastructure. Field studies by Neogi and Engel underline how dependable electricity, stronger connectivity for rural health facilities, and reliable supply chains for consumables directly shape whether these diagnostic tools can function effectively on the ground. These fundamentals determine if point-of-care testing becomes part of routine healthcare delivery or remains confined to isolated pilot efforts. Training programmes should teach health workers how to use digital consent tools and how to do their jobs in a way that is ethical. Longitudinal cost-effectiveness research ought to inform future public spending, a priority highlighted by Varghese’s health-economics assessment. Looking Ahead Over the next ten years, POCD is expected to become an integral part of India’s digital health ecosystem. According to emerging clinical technology reviews discussed by Varghese, the integration of artificial intelligence will strengthen image interpretation, enable automated quality assurance, and support multi-disease testing through cloud-based analytics. Smartphone platforms are likely to become routine clinical tools for ASHAs and auxiliary nurse midwives. Interoperability with ABHA databases will support the creation of lifelong digital health records for individuals. Integrated reporting systems will strengthen national registries by enabling better tracking of tuberculosis elimination targets, maternal health outcomes, and trends in non-communicable diseases. Public-private partnerships are expected to make devices more affordable and speed up developments in rural manufacturing that are in line with how things work in India.   Dr Sabine Kapasi, CEO at Enira Consulting; Founder of ROPAN Healthcare and UN advisor ]]> https://biospectrumindia.com/views/21/27199/solving-medical-inflation-why-the-tpa-model-must-evolve.html https://biospectrumindia.com/views/21/27199/solving-medical-inflation-why-the-tpa-model-must-evolve.html Tue, 20 Jan 2026 00:00:00 +0530 India’s healthcare industry is undergoing a remarkable transformation. Projected to be valued at approximately $638 billion by 2025, it remains one of the fastest-growing sectors in the country, fuelled by rising income levels, increased health awareness, and expanding insurance coverage. Yet, despite this impressive growth, the gap between access and affordability continues to widen. Medical inflation in India is rising at an annual rate of 12 to 14 percent, pushing many families into the agonising position of choosing between essential healthcare and financial security. This strain is becoming increasingly visible. Insurance premiums are rising, driven by growing out-of-pocket expenses, costly pharmaceuticals, increasing operational expenses in hospitals, and the introduction of new technologies and rising professional fees. As the economics of healthcare evolves, there is a pressing need for smarter, more transparent systems that empower consumers to make informed and strategic choices. Individuals must be able to evaluate health plans more effectively by considering deductibles, long-term needs, family floater options, and policy comparisons. Leveraging preventive care and choosing providers from a robust cashless network can significantly enhance cost efficiency. This is where third-party administrators (TPAs) are stepping in, not merely as intermediaries but as enablers of affordable, value-driven healthcare. The future of healthcare financing and delivery must be powered by technology and intelligence. The role of TPAs has already evolved well beyond claims processing. Today, TPAs are simplifying complex processes, reducing costs, and creating tangible value across the healthcare ecosystem for insurers, corporates, hospitals, and most importantly, policyholders. Over the past few years, several high-impact innovations have redefined the TPA model. These include AI-led fraud detection, real-time cost prediction, automated claims workflows, and data-driven hospital network design. Such innovations are not just theoretical; they have helped partners reduce healthcare inflation to as low as 5 percent, well below national averages, delivering meaningful savings to both insurers and individuals. One of the most effective strategies has been smart network optimisation. By analysing cost-effective hospitals and procedures through AI-powered analytics, TPAs are helping steer members towards high-quality, affordable treatment options. At the same time, they support insurers in better managing claim payouts. These insights also enable more effective negotiations with hospitals, reducing claim sizes and ensuring better rates for all stakeholders. Insurance fraud remains another persistent challenge, one that modern TPAs are tackling head-on. Advanced machine learning models are helping detect anomalies such as inflated bills or unnecessary treatments before they translate into payouts. In some cases, fraud detection rates have improved by over 60 percent year-on-year. This is a crucial development that protects honest policyholders and reinforces fairness in the system. Efficiency is another critical pillar. With end-to-end digitisation of enrolments, pre-authorisation, discharges, and claims settlement, TPAs are drastically lowering turnaround times and administrative costs. One standout innovation is the real-time estimation of out-of-pocket expenses using AI-powered tools. These provide members with cost projections tailored to their specific plan and provider, eliminating ambiguity and helping them plan better. In addition to these capabilities, newer initiatives are taking a more human-first approach. Some TPAs now offer concierge-style services that assist members throughout their healthcare journey, from navigating hospitals to real-time resolution of policy queries and claims. These services combine the precision of technology with the empathy of personal support, making healthcare more accessible and less intimidating. India’s medical inflation challenge is complex but not insurmountable. As the industry scales, the focus must shift from volume to value, led by data-driven solutions that reduce costs while safeguarding care quality. TPAs are leading this shift by proving that healthcare can be transparent, cost-effective, and compassionate at the same time. At a time when millions of Indian households remain vulnerable to healthcare-related financial shocks, the role of TPAs has never been more important. They are no longer just claim processors. They are strategic partners helping individuals, insurers, and the broader ecosystem transition to a more equitable and efficient healthcare future.   Dr Vijay Sankaran, Chief Claims Officer at Medi Assist ]]> https://biospectrumindia.com/views/21/27142/minimising-the-impact-of-nipah-virus-in-india.html https://biospectrumindia.com/views/21/27142/minimising-the-impact-of-nipah-virus-in-india.html Mon, 05 Jan 2026 00:00:00 +0530 India has taken a major step forward in its efforts to combat the Nipah virus (NiV), a deadly emerging infection globally. A new vaccine (ChAdOx NipahB vaccine) targeting this virus has recently entered Phase 2 clinical trials (taking place in Bangladesh) under collaborative forces of Pune-based Serum Institute of India, Coalition for Epidemic Preparedness Innovations (CEPI) in Norway, and the University of Oxford in the UK. With the virus causing sporadic but highly fatal outbreaks across South and Southeast Asia, this marks a significant moment in epidemic preparedness and vaccine innovation. Nipah virus is a deadly disease from the same viral family as measles, the paramyxoviruses, and is recognised by the World Health Organization (WHO) as a research priority due to its pandemic potential. Thus, a vaccine is urgently needed as the disease can be fatal in up to 75% of cases. In 2025, a total of nine NiV outbreaks have been reported in Kerala State. Recent case numbers reported in Kerala State are consistent with trends observed in previous years and are therefore not entirely unexpected. However, they continue to highlight a localised risk associated with NiV in that area. As a result, the state has launched a critical sero-surveillance initiative aimed at uncovering hidden transmission pathways. A new testing kit, developed by the Institute of Advanced Virology (IAV), is at the core of the effort, designed to detect Nipah antibodies in both humans and animals. The IAV team has developed innovative Nipah virus-like particles (VLPs) that mimic the Nipah virus in appearance and behaviour but lack the genetic material necessary for replication, making them non-infectious and safe to handle in Biosafety Level 2 (BSL2) laboratories. This allows researchers to safely study how the virus enters host cells. Once the precise entry mechanism of the Nipah virus is fully understood, the team plans to test various antiviral drugs that could prevent the virus from attaching to receptor cells. On the other hand, the Indian Council of Medical Research (ICMR) has developed a technology i.e. a colorimetric RT-LAMP assay, for rapid detection of Nipah Virus and has invited expression of interest for its commercial production. The ICMR is also exploring collaboration with industry partners for manufacturing indigenously developed monoclonal antibodies for treating the deadly Nipah Virus. On the global stage, recent advancements in monoclonal antibodies, particularly hu1F5 and mAb92, show promise in treating Nipah virus infections, demonstrating effectiveness in animal models and paving the way for potential human clinical trials. While these advancements in monoclonal antibodies, antiviral drugs, and vaccine candidates are encouraging, substantial effort is still required by all stakeholders to provide a clear roadmap of tackling this infection with a pandemic potential.   Somya Jain, Freelancer  ]]> https://biospectrumindia.com/views/21/27123/how-indias-healthcare-talent-powers-global-mobility-through-h-1b-pathways.html https://biospectrumindia.com/views/21/27123/how-indias-healthcare-talent-powers-global-mobility-through-h-1b-pathways.html Fri, 26 Dec 2025 00:00:00 +0530 The world doesn’t have a talent shortage. It has a mobility infrastructure problem. Global healthcare systems, particularly, grapple with unrelenting demand pressures. These include ageing populations in the West, rising chronic diseases everywhere, and chronic staffing shortages that domestic training pipelines simply cannot fill fast enough. Retention challenges compound the issue, leaving hospitals and clinics worldwide scrambling for reliable talent. Yet the pathways designed to bridge this gap, like the H-1B  visa, were architected for tech giants and corporate hiring, not the frontline clinical roles that define healthcare, creating a profound misalignment between supply, demand, and real-world needs. Healthcare offers the clearest lens on this systemic breakdown. Indian nurses, technologists, physiotherapists, and doctors now bolster hospital and community systems globally, filling irreplaceable gaps. In the US alone, over 32,000 Indian registered nurses represent about 6% of the immigrant nursing workforce, while more than 59,000 Indian doctors make up nearly a fifth of immigrant physicians. This tension is unsustainable. As dependence on India’s skilled workforce grows, mobility architecture must urgently evolve, prioritising fairness, transparency, and long-term sustainability to balance ethics with opportunity.   Where H1B Helps and Where It Needs Reform For many specialised healthcare workers, the H1B pathway has become a practical route to international opportunities. It enables skilled professionals to support systems that cannot meet staffing needs on their own. At the same time, the pathway carries structural limits. In fiscal year 2024–25, nearly 400,000 H-1 B petitions were approved, and 16,937 of them, or 4.2%, were for medical and health occupations. Half were for physicians and surgeons. Yet entry still depends on a lottery, employer obligations vary, and protections are inconsistent, leaving some professionals to navigate unclear contracts or relocation processes. These gaps underline why ethical mobility is now central to workforce planning. When recruitment involves hidden fees, vague commitments or restrictive terms, the process becomes extractive. Healthcare workers take on critical responsibility from the day they arrive and cannot be placed in roles that compromise safety or growth. Ethical mobility ensures transparency, predictable progression and clarity of rights.   The Problem of Devaluing Indian Professionals The problem isn’t skills—it’s visibility. Global healthcare systems still struggle to recognise the full breadth of Indian clinical capability, leading to systemic undervaluation of their adaptability, multi-role training, and rapid mastery of new protocols. Indian professionals excel in intensive environments, blending strong clinical grounding with empathy and communication skills that thrive in multicultural settings. They consistently upskill through certifications, reliably filling acute shortages in rural hospitals and community centres, and powering entire service lines. This misrecognition risks depleting a finite talent pool. Ethical mobility must address it, ensuring fair pathways that value India’s contributions while benefiting both origin and destination countries   The Need to Keep Indian Systems Sustainable Through Circular Mobility Ethical mobility isn’t protectionist. It’s how you keep systems sustainable. India graduates over 180,000 doctors annually, yet faces uneven distribution and persistent domestic shortages, even as global healthcare demand surges for its talent. Fair, transparent pathways promote circular mobility. This means that professionals gain international experience, skills, and earnings abroad, while open channels enable their return for reinvestment, knowledge transfer, and leadership roles that strengthen India’s own systems in the long run. AI-based systems can’t fix a broken mobility system, but they accurately reveal where it is broken. By mapping clinical experience, certifications, and training into globally recognised formats, AI ensures transparency in credential verification. It accelerates recruitment timelines from months to weeks, prevents fraud through secure, tamper-proof records, and enhances skills visibility, thereby preventing qualified Indian nurses and doctors from being undervalued or overlooked due to mismatched documentation.   A Better Way Forward for Global Healthcare Mobility Across the mobility ecosystem, common gaps show where reform is needed. Many experienced nurses and allied professionals find that their capabilities are not fully visible because their records do not match international formats. Employers want ethical recruitment but face slow credential checks and uneven guidance. Workers seek global exposure yet need assurance that their dignity, safety and growth will be protected. These realities point to transparency, reducing uncertainty for everyone. Clear contracts, structured relocation support and defined career pathways help professionals plan their progression abroad. Standardised skill validation ensures fair assessment across diverse training backgrounds. Recruitment fees should never fall on workers, and their right to move within legal boundaries should remain protected. When these principles are applied, trust builds, and mobility becomes stable for both destination countries and India’s workforce priorities.   Conclusion India has the potential to become the world’s most trusted source of healthcare talent, not merely because of scale, but because of the depth, adaptability, and resilience of its professionals. Countries such as the United States offer meaningful opportunities for clinical growth, exposure, and contribution in return. However, this exchange can only remain sustainable if mobility systems evolve. Healthcare professionals shoulder responsibility for patient lives from the moment they step into a clinical setting. Mobility pathways must reflect that responsibility - offering clarity, fairness, and protection alongside opportunity. Visa frameworks like the H-1B, and global mobility systems more broadly, need to prioritise transparency, skill recognition, and long-term workforce stability. The world does not need more migrant labour. It needs mobility systems that treat healthcare professionals with the same dignity they extend to their patients every day. If India helps shape global benchmarks for ethical healthcare mobility, the outcome benefits everyone - healthcare workers, destination systems, and the patients whose care depends on them.   Avinav Nigam, Founder and CEO of TERN Group   ]]> https://biospectrumindia.com/views/21/27090/why-strategic-partnerships-are-the-future-of-pharma-growth-.html https://biospectrumindia.com/views/21/27090/why-strategic-partnerships-are-the-future-of-pharma-growth-.html Thu, 18 Dec 2025 00:00:00 +0530 In today's fast-evolving pharmaceutical landscape, collaboration is now the new competitive advantage. Imagine a world where patients can gain access to lifesaving drugs in months, not years; this is no longer some endpoint but an ongoing reality powered by strategic partnerships that are rewriting the way the global pharma industry innovates, scales, and delivers. The driving force for speed, innovation, and resilience in drug manufacturing is no longer competition but collaboration. The global pharmaceutical market today has crossed the $1.5 trillion mark, driven by an increasing number of partnerships between large pharmaceutical players, biotech innovators, and technology disrupters. A Pfizer–BioNTech alliance during COVID-19 showed the world how partnerships can shrink timelines from ten years to less than one year and save millions of lives. This shift points to a new era where the ability of organizations to co-create, share risks, and innovate together is going to be the strongest form of competitive strength. The pharmaceutical industry is changing in a world where increasing R&D costs, restrictive regulations, and growing demand for personalized therapy require strategic collaboration-a proven solution to share expertise and mitigate risk while being agile with evolving regulations. Whether it be in the realm of research, manufacturing, or marketing, these alliances enable companies to diversify portfolios, enhance efficiency in operations, and reach markets faster. Drug development is not a solitary pursuit anymore; it's a networked process, powered by open innovation and shared resources. As the Tufts Center for the Study of Drug Development points out, R&D costs now top $2.6 billion for every approved drug, an order of magnitude larger than the early estimates. With AI-led discovery, cloud-based data platforms, and real-world evidence transforming healthcare, partnerships are the lifeblood of accelerated innovation and expanded access. In this increasingly interconnected environment, open collaboration is emerging as the true source of sustainable competitiveness. India's pharmaceutical industry is fundamentally a very strong example of partnership. Contributing almost 20% of total global generic exports and fulfilling more than 60% of global vaccine demand, India has emerged as a trusted global partner for both research and production on account of its strong R&D base and cost-efficient manufacturing capabilities. This is further reflected in various global collaborations led by the Serum Institute of India on vaccines and biosimilars. Backed by various government initiatives such as ‘Make in India’, the Production Linked Incentive (PLI) scheme, and the Pharma Vision 2047 roadmap, India is well on track to lead scientific and industrial collaboration across borders—exporting not just medicines, but trust and technological expertise. However, building truly effective partnerships is not always easy. Differences in corporate cultures, management styles, and governance processes regularly lead to friction. Intellectual property complications and multinational regulations can slow things down even further. It takes a meeting of the minds on objectives, openness in communication, thorough due diligence, and mutually rewarding structures. In other words, the success of any partnership is as much a function of the relationship strategy as the business strategy itself. Collaboration will be the defining growth multiplier in the future of the pharmaceutical industry worldwide. Strategic partnerships unleash the power of innovation and maximize resources while extending the reach of life-saving therapies. Within a context where the boundaries between pharma, biotech, and digital health continue to blur, those who build adaptive, trust-based ecosystems will be the ones writing the next chapter of healthcare evolution. Collaboration is no longer optional; it is the bedrock of a more resilient, more equitable, and more innovative pharmaceutical world.   Bhavin Mukund Mehta, Whole-Time Director, Kilitch Drugs Limited & Vice-Chairman, Pharmexcil  ]]> https://biospectrumindia.com/views/21/27047/biomanufacturing-2-0-indias-opportunity-to-lead-through-frugal-innovation-and-bioe3-driven-scale-.html https://biospectrumindia.com/views/21/27047/biomanufacturing-2-0-indias-opportunity-to-lead-through-frugal-innovation-and-bioe3-driven-scale-.html Tue, 09 Dec 2025 00:00:00 +0530 Biomanufacturing has moved from a background capability to a global strategic priority. The COVID-19 pandemic made that unambiguously clear. The race for vaccines and raw materials exposed how fragile even the strongest supply chains were. It also showed that local biomanufacturing strength can alter global outcomes. Few countries have internalised this lesson as quickly or as decisively as India. India’s leap into the global bioeconomy India today supplies nearly 60 percent of the world’s vaccines by volume. The country also exports biopharmaceuticals, enzymes, and fermentation products ranking India among top global producers. India’s bioeconomy has expanded from roughly $10 billion in 2014 to an estimated $165–170 billion in 2024, growing at approximately 18 percent in the last 4 years and now contributing over 4 percent to national GDP. This transformation not only reflects a conducive policy environment, but also a rapidly maturing innovation ecosystem. And the economic effects are tangible: stronger supply chains, import substitution for critical intermediates and raw materials, and billions saved annually. Much of this momentum in efficiency and scale can be attributed to the last decade. What has changed? The shift: Biomanufacturing 1.0 versus 2.0 Traditional biomanufacturing was built around large, fixed installations. These plants required enormous capital investment, took years to construct, and relied predominantly on microbial fermentation or mammalian cell systems housed in heavy stainless-steel infrastructure. While this model worked, it was slow, capital-intensive, and inflexible. Water consumption, power requirements, and waste generation ran high and the ability to pivot quickly during crises was limited. Biomanufacturing 2.0 is different in almost every dimension. It's built around faster design cycles, modular bioreactors, distributed facilities, and digital tools that eliminate months of trial-and-error. AI modeling, automation, and real-time monitoring make it possible to adjust processes dynamically without lengthy validation cycles. The entire system becomes lighter, faster, and substantially less environmentally burdensome. This is exactly the kind of shift where India has natural advantages. The country's cost structure, engineering culture, and demonstrated ability to innovate under constraint align perfectly with this new paradigm. India's long-standing ability to "do more with less" is being re-expressed in this next generation of biomanufacturing. When markets and governments push in the same direction Frugal innovation has been part of India’s DNA. Whether it’s space tech like Chandrayaan-3 or digital infrastructure like UPI, when industry and government efforts align, we can achieve much efficiency at scale. For Biomanufacturing 2.0, the BioE3 policy is a major catalyst. Launched in 2023, BioE3 has the ambitious aim of making India achieve a US $300 billion bioeconomy by 2030, with focus on advanced fermentation, distributed manufacturing, and precision bioprocessing. The BioE3 advanced biomanufacturing hubs are providing startups and mid-size innovators access to equipment and facilities they normally cannot afford, from omics tools to digital systems, from analytics labs to pilot-reactor spaces. For large businesses, BioE3 means an environment where practices and expectations can get aligned earlier in the development cycle, especially around quality, data, and regulatory requirements. Thanks to this push from the Centre, companies are building modular bioreactors with reduced capex,  deploying continuous fermentation systems that cut energy consumption and operating pilot lines with that shorten scale-up timelines by several months. India is also developing strain-design platforms, AI-driven process-control systems, and micro-biomanufacturing networks for food, feed and materials. These are the early signals of a system that is learning to innovate at scale. The strategic imperative ahead The coming decade will show how well India converts this momentum into long-term leadership. Between 2025 and 2027, the focus must be on fully activating the BioE3 hubs, improving supply chains for raw materials, intermediates and equipment, ultimately reducing our dependence on imports. As we move into the following years, the integration of AI-driven optimisation, automated control systems, and the blending of biomanufacturing will define the country’s competitiveness. After 2030, as more countries tie trade access to sustainability metrics and environmental performance, India will have the chance to export not only products but entire manufacturing services that are designed for frugal, compliant, and environmentally mindful production. Natural advantage + competitive advantage = global leadership: In addition to policy, India’s biodiversity, climate, and broad base of natural flora and fauna are a huge advantage for research and for developing new biological processes. These are strengths that many countries are now trying to rebuild or compensate for. Power, labour, land, all of these are far cheaper than in Western markets. A large-scale fermentation facility costs 25–30 percent less to operate in India than in North America or Europe. This difference lets teams experiment without burning money at the same speed as their global competitors. An unintended effect of the pandemic is also the transformation in investor’s mindset. Those who previously avoided manufacturing now actively look for opportunities in bioprocessing, deep tech, and advanced production. They understand that biology-based solutions are not just another industry; they are the base for healthcare resilience, food security, and sustainable materials. Today, investors are backing companies from seed stage all the way up to growth rounds, something that was rare even five years ago. The next decade of global biomanufacturing will be defined by a single question: Can the world do more with less? Fewer resources, lower costs, smaller environmental footprints, faster development cycles, greater resilience. If there is one country that has repeatedly shown this is possible, it's India. The foundational elements are in place: a growing bioeconomy, supportive policy frameworks, proven cost advantages, and a track record of frugal innovation. The infrastructure is being built. The talent pipeline is expanding. Investment momentum is real and accelerating. What remains is strategic clarity. What kind of biomanufacturing system does India need to build to stay competitive in a world moving at digital speed? The answer to that question will determine whether India becomes not just a supplier, but the global center of gravity for next-generation biomanufacturing. Environmental necessity, proven operational advantages, and rising global demand have converged to create an opportunity that India is uniquely positioned to seize.   Ankit Alok Bagaria, CEO & Co-Founder at Loopworm ]]> https://biospectrumindia.com/views/21/27025/the-guardians-of-self-from-nobel-medicine-to-immune-engineering.html https://biospectrumindia.com/views/21/27025/the-guardians-of-self-from-nobel-medicine-to-immune-engineering.html Tue, 02 Dec 2025 00:00:00 +0530 Immunologists spent the better part of eighty years puzzling over something odd. We each carry an enormous variety of antibodies and T-cell receptors, and plenty of these could, at least in theory, turn on our own tissues. The strange part is they mostly don't. It comes down to a classification problem. Under uncertainty, how does the body figure out what's friendly versus hostile? And having made that call, how aggressively should it respond? These aren't easy questions. You see the classification problem everywhere now. Email filters trying to catch scams without losing legitimate messages. Smoke detectors that need to ignore burnt toast. Airport scanners, fraud detection at banks, autonomous vehicles deciding what's a pedestrian and what's a plastic bag. None of this is straightforward. And it's more or less what regulatory T cells have to do inside the body. The Nobel Assembly at Karolinska announced the 2025 Physiology or Medicine prize in October. It went to Mary E. Brunkow at the Institute for Systems Biology, Fred Ramsdell at Sonoma Biotherapeutics, and Shimon Sakaguchi at Osaka University. What they figured out, collectively, was how the immune system knows when to stop: regulatory T cells (T-regs) controlled by a gene called FOXP3. Brunkow's group at Celltech, back in the late 1990s, spent long nights chasing a lethal autoimmune problem in mice. Marker maps, gels that nearly worked, the usual grind. Eventually they landed on FOXP3. It turned out to be the switch that makes ordinary T cells into regulators. Paediatricians later encountered the same gene when children presented with IPEX syndrome. But Ramsdell was the connector. He saw FOXP3 as one leg of a relay: mouse genetics handing off to human genetics, then cell therapy, then manufacturing. He likes to say science moves when you make room for whoever comes next. On the other hand, Sakaguchi took a different path. He'd been interested in "suppressor T cells," which had fallen out of favour in the 1970s. Most researchers had moved on. He stuck with it, rebuilt the evidence more carefully, and eventually linked CD4+CD25+ cells to FOXP3. Someone once asked him why he kept coming back to the same question. He said the answer keeps helping patients, a little more each year. The evidence, once it came together, was hard to dismiss. Mice with FOXP3 mutations got sick. Give them working copies and they recovered. Humans with mutations in the same gene developed IPEX. Gene, function, mechanism: it all lined up. Immune tolerance isn't one checkpoint. It's layered. The thymus handles the first pass, weeding out T cells that react too strongly to self. But that's not the whole system. Out in the blood and tissues, FOXP3+ T-regs keep watch, reading context and tamping down whatever self-reactivity slipped through earlier. You get deletion where certainty is high, active regulation where it isn't. When T-regs don't work properly, you see more autoimmune disease: type 1 diabetes, MS, inflammatory bowel conditions. When they function well, inflammation clears up and tissues heal without as much collateral damage. During pregnancy, T-regs help tolerate the foetus. Tumours, unfortunately, have learned to recruit them to dampen immune pressure, which is something newer therapies are trying to undo. The gut is a good example of all this in action: constant exposure to foreign material, mostly harmless, with T-regs keeping things peaceful while still watching for genuine threats. Once researchers understood the circuitry, engineering became feasible. CAR-T-regs (chimeric antigen receptor regulatory T cells) can be designed to hit specific targets with a light touch. Protect a transplant without shutting down the whole immune system. Or quell autoimmunity while leaving host defence intact. There's also a pharmacological route: nanoparticles loaded with FOXP3 mRNA, or localised cytokine delivery. Computational tools are changing how this work gets done. Deep-learning models try to predict where engineered cells will end up and how stable they'll be. Simulations map out antigen-cell-tissue interactions before anyone gets dosed. Some groups build "digital twins" of patients, feeding in lab results and imaging to test dosing strategies in silico first. Is one big infusion better, or several smaller ones? You can model it. Tigran Petrosian once said he tries to avoid chance, that those who rely on it should play roulette, not chess. That's the idea behind all this modelling. Take the gamble out of it. Researchers run simulations to see whether receptors might cross-react with the wrong peptides, checking against each patient's HLA profile. Safety switches get tested across thousands of hypothetical inflammatory situations. In cancer treatment, the models help figure out when to reduce T-reg activity locally (so the immune system can attack the tumour) without wrecking tolerance elsewhere. Humans can oversee this kind of decision, but actually computing it by hand? Not really possible. The goal now is making this personal. Match the cell type to the patient, get manufacturing reliable, catch problems before they happen. Whether that takes five years or fifteen, nobody knows. But the groundwork is there.   Saurabh Singal, CEO & Founder of Molecule AI ]]> https://biospectrumindia.com/reports-white-papers/21/27021/move-without-worry-using-a-knee-cap-for-pain-relief.html https://biospectrumindia.com/reports-white-papers/21/27021/move-without-worry-using-a-knee-cap-for-pain-relief.html Mon, 01 Dec 2025 00:00:00 +0530 Knee pain can turn everyday activities such as walking, climbing stairs, or enjoying moments with loved ones into uncomfortable experiences. A knee cap provides gentle support and stability, easing pressure and reducing discomfort. It helps your knees feel cared for while making each step smoother and movement more comfortable. With the right knee cap for pain relief, you can stay active, enjoy your daily routines, and move through your day without hesitation. Taking care of your knees allows you to live fully, feel secure with every step, and experience the comfort and ease of healthy, supported movement every single day.   Understanding the Role of a Knee Cap for Pain Relief A knee cap for pain relief is designed to provide gentle compression, stability, and support to the knee joint. It helps in reducing inflammation, alleviating pain, and improving circulation in the area. By stabilizing the knee, the cap reduces the strain on muscles and ligaments, which allows for smoother and more controlled movements. People recovering from injuries or managing chronic knee conditions often find a knee cap to be a simple yet effective aid in daily life. They are lightweight, adjustable, and easy to wear, making them suitable for both active individuals and those needing everyday support. By offering targeted support, a knee cap for pain relief ensures that users can maintain an active lifestyle without constantly worrying about exacerbating pain or injury.   Key Benefits of Using a Knee Cap A knee cap helps you move freely, stay active, and protect your joints from further strain. Here are the key benefits of using a knee cap:   Pain Reduction: The primary purpose of a knee cap is to alleviate discomfort caused by knee problems. Compression around the joint can reduce swelling and inflammation, providing instant relief. Enhanced Stability: For those who experience weakness or instability in the knee, a knee cap provides external support. This helps prevent sudden twists or movements that could worsen the condition. Improved Mobility: With reduced pain and better stability, users can move more freely. This includes everyday tasks like walking, climbing stairs, or light exercise, making life more comfortable and active. Faster Recovery: Post-injury or surgery, a knee cap can aid in faster recovery by minimizing unnecessary strain and supporting proper alignment of the joint. Preventative Care: Even for those without current knee problems, using a knee cap during high-impact activities like running or hiking can prevent injuries and maintain knee health.     Who Can Benefit from a Knee Cap? A knee cap can help a diverse range of individuals, including:   Athletes: Those involved in sports like basketball, running, or tennis may face knee strain or injuries. A knee cap can offer support and help maintain performance. Older Adults: Age-related wear and tear can lead to conditions like arthritis. A knee cap helps reduce discomfort and supports joint function. Individuals with Injuries: Post-surgery recovery or injuries like ligament tears can be supported with a knee cap to reduce stress on the joint. Active Professionals: People who spend long hours standing or walking can benefit from the added support a knee cap provides.     How to Choose the Right Knee Cap for Pain Relief Selecting the right knee cap for pain relief is essential for comfort and effectiveness. Here are some factors to consider:   Material: Look for breathable, flexible materials that provide adequate compression without irritating. Fit: A knee cap should fit snugly but not be overly tight. Adjustable straps or sleeves can help achieve the perfect fit. Purpose: Identify if your need is mild discomfort, chronic pain, or post-injury recovery. Different knee caps are designed to address specific needs. Durability: Choose a product that can withstand daily wear, especially if it will be used during sports or work.     Tips for Using a Knee Cap for Pain Relief To get the maximum benefit from a knee cap for pain relief, follow these tips: Wear Consistently: Regular use, particularly during activities that strain the knee, helps maintain steady support.  Combine with Exercise: Gentle stretching and strengthening exercises complement the support provided by a knee cap. For activities that involve repetitive hand or wrist movements, using a wrist support brace can further enhance your overall stability. Check Fit Frequently: Over time, the knee cap may loosen. Ensure it maintains proper compression for effective relief.   Caring for Your Knee Cap Maintaining your knee cap for pain relief is simple but important: Wash regularly to keep it hygienic. Store in a cool, dry place when not in use. Inspect periodically for wear and tear, replacing if necessary. A well-maintained knee cap ensures long-term effectiveness and comfort.   Experience Each Step with Comfort Knee pain should not dictate your lifestyle. With a knee cap, you can move freely and participate in activities that bring joy and fulfillment. It stabilizes the joint and promotes faster recovery. When used alongside overall physical wellness routines and, if necessary, a wrist support brace, a knee cap can greatly help in maintaining an active and worry-free lifestyle. Healthcare and wellness solution providers like AGEasy encourage the use of supportive aids like these to move more easily and pain-free. By choosing the right knee cap, wearing it consistently, and taking care of your overall joint health, you can enjoy everyday movements without fear. Move without worry and experience each step with comfort.   ]]> https://biospectrumindia.com/views/21/27018/world-aids-day-2025-the-progress-the-gaps-and-the-road-ahead-for-india.html https://biospectrumindia.com/views/21/27018/world-aids-day-2025-the-progress-the-gaps-and-the-road-ahead-for-india.html Sat, 29 Nov 2025 00:00:00 +0530 United Nation estimate 40.8 million persons are living with HIV globally and among them 25,44,000 are in India. In the year 2024 alone 1.3 million new infections worldwide and India has reported 68,450 newly infected persons with HIV. Today with the availability of potent Antiretroviral therapy, persons with HIV who have access to these medications never fall sick of AIDS anymore. Research has shown, the Life expectancy of HIV infected persons who are receiving Antiretroviral therapy and virologically suppressed are almost like persons who don’t have HIV. This was possible due to the scientific discoveries of several antiretroviral medications which are given in combination to persons with HIV. Improving Quality of Life for Patients From a patient perspective, this progress translates to a radically improved quality of life. Individuals living with HIV can now work, travel, start families, and plan long-term goals—benefits unimaginable two decades ago. Access to counselling, adherence support, and regular follow-up care further empowers patients to stay healthy and socially integrated. There are still no vaccines to prevent HIV infection, but the introduction of a long-acting injectable antiviral medicine has opened new possibilities for HIV prevention. When used as part of pre-exposure prophylaxis (PrEP), this innovation offers a promising new avenue to reduce new infections—an important milestone in the absence of a cure. Progress and Persistent Gaps in the Treatment UNAIDS report shows that at the end of 2025, just before a collapse in global funding triggered a crisis in the global AIDS response, the remarkable efforts of communities and governments had brought down the numbers of new HIV infections by 40% and of AIDS-related deaths by 56% since 2010. But it also shows that huge gaps in HIV prevention remained, with 1.3 million new infections in 2024— almost unchanged from the year before. More than 95% of funding for HIV treatment and prevention in India are supported by Govt of India. 92% of the antiretroviral medications prescribed globally are supplied by Indian generic manufacturers and this is laudable. India is yet to implement pre-exposure prophylaxis(PrEP) through the National program, which is a gap. Efforts should be made along with political to implement PrEP in India to have Zero new infections. The consensus behind the old model of financing the HIV response may be coming to an end, but the international community is forging a new, more sustainable path. It is time even lower- and middle-income countries take ownership to support the HIV prevention and treatment efforts along with their health care programs rather than depending on international assistance. Twenty-five of the 60 low- and middle-income countries have found ways to increase HIV spending from domestic resources into 2026 as shown in the UNAIDS report. This is the future of the HIV response— nationally owned and led, sustainable, inclusive and multisectoral. This transformation cannot happen overnight, however Global solidarity and renewed commitment from funding partners will be needed as countries plan and lead sustainable transitions towards self-financing. India has done this well and can lead the global efforts. The Path to Ending AIDS as a Public Health Threat The HIV response has already saved 26.9 million lives worldwide. With an HIV prevention revolution, we could end AIDS as a public health threat, saving many more lives as per UNAIDS. And it could be better value for money too: UNAIDS estimates that if the world including India embraces new technologies and newer interventions, the annual cost of the HIV response could fall by around $7 billion globally.   Dr N Kumarasamy, Vice President, AIDS Society of India & Chief and Director, VHS Infectious Diseases Medical Centre Voluntary Health Services, Chennai   ]]> https://biospectrumindia.com/views/21/26962/the-future-of-human-and-ai-collaboration-in-medicine.html https://biospectrumindia.com/views/21/26962/the-future-of-human-and-ai-collaboration-in-medicine.html Fri, 21 Nov 2025 00:00:00 +0530 There's a fear lurking in hospitals and clinics across the world. One hears whispers that artificial intelligence will replace doctors, rendering decades of medical training obsolete. However, this fear misses the actual story unfolding in leading healthcare institutions today. The real narrative is far more interesting, as AI and physicians are learning to work together in ways that make both sides stronger. In 2025, any major hospital offers countless examples of this collaboration in action. A radiologist reviews AI-flagged anomalies on a chest X-ray before finalizing her diagnosis. An emergency physician receives an early warning that a patient’s condition is deteriorating, gaining crucial minutes to intervene. An admissions clerk spends less time on paperwork because an AI system automates repetitive documentation. None of these professionals view themselves as replaced. Instead, they have gained something invaluable: more time and better information. When researchers at Stanford and MIT compared how radiologists performed with and without AI assistance, the results were clear. Doctors working alongside AI achieved higher accuracy rates than either working alone. That's not competition between humans and machines. That's augmentation. That's what happens when you combine human judgment with machine precision. Consider Kaiser Permanente, one of America's largest integrated health systems. The organization has developed an early warning system that continuously monitors patient vital signs and lab work, predicting which patients might crash before it happens. The system caught deteriorating patients and alerted medical teams early enough to prevent adverse events. The result? Around 500 lives are saved per year, and a 10% reduction in readmissions. Here is the catch: it’s the medical professionals who interpret the AI’s warnings and act on them. The technology processes data; the clinicians make decisions. A similar model exists at the Mayo Clinic, where collaboration with Google has produced an AI tool that analyzes patient records, genetic data, and the latest medical literature to suggest personalized cancer therapies. Patients receiving AI-informed treatments showed higher response rates than those on standard regimens. Still, it is the oncologist who discusses the options, contextualizes the recommendations, and ensures that each decision aligns with the patient’s needs and values. What makes this collaboration particularly powerful is that AI lightens the administrative load that drains the doctors’ energy. Physicians spend roughly a quarter of their workday on administrative tasks. Kaiser deployed AI that listens to patient visits and automatically generates clinical notes. In its first year, the system handled 2.5 million encounters and saved doctors nearly 16,000 hours of typing. More importantly, it changed how those doctors felt about their jobs and redirected their attention towards patients instead of the screen. This is the unglamorous truth about healthcare AI that doesn't make headlines. It's not about brilliant machines making diagnosis-changing discoveries. It's about taking the repetitive drudgery out of medicine so doctors can actually practice medicine. Effective collaboration follows a clear pattern. Certain tasks, once reliability thresholds are met, can be fully automated, such as routine monitoring, documentation, and data analysis. Other responsibilities benefit from human oversight, particularly in diagnostic decision-making, where AI presents possibilities and physicians apply clinical context. And some moments in medicine remain inherently human by offering empathy, delivering difficult news, and building trust. The most effective healthcare AI projects share critical traits. They begin with well-defined clinical challenges, invite doctors into the design process, and prioritise measurable improvements in patient care. Importantly, they keep physicians in control, ensuring algorithms offer support, not unchecked authority. The challenges are real, though. Healthcare institutions worry about data security and whether algorithms trained on diverse populations actually work well for their specific patient populations. They grapple with questions about accountability. If an AI system makes a wrong recommendation, who bears responsibility? The answer remains clear: the doctor does. That's why training healthcare professionals to work effectively with AI matters as much as developing the AI itself. Some healthcare leaders describe this as moving from "artificial intelligence" to "augmented intelligence." The distinction matters. One is a machine that thinks. The other is a tool that helps humans think better. In medicine, the second definition is what actually works. Looking ahead, this synergy will only deepen. AI will become even better at spotting hidden patterns, enabling doctors to deliver more targeted treatments and easing the day-to-day drudgery of healthcare. Yet the fundamentals remain unchanged: physicians will always be the guardians of patient care and the stewards of ethical decision-making. AI, for all its advances, will be the enabler, not the replacement. The future of healthcare isn’t a contest between humans and machines. It is a collaboration, each side elevating the other in the shared mission to heal.   Ayush Jain, CEO and Co-founder of Mindbowser ]]> https://biospectrumindia.com/views/21/26908/the-economic-toll-of-heart-disease-why-india-cant-afford-to-ignore-cardiovascular-health.html https://biospectrumindia.com/views/21/26908/the-economic-toll-of-heart-disease-why-india-cant-afford-to-ignore-cardiovascular-health.html Tue, 11 Nov 2025 00:00:00 +0530 Heart diseases remain a major health crisis in India in 2025, accounting for around 33% of deaths and significantly impacting the younger population. India's public health story, commonly presented as a double burden of communicable and non-communicable diseases, essentially downplays the systemic threat posed by Cardiovascular Disease (CVD) in general. In addition to a health emergency, Cardio Vascular Diseases poses as a enormous, ongoing capital drain, strategically depleting India's human capital stock and levying a structural tax on its macroeconomic potential. A closer, more technical analysis shows that the Indian epidemic is defined by a distinct pathophysiology that worsens its economic toll. The "Asian Indian Phenotype" is characterized by a group of atherogenic traits, such as a dyslipidemia that is rich in high ApoB/ApoA1 ratios and elevated lipoprotein (a) levels, which creates a more thrombogenic and inflammatory environment than what is reflected in conventional cholesterol assessments. This genetic vulnerability, overlaid with a very high prevalence of metabolic syndrome, results in rapid endothelial dysfunction and premature, diffuse atherosclerosis. This biological fact appears as Premature Coronary Artery Disease, in which myocardial infarctions in men less than 50 years old are not exceptions but rather an epidemic trend, thus putting the economic burden squarely onto the most productive portion of the lifespan and exacerbating the resulting productivity loss. The economic conduits of this crisis reach much deeper than shallow calculations of hospital and doctor fees. The direct expenditures are characterized by their procedural intensity, driven by high-tech procedures such as drug-eluting stents, advanced fractional flow reserve imaging, and cardiac resynchronization therapy. This "cascade of care" produces an insistent capital cost for households and the state alike, wherein each rupee spent on tertiary reactive treatment is a rupee taken from high-return preventive investment in primary care, which generates a negative feedback loop for the entire health system. At the same time, the indirect losses are a deep depletion of human capital. Absenteeism can be seen, but the more subtle cost is presenteeism, as workers or employees with chronic heart disease experience impaired cognitive function from fatigue, medication side effects, or low-grade ischemia, resulting in diminished innovation and compromised decision-making at the firm level. Moreover, the intergenerational impact is severe; the financial catastrophe of a cardiac event often forces families to remove funds from next generation's education, creating a human capital debt that perpetuates cycles of poverty and compounds over decades. At a macroeconomic level, this drain operates as a structural constraint to growth. Disastrous health spending reduces household savings, lowering the national rate of savings and directly constraining the available capital for domestic investment. For firms, the cost falls in the form of high health insurance costs and hidden retraining and lost institutional expertise costs. The greatest cost, though, is the net present value of future income foregone due to premature death. The loss of a productive 40-45-year-old is the economy writing off the discounted value of their future productivity for the next two decades, an enormous devaluation of the country's human capital resource. To treat this fiscal infarction requires a technocratic paradigm shift from treatment to the creation of systemic resilience. This requires transcending superficial awareness to precision public health, utilizing India's IT strength to create risk stratification models combining genetic information and biometrics for effective, cost-reducing intervention. To fortify primary care means retooling Ayushman Bharat centres as algorithmic first responders, institutionalizing systematic CV risk scoring, and task-shifting for protocol-guided management of hypertension. Policy should also go beyond sin taxes and incorporate evidence-based Front-of-Pack Warning Labels and public procurement policies requiring heart-healthy standards in institutions, building a strong demand signal for the food industry to make reformulations. Finally, a strategic war against CVD is a fiscal imperative. The disease is a persistent "reverse sovereign fund," draining the country's most valuable resource. An investment in a state-of-the-art, prevention-oriented cardiovascular strategy is thus, an indispensable investment in national infrastructure, without which India cannot ensure its economic sovereignty and demographic destiny.   Dr Basavaraj Utagi, Senior Consultant- Cardiology, Fortis Hospital, Cunningham Road, Bengaluru ]]> https://biospectrumindia.com/views/21/26922/significant-advantages-of-stem-cell-biobanks.html https://biospectrumindia.com/views/21/26922/significant-advantages-of-stem-cell-biobanks.html Mon, 03 Nov 2025 00:00:00 +0530 India’s first Animal Stem Cell Biobank was inaugurated in August 2025 at the National Institute of Animal Biotechnology (NIAB), Hyderabad, marking a pioneering step that places the nation on the global map of animal biotechnology. Designed to preserve and provide high-quality stem cells from diverse animal species, the biobank will accelerate research in regenerative veterinary medicine, cultivated meat, disease modelling, and biodiversity preservation. Due to their potential to differentiate into multiple forms of cells, stem cells allow for a unique way to study cellular processes, tissue regeneration, and genetic disease. In being able to preserve a consistent and reliable source of stem cell lines, researchers will be able to investigate therapies that not only enhance animal health but also generate viable substitutes to traditional production agriculture. One such example is cultivated meat production. With global demand for protein rising, stem cell biobanks make it possible to grow animal-derived meat in laboratory conditions without the need for large-scale animal rearing. This initiative welcomes India as it joins countries that have established similar repositories with proven success. For instance, the RIKEN Cell Bank in Japan and the Roslin Institute in the UK have been well-equipped with cell lines of animals for the studies of diseases and gene-editing research for a long time, thus proving the trustworthiness and reliability of the cells as the basis of major innovations like the creation of lab-grown meat and the lessening of animal testing in drug ‍‌‍‍‌‍‌‍‍‌discovery. Globally, stem cell biobanks are already demonstrating significant advantages. In the United States and Singapore, these cell banks have been vital to the cultivated meat industry, assisting researchers in growing genuine animal tissue in the lab, which helps lessen the environmental and ethical issues linked to livestock farming. In Europe, advancements in veterinary stem cell research are leading to better regenerative therapies for horses and dogs, which improves their recovery rates and lowers euthanasia numbers. India’s facility has the potential to replicate and broaden these benefits across its agricultural and veterinary sectors. Indubitably, setting up this biobank goes beyond India’s position as a leader in scientific tech innovation and a prime example of how biotech could contribute to sustainability. The biobank reduces the need for live-animal experiments, thus, aligning with global ethical principles of research. Additionally, the availability of stem cells from native breeds will allow India to have a genetically diverse pool for the next phase of industrial-agricultural development. The path forward is integration, involving universities, veterinary hospitals and private biotech firms in a rich, collaborative ecosystem. Broader partnerships with international cell repositories can help standardize data and protocols for global compatibility. Over time, India’s Animal Stem Cell Biobank could grow from a national resource into a regional hub for innovation, advancing sustainable food systems and next‑generation veterinary medicine across Asia.   Somya Jain, Freelancer    ]]> https://biospectrumindia.com/views/21/26823/bridging-the-healthcare-gap-how-technology-is-transforming-access-and-fulfilment.html https://biospectrumindia.com/views/21/26823/bridging-the-healthcare-gap-how-technology-is-transforming-access-and-fulfilment.html Tue, 21 Oct 2025 00:00:00 +0530 Healthcare access has long been a challenge in India, particularly in rural and underserved urban areas. Despite significant progress in recent years, large segments of the population still struggle to receive timely and reliable care. Issues such as infrastructure gaps, shortages of qualified doctors, and fragmented service delivery create barriers to effective treatment. Technology, however, is emerging as a powerful force that can bridge these gaps, enabling greater reach, accessibility, and efficiency in the way healthcare is delivered.   The Healthcare Access Challenge Access to healthcare in India remains uneven, especially in rural areas where patients often travel long distances and face limited specialist availability. According to the Ministry of Health and Family Welfare (2022), India has a doctor-to-population ratio of 1:834, better than the World Health Organisation’s standard of 1:1000. However, most doctors are concentrated in urban centres, leaving rural populations underserved. The gap is sharper at the community level, with an 80% shortfall of specialists at Community Health Centres (CHCs), resulting in delays in diagnosis and treatment. Financial barriers compound these challenges. The National Health Accounts 2021–22 show that out-of-pocket expenditure (OOPE) accounted for 39.4% of total health spending. This remains a heavy burden for households and often discourages timely or preventive care, deepening the healthcare gap.   Technology’s Role in Bridging the Gap Digital health tools are steadily reshaping the way people access care in India. Online consultation has emerged as one of the most impactful solutions, enabling patients to consult doctors and specialists without the time and expense of travel. Remote diagnostics, portable devices, and at-home test kits support early detection and monitoring of chronic conditions more effectively. Similarly, e-pharmacy platforms have eased the challenge of medicine access. People living in remote or semi-urban areas can now order medicines online and have them delivered to their doorstep, reducing reliance on distant or poorly stocked local pharmacies. Meanwhile, AI-driven triage systems, such as chatbots and symptom checkers, are providing patients with initial guidance on their health concerns. These tools help individuals decide whether their condition requires urgent medical attention or if a routine consultation would suffice. Together, these technologies are breaking down barriers of geography and infrastructure, making healthcare more accessible, timely, and reliable for millions of people across the country.   Government and Policy Push for Digital Healthcare Policy support has been crucial in driving digital healthcare adoption in India. The Ayushman Bharat Digital Mission (ABDM) is building a nationwide digital backbone through unique health IDs, registries, and interoperable records, enabling more connected and consistent care. Complementing this, the National Digital Health Blueprint lays the foundation for a federated, patient-centric system. The release of Telemedicine Practice Guidelines in 2020 gave doctors a clear legal framework for remote consultations, accelerating telehealth adoption during the pandemic and beyond. At the primary care level, over 1.78 lakh Ayushman Arogya Mandirs are now operational across the country, expanding essential frontline services and serving as gateways for digital healthcare. Collectively, these initiatives are creating the right conditions for collaboration between government, private providers, and technology companies.   Benefits of Technology-Enabled Healthcare Access The benefits of digital healthcare are already evident. Patients in remote regions can consult specialists without travel, access medicines and diagnostics at home, and manage chronic conditions with virtual follow-ups and reminders. Doctors, in turn, make more informed decisions using electronic health records and data insights. Integrated digital platforms that combine consultations, tests, medicines, and payments are simplifying the care journey, while insurance and cashless options are reducing financial barriers. Together, these advances are making healthcare more consistent, efficient, and within easier reach for communities across India.   Conclusion Technology is playing an increasingly important role in improving healthcare access in India, but the journey is far from complete. Policymakers, healthcare providers, insurers, and technology companies will need to work together to build solutions that are inclusive, sustainable, and easy to use. With sustained effort, India can move towards a future where quality care is within reach for all.   Enbasekar D, Co-Founder and CTO, MediBuddy ]]> https://biospectrumindia.com/features/21/26813/which-is-the-best-fertility-hospital-in-bangalore-for-pcos-treatment-and-ivf-success.html https://biospectrumindia.com/features/21/26813/which-is-the-best-fertility-hospital-in-bangalore-for-pcos-treatment-and-ivf-success.html Fri, 17 Oct 2025 00:00:00 +0530 However, for some couples, fertility problems can make this path more challenging. In many cases, hormonal conditions such as PCOS (Polycystic Ovary Syndrome) make it harder to conceive naturally. Thankfully, medical science today offers advanced treatments, such as IVF (In Vitro Fertilisation), that can help couples overcome these challenges. If you’ve been wondering how to choose the best fertility hospital in Bangalore for PCOS and IVF treatment, here is everything that will help you understand what truly matters. Understanding the Link Between PCOS and Fertility Polycystic Ovary Syndrome, or PCOS, is one of the most common causes of infertility among women. It’s a hormonal condition that affects the way the ovaries function. Women with PCOS often experience irregular periods, excessive hair growth, weight gain, or acne, but one of the biggest concerns is irregular ovulation or no ovulation at all. Without regular ovulation, it becomes harder to conceive naturally. However, PCOS doesn’t mean infertility is permanent. With the proper medical support and lifestyle management, many women go on to have successful pregnancies. Treatments like ovulation induction and IVF have given thousands of couples new hope. The key is finding a fertility hospital that understands PCOS from every angle: hormonal, physical, and emotional. Why Bangalore Is a Preferred Destination for Fertility Treatment? Over the years, Bangalore has earned a strong reputation as one of India’s leading hubs for fertility and IVF care. The city is home to experienced reproductive specialists, advanced embryology labs, and research-driven approaches that bring higher success rates. Many fertility hospitals in Bangalore prioritise evidence-based treatment methods and ethical medical practices, enabling patients to feel confident and informed throughout their journey. In addition to its expertise, the city also offers comfort through easily accessible healthcare infrastructure and cost-effective treatment packages, making it a practical choice for couples from across India and abroad. What Makes the Best Fertility Hospital in Bangalore for PCOS and IVF Treatment? Choosing the right fertility hospital isn’t about popularity or advertising. It’s about finding a centre that offers personalised, transparent, and comprehensive care. Here are the factors that truly define the best fertility hospital in Bangalore: 1. Expertise of Specialists Look for hospitals with a strong team of reproductive endocrinologists, gynaecologists, embryologists, and counsellors. PCOS is a complex condition that affects hormones, metabolism, and ovulation. A multidisciplinary team ensures that every part of your treatment, from diagnosis to IVF, is handled with precision. 2. Personalised Treatment Plans Every woman’s PCOS journey is different. Some respond well to medication and lifestyle changes, while others may need assisted reproductive techniques like IVF. The best hospitals don’t follow a one-size-fits-all plan; they tailor treatments to your body’s response, hormone levels, and health goals. 3. World-Class IVF Laboratory The success of IVF largely depends on the quality of the embryology lab. A good hospital maintains controlled environments for embryo growth and utilises advanced tools, including time-lapse monitoring, ICSI, and laser-assisted hatching. These technologies increase the chances of successful fertilisation and implantation. 4. Transparency and Success Rates Hospitals that openly share their IVF success rates show integrity. Genuine hospitals explain how success rates vary depending on age, egg quality, and medical history, rather than promising unrealistic results. Transparency builds trust, which is essential when investing time, money, and hope. 5. Emotional and Psychological Support Fertility treatment can be emotionally exhausting. The best hospitals provide counselling sessions, stress management support, and a warm, patient-friendly atmosphere. Knowing that you’re cared for emotionally makes a big difference in how you experience your journey. Common Treatments for PCOS-Related Infertility Fertility hospitals in Bangalore usually begin with a detailed diagnosis that includes hormonal assessments, pelvic scans, and metabolic evaluations. Once the cause of infertility is clear, doctors design a step-by-step treatment plan. Typical approaches include: Lifestyle Management: Guidance on weight management, balanced nutrition, and regular exercise. Medication: Ovulation induction drugs to stimulate egg release. Laparoscopic Surgery: In some cases, ovarian drilling may help restore ovulation. IVF (In Vitro Fertilisation): When simpler methods don’t work, IVF becomes an effective solution. It involves egg retrieval, fertilisation in a lab, and embryo transfer into the uterus. Women with PCOS often respond well to IVF when their hormone levels are carefully managed. The process might seem overwhelming at first, but a supportive medical team makes it much easier to navigate. How to Evaluate a Fertility Hospital Before Choosing? Here are a few practical ways to find a hospital that’s right for you: Check the Doctor’s Experience: Ask about their success rate in treating PCOS-related infertility. Visit the Facility: Observe how staff communicate and whether the environment feels welcoming. Understand the Process: Ask about treatment options, duration, and expected outcomes. Discuss Costs Clearly: A good hospital will explain fees openly without hidden charges. Read Real Reviews: Look for patient stories that describe empathy, clear communication, and realistic expectations. Ask About Counselling: Mental health support is just as important as medical treatment. Choosing a fertility hospital is a personal decision, and taking time to research will help you feel more confident and prepared. How Technology Improves IVF Success? Modern fertility hospitals in Bangalore use advanced reproductive technologies that increase success rates while keeping the process safe. AI-based embryo selection, genetic testing (PGT), and time-lapse imaging enable doctors to identify the healthiest embryos, thereby reducing the risk of complications and improving outcomes. While technology is essential, it’s most effective when combined with human expertise. The best hospitals invest in technology to support, not replace, personalised care. Emotional and Lifestyle Support During Treatment Undergoing fertility treatment can stir up many emotions, from anxiety and self-doubt to hope and anticipation. PCOS adds another layer of hormonal fluctuation that can affect mood and energy levels. That’s why emotional and lifestyle support is essential. Simple changes, such as eating balanced meals, maintaining a regular sleep schedule, practising mindfulness, or joining support groups, can help you stay positive. The best hospitals encourage such holistic care because they understand that mental well-being has a direct impact on physical recovery and IVF success. Questions to Ask Before Starting Treatment When you meet a fertility specialist, don’t hesitate to ask questions like: What is your experience with PCOS and IVF patients? How do you personalise treatment based on hormone levels and cycle response? What’s your success rate for women in my age group? What technology do you use in your IVF lab? What support do you provide after an IVF cycle? How are costs structured, and what is included in the total? Being informed helps you feel in control of your journey. Conclusion Finding the best fertility hospital in Bangalore for PCOS treatment isn’t about chasing big names; it’s about choosing a place that values your trust and treats you as more than a case number. Look for a hospital that listens, guides, and supports you at every stage. PCOS may make conception challenging, but with the right medical team, patience, and care, success is absolutely possible. Every journey is unique, but the right hands can turn uncertainty into hope and hope into the beautiful possibility of life. ]]> https://biospectrumindia.com/features/21/26788/the-impact-of-nutrition-on-breast-cancer-risk-foods-to-avoid-and-embrace.html https://biospectrumindia.com/features/21/26788/the-impact-of-nutrition-on-breast-cancer-risk-foods-to-avoid-and-embrace.html Thu, 09 Oct 2025 00:00:00 +0530 While many causes of breast cancer are linked to factors we cannot change, like age, family history, or genetics, some lifestyle choices may reduce or increase risk. Among these, diet plays an important role. What we eat every day can influence our overall health, body weight, and in some cases, even cancer risk. Let’s discuss how diet fits in alongside other steps like regular screening and timely breast cancer treatment. Understanding the Importance of Diet Research shows that certain foods contain nutrients that may protect the body against cancer by reducing inflammation, strengthening the immune system, and preventing DNA damage. On the other hand, some eating habits, like consuming too much processed food or sugar, may contribute to obesity or hormone changes that increase the chance of developing cancer. It is important to remember that diet alone cannot prevent or cure cancer. However, it can be a strong support for healthy living and lower the risk of many diseases. Foods That May Help Reduce Breast Cancer Risk Leafy Green Vegetables Vegetables like spinach, kale, and mustard greens are full of vitamins, fibre, and antioxidants. These nutrients help protect cells from damage.  Cruciferous Vegetables Vegetables such as broccoli, cauliflower, and cabbage are called cruciferous vegetables. They contain compounds that may slow the growth of cancer cells and help the body remove harmful substances. Citrus Fruits Fruits like oranges, lemons, and grapefruits are rich in vitamin C and antioxidants. These may protect the body from cell damage and support the immune system. Berries Blueberries, strawberries, and raspberries are packed with plant chemicals that fight inflammation. Research has linked berry consumption to a reduced risk of certain types of breast cancer. Beans and Legumes Beans are rich in fibre and protein. Eating beans regularly may support healthy weight management and lower cancer risk. Whole Grains Whole wheat, oats, brown rice, and quinoa are high in fibre and important nutrients. Replacing refined grains with whole grains may help lower the risk of breast cancer. Fatty Fish Fish like salmon, mackerel, and sardines contain omega-3 fatty acids. These healthy fats may reduce inflammation and support heart and body health. Nuts and Walnuts Walnuts, almonds, and peanuts provide healthy fats, fibre, and vitamins. Some studies suggest nuts may lower the chances of breast cancer developing or spreading. Fermented Foods Foods like yoghurt, kimchi, and miso contain probiotics that support gut health and may strengthen immunity. A healthy gut can play a role in protecting against cancer. Herbs and Spices Spices such as turmeric, ginger, and parsley contain natural compounds with anti-inflammatory and antioxidant effects. Adding them to daily meals may help support better health. Foods and Habits to Avoid or Limit Alcohol Drinking alcohol is a strong risk factor for breast cancer. Even small amounts may increase risk, and heavy drinking is especially harmful. Reducing or avoiding alcohol is an effective lifestyle steps to lower breast cancer risk. Processed Meats Foods like sausages, bacon, and ham contain preservatives and chemicals that may raise cancer risk. Limiting processed meats is important for overall health. Fried Foods Eating fried foods regularly adds unhealthy fats and calories to the diet. Research shows that a high intake of fried foods may increase breast cancer risk. Fast Food and Junk Food Fast foods are often high in fat, sugar, and salt. They contribute to obesity, which is one of the known causes of breast cancer, especially after menopause. Added Sugars Sugary drinks, sweets, and desserts raise calorie intake and can lead to weight gain. Excess weight may increase hormone levels in the body, which can trigger cancer growth. Refined Carbohydrates White bread, white rice, and baked goods made with refined flour can raise blood sugar levels quickly. A diet rich in refined carbs is linked to higher cancer risk. Lifestyle Choices Beyond Food Nutrition is only one part of the picture. Other lifestyle habits also matter in reducing breast cancer risk. Staying physically active, maintaining a healthy weight, avoiding smoking, and getting enough rest all support overall health. Regular screenings like mammograms and self-checks are equally important. These help detect breast cancer at an early stage when breast cancer treatment is most effective. The Role of Nutrition in Treatment and Recovery For people already diagnosed with breast cancer, eating a balanced diet can support recovery. Nutritious foods help the body handle treatments such as chemotherapy, radiation, or surgery. They also reduce side effects like fatigue and weakness. Doctors often recommend that patients eat small, frequent meals that include vegetables, fruits, lean proteins, and whole grains during breast cancer treatment. Drinking enough water and avoiding alcohol or processed foods are also key. Final Thoughts While we cannot control all the causes of breast cancer, we can make healthy choices to support our bodies. A diet rich in fruits, vegetables, whole grains, beans, fatty fish, and nuts may lower risk, while reducing alcohol, fried foods, and processed meats can help too. Making these changes step by step, along with exercise, regular medical check-ups, and guidance from Onco Life Hospitals, can protect long-term health. Onco-Life Cancer Centre understands the importance of nutrition and lifestyle in cancer care. By combining medical expertise with guidance on healthy living, patients and families can take stronger steps toward prevention, recovery, and overall well-being. ]]> https://biospectrumindia.com/views/21/26708/looking-at-migraine-as-complex-neurological-disease.html https://biospectrumindia.com/views/21/26708/looking-at-migraine-as-complex-neurological-disease.html Mon, 22 Sep 2025 00:00:00 +0530 As we observe World Migraine Day on September 12th each year, it is important to understand that migraine is much more than “just a headache.” It is a debilitating and complex neurological disease that impacts millions of people each year around the globe, and can drastically disrupt personal and professional lives and overall quality of life. The Global Burden of Disease (GBD) study showed that migraine has consistently ranked as the second overall cause of disability globally. Disturbingly, it affects more than 1.1 billion people around the world, which includes more than 213 million people in India each year, making it one of the most common neurological diseases recorded. As a neurologist, I frequently see the silent struggle of my patients. They often feel misunderstood, neglected, and their pain dismissed as "just a headache" by friends and family members. It is important to shed light on what migraine truly is and developments in this field. Because of how much migraine can impact lives, not just in India but around the world, one might ask: what causes and drives this widespread condition? What constitutes the foundation of migraines? Knowing these realities, can help with early recognition and early prevention and likewise empower people to seek out viable options to engage with their health. Leading Cause of Disability: According to the Global Burden of Disease (GBD) study, migraine ranks as the second leading cause of years lived with disability (YLDs) globally. Among people aged 15-49, it's the leading cause. This highlights its significant impact on a person's ability to work, study, and engage in daily life Gender Disparity: Migraine is overwhelmingly more common in women. Women are approximately two to three times more likely to experience the condition than men. This disparity is believed to be linked to hormonal fluctuations. Peak Age: The prevalence of migraine is highest during the most productive years of life, typically between the ages of 25 and 55. This is a major reason for its substantial societal and economic impact A typical migraine attack often unfolds in four distinct phases, though not everyone experiences all of them: The Prodrome (The Warning Signs): This phase can begin a day or two before the headache. Patients may notice subtle changes like mood swings (from irritability to euphoria), food cravings, neck stiffness, frequent yawning, or increased urination. This is your body's early warning system. The Aura (The Visual Disturbance): About a quarter of migraine sufferers experience an aura. This is a temporary sensory disturbance that happens just before or during the headache. The most common aura is visual, with symptoms like seeing zigzag lines, shimmering lights, or blind spots. An aura can also manifest as tingling on one side of the face or body, or even difficulty speaking. The Headache (The Attack): This is the main event. The headache is often described as a throbbing or pounding pain, usually on one side of the head, but it can be on both. This pain is often accompanied by other debilitating symptoms such as: Nausea and vomiting Extreme sensitivity to light (photophobia) Extreme sensitivity to sound (phonophobia) Sensitivity to smell (osmophobia) The Postdrome (The Migraine "Hangover"): After the main pain subsides, many people feel drained, exhausted, or "hungover." They might have difficulty concentrating, feel a dull head pain, or experience neck stiffness. This phase can last for another 24 to 48 hours.   Triggers: The Cues that Start the Storm Understanding your triggers is one of the most powerful tools for managing migraine. A trigger is rather a factor that can initiate an attack in someone who is already susceptible. The good news is that there are more treatment options available today than ever before. Let's work together to move beyond the stigma and toward a world where every migraine patient is heard, understood, and effectively treated. Most investigations done to evaluate migraine will be normal. Treatment Options: A Modern Approach to Management Managing migraine is a personalised journey, and what works for one person may not work for another. The good news is that we have a wider range of effective treatments than ever before. These can be broadly divided into two categories: Acute treatments, which stop an attack once it has started, and Preventive treatments, which are taken regularly to reduce the frequency and severity of attacks. Acute Treatments (Stopping the Storm): These are medications you take at the first sign of a migraine attack to relieve pain and other symptoms. Over the Counter (OTC) Medications: For mild to moderate attacks, many people find relief with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. Caution is advised to prevent "medication overuse headaches." Triptans: For years, Triptans have been the gold standard for moderate to severe migraine. They act by narrowing blood vessels and blocking pain pathways in the brain. They are available in various forms, including pills, nasal sprays, and injections. Gepants: This is a newer class of oral medications. They work by blocking the CGRP (calcitonin gene-related peptide) receptor, a protein known to play a key role in migraine pain. Gepants offer an alternative for patients who cannot take triptans due to cardiovascular risks or for whom triptans are not effective. Ditans: Lasmiditan (Reyvow) is a new oral medication that relieves migraine pain without causing blood vessel constriction, making it a viable option for patients with cardiovascular risk factors or those who cannot tolerate triptans. Preventive Treatments: They are taken regularly, whether daily or monthly, to reduce the number of migraine days and make attacks less severe. CGRP Monoclonal Antibodies (mAbs): This is a major breakthrough in migraine treatment. These targeted therapies, are highly effective and are typically administered as self-injections once a month or once every three months. Botox (Botulinum Toxin): Botox injections into specific areas of the head and neck can be highly effective. The injections work by blocking the release of chemicals that activate pain pathways. Oral Medications: Several oral medications originally developed for other conditions have proven effective for migraine prevention. These include: Beta-blockers (e.g., propranolol, metoprolol) Antidepressants (e.g., amitriptyline, venlafaxine) Anti-seizure drugs (e.g., topiramate) Gepants (e.g., rimegepant and atogepant have been approved for preventive use) Neuromodulation Devices: These devices use electrical or magnetic stimulation to change nerve signals and prevent or treat migraine. Some are worn as a headband or armband and can be used to treat an acute attack or for daily prevention. Lifestyle and Behavioural Strategies: Consistent Routines: Maintaining a regular sleep schedule, eating meals at consistent times, and staying hydrated can significantly reduce the frequency of attacks. Stress Management: Since stress is a major trigger, techniques like meditation, yoga, biofeedback, and mindfulness can be invaluable. Regular Exercise: Consistent, moderate-intensity aerobic exercise has been shown to reduce migraine frequency and severity. Trigger Avoidance: Identifying and avoiding personal triggers—be it certain foods, bright lights, or strong smells—is a powerful non-pharmacological strategy. On this World Migraine Day, it is advisable to see migraine as a complex neurological disease that demands our attention, understanding, and effective treatment. It is not "just a headache". Understand your triggers, recognise the phases of an attack, and know that you have more treatment options than ever before. Partner with a specialist, build your management plan. For those who live with it, your pain is real, and for those who support them, your empathy is a powerful form of care.   Dr Sreekanta Swamy, Additional Director- Neurology, Fortis Hospital, Bannerghatta Road, Bengaluru ]]> https://biospectrumindia.com/views/21/26685/new-age-devices-to-manage-heart-failure.html https://biospectrumindia.com/views/21/26685/new-age-devices-to-manage-heart-failure.html Mon, 15 Sep 2025 00:00:00 +0530 The Indian cardiovascular devices market had an estimated value of $2.2 billion in 2024, and it is projected to reach $4.1 billion by 2033, with the growth transitioning into a CAGR of 6.8% during 2025–2033. This growth represents a major opportunity for innovation and access to the cardiovascular market. Some of the factors favouring this growth include- New Burden of Disease: Given that there are many patients suffering from the chronic condition of heart failure in India, there is a need or rather the demand for advanced cardiac care has increased. Launch of Government Schemes: As health insurance programmes expand (with Ayushman Bharat, for example), the cost of high-cost procedures and devices are available to a major patient population. Advances in Technology: The shift towards minimally invasive procedures, and the digital health phenomenon, are transforming the delivery of patient care in both metropolitan areas and small cities.   New Age Devices and Market Trends In India, the heart failure device market has many sub-categories; each one is driven by its own unique drivers and opportunities to grow, some of which are- Implantable Devices: These devices continue to hold a dominant market position traditionally in implantable cardioverter-defibrillator (ICDs), pacemakers and other mechanical circulatory support systems. There are actions being taken to make these devices more accessible and affordable to the patients in India, and the growth of domestic manufacturers is helping to decrease pricing. Mechanical Circulatory Support: This segment is fast growing, particularly in advanced heart failure. Devices such as Left Ventricular Assist Devices (LVADs) and Total Artificial Hearts (TAHs) are becoming more durable from a temporary support device to a long-term use, representing significant market growth opportunities. Digital Health and Remote Monitoring: An evolving and disruptive space, there is a revolution in cardiac care shifting to proactive management and away from reactive management with the help of digital health tools. Remote monitoring platforms, mHealth applications, and AI-driven analytics provide the ability to assess risk in real time, assess the risks of complications manifesting, and re-evaluate the plan of care to the clinicians. By changing the approach to cardiac care, patient outcomes improve as potential hospitalizations decrease, and care costs reduce. Among these rapidly advancing technologies, LVADs exemplify how innovation in mechanical circulatory support is redefining patient outcomes and creating new standards of care   LVADs' Outcomes: Bridge to a Better Quality of Life A Left Ventricular Assist Device (LVAD) is one of the most potentially impactful therapies for advanced heart failure. Reports indicate that across several clinical trials, LVADs demonstrate its efficacy and safety in patients awaiting heart transplantation. While traditional treatments demonstrate efficacy via symptom relief or laboratory markers, LVADs, by nature, provide a supportive role through mechanical movement of blood leading to a more normalised circulation. In the case of patients awaiting heart transplantation viability via donors, LVAD therapy can be lifesaving. The therapy leads to stabilisation of the patient’s clinical condition, improvement in disability-associated symptoms, and enhanced organ viability and function. This transition to compensated symptoms not only improves patient quality of life but more extends the opportunity for patient eligibility for a successful heart transplant. LVADs serve as a bridge, providing patients on the waiting list an opportunity for an improved quality of life, whilst simultaneously waiting for the definitive treatment and opportunity for a fresh start.   Dr VS Prakash, Director - Ramaiah Institute of Cardiac Sciences, Ramaiah Memorial Hospital, Bengaluru ]]> https://biospectrumindia.com/news/21/26665/how-to-invest-in-bajaj-finserv-mutual-fund-online.html https://biospectrumindia.com/news/21/26665/how-to-invest-in-bajaj-finserv-mutual-fund-online.html Fri, 12 Sep 2025 00:00:00 +0530 Among the suitable methods of investment routine followed by the Bajaj Finserv Mutual Fund is to partake in various schemes and other products aimed at money multiplication, regular money distribution, or capital preservation. Therefore, to the new and old investors, learning these schemes is vital to making investment decisions that inform them on facts about how an online mutual fund scheme will serve all those criteria. Analyzing Bajaj Finserv Mutual Fund Bajaj Finserv Mutual Fund is a financial product administered by Bajaj Finserv Asset Management Company. It operates under the jurisdiction of the AMFI (Association of Mutual Funds in India) and SEBI (Securities and Exchange Board of India). This mutual fund promotes the pooling of money by a variety of investors into a rather diversified portfolio of securities, including equities, bonds, and money market instruments. Bajaj Finserv Mutual Fund Provides Institutions with Different Investment Endeavors: Equity Funds – Investors plan for a long-term growth opportunity by investing primarily in stocks. Debt Funds—Focus on instruments yielding fixed income like bonds, government securities, and money market instruments. Hybrid Funds—Simply combine an equal amount of assets from equity and debt, where the risks of debt and equity may come to an equal level, based on the notion of risk and return. Why Invest in Bajaj Finserv Mutual Fund? Investing through mutual funds comes with various benefits, such as professional fund management and diversification. Bajaj Finserv Mutual Funds offer schemes tailored to different customer risk profiles: time-horizon factors, among others. In that case, for an investor with a long-term pooled interest, an equity fund for all possible investments or a debt-oriented type for those seeking stability. Role of AMFI in Mutual Fund Investments The Association of Mutual Funds in India (AMFI) plays a crucial role in attaining transparency and education for investors in the mutual fund industry. Therefore, the registered asset management companies, including Bajaj Finserv Asset Management, shall abide by their code of conduct for operation through AMFI. It is not entirely outside the investor's control, so they must bear in mind that when parting with their funds, they must consider dealing with an AMFI-registered distributor or platform. How to Invest in Bajaj Finserv Mutual Fund Online Complete Your KYC Before starting any investments, ensure that your KYC process is done in compliance with the SEBI rules. KYC requirements include submission of Know Your Customer (KYC) documentation, including identity and address proof, along with a photograph. You can do KYC online. It is a relatively simple step where, once more, they use an Aadhaar card-based OTP enabled verification. Without the completion of your KYC, you cannot be an investor in any mutual fund. Choose the Right Scheme See your business/tax goals and risk tolerance before investing in a Bajaj Finserv Mutual Fund scheme. Each mutual fund scheme has investment objectives, a load profile, and asset allocation patterns. Always go through the fund's fact sheet, as you would want all the up-to-date information on the fund's portfolio. Decide on Investment Mode Either invest in a lump sum or take advantage of a Systematic Investment Plan (SIP): Lump Sum Investment: A single amount that is invested in one go. SIP: A fixed amount at regular intervals, which would help in averaging out the market volatility. Register on an Online Platform One may visit Bajaj Finserv Mutual Fund's website or an authorised distributor's platform. They should register by filling in all the necessary details and doing the KYC verification. The platform must indeed be registered with AMFI for credibility and safety. Select the Scheme and Enter Investment Details Once the account is active, specific schemes can be picked from the platform to invest in. You can decide on your investment amount, choose the mode of payment, and confirm your SIP if you have selected it. Make Payment Securely Make the payment with any of the online payment systems, such as net banking, UPI, or debit mandate. Always make sure that the payment gateway is secure and authorised. What to Consider Before Investing? Understand Risks: Any mutual fund carries some risk; be clear about your risk-bearing capacity before investing in any scheme. Read Carefully the Scheme Documents: You should read the Scheme Information Document (SID) and Key Information Memorandum (KIM) to know in depth about the investment objective, asset allocation, and related fees. Expense Ratio and Exit Load: Always look at these charges to get a sense of your total returns before you invest. Investment Horizon: Decide on a scheme based on the time for which you can wait. Equity funds usually need long time horizons; debt funds, on the other hand, suit short- to medium-term goals. Investor Protection and Grievance Redressal To give some comfort to aggrieved investors, AMFI and SEBI have laid down certain guidelines. Just in case an investor wants to complain about their mutual fund investment in Bajaj Finserv, an official grievance redressal mechanism exists. The investor should always see that the investment is channeled properly through channel partners to prevent fraud in any manner. In conclusion, the online space for Bajaj Finserv Mutual Fund offers the ease, flexibility, and convenience to invest that one needs to start the process successfully. With clearly defined goals, a thorough risk assessment, and adherence to guidelines from the AMFI, individuals will finally get to interact with the right portfolio choices. Pursuing the preceding steps, then, may put you in a much more comfortable position as you embark on your mutual fund investing endeavor and then maybe make profits soon.   ]]> https://biospectrumindia.com/features/21/26658/protecting-life-health-step-by-step-guide-to-buying-term-insurance-online.html https://biospectrumindia.com/features/21/26658/protecting-life-health-step-by-step-guide-to-buying-term-insurance-online.html Tue, 09 Sep 2025 00:00:00 +0530 Today, when you buy term insurance online, you can compare multiple policies, calculate premiums, and customise coverage in just a few minutes. As a result, you are able to make decisions based on clear information rather than relying on guesswork. Term insurance is one of the most affordable ways to safeguard your loved ones, yet the process of choosing a plan may feel confusing for first-time buyers. This guide breaks the journey into simple steps, helping you identify coverage needs, compare options, and confidently buy term insurance online to secure your family's future. Follow These Steps to Purchase Term Insurance Online with Ease Buying term insurance online may feel complex at first, but the process is far more straightforward than it seems. By following a clear set of steps, you can assess your needs, compare plans, and finalise coverage with confidence. Each stage builds towards securing reliable protection for your family while making the most of digital convenience. Assess Your Coverage Needs The first step is to estimate your family's financial needs if you were not around. As a rule of thumb, choose coverage that is 10 to 15 times your yearly earnings. You should also account for existing loans, children's education, healthcare needs, and daily living expenses. Accurately calculating this amount helps you select the right sum assured when you buy term insurance online. Decide the Policy Term The policy term should ideally cover your working years, ensuring your family is financially secure until you retire or accumulate enough wealth. For example, if you are 30 years old and plan to work until 60, a 30-year policy term is appropriate. Online platforms make it simple to adjust terms and instantly view the impact on premiums before you buy term insurance online. Compare Different Plans Comparison is one of the biggest advantages of buying insurance digitally. Use trusted platforms to compare features such as: Premium amounts across insurers. Coverage options like critical illness riders. Claim settlement ratios, which reflect insurer reliability. Flexibility in premium payment (monthly, quarterly, or annually). When you buy term insurance online, these comparison tools provide clarity, helping you balance affordability with comprehensive protection. Select Add-on Riders Riders enhance your base policy, offering broader protection. Common riders include: Accidental Death Benefit: Additional payout in case of accidental death. Critical Illness Rider: Covers specific life-threatening illnesses with a lump sum payout. Waiver of Premium: Future premiums waived in case of disability or critical illness. Choosing relevant riders ensures your term plan provides well-rounded security when you buy term insurance online. Use an Online Premium Calculator Premium calculators are easy-to-use tools that give you an estimate of the cost based on age, income, lifestyle, and sum assured. These calculators are particularly useful because they allow you to experiment with different terms and coverage amounts before finalising your decision. A calculator used beforehand ensures you know the likely premium outlay when you buy term insurance online. Fill in Accurate Personal Details When applying, provide precise information about your age, occupation, income, and lifestyle habits. Insurance relies heavily on accurate disclosure. Concealing facts such as smoking habits or existing medical conditions can lead to claim rejection later. Being transparent when you buy term insurance online protects your family from potential disputes during claim settlement. Check if a Medical Examination is Required In some cases, insurers may request a basic medical check-up before approving your application. This usually applies when you opt for higher coverage, fall into certain age brackets, or disclose health conditions. The purpose is to ensure that your premium reflects your health profile fairly. When you buy term insurance online, insurers often coordinate these appointments at partner clinics to make the process easier if required. Review Policy Terms and Conditions Always read the fine print carefully before making a payment. Pay special attention to exclusions, claim settlement procedures, and renewal terms. A thorough review ensures that when you buy term insurance online, you are fully aware of the policy's scope and limitations. Make a Secure Payment Most insurers accept multiple digital payment modes, including net banking, debit/credit cards, and UPI. Always ensure the platform is secure, and keep your acknowledgement receipt for reference. This step finalises your decision to buy term insurance online, after which you will receive the policy documents directly in your registered email. Keep Documents Accessible After purchase, store both digital and physical copies of your policy in a safe place. Inform your family members about the policy and its benefits, so they know how to proceed in case of an emergency. When you buy term insurance online, insurers usually provide a digital dashboard where you can access, download, or update documents anytime. The Way Forward: Protect What Matters Most Term insurance goes beyond being a policy. It is a commitment to your family's financial stability. Choosing to buy term insurance online makes the entire process quicker, more transparent, and easier to customise. The key is to focus on a plan that reflects your responsibilities, long-term goals, and the level of security your family will need in your absence. With online insurance brokers like Jio Insurance Broking Ltd., exploring multiple policies, comparing benefits, and receiving expert guidance becomes simple and transparent. Take the next step today to buy term insurance online and provide your loved ones with dependable financial protection for the years ahead. ]]> https://biospectrumindia.com/views/21/26652/why-preventive-care-is-the-missing-link-in-indias-senior-wellness-ecosystem.html https://biospectrumindia.com/views/21/26652/why-preventive-care-is-the-missing-link-in-indias-senior-wellness-ecosystem.html Fri, 05 Sep 2025 00:00:00 +0530 India is on the cusp of a demographic revolution. It is estimated that by 2050, more than 346 million individuals in the nation will be 60 years and older, making India home to one of the biggest elderly populations worldwide. Such an upsurge represents a wealth of experience and potential societal contribution, yet it also presents unmatched healthcare challenges. Chronic illness, limited mobility, dementia, and mental illness are on the rise among older people, but the healthcare system still emphasises treating rather than preventing them. This shortfall is not only a health issue—it threatens the well-being, independence, and economic engagement of India's ageing population.   The Current State of Senior Healthcare in India: Reactive Care and Limited Accessibility Healthcare for seniors largely follows a reactive model. Majority of the policies and programs concentrate on treating illnesses once they've already started, instead of trying to stop them before they happen. The basic healthcare setup isn't evenly spread out, with cities usually having better resources than rural spots. This means seniors often don't get regular check-ups, advice on healthy living, or the screenings that can catch issues early. As a result, they're more at risk for developing serious, long-term health conditions and related complications. India's growing senior population is set to put enormous strain on its healthcare system. It is predicted that by 2030, older adults will likely account for about 45% of the country's overall disease burden. Conditions like dementia, which already affects roughly 4 million people, are expected to surge. By 2050, around 13.4 million Indians could be impacted, contributing to an estimated annual cost of about $1 trillion. Additionally, women and seniors who are economically disadvantaged often encounter extra hurdles. Issues like limited mobility, cultural expectations, and financial limitations frequently stop them from getting medical advice promptly or taking part in wellness activities. This leads to diagnoses being made too late, more hospital stays, and puts a greater financial and emotional strain on families. Without a strong system for prevention in place, India could face rising healthcare expenses and a lower quality of life for its older citizens.   The Preventive Care Gap and Its Consequences: Chronic Illnesses and Escalating Costs Lack of organised preventive programs makes seniors vulnerable to avoidable diseases. Periodic screening, nutritional advice, and physical activity guidance are in short supply or not used at all, especially in rural areas. The health insurance offerings are more inclined toward treatment rather than wellness incentives, discouraging active participation in health management. This reactive strategy has ripple effects. Older persons have higher levels of chronic illness, increased hospital stays, and reduced functional status. Families not only shoulder financial burdens but also emotional strain. In addition, the broader healthcare system becomes strained due to avoidable hospitalisations and resource-intensive care, emphasising the urgent need for preventive interventions.   Community Support as a Pillar of Senior Wellness: Social Engagement and Integrated Care Preventive care is most effective when coupled with strong community support. Social engagement, group fitness programs, and community wellness centres encourage seniors to adopt healthier habits while simultaneously combating loneliness and mental health challenges. Integrated senior living communities offer a well-rounded way of life, thoughtfully combining medical care, social support, and engaging activities all under one roof. These kinds of programs help older adults stay independent while keeping those important social ties that are so good for mental and emotional health. Plus, the activities and programs offered within the community encourage seniors to take better care of themselves, making sure they get regular check-ups, stay active, and stick to healthy habits.   Economic and Societal Benefits of Preventive Care: Unlocking the Silver Dividend Investing in preventative care has wide-reaching economic and social impacts. Healthy seniors can prolong their productive years, impart their knowledge, and continue making contributions in the form of volunteering and caregiving. This situation is usually referred to as the "silver dividend" and assures that ageing is not only dependent but also participatory. Preventive health initiatives enable elders to remain active for longer, turning them into productive social and economic assets and not mere passive recipients of treatment. No less significant are the ripple impacts on families, communities, and the economy at the national level. Preventive care eliminates unnecessary hospitalisations and postpones the onset of chronic illnesses, reducing long-term healthcare costs to households and public systems. At the community level, independent elders build local economies through commerce, knowledge transfer to younger generations, and civic engagement. Preventive care in this respect is not merely about safeguarding health—it is about maintaining social capital and creating economic resilience for the future.   Building a Preventive Ecosystem for seniors: Policy, Awareness, and Collaboration Shifting from a reactive "sick-care" model to a proactive preventive model necessitates multi-stakeholder cooperation. Policymakers, healthcare professionals, insurance firms, and neighbourhood organisations need to collaborate in developing programs for early detection, disease management, and lifestyle alterations. Public campaigns, discounted well-being check-ups, and rewards for healthy living can motivate older adults to make preventive care a priority. By incorporating preventive care within the overall healthcare system and community support network, India can help seniors stay active, independent, and socially engaged well into their older years.   Conclusion: Prioritising Preventive Care to Empower India’s Ageing Population Preventive care is the missing puzzle piece in India's elder wellness system. Without preventive care, increased healthcare expenses, decreased quality of life, and foregone opportunities for economic and social contributions will continue to hinder the ageing population. Prioritising prevention, encouraging community involvement, and rewarding wellness through insurance and public health initiatives can revolutionise elder care. India's future is at stake with proactive, inclusive, and community-based solutions that enable seniors to live longer, healthier, and more rewarding lives.   Sonia Mehta, Founder, Everbloom ]]> https://biospectrumindia.com/features/21/26617/how-delhi-hospitals-ensure-safety-in-complex-heart-surgeries.html https://biospectrumindia.com/features/21/26617/how-delhi-hospitals-ensure-safety-in-complex-heart-surgeries.html Fri, 29 Aug 2025 00:00:00 +0530 For patients and families, safety is always the biggest concern. The good news is that hospitals in Delhi are continuously raising standards by adopting advanced technologies, refining techniques, and building strong post-operative care systems. If you or a loved one is exploring treatment, knowing how a heart surgery hospital in Delhi prioritises safety can help you feel more confident in making the right decision. Skilled and Specialised Teams Behind every successful heart surgery is a team of experts working in perfect sync. At leading hospitals, surgeries are performed by highly trained cardiothoracic surgeons supported by cardiac anaesthesiologists, perfusion technologists, operating theatre nurses, and intensive care specialists. Unlike smaller setups where general anaesthesiologists may be involved, top centres usually have fellowship-trained cardiac anaesthesiologists. This multidisciplinary teamwork ensures that risks are minimised and patient outcomes are improved. Advanced Operating Theatres Modern hospitals in Delhi are equipped with state-of-the-art cardiac operating theatres. Essential systems such as the cardiopulmonary bypass machine (CPB) are standard. At the same time, advanced life-support devices like ECMO (extracorporeal membrane oxygenation) are available in select tertiary centres for high-risk or emergency cases. The presence of modular theatres, advanced anaesthesia systems, and real-time monitoring ensures surgeries are carried out in the safest environment possible—something that defines the care at a reputed heart surgery hospital in Delhi. Minimally Invasive and Beating Heart Surgeries Safety is further enhanced through surgical approaches that minimise trauma to the body. Minimally invasive cardiac surgeries (MICS) use smaller incisions, leading to less pain, quicker recovery, and a lower risk of infection. Similarly, off-pump coronary artery bypass (OPCAB) enables surgeons to perform bypass procedures on a beating heart without relying on a heart-lung machine, reducing some risks associated with traditional methods. At centres such as Venkateshwar Hospital, these advanced techniques are employed to optimise patient outcomes and support faster, safer recoveries. Precision in High-Risk Surgeries Some of the most challenging procedures include aortic root replacements, ventricular assist device implantation, and redo surgeries. To improve safety, real-time imaging such as transoesophageal echocardiography (TEE) is used in advanced hospitals to guide surgeons during operations. These tools help teams respond quickly if complications arise, improving patient outcomes. Focus on Vascular and Hybrid Procedures Cardiac safety also extends to vascular surgeries such as managing aneurysms, carotid artery disease, and complex aortic conditions. Larger Delhi hospitals are increasingly using endovascular and hybrid approaches, which combine surgery with catheter-based techniques. While not yet common for every condition, these methods are particularly valuable in high-risk vascular cases where minimally invasive repair reduces blood loss and recovery time. Structured Heart Programmes Specialised heart programmes add another layer of safety. These may include: Heart failure surgeries such as Left Ventricular Assist Devices (LVADs) Valve repairs and replacements Congenital and paediatric heart surgery Such structured programmes are most often seen in larger multi-speciality hospitals, which maintain consistent safety protocols across complex procedures. Post-Operative Care and Monitoring Safety does not end when the surgery is over. Dedicated cardiac ICUs play a vital role in stabilising patients, monitoring vital signs, and preventing complications. Specialist nurses and intensivists ensure patients receive constant attention, though infection control remains a significant challenge in India. Some hospitals also offer physiotherapy and dietary guidance as part of recovery, though fully structured cardiac rehabilitation programmes—common in Western centres—are still limited to select large hospitals in Delhi. Commitment to Ethics and Innovation What distinguishes leading hospitals is not only their technology but also their approach to patient care. Institutions that communicate openly with families, explain risks clearly, and follow global safety practices inspire greater trust. At Venkateshwar Hospital, advanced cardiothoracic and vascular procedures are performed with a strong emphasis on patient safety and ethical care. Supported by NABH accreditation, modern infrastructure, and a team of experienced cardiologists and surgeons, the hospital ensures comprehensive cardiac treatment—from diagnosis and surgery to recovery and long-term management—under one roof. Conclusion Complex heart surgeries require expertise, precision, and high standards of safety. Delhi hospitals are achieving this by strengthening surgical teams, upgrading technology, and refining post-operative care. While not every hospital has access to the same level of infrastructure, large multi-speciality centres like Venkateshwar Hospital are setting benchmarks in ensuring safer outcomes for patients. For families, consulting directly with cardiac specialists helps in choosing the best and safest treatment path for their unique needs. ]]> https://biospectrumindia.com/news/21/26574/how-to-choose-the-right-laboratory-vial-for-your-experiment.html https://biospectrumindia.com/news/21/26574/how-to-choose-the-right-laboratory-vial-for-your-experiment.html Fri, 22 Aug 2025 00:00:00 +0530 This guide explains the different types of laboratory vials, their applications in analytical chemistry, and how to select the best option based on sample type, instrument compatibility, and closure type.   Everything You Need to Know about Laboratory Vials   Laboratory vials serve as sample containers in various analytical processes, playing a crucial role in preserving chemical composition, preventing contamination, and maintaining analytical accuracy. Some of the most common functions of laboratory vials are as follows:   Key Functions of Laboratory Vials   Chemical Stability: Ensures compatibility with solvents, acids, and bases used in analytical methods. Sealing Integrity: Prevents evaporation, contamination, or leakage during storage and analysis. Instrument Compatibility: Designed to fit autosamplers for HPLC and GC applications. Regulatory Compliance: Must meet ISO 15378 certification standards for pharmaceutical and chemical testing.   Types of Laboratory Vials Based on Applications   Vial Type Application Sealing Type Typical Volume HPLC Vials Chromatographic analysis (HPLC) Screw Cap / Crimp Top 1.5mL - 2mL GC Vials Gas Chromatography (GC) Crimp Top 1.5mL - 2mL Treated / pH Sensitive Vials For reactive or pH-sensitive samples Screw Cap / Crimp Top 1 mL - 100 mL Certified Vials USP-compliant pharma testing Screw Cap / Crimp 5mL - 50mL   Comparing Screw Cap Vials vs Crimp Top Vials   Screw cap vials from Borosil Scientific and crimp top vials are the most common choices for analytical testing. Selecting between them depends on sealing requirements, handling convenience, and sample volatility.   Feature Screw Cap Vials Crimp Top Vials Snap Top Vials Sealing Strength Moderate (reusable) High (airtight, tamper-proof) Medium to High (Depends on top type) Ease of Handling Can be opened and resealed Requires a crimping tool Easy to open and close Evaporation Resistance Suitable for low-volatility samples Ideal for volatile solvents Suitable for short term storage Instrument Compatibility HPLC and GC autosamplers GC applications requiring airtight sealing HPLC autosamplers with snap top support   Best for HPLC applications: Screw cap vials with PTFE-lined closures. Best for GC applications: Crimp top vials to prevent solvent loss. Best for quick HPLC runs or routine sampling: Snap top vials for fast, manual access.   Material Considerations: Glass vs. Plastic Vials   Material selection impacts sample stability, chemical reactivity, and analytical precision.   Material Properties Applications Borosilicate Glass (3.3 Expansion) High thermal resistance, low alkali content Suitable for high-temperature applications and lab glassware. Borosilicate Glass (4.9 Expansion) Enhanced chemical durability, lower thermal expansion Pharmaceutical packaging, sensitive formulations. Borosilicate Glass (5.1 Expansion) USP Type I compliance, low extractables, chemically inert HPLC, GC, pharmaceutical analysis Amber Glass UV-resistant, prevents light degradation Light-sensitive compounds   For volatile solvents: Choose borosilicate glass for low leachability and chemical stability. For light-sensitive samples: Use amber glass vials to protect against UV exposure.   Certified Sampling & Storage Vials: Ensuring Compliance   For pharmaceutical, chemical, and biological testing, certified vials from Borosil Scientific meet regulatory standards to ensure accuracy and reproducibility.   Key Features of Certified Vials:   ISO “Class 8” Cleanroom Packing: Minimises particulate contamination. USP Type I Borosilicate Glass: Ensures low leachability and chemical purity. PTFE-Silicon Septa Caps: Provide airtight sealing for long-term sample stability. Amber Colour Protection: Shields light-sensitive compounds from degradation.   Certified vials are ideal for pharmaceutical working standards, chemical reference samples, and stability studies.   Selecting the Right Vial for HPLC and GC Analysis   HPLC Vials to Maintain Sample Integrity and Autosampler Compatibility Must be made from low-extractable borosilicate glass. Volume range: 1.5mL - 2mL. Screw cap vials with PTFE/Silicone septa for minimal sample contamination.   GC Vials for Evaporation Control and Precision Sealing Designed for gas chromatography and mass spectrometry (GC-MS). Crimp top vials are preferred for airtight sealing of volatile samples. Septa should be thermally stable for high-temperature GC analysis.   Best Practices for Handling and Storing Laboratory Vials   To maintain vial integrity and prevent contamination, follow these guidelines:   Storage and Handling Store in a clean, dust-free environment. Use vial racks to prevent breakage or misplacement.   Cleaning and Preparation Rinse new vials with HPLC-grade solvents before use. Avoid direct handling. Use tweezers or vial holders.   Sample Management Do not overfill vials. Maintain 20% headspace. Secure caps properly to prevent leakage or evaporation.   Key Considerations for Choosing the Right Laboratory Vial   Factor Why It Matters Chemical Compatibility Prevents leaching, degradation, and contamination Sealing Type Ensures airtight protection for sensitive samples Autosampler Fit Prevents misalignment and cross-contamination Regulatory Compliance ISO 15378-certified vials for pharmaceutical use   For trace analysis: Use low-extractable glass vials to avoid contamination. For long-term sample storage: Choose PTFE-lined screw caps to prevent moisture intrusion.   Conclusion   Selecting the correct laboratory vial from brands like Borosil Scientific is essential for sample integrity, analytical precision, and regulatory compliance. Whether used in HPLC, GC, or chemical storage, vials must be chosen based on material compatibility, sealing strength, and instrument specifications.   For HPLC applications: Use screw cap and snap cap vials with PTFE/Silicone septa. For GC analysis: Opt for crimp top vials to prevent solvent loss. For pharmaceutical storage: Use ISO 15378-certified borosilicate glass vials.   By selecting the right vial for chromatography, sample storage, or reagent preparation, laboratories ensure reliable data, contamination-free workflows, and accurate analytical outcomes. ]]> https://biospectrumindia.com/views/21/26565/why-doctors-need-legal-and-financial-safeguards-more-than-ever.html https://biospectrumindia.com/views/21/26565/why-doctors-need-legal-and-financial-safeguards-more-than-ever.html Thu, 21 Aug 2025 00:00:00 +0530 Healthcare has come a long way, but the pressure on doctors keeps growing. With new technology changing how care is delivered, expectations are higher than ever, along with the risks. Today, doctors are being watched closely, not just by peers, but by patients and legal systems too. Even when doctors act responsibly, they can still face lawsuits or financial claims. People are more informed, which means they are more likely to face legal exposure. Professional Indemnity Insurance helps protect doctors when things go wrong, allowing them to continue focusing on what they were trained to do: caring for others.   Rising Medical negligence Litigation: A growing Concern Medical malpractice lawsuits in India have seen a remarkable increase over the last decade. The National Consumer Disputes Redressal Commission (NCDRC) has documented thousands of cases annually for medical malpractice. In the high-shaft cases, specifically surgery, a slight issue can escalate into lawsuits. Many of these significant cases, regardless of standard, lead to demanding legal proceedings, reputational damage. Compensation amounts have also surged, with courts demanding in crores for the renowned or eminent cases. Such payouts can be stressful for the small business owners and the individual medical practitioners to pay.   What is Professional Indemnity for Doctors Professional indemnity insurance offers financial protection and legal liability against errors made unintentionally and omissions made by the doctor while performing their professional services. If the patient or their family claims that the doctor has mistreated, performed a surgical or diagnostic error during the treatment, this policy covers various coverages like out-of-court settlements, compensation up to the insured limit. This insurance is not only for doctors and surgeons, but also for general medical practitioners, dentists, psychologists, and neurologists under professional indemnity for doctors.   Why it’s more important for Doctors Enhanced Consumer Rights & Patient Awareness - With modern technology, individuals have a better understanding of their rights, but sometimes, if their expectations do not meet reality, they act quickly. With the awareness of the Consumer protection rights, patients can file their complaints for the services. This policy is crucial as it is designed to indemnify you against such legal liability and the associated costs of defending a claim. Increasing the Range of Medical Practice- As medical technology and treatments advance, practitioners can address more complex conditions. However, adopting these innovations can also introduce unforeseen risks and less predictable outcomes. This expansion of your medical practice increases the potential for claims alleging error, omission, or negligence, making professional indemnity coverage essential for managing these emerging liabilities. High Settlements & Judicial Precedents - Indian courts need to be more assertive towards patients, allocating considerable damages. Even if the doctor is found not guilty and unburdened of any negligence, even then, the legal procedures can still be hefty. Professional image at risk - Legal procedures not only affects the financial stability, but in most cases, they become a major hit to their medical practice. Having professional indemnity insurance indicates and helps during the crisis, comforting both the medical practitioner and the patients.   Conclusion The Medical Practitioners devote their whole life to heal others, often under uncertain situations, and they may end up doing something that wasn’t intentional but caused discomfort to the patient. In consideration of the same, they do deserve a wholesome policy which provides coverage against the unforeseen circumstances, mainly the legal procedures, settlements avoiding the risks. As the medical environment is widespread, investing in specific insurance is the most crucial step that every healthcare professional must take in this growing era.   Pratyush Kumar, Head of Product, PI for Doctors, Policybazaar for Business ]]> https://biospectrumindia.com/features/21/26543/engineering-contamination-out-product-led-innovation-for-a-safer-smarter-pharma-floor.html https://biospectrumindia.com/features/21/26543/engineering-contamination-out-product-led-innovation-for-a-safer-smarter-pharma-floor.html Tue, 19 Aug 2025 00:00:00 +0530 Across the pharmaceutical industry, I keep hearing one message from regulatory auditors: manual intervention must go. With new global guidelines such as EU-GMP Annex 1 placing heightened emphasis on contamination control, manufacturers—especially in sterile operations—are being pushed to challenge long-standing practices. For me, eliminating contamination has never been just about meeting compliance checklists. It’s about designing cleaner, more resilient manufacturing ecosystems that can keep pace with today’s demands for agility, speed, and uncompromising quality. In sterile and injectable manufacturing, even the smallest manual touchpoint can carry unacceptable risk. Over the years, I’ve moved away from a reactive quality-control approach to one centred on designing risk out of the process entirely. This mindset shift has been powered by targeted engineering innovations—solutions that are not only smarter and faster, but grounded in the realities of day-to-day production. Closing the Loop on a Contamination Risk One vulnerability I’ve seen repeatedly is the manual loading of aluminium seals and rubber stoppers into fill-finish lines. In many legacy setups, operators still cut open sterile bags and empty them into hoppers—introducing direct contamination risks and failing to meet modern aseptic handling expectations. To solve this, my team at Kairish Innotech developed a fully customised automatic bag cutting and loading system. It removes the human element from one of the most frequent intervention points in injectable production. Key capabilities include: Fully enclosed, hands-free bag opening Direct integration with isolators or RABS Customisable hopper or chute interfaces Built-in cleaning and monitoring mechanisms Importantly, it enables manufacturers to upgrade existing lines without full-scale rebuilds. Several CDMOs and regulated-market suppliers have already adopted the system to align legacy infrastructure with 21st-century compliance. When a Needle Changed Everything Not all innovation starts in the R&D lab—sometimes it begins with a problem on the shop floor. A client once approached us with a heat-sensitive injectable struggling at 70% yield. The cause: tiny droplets forming in the ampoule neck during filling, which carbonised during flame sealing, degrading the product. Working closely with their formulation and production teams, we re-engineered the filling needle. Multiple trials led to a low-turbulence, anti-drip design that solved the issue entirely. Results included: Yield increasing from 70% to 95% Batch rejections dropping to near zero No changes required to ampoule specs or fill volumes For patients depending on those critical doses, this quiet innovation made a life-changing difference. A Two-Week Turnaround that Saved ₹250 Crore Sometimes, the most critical factor isn’t design—it’s speed. A large pharmaceutical company’s sterile facility came to a complete halt due to a faulty buffer tank. The OEM quoted a six-month lead time for a replacement—unacceptable for a plant producing time-sensitive medicines. We took on the challenge. Within two weeks, we had: Reverse-engineered the tank Sourced GMP-grade stainless steel with full material traceability Completed welding and qualification to ASME-BPE standards Delivered a leak-tested, validated, fully documented replacement This rapid intervention didn’t just save production—it protected the company’s reputation and ensured patients received their treatments on time. Why This Matters These experiences—whether removing contamination risk, rescuing yield, or accelerating recovery—reinforce a lesson I’ve learned repeatedly: the future of pharmaceutical manufacturing depends on responsive, intelligent, engineering-led problem solving. With regulatory expectations tightening, global CDMO competition intensifying, and patient demands rising, pharma innovation must extend beyond molecules. Smarter systems, built around everyday production realities, are just as vital. In my experience, it’s often the targeted, practical solutions—not the headline-grabbing breakthroughs—that transform the pharma floor into a safer, smarter, and more resilient space. ]]> https://biospectrumindia.com/news/21/26532/evolution-of-hepatitis-testing-from-conventional-methods-to-next-gen-elisa-rapid-kits.html https://biospectrumindia.com/news/21/26532/evolution-of-hepatitis-testing-from-conventional-methods-to-next-gen-elisa-rapid-kits.html Wed, 13 Aug 2025 00:00:00 +0530 Hepatitis, an inflammation of the liver, is usually caused by viruses such as Hepatitis A, B, C, D, and E and occupies a key place on the global health concern list. Types B and C, especially, pose a severe public health concern in India and worldwide. These silent viral infections often remain undetected until severe liver disease sets in, including cirrhosis or hepatocellular carcinoma. With an estimated 296 million people living with chronic Hepatitis B and 58 million with chronic Hepatitis C across the globe (WHO 2023), the need for early detection is more than ever. The past few decades have brought significant changes to diagnostic tools for hepatitis, from conventional, tedious methods to faster and far more accessible next-generation technologies, such as ELISA and rapid diagnostic kits. With advances in diagnostic accuracy and the ability to bring testing to the doorstep of even the most remote populations, this progress will unfold.   Hepatitis Testing- Evolution Discussed Hepatitis infections were previously diagnosed using basic techniques. Blood tests included liver function tests (LFTs) that evaluated the elevation of enzymes Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT), which are indirect markers of liver injury. However, LFTs were no confirmation for viral etiology. Hepatitis B and C had to be detected through RIA-based assays and gel-based electrophoresis, all of which were cumbersome, required specialized laboratories to perform, and, more importantly, presented hazards of radiation exposure. Back then, screening was often limited to high-risk groups, the definition of which included blood donors, pregnant women, or symptomatic patients, thereby leading to underdiagnosis and delayed treatment.   ELISA Revolution for Hepatitis Testing A giant leap forward in hepatitis diagnostics was then brought by the introduction of the ELISA (Enzyme-Linked Immunosorbent Assay) in the mid-1980s. The ELISA method provided enhanced sensitivity and specificity for detecting viral antigens of Hepatitis B and antibodies to Hepatitis C. What made ELISA unique? It was accurate, as it could discriminate between current infections and past exposure and immunity. It was scalable, as it could test large volumes in blood banks and diagnostic labs. It was safe - it discontinued the use of radioactive substances, unlike radio-immunoassay (RIA). With the advancement of ELISA generations, from the first to the fourth, both antigens and antibodies can be detected simultaneously, greatly reducing the diagnostic window period- the time frame between infection and the development of detectable markers. This became very important in the prevention of the transmission of hepatitis via blood transfusions and medical procedures.   Rise of Rapid Diagnostic Tests (RDTS) Despite ELISA being accurate, these assays required laboratory confirmation and were time-consuming. This impeded communities from implementing diagnosis in rural or low-resource settings. To the rescue came rapid diagnostic tests, which had a significant impact. Present-day RDTs for hepatitis provide results in 15 to 20 minutes using a drop of blood or serum. They essentially work on immunochromatographic principles, wherein antigen-antibody reactions produce a visible colored line (similar to a pregnancy test). They are characterised by: No requirement for electricity No fancy machinery Minimal training  They have changed the scenario of mass screening, point-of-care testing, and outreach health camps by cutting down the cost and time. The Indian health surveys have identified large-scale hepatitis screening drives in rural areas due to the use of RDTs, detecting thousands of hidden cases.   Next-Gen ELISA While change and novel improvements were taking place in technology, ELISA remained on its path towards improvement. Modern-day next-generation ELISA systems are likely fully automated, capable of processing hundreds of samples per hour with virtually no manual error. Such platforms feature: Multiplexing, which allows for the detection of multiple hepatitis types (i.e., HBV, HCV, HIV) from a single sample Shortened window periods, which would enable for enhanced antigen-antibody combination assays Improved specificity- Reducing false positives and unnecessary anxiety. Automated ELISA systems are becoming increasingly prevalent in blood banks and large hospitals throughout India, helping to fulfill NABH and WHO quality standards.   Toward Elimination in India India is estimated to have over 40 million people infected with Hepatitis B and 10 to 12 million with Hepatitis C. Recognizing the burden, the National Viral Hepatitis Control Programme (NVHCP), which began in 2018, has been actively facilitating free screening and treatment through the National Health Mission. Under this programme: Confirmatory testing is performed in government centers using the ELISA method. RDTs are used in camps, PHCs, and wellness centers to reach vulnerable populations. Training and awareness have increased for promoting early testing and vaccination (for hepatitis B). To eliminate hepatitis B and C as public health problems by 2030, according to the WHO's global strategy. The evolution of hepatitis testing mirrors a broader trend in healthcare: from centralized laboratories to community-level diagnosis. With persisting innovation, we envision: AI-supported diagnostic tools predicting infection risk and its progression Home-based rapid tests for COVID-19 Portable microfluidic devices for real-time screening of hepatitis The speed, accessibility, and patient involvement in diagnostics will further enhance our capacity to address viral hepatitis. From slow, basic approaches to the rapid tests and next-generation ELISA platforms of today, the history of hepatitis testing is vast. The evolution was imperative not only for better detection and treatment outcomes but also to take testing to an even higher level of inclusiveness.   Dhiren Trambadia, Vice President, Trivitron Healthcare ]]> https://biospectrumindia.com/features/21/26407/how-vitamin-b-deficiency-affects-nerve-and-brain-health.html https://biospectrumindia.com/features/21/26407/how-vitamin-b-deficiency-affects-nerve-and-brain-health.html Mon, 21 Jul 2025 00:00:00 +0530 Of those, B₁ (thiamine), B₆ (pyridoxine), and B₁₂ (cobalamin) are especially essential for proper nerve health and cognitive function. Deficiency in one or more of these vitamins for either intake or absorption can thus result in structural and functional damage to the nervous system Exploring the Importance of Key B Vitamins Thiamine (Vitamin B₁): Acts as a coenzyme for glucose and neurotransmitter metabolism It assists in the conduction of electrical impulses down the nerves. Pyridoxine (Vitamin B₆): Utilized in the production of GABA, dopamine, and serotonin—mood and cognition-related neurotransmitters. Helps with myelin production and myelin enhances nerve fibre insulation. Cobalamin (Vitamin B₁₂): Required for DNA replication, production of red blood cells and for myelin upkeep. Protects the spinal cord and make signals are sent quicker to the brain. Other B Vitamins (B₂, B₃, B₅, B₇, B₉): Assist in energy metabolism, cellular growth, and repair. indirectly contribute through supporting cellular health Why Early Intervention Matters For mild B-vitamin insufficiency, the symptoms can be imperceptible, general fatigue, irritability, or slight memory problems, but any type of early symptom that develops shouldn't be disregarded. Due to the health risks associated with B12 deficiency, healthcare professionals are now recommending proactive screening in at-risk populations, which include older adults, pure vegetarians, and individuals with gastrointestinal disorders that interfere with absorption. More specifically, intravenous therapies like eldervit injection is used for repletion of serum cobalamin levels more rapidly than oral supplements are capable of providing when oral supplements are ineffective. Effects of Deficiency in Vitamin B on Nerve Health Peripheral Neuropathy The first to suffer damage are often the nerves in the hands and feet, when B-vitamin levels run low: Signs and symptoms: Tingling, numbness, burning pain and muscle weakness. A 2024 trial showed that a combined supplementation of B₁₂ and B₆ decreased the neuropathic pain scores in the participants by 35% over a period of three months. Autonomic Dysfunction However, it is not just sensory nerves that can be involved; autonomic fibres which control blood pressure and gut motility, are also at risk: Signs and symptoms:  Postural dizziness, dysmotility, and hyperhidrosis. Defective transmission of the autonomic neurons due to mitochondrial dysfunction Effect on Brain Activity and Mental Health Cognitive Decline Long-term deficiency of B₁₂ and folate (B₉) is associated with a more rapid decline in memory and executive function. Symptoms include forgetfulness, short attention span, and slower processing speed. Neural damage resulting from deficient DNA repair and increased homocysteine 2023 Clinical Trials: Weekly B₁₂ injections have been shown to improve mild cognitive impairment cognitive test scores from 4 to 20 O/C in 2023. Mood Disorders Lowering of B₆, B₉, and B₁₂ has been associated with depressive symptoms and anxiety: Signs: Low mood lasting a relatively long time, discomfort, and a lack of sleep. Reduced neurotransmitter production and enhanced neuroinflammation Neurodegenerative Risk Chronic hyperhomocysteinaemia, usually caused by B₁₂ or B₉ deficiency, is a risk factor for Alzheimer’s disease and other neurodegenerative diseases. Current research is assessing whether persistent restoration of B-vitamin concentrations can attenuate disease progression. Management Oral Supplementation Common dosages: 1,000–2,000 µg/d B₁₂ and 50–100 mg/d B₆ in tablets per day. Limitations: Malabsorption, pernicious anaemia or GI surgical procedure. Parenteral Therapy Injectables B₁₂ preparations: IM or SC injectables that bypass absorption hurdles Once weekly to start stores, then monthly for maintenance. B₁₂ with folate has been combined in formulations such as the eldervit injection for the concomitant recovery of both vitamins. Dietary Interventions Animal-Source Foods: Meat, dairy and eggs offer easy access (bioavailable) B₁₂. Some fortified food items: Cereals, plant-based milk alternatives fortified with B₁₂ and folic acid. Vegetarians and Vegans: Fortified nutritional yeast and high-dose oral supplements. Preventative and supportive actions Annual monitoring for high-risk patients will prevent irreversible nerve damage. Lifestyle Changes: A healthy diet, moderate alcohol consumption, and not smoking maintain B-vitamin status and general neural well-being. Adjunctive Therapies: Options for pain relief in neuropathy may also include physical therapy, topical agents, and neuromodulatory medications. Recent Developments Higher Older Adult RDAs (2024): Reported a higher daily intake guideline for older adults, due to the decreased absorption with age. Mobile health app New apps monitor nutrient consumption and send reminders to take supplements or injections. Synergistic approaches are continuing to develop, such as B-vitamins with vitamin D and omega-3 fatty acids with neuroprotective co-effects. Conclusion Although the lack of vitamin B is a significant danger to the nerves and brain, which contribute to lost function, there is an opportunity to help the individual as many of its effects are easily totally reversed with early supplementation. Target parenteral, oral , and injectable therapies all have important roles in promoting clinical well-being.  In order to ensure patients get reliable cobalamin repletion, especially in cases where absorption is impaired, consider these innovative combination therapies, walcobal kit injection 1, providing accurate dosages of B₁₂ and other supporting B-vitamins for long term neurological health support. ]]> https://biospectrumindia.com/features/21/26403/sme-loan-essentials-a-first-time-borrowers-guide-to-biotech-and-business-funding.html https://biospectrumindia.com/features/21/26403/sme-loan-essentials-a-first-time-borrowers-guide-to-biotech-and-business-funding.html Fri, 18 Jul 2025 00:00:00 +0530 Running a small or medium-sized enterprise takes vision, dedication, and, most importantly, financial resources. If you are a first-time borrower planning to apply for an SME Loan, meeting the right eligibility conditions is crucial.  A loan can help you expand operations, boost working capital, or invest in machinery or manpower. However, before the funds are received, your SME Loan eligibility must be in order. Here is a detailed checklist that first-time borrowers in India can use to prepare and apply confidently. Basic Eligibility Criteria for SME Loans Before starting the application process, it is essential to review the fundamental criteria that most lenders look for. If you are looking to apply for an SME Loan with L&T Finance, the following SME Loan eligibility criteria must be fulfilled: Age Limit: Applicants should be between 24 to 65 Years. Business Turnover: Annual turnover must range from ₹ 80 Lakh to ₹ 500 Crore. Ownership of Property: The applicant must own either the business premises or the residence. Business Continuity: The business must be in operation for at least 3 Years. Credit History: A minimum credit history of 6 months is essential. How Is SME Loan Eligibility Calculated? Understanding how your eligibility is determined helps you prepare more effectively. Lenders use a combination of financial, credit, and business factors to evaluate loan applications. 1. Revenue Assessment Your business's annual turnover and net profit are evaluated to judge its earning capacity. A strong and consistent income shows lenders that you are likely to repay the loan on time. 2. Financial Ratios Two key financial ratios are commonly used: Debt-to-Income Ratio: This indicates the percentage of your income that is already being used to repay existing debts. Lower is better. Current Ratio: Indicates whether your business has enough assets to cover short-term liabilities. 3. Credit History Check A healthy credit report reflects your repayment behaviour. Lenders check your: Past repayment track record Outstanding debts History of loan defaults or delays 4. Collateral Valuation (For Secured Loans) If the SME Loan requires collateral, its value is assessed to ensure it adequately covers the loan amount being requested. 5. Business Plan Evaluation Lenders often review your business plan to understand: The purpose of the loan Growth projections Expected outcomes from the loan utilisation This gives them confidence in your business direction. Factors That Impact SME Loan Eligibility When applying for an SME loan, several key elements of your business profile are considered in determining your eligibility. Here are the key factors lenders usually evaluate: Credit Score: A good credit history reflects your business’s ability to repay loans on time and can influence approval decisions. Business Vintage: Lenders typically prefer businesses that have been operational for a minimum of 2–3 years or more. Annual Turnover and Revenue Stability: A steady and sufficient revenue stream assures lenders of your ability to repay. Profitability and Financial Ratios: Healthy profit margins and strong financial ratios, such as the debt-to-income ratio, indicate sound financial management. Cash Flow Management: Consistent cash flow helps ensure timely EMI payments, reducing the risk for lenders. Tax Return Filings: Regular and updated income tax and GST filings demonstrate transparency and financial discipline. Existing Liabilities: Lenders assess your current debt obligations to evaluate if your business can handle additional repayment responsibilities. Documentation and Compliance: Proper submission of required documents, including KYC, financial statements, and business proofs, is essential for smooth loan processing. Required Documents for SME Loan Application Having all the documents ready is a must. While the exact list varies, most lenders require: KYC Documents: Aadhaar Card, PAN Card, Passport, Driving Licence. Business Registration Proof: GST registration, shop act licence, etc. Income Proof: Audited financials, bank statements, and income tax returns for the past 1–2 years. Ownership Proof: Documents proving ownership of residence or office premises. Accurate and updated documentation can significantly reduce processing time and improve your chances of approval. How to Improve Your SME Loan Eligibility If you feel your profile may not meet all the conditions, do not worry. There are practical ways to improve your position before applying. 1. Maintain a Healthy Credit Score Pay your EMIs and credit card bills on time. Avoid applying for multiple loans at once. A strong credit score helps you qualify for better loan terms and a competitive SME Loan interest rate. 2. Organise and Update Financial Records Ensure your business is fully compliant with tax filings and regulatory documentation. Lenders appreciate transparency. 3. Improve Cash Flow Ensure your bank statements reflect a consistent inflow of revenue. Delay in vendor payments or erratic account activity could create doubts. 4. Reduce Existing Debts Repaying smaller loans or credit lines will reduce your debt burden and improve your SME Loan eligibility. 5. Build a Clear Business Plan Your application must show how the loan will be used. Having a focused plan with revenue projections and return timelines strengthens your credibility. Importance of SME Loan Interest Rate When planning to borrow, the SME Loan interest rate plays a significant role in determining your total borrowing cost. A lower interest rate helps reduce the EMI and total interest outgo. Factors that influence the interest rate you are offered include: Credit score Business financials Loan amount and tenure Type of loan – secured or unsecured Improving these aspects before applying gives you the advantage of securing a better deal. Conclusion If you’re a first-time borrower, knowing where you stand and taking proactive steps to strengthen your profile is key. Understanding SME Loan eligibility and the factors affecting the MSME Loan interest rate ensures your journey towards funding your business is smoother, faster, and more successful. ]]> https://biospectrumindia.com/features/21/26345/court-states-that-maternity-leave-is-a-vital-right-for-women-in-the-workforce.html https://biospectrumindia.com/features/21/26345/court-states-that-maternity-leave-is-a-vital-right-for-women-in-the-workforce.html Tue, 08 Jul 2025 00:00:00 +0530 This landmark observation, delivered during a recent case involving a woman denied leave for her third child, highlights the evolving role of maternity insurance and health insurance for parents in safeguarding family and workforce interests. This declaration not only protects the rights of mothers but also reinforces the broader healthcare ecosystem that must adapt to the changing realities of Indian families and workplaces. Maternity leave as a constitutional necessity In a strong statement, the apex court ruled that maternity leave is not merely a benefit or privilege, but an enforceable constitutional right. The case pertained to a woman government servant who had applied for maternity leave following the birth of her third child. Despite existing Central Civil Services Leave Rules limiting benefits beyond two children, the Supreme Court underscored that no woman should be forced to choose between employment and motherhood. The court noted that maternity leave plays a critical role in protecting the health of both the mother and the child. This stands aligned with international conventions as well, including the Maternity Protection Convention of the International Labour Organization, which India has ratified. Intersection of maternity insurance and employee rights With the court’s emphasis on maternity as a right, the focus is now shifting to adequate coverage through maternity insurance. In India, most comprehensive health plans now include some form of maternity benefit, but there are caps, sub-limits, and waiting periods that often make access difficult for many women, especially in the private workforce or informal sector. Maternity insurance typically covers: Hospitalisation costs during delivery (normal or C-section) Pre-natal and post-natal expenses Newborn care (up to 90 days in some policies) Vaccination and consultation costs in certain plans However, many health policies require a waiting period of 9 months to 4 years before these benefits can be accessed. This presents a barrier for newly married or expecting couples who did not plan early. Given the court's stand, there is likely to be more regulatory pressure on insurers to offer more inclusive maternity insurance options. Role of health insurance for parents in household security While maternity insurance focuses on new life, health insurance for parents remains a parallel concern for many families, especially when managing finances across generations. With rising healthcare costs and increased life expectancy, ensuring elderly parents have access to quality treatment is essential. Many employers now offer health insurance for parents as an add-on benefit under group health schemes. These policies provide: Coverage for pre-existing diseases (subject to waiting periods) Cashless hospitalisation Access to a wide network of hospitals Option for top-up or super top-up policies for additional protection As more Indian households adopt nuclear family structures, providing health insurance for parents becomes not only a financial strategy but also an emotional commitment. The combination of maternity benefits for new mothers and health coverage for aging parents is a balanced way to secure all generations of a family. Impact on women’s participation in the workforce The Supreme Court’s reiteration of maternity rights is a step toward closing the gap in female workforce participation. Many women in India either leave jobs during pregnancy or are denied re-entry into the job market due to lack of supportive infrastructure. Recognising maternity leave as a legal right, regardless of the number of children, could help improve workforce retention and gender equality. Workplaces with inclusive maternity policies often report higher employee satisfaction, better long-term productivity, and lower attrition rates among women employees. Employers may also need to revise their HR policies in line with judicial guidance to avoid future legal risks. Public and private sector response While government employees are typically entitled to 180 days of paid maternity leave, private sector policies vary significantly. The Maternity Benefit (Amendment) Act, 2017 mandates 26 weeks of paid leave for establishments with more than 10 employees. However, implementation and enforcement remain inconsistent. Given the court’s directive, the Insurance Regulatory and Development Authority of India (IRDAI) may consider introducing guidelines that mandate maternity coverage in all comprehensive individual and family health policies. Additionally, incentives could be provided to insurers who offer maternity benefits without excessive waiting periods. The path forward for inclusive healthcare This judicial ruling should prompt both government bodies and private employers to re-examine their healthcare policies. A more inclusive approach to maternity insurance and broader health insurance for parents can promote a healthier workforce and family structure. Moreover, awareness drives are needed to educate employees, especially women, about their legal rights and healthcare options. Many workers remain unaware of the benefits they can claim or the insurance they are eligible for. Building a culture of informed decisions and proactive planning is essential to bridge this gap. Conclusion Maternity leave is not merely a personal need; it is a societal responsibility and a constitutional right, as reaffirmed by the Supreme Court. This judicial clarity strengthens the case for better maternity insurance, comprehensive health coverage, and improved support for working women. As India advances toward a more equitable and health-conscious future, equal emphasis must be placed on both ends of the family spectrum—ensuring new mothers are cared for through maternity benefits, while elderly parents are protected through health insurance. When combined, these safeguards form the foundation of a healthy, balanced society.   ]]> https://biospectrumindia.com/views/21/26232/future-of-cardiothoracic-surgery-with-robotics.html https://biospectrumindia.com/views/21/26232/future-of-cardiothoracic-surgery-with-robotics.html Wed, 11 Jun 2025 00:00:00 +0530 Cardiothoracic surgery is one of the most complex subspecialties of surgical medicine and is on the verge of a transformation, a technological change. Transcatheter and Robotic-assisted surgery are at the center of this change and promise to make cardiothoracic surgery less invasive and with lesser duration of hospitalization and more cosmetically appealing with early return to work.  While still evolving, robotic systems are increasingly becoming a part of the surgical landscape, offering new possibilities for hospitals, clinicians, and patients alike. Need for Precision Cardiothoracic procedures deal with critical organs like the heart, lungs, and surrounding structures in the chest. Historically, these procedures entail extensive incisions, rib spreading, and extended recovery times. Robotic surgery is changing this paradigm. By enabling surgeons to work from tiny wounds with robotic arms controlled via a console, these systems offer unparalleled precision, versatility, and control. High-definition 3D visualization and motion scaling allow surgeons to execute fine maneuvers that would be challenging with the human hand with a small hole. Therefore, mitral valve repairs that were once done via open-heart surgery now can be done with keyhole wounds, often with comparable outcomes in experienced hands. Advantages Outside of the Operating Table Benefits from robotic cardiothoracic surgery are being observed everywhere. Smaller wounds Less blood loss Fewer chances for infection Less time spent in the ICU and quicker recovery Less pain after surgery and quicker return to work Research has demonstrated that robot-assisted coronary artery bypass and valve surgery can shorten hospital stays by up to 50%, with patients being discharged as quickly as 3–4 days after surgery. Adoption is Accelerating Worldwide, robotic surgery procedures have surpassed 1.2 million annually, with cardiothoracic and cardiovascular surgeries comprising an increasing share of advanced interventions. The global robotic surgery market is expected to reach $14.4 billion by 2026, with double-digit growth expected in Asian-Pacific economies. In India, adoption is increasing steadily and several super-specialty hospitals in metros such as Delhi, Mumbai, Bengaluru, and Chennai have started performing robotic-assisted cardiothoracic surgeries. Although it is still a small percentage of total cardiac surgeries, year-on-year growth is increasing, and indicates increasing confidence in robotic systems both from clinicians and patients. The surgical instruments designed for robotic systems in India come from both international and local suppliers. These companies are also involved in the development of robotic surgical platforms and thereby also contributes to the Indian economy. This whole ecosystem and chain of supply contributes to many hospitals obtaining high-end technology that has been developed with Indian surgery needs and cost in mind. Moreover, healthcare centres are starting to incorporate robotic training modules into their surgical programmes and get their consultants trained in robotic surgery. This is an important measure in providing long-term scalability and developing a next generation of robot-capable surgeons. Realigning Surgical Training and Mindsets The incorporation of robotics is transforming not only tools but methods. Surgeons are taught to think differently, transitioning from direct hand proficiency to console-based coordination. This necessitates new ways of training, such as simulation-based modules, remote mentoring, and increased learning curves. The difficulty is in standardizing this training throughout institutions, geographies and differing surgical volumes.  But the advantage is considerable: hospitals that invest in early robotic skill-building are likely to be better prepared as robotic systems become commonplace in surgical care. Challenges Still Remain While the advantages are obvious, there are hurdles to wider adoption: High cost of equipment and maintenance Marginally accessible to non-urban and tier 2/3 areas Requirement of specialized mentorship and training More extended operation time in the early phases of learning Diffuse and calcific coronary artery disease In India Smaller coronary arteries compared to Caucasian cohorts Smaller intercostal spaces compared to Caucasian patients Case selection due to demand Lesser number of grafts during learning curve These challenges are considerable, particularly in low-resource environments. Still, as larger numbers of hospitals come forward and document successful cases and learning results, the financial bottom line will be likely to shift in the favor of robots. Government measures and healthcare reimbursement models can likewise contribute to push fair access through incentivizing the use of robots as well as education in public hospitals. What's Next? Looking to the future, the future waves of robotic development will involve: Robotic systems aided by AI that recommend the best patient selection and cohorts, incision points or tissue manipulations 5G-enabled remote surgeries, enabling the best surgeons to treat patients from anywhere in the world Seamless analytics, providing real-time insights into patient vitals, surgical optimization, and predictive results All these are not decades ahead and are already under development or in a small pilot phase in research institutes across the globe. For India, this presents an opportunity to leapfrog traditional models and directly integrate next-gen surgical infrastructure, especially in centers of excellence. Robotic-assisted cardiothoracic surgery is not a replacement for skilled surgeons, it is an enhancement. As hospitals and health systems plan, now is the time to invest in infrastructure, training, and talent that can support this evolving approach. The future of cardiothoracic surgery will not be defined solely by the surgeon’s hand, but by how well human skill and robotic precision can work together in achieving better outcomes for patients.   Dr Anandathirtha HS, Sr. Consultant and Head – Cardiovascular & Thoracic Surgery, Ramaiah Institute of Cardiac Sciences, Ramaiah Memorial Hospital ]]> https://biospectrumindia.com/views/21/26208/why-we-must-clarify-the-difference-between-drugs-and-nutraceuticals.html https://biospectrumindia.com/views/21/26208/why-we-must-clarify-the-difference-between-drugs-and-nutraceuticals.html Thu, 05 Jun 2025 00:00:00 +0530 In India’s evolving health marketplace, consumers today have unprecedented access to a wide range of products from over-the-counter (OTC) medications to dietary supplements and herbal remedies. But this growing access comes with a growing misconception: that all health products available at pharmacies or online have been subjected to the same level of clinical testing and regulatory scrutiny. Self-medication, the act of individuals treating their own health conditions without professional consultation, is common in India, especially among lower- and middle-income groups, with prevalence rates ranging from 8.3% to 92%. Rising healthcare costs, long wait times, and easily available online information have only accelerated this trend. At the same time, the rise of wellness-focused products such as supplements, herbal extracts and fortified foods, has blurred the line between what qualifies as a drug and what does not. Nutraceuticals, dietary supplements or fortified foods promoted for health benefits, often mimic the appearance of drugs, from packaging to placement in pharmacies, making them indistinguishable from medicines. . Without clear communication, it’s easy to assume that all health-related products undergo similar clinical testing before reaching consumers. In reality, that is far from the case. Regulatory Differences: OTC Drugs vs Nutraceuticals OTC drugs, such as paracetamol or ibuprofen, are regulated by the Central Drugs Standard Control Organisation (CDSCO) under the Drugs and Cosmetics Act, 1940. These products undergo a multi-phase clinical trial process spanning 3-5 years or even longer. These trials evaluate safety, efficacy, dosage, pharmacokinetics, and potential drug interactions with oversight from institutional ethics committees (IECs) to ensure informed consent and monitor adverse events. Nutraceuticals, by contrast, fall under the purview of the Food Safety and Standards Authority of India (FSSAI). These include dietary supplements, functional foods, and herbal preparations. While some studies may be conducted to support general wellness claims, there is no legal requirement for large-scale clinical trials before launch. Most do not undergo long-term safety monitoring or pharmacological evaluation. This regulatory divergence is critical but often unknown to the end user. One of the reasons for this perception is a lack of awareness about what clinical trials actually involve. For pharmaceuticals, clinical trials are structured, multi-phase studies that include hundreds to thousands of participants. They assess how a product behaves in the body, what potential adverse effects it might have, and how it compares to existing treatment options. By comparison, when nutraceuticals are studied, the trials are typically small-scale often with fewer than 200 participants and focused more on general well-being than treatment outcomes. These studies are typically shorter in duration, and often lack the level of regulatory or ethical oversight required for pharmaceuticals. Real-World Risks Although FSSAI and the Advertising Standards Council of India (ASCI) provide guidance on health claims, enforcement can be inconsistent. The rise of digital platforms and influencer-led promotions makes it easier than ever for ambiguous messages to reach large audiences. As a result, consumers may believe that all products are backed by rigorous evidence, when in fact the standards vary widely. The consequences of this misconception are significant. Misguided reliance on untested supplements can lead to health risks, such as liver toxicity, kidney damage, heart complications, or adverse interactions with medications. In addition, lower-income groups, often unable to afford doctor visits or diagnostics, are particularly vulnerable, relying heavily on affordable but unverified products. The rise of e-commerce exacerbates these risks. Online platforms, with their vast reach and minimal oversight, amplify misleading claims through unverified sellers or influencer endorsements. User reviews often present anecdotal success stories as scientific proof, further confusing shoppers. Solutions for a safer tomorrow As India’s health ecosystem expands, so too does the need for clearer public communication. Consumers deserve to understand the difference between products that have undergone extensive testing and those that have not. Greater transparency around clinical evidence, regulatory standards, and marketing claims can help individuals make more informed choices and strengthen public trust in the system as a whole. Bridging the knowledge gap between pharmaceuticals and nutraceuticals is not about limiting access or innovation. It’s about ensuring that safety, science, and informed decision-making go hand in hand.   Dr Kausik Maiti, Executive Director, Safety Medical Sciences, Parexel ]]> https://biospectrumindia.com/views/21/26076/navigating-cdscos-new-application-policy-for-cosmetics-the-50-product-limit-explained.html https://biospectrumindia.com/views/21/26076/navigating-cdscos-new-application-policy-for-cosmetics-the-50-product-limit-explained.html Mon, 05 May 2025 00:00:00 +0530 In India, the Central Drugs Standard Control Organization (CDSCO) regulates cosmetic products under the Drugs and Cosmetics Act 1940 and the Cosmetics Rules 2020. All cosmetic products—whether imported or locally manufactured—must comply with registration, labeling, and safety requirements before entering the market. For imported cosmetics, brand owners must register each brand and product category (e.g., creams, lotions, masks) with the CDSCO. This process involves submitting Form COS-1 through an authorized Indian agent and documentation such as a Free Sale Certificate (FSC), product specifications, Letter of Authorization (LOA), and other necessary documents. Previously, there was no limit on the number of products per application, but each product and variant had to be distinctly listed. Registration Certificates are valid for five years upon approval. Effective August 16, 2024, the CDSCO has introduced a new guideline through the SUGAM portal, capping each application at a maximum of 50 products. Companies can still submit multiple applications for additional products. This change aims to streamline the registration process and enhance efficiency while aligning with the Cosmetics Rules, 2020. This editorial explores the rationale, benefits, and challenges associated with this policy shift to help stakeholders adapt to the updated requirements.   Understanding the Policy Change The CDSCO’s 50-product limit per application is designed to optimize the cosmetics registration process in India. By capping submissions to a manageable number of products, the CDSCO aims to reduce processing times and improve the quality of reviews. This adjustment addresses the increasing volume of applications in India's rapidly expanding cosmetics market, allowing for a more efficient and thorough examination of each submission. This policy is part of the CDSCO’s broader mission to reinforce regulatory compliance across the industry, ensuring that products meet stringent safety and quality standards. By expediting market entry for compliant products, the CDSCO establishes a more accountable framework that minimizes risks associated with unregulated or inadequately documented products. Overall, this initiative advances the CDSCO's commitment to public health by enforcing higher standards and bolstering the credibility of cosmetic products available to Indian consumers.   Rationale Behind the 50-Product Limit The introduction of the 50-product cap strategically addresses the increasing volume of applications in the rapidly growing cosmetics sector. The CDSCO faces the challenge of processing a high number of submissions while upholding rigorous quality control standards. This new policy enables the organization to focus its resources more effectively, leading to reduced processing delays and enhanced application reviews. By limiting the number of products submitted in a single application, the CDSCO can ensure each application receives the necessary attention. This approach not only improves processing times but also fosters a streamlined review process, ultimately facilitating quicker market access for compliant products. Furthermore, this limit aligns with the CDSCO’s commitment to upholding the Cosmetics Rules, 2020, which emphasize safety and quality. By preventing an overwhelming influx of applications, the CDSCO safeguards public health and consumer trust in available cosmetic products. Thus, this policy reflects a proactive step toward balancing industry growth with regulatory diligence.   Benefits of Streamlined Applications Efficiency in Processing Limiting the number of products per application allows for a more focused review, reducing bottlenecks in evaluation and leading to more efficient resource allocation within the CDSCO. Improved Quality Control: A manageable application size enables thorough scrutiny of each product, reinforcing safety and efficacy standards to ensure compliance before market entry. Timely Disposal of Applications: A cap provides applicants with quicker responses, facilitating faster product launches and enabling companies to respond more agilely to market demands. Enhanced Clarity in Documentation: With fewer products to evaluate simultaneously, the chances of documentation errors or inconsistencies are minimized, resulting in a more straightforward application process. Facilitation of Compliance Training: A streamlined process can serve as a learning opportunity for companies to better understand compliance requirements, leading to improved quality in future applications. Encouragement of Strategic Planning: Companies may prioritize product launches and submissions more thoughtfully, leading to a more strategic approach to market entry. Support for Regulatory Transparency: Clearly defining application limits enhances transparency in the regulatory process, allowing stakeholders to better understand submission requirements and fostering trust and collaboration.   Challenges for Stakeholders While the new 50-product limit offers notable advantages, it also presents challenges for stakeholders in the cosmetics industry. Companies accustomed to submitting large batches of products in a single application must adapt to this segmented approach, impacting their operational processes. Administrative Adjustments: Transitioning to a model that limits products per application necessitates re-evaluating existing administrative workflows. Businesses may need to implement new systems to manage multiple applications effectively, leading to potential disruptions during the adjustment period. Increased Resource Demands: The segmented approach may require additional resources in terms of personnel and technology. Companies may need to hire more staff or reassign existing employees to handle the increased workload, which can strain smaller businesses with limited budgets. Potential for Increased Costs: Managing multiple applications could lead to higher operational costs, including additional fees for separate submissions and potential consulting services to navigate the new requirements. Companies must carefully consider budget allocations for these changes. Maintaining Consistency: Ensuring consistency across multiple submissions is critical. Stakeholders must establish robust internal checks to guarantee adherence to standards, as inconsistencies could result in delays or rejections. Communication Challenges: Clear communication between stakeholders, including regulatory authorities and internal teams, is essential. Miscommunication can lead to confusion and delays, especially when different teams manage separate applications. Navigating Regulatory Changes: Staying informed about ongoing changes in the cosmetics regulatory landscape requires a commitment to continuous learning and adaptation, which can be challenging in a fast-paced market. Overall, while the new policy aims to enhance the registration process, stakeholders must be prepared to face these challenges head-on. By adopting proactive strategies and investing in resources, companies can effectively navigate this transition and thrive in the evolving cosmetics market. Conclusion The CDSCO's implementation of the 50-product limit marks a significant shift in the cosmetics registration landscape in India. This policy is designed to streamline the application process, enhance regulatory compliance, and improve the overall quality of cosmetic products entering the market. While the new limit offers benefits such as increased efficiency and quicker processing times, it also poses challenges for stakeholders accustomed to submitting large batches of products. Companies must adapt to a more segmented approach, requiring adjustments to workflows, resource allocations, and strategic planning. Successfully navigating these challenges depends on the industry's willingness to embrace transparency, maintain clear communication, and invest in training and resources. As the cosmetics market continues to grow, collaboration among stakeholders—including regulatory authorities, manufacturers, and consumers—will be crucial for ensuring compliance and safety. By proactively addressing the challenges associated with this new policy, stakeholders can contribute to a more robust regulatory framework that prioritizes public health and consumer trust. Ultimately, the 50-product limit represents not just a regulatory change but an opportunity for the cosmetics industry to enhance its standards and practices, fostering a safer and more competitive market for all.   Saba Anjum, Junior Associate, Consumer - Cosmetics, Freyr Solutions ]]> https://biospectrumindia.com/views/21/26073/future-of-patient-recruitment-lies-in-strategic-supportable-engagement-.html https://biospectrumindia.com/views/21/26073/future-of-patient-recruitment-lies-in-strategic-supportable-engagement-.html Sat, 03 May 2025 00:00:00 +0530 I'll start the article by introducing the ‘Recruitment Drift Syndrome’. What does it signify? Patients drift away before the site is ready to recruit. But what about commitments we (Site team) were given while filling feasibility and during site selection visit? India is experiencing a significant change in the clinical research landscape. The nation is becoming a considerable location for international clinical trials due to its fast expanding pharmaceutical industry, rising disease load, and advancements in digital healthcare. A major problem, nevertheless, even with the large patient base and expanding infrastructure i.e. Patient recruitment. More than 80% of trial delays worldwide are caused by delayed patient recruitment, and socio-cultural complexity, ignorance, and low interaction between sponsors and investigators create additional obstacles in India. With more than 20 years of experience as a clinical research professional, I have seen firsthand both the problems and the solutions that can change this story. A site-centric, technology-enabled paradigm designed specifically for India is presented in this paper. It enhances patient recruitment while fostering long-lasting relationships between sponsors and clinical sites.   The Actual Situation; Difficulties in Recruiting Patients: Insufficient Patient Knowledge The majority of patients in India are not aware that clinical trials are a viable therapeutic option, despite the country's high disease burden. Few people think about taking part, mostly because they are afraid, feel stigmatized, or don't know enough about it. Overworked Sites and Investigators Site staff frequently handle several studies with little assistance, which restricts their ability to successfully recruit, interact with patients and search patient outside the site. We should not forget that oversee the clinical study is not a primary job of Investigators involved in this, they have other tasks as Clinician, Academician, Member of different committees and vice versa. Issues with Eligibility and Protocol Complexity A high screen failure rate is caused by strict inclusion/exclusion criteria and inadequately localized methods. Fewer Referrals to Doctors Private practitioners and trial locations are not in communication. The majority of doctors are neither encouraged nor trained to refer qualified patients to the trial site. Insufficient Technology Use Digital technologies that facilitate recruitment, engagement, and data flow are frequently lacking for sites and investigators especially in tier-2/3 cities.   Presenting the Tech-Enabled and Site-Centric Model: Sponsors need to reconsider their recruitment approach in order to overcome these obstacles. A successful model needs to be:   Adaptable to the local environment (Plan A might work for Site X but not for Site Y). Digitally connected (referral & outreach dashboards, digital pre-screening tools, and EMR/OPD data integration). Focused on the referral network and location (e.g., feedback loops, doctor education programs, referral mapping, feedback loops, ethical honoraria, certificates, or acknowledgments). This is a model that has worked well in many studies although providing outcome seen in Ophthalmology and Paediatrics. Using Sites as Strategic Centres When equipped with the appropriate tools and ecosystem, sites become more than just places to conduct trials; they are also recruitment engines. Sponsors ought to: Work together to determine viability with site input on reasonable schedules Co-create recruitment objectives and metrics Assign coordinators specifically for site recruitment.   Making Use of the PICs Framework Presenting the PICs Framework, a strategy model for locating and enlisting physicians to refer patients to trials: PICs = Potential + Interested + Comfortable doctors Impact on Sponsors: Increases referral rates and site-level enrollment forecasts. Targeted engagement results in fewer screen failures.   Online Promotion and Pre-Screening To lessen the workload for coordinators, sponsors ought to invest on e-consent, chatbot-assisted patient education, and pre-screening systems that are coupled with EMR/EHR tools. Employ geo-targeted advertisements to inform particular patient groups. To assess interest, use mobile-friendly pre-screeners. Use dashboards to share pre-screening data with websites. Content for Localized Patient Education Convert recruitment brochures, trial summaries, and other site or study specific material into local languages. Culturally relevant content increases engagement delivered via SMS or WhatsApp,.   Honoraria and Referral Partnerships Openness (Under guidelines of Ethics Committee or Regulatory Body). Through fair recognition, referral acknowledgment, and MOU-based referral systems, promote moral and open doctor collaboration. Arrange referral summits every three months with involved HCPs. Provide documentation of every referral touch points that is audit-safe.   Real-World Application: Ophthalmology study in Lucknow: Using the PICs model including tech-enabled support, our team activated over 100 referral doctors (Government Hospitals/Private centres/Clinics/Diagnostics centres especially doing OCT) in around 6 months across same city and periphery of 300 km. Within 30 days: Referral-to-consent ratio improved by 41% Completed enrolment 22 days ahead of schedule Doctor engagement satisfaction increased Site had finished at 2nd in global ranking   Paediatric study in Delhi and Lucknow: Our team actively approached more than 120 referral physicians in the same city over the course of about six months (Government Hospitals, Private Centres, Clinics, and particularly Paediatricians, including Mohalla Clinics). In ten days, we started getting referrals and finally came to conclusion: 450 subjects were enrolled at 3 sites in 2 cities in around 6 months 100 subjects were enrolled in just 4 weeks at Lucknow site Referral-to-consent ratio improved by 85% Trial completed enrollment 10 days ahead of schedule   Strategic Recommendations: Create referral-ready procedures while taking Indian site constraints into account. The study startup phase budget for digital pre-screening tools. Include the PICs model in the outreach and site viability plan. Assist sites undergoing digital transformation, from EMR integration to WhatsApp outreach. Create a site-sponsor-doctor triangle that encourages cooperation rather than only observation. Small budget for recruitment leads to substantial impact to the clinical trial cycle.   Conclusion: India has enormous potential for patient recruitment, but sponsors need to think beyond the box. In addition to expediting their deadlines, sponsors can establish credibility within the local clinical research ecosystem by developing site-centric, digitally enabled, and referral-smart models, such as the PICs framework designed by the author. The future of patient recruitment lies in strategic, supportable engagement — and the time to act is now. A well-crafted and practical recruitment strategy, tailored to the real-world challenges of the site, facilitates faster link with the right patients and drives the accomplishment of research goals. “In research, time isn’t just money — it’s medication, momentum, and meaningful outcomes.” Every delayed enrolment in any clinical study is a step away from hope — for the patient, the doctor, and the data.   Puneet Kumar, Clinical Research Consultant, Founder, Medivista Research (India) ]]> https://biospectrumindia.com/views/21/25962/future-of-medtech-and-medical-services-in-india-a-transformational-leap.html https://biospectrumindia.com/views/21/25962/future-of-medtech-and-medical-services-in-india-a-transformational-leap.html Tue, 08 Apr 2025 00:00:00 +0530 The Indian MedTech and healthcare services industry stands at the brink of a groundbreaking transformation. Fuelled by rapid technological advancements, progressive government initiatives, and a substantial increase in healthcare expenditure, the MedTech sector is primed for unprecedented expansion. The Union Budget 2025 laid a strong foundation for a more resilient and advanced healthcare ecosystem, thereby setting the stage for remarkable progress in Point-of-Care (PoC) technology, AI-driven diagnostics, and cutting-edge digital healthcare solutions in the coming years.   Union Budget 2025: A Boost for Healthcare Finance Minister Nirmala Sitharaman’s announcement of an 11% increase in healthcare expenditure from the previous fiscal year signals the government’s reinforced commitment to strengthening the sector. With rising healthcare demands and an evolving MedTech landscape, this boost in spending is both timely and necessary. This budgetary allocation is designed to: Strengthen healthcare infrastructure to provide better accessibility and quality of care across the country. Promote medical tourism, thereby making India a preferred global destination for high-quality, affordable treatments. Encourage research and development (R&D) in medical technology to develop cutting-edge solutions. Boost public-private partnerships to ensure government policies and private sector capabilities work together for better healthcare services. Although this is a step in the right direction, experts believe that there are gaps that require urgent attention. Industry professionals expected bigger incentives for R&D in medical technology, extensive tax benefits for private healthcare investments, and increased support for manufacturing medical devices in India under the 'Make in India' initiative. Without these, India's MedTech sector may struggle to keep pace with global counterparts, limiting its potential to become a true leader in healthcare innovation.   The Digital Healthcare Revolution One of the most transformative changes in India’s healthcare sector is the adoption of digital healthcare technologies. AI-driven diagnostics and automation are reshaping how doctors identify and treat diseases, making healthcare more precise and efficient. By minimizing misdiagnoses, accelerating treatment decisions, and optimizing medical workflows, AI is alleviating the strain on India’s overburdened healthcare system. With rising patient loads, these intelligent solutions enable doctors to deliver faster and more accurate care, ultimately improving patient outcomes. Another significant advancement is the growth of telemedicine and IoT-enabled (Internet of Things) medical devices. These technologies are bridging the gap between patients and healthcare providers, particularly in remote and underserved areas. Through virtual consultations, individuals can access expert medical advice without the need for long and costly travel. IoT-enabled medical devices further enhance patient monitoring, allowing real-time tracking of vital health parameters and early detection of potential health issues. As digital healthcare platforms gain widespread adoption, India’s healthcare system is evolving into one that is more accessible, patient-centric, and cost-effective. By integrating these innovations, the country is not only addressing healthcare disparities but also paving the way for a future where high-quality medical care is within reach for all.   The Rise of Point-of-Care Technology and AI PoC technology, combined with the IoT, is redefining modern healthcare. Patients can now track vital health parameters from the comfort of their homes, drastically reducing dependency on traditional lab visits. This paradigm shift, powered by AI and ML (Machine Learning) integration, is revolutionizing early detection, thus enabling faster interventions, and significantly improving patient outcomes. The global PoC diagnostics market is projected to soar to $85.6 billion by 2027, with a robust CAGR of 9.4%. Meanwhile, AI-driven diagnostics have enhanced accuracy by 30-40%, slashing misdiagnoses rates and accelerating treatment decisions. The exponential rise in smart wearables and remote monitoring devices is paving the way for real-time health analytics and predictive care solutions, making proactive healthcare more accessible than ever before. For India’s overburdened public healthcare system, AI-driven early screening through PoC technology presents a game-changing opportunity. By shifting the focus from reactive to preventive care, this advancement can ease pressure on hospitals, optimise resource utilization, and ensure swifter, more efficient treatment for millions.   India as a Global Medical Tourism Hub India is rapidly establishing itself as a leading destination for medical tourists from around the world. With internationally accredited private hospitals, cutting-edge medical technology, and treatment costs that are significantly lower than those in Western countries, India is attracting a growing number of patients seeking high-quality healthcare at affordable prices. The country’s medical tourism industry is projected to reach $13 billion by 2026, driven by increasing global demand for advanced yet cost-effective medical treatments. Several factors make India a preferred choice for international patients: Highly qualified doctors and surgeons trained in globally recognized institutions, offering expertise in a wide range of medical specialties. State-of-the-art hospitals equipped with world-class infrastructure and the latest innovations in medical technology, ensuring high success rates in complex procedures. Affordable healthcare, with treatments costing 50-70% less than in countries like the U.S., U.K., and other Western nations, making it a cost-effective alternative for patients without insurance or those facing long wait times in their home countries. Comprehensive alternative medicine options, including Ayurveda, naturopathy, and holistic therapies, which attract wellness-focused travellers looking for integrative treatment approaches. Additionally, India’s private hospitals are making significant investments to improve patient care, infrastructure, and service quality. Over the next two years, private healthcare spending is expected to grow by 12-15%, further boosting the MedTech and pharmaceutical industries. Many hospitals are also enhancing their international patient services by offering visa assistance, language support, concierge services, and specialized medical tourism packages. As India continues to refine its healthcare ecosystem with advanced medical procedures, cutting-edge research, and superior patient services, it is well on its way to becoming a global leader in medical tourism and a preferred destination for high-quality, affordable healthcare.   The Ayushman Bharat Digital Mission: A Game Changer The Indian government is also taking major steps to digitize healthcare through the Ayushman Bharat Digital Mission (ABDM). This initiative is transforming how medical records and patient data are managed. By using cloud computing and encrypted digital systems, ABDM will: Enable seamless transfer of patient information between hospitals and clinics. Improve transparency in medical records, allowing patients to access their data easily. Reduce medical errors, unnecessary tests, and treatment duplications, making healthcare more efficient and precise. By streamlining patient data management, ABDM is laying the foundation for a smarter, more efficient, and globally competitive healthcare system in India.   The Road Ahead for India’s MedTech Industry Although India is still in the early stages of fully integrating medical technology into its healthcare system, the momentum is undeniable. With strong government backing, rapid technological advancements, and increasing private sector investments, the country is on track to become a global leader in healthcare innovation. The widespread adoption of AI-driven diagnostics, Point-of-Care technology, and digital healthcare solutions is set to transform the industry. These advancements will enhance efficiency, improve accessibility, and lower costs, making high-quality healthcare more attainable for millions. Beyond serving its growing population, India’s progress in MedTech will also strengthen its position as a key player in the international healthcare market. India is not just embracing a healthcare revolution—it is shaping the future of global medical innovation.   Mahesh Makhija- Founder, Chairman, and Managing Director of QMS Medical Allied Services ]]> https://biospectrumindia.com/views/21/25905/global-crisis-of-dental-caries-.html https://biospectrumindia.com/views/21/25905/global-crisis-of-dental-caries-.html Fri, 28 Mar 2025 00:00:00 +0530 Dental caries is one of the most common diseases in humans and have been a significant issue within the dental community that can cause pain, various infections, and loss of teeth. This could eventually lead to functional and emotional trauma by affecting a person's appearance, emotional well-being, and self-esteem.  For decades, dentists and numerous health organisations have been working tirelessly to prevent this by attempting to decipher effective and efficient ways to decrease the prevalence of dental caries in patients. In order to eliminate the prevalence of dental caries across all age groups and genders, it is vital to understand how they affect the individual groups. A research project in the US has found that individuals ages 31-50 have the greatest amount of treated dental caries while individuals aged 6-8 have the least amount of treated dental caries. This is based on the evidence that the prevalence of treated dental caries was the highest among individuals aged 31-50 (52.7%) and the lowest among individuals aged 6-18 (49.7%).  The same project also concluded that females have a higher prevalence of treated dental caries than males across all age groups based on data suggesting that there is not only a greater amount of treated dental caries in females than males, but significantly more by at least 5.3%. Additionally, the average prevalence of treated dental caries in females of all ages was 29.9%, while the average prevalence of treated dental caries in males of all ages was 22.7%.  Considering India makes up around 17.5% of the world's population, it's an important country to observe when it comes to assessing the prevalence of dental caries based on demographics. Research from the EAS Journal of Dentistry and Oral Medicine in 2023, suggests that out of the 1.4 billion individuals in India, over half of them are affected by dental caries. Dental caries had a prevalence of 62% in patients over the age of 18 and 52% in patients aged 3-18 among the Indian population.  The presence of dental caries in India between males and females are quite similar with males showing a prevalence of 52%, and females with 49%. The males were proven to be mainly caused by behavioural factors while the prevalence indicated in females were related to genetic and biological factors.  Currently in India, there has been limited developments in the form of studies and research projects to find treatment for dental caries. This shields more than half the population from getting the healthcare needed to get treatment for their dental caries.  On the other hand, studies across the globe are showing developments of innovative solutions to counter this growing healthcare burden. For instance, a recent study from the Frontiers in Cellular and Infection Microbiology states that nanosystems for drug delivery has been a major development in terms of prevention and treatment of dental caries. The systems directly provide the drug to the lesion sites of the teeth, thus inducing a therapeutic effect on the patient, leading to fewer side effects that fortify the intended treatment effect by enhancing the bioavailability of the drug.  Further, the latest technology of 3D printing is educating patients by providing them with tangible and visual models of their oral anatomy and treatment plans, allowing for greater understanding and collaboration. The latest edition of 3D printing makes the treatment process of dental caries and other oral diseases significantly more efficient. It revolutionises dentistry by allowing for highly accurate and precise dental models, prosthetics, and surgical guides, which leads to better-fitting restorations, safer surgeries, and improved patient outcomes.  In addition to these new technological developments, dental caries can be decreased through cost effective prevention strategies which should pivot around spreading awareness among masses about the undesirable outcomes of oral health diseases and educating them about the importance of good oral hygiene.   Nysa Sharma ]]> https://biospectrumindia.com/reports-white-papers/21/25873/top-3-term-insurance-plans-in-india-with-high-coverage-and-low-premiums.html https://biospectrumindia.com/reports-white-papers/21/25873/top-3-term-insurance-plans-in-india-with-high-coverage-and-low-premiums.html Mon, 24 Mar 2025 00:00:00 +0530 It covers a fixed premium over a certain term for an assured sum that is paid to the beneficiary in case of their demise during the insurance term. People tend to weigh in on options to find the best term plan that fits their budget while maintaining decent coverage. Others advocate the most rewarding plan, which offers a return on premium, i.e., the insured gets all premiums paid back if he survives the term.    In this post, we will examine the three most popular term insurance plans in India, which offer the highest coverage for the lowest premium, and discuss what distinguishes them from other options.   Understanding the Benefits of a Term Plan   People often look for the best term plan to protect their family. But what makes a term policy so special compared to other saving options? One of the most important factors is that it has no investment component. This means you are not paying extra for wealth-building. It’s purely about giving your family a safety net if you aren’t there. That often translates into lower premiums for higher coverage compared to other investment products. Terms can range from five years to as long as 50 years. Premiums usually remain the same throughout, which is great for long-term planning.   Many term plans also come with a possibility for riders, like an accidental death benefit or waiver of premium if you’re diagnosed with certain illnesses. Some allow a return of premium option, often called TROP (Term Return of Premium), which means that if you survive the policy term, you get back all or most of the premiums paid, excluding taxes and rider charges. This is especially appealing to those who want the best term plan with return of premium since it combines protection with some money-back component.   Top 3 Term Insurance Plans In India   The following table provides an overview of the top 3 term insurance plans in India for 2025. These are known for offering high coverage at relatively low premiums, though the exact cost can vary based on factors like age, health conditions, and the sum assured. Look through the table to get a basic idea of what each plan offers.   Insurance Provider Plan Name Entry Age Maximum Maturity Age Sum Assured Axis Max Life Insurance Company Limited Max Life Smart Total Elite Protection 18-65 yrs 85 yrs Rs. 2 Crore- No limit Aditya Birla Sun Life Insurance Company Limited ABSLI Income Suraksha Plan 21-55 yrs 70 yrs Rs. 25 Lacs - Rs. 25 Cr Aviva Life Insurance Company India Limited Aviva Signature 3D Term Plan 18-65 yrs 80 yrs Rs. 5 Lacs - No Limit   Each plan has its own unique features.  Some have certain advantages with optional riders, while others have been basically recognised for their quick claim settlements. You will have to look closely at other factors too, such as whether the plan pays the sum assured all at once or periodically over a month, to know which one suits your family best.    Exploring the Top 3 Plans in Detail   Max Life Smart Total Elite Protection – Best Overall Coverage with Customisation Offers broad coverage options, including a sum assured above Rs. 2 crore, plus features like terminal illness cover. You can customise the payout structure into a lump sum, monthly income, or a combination. It also highlights a high claim settlement ratio of around 99.65%.   Aditya Birla Sun Life Income Suraksha Plan – Best for Stable Income Replacement Designed to provide regular income to the nominee in case of the policyholder’s death. This stable income approach helps families manage monthly expenses without handling a large lump sum all at once.    Aviva Signature 3D Term Plan – Best for Critical Illness and Disability Cover Emphasises broad coverage with no stated upper limit on the sum assured. It includes benefits for a variety of critical illnesses, disabilities, and other conditions. Policyholders can choose from different payout styles. How to Choose the Best Term Plan? Now that we’ve gone through the top contenders, how do you pick the one that works best for you? Consider the following -   What’s Your Life Stage? If you’re single, a basic term plan might be enough. If you have a family, consider one with income replacement. Do You Have Liabilities? If you have loans, go for a higher sum assured to cover those debts. Do You Want Riders? Consider critical illness cover, accidental death benefits, and premium waiver options. How Long Do You Need Coverage? Plans with maturity ages of 80+ years work well if you want to leave a financial legacy.   Conclusion   Each policy we highlighted can be considered the best term plan for a particular group of people. Axis Max Life’s product stands out for its broad coverage and customisable features. Aditya Birla Sun Life’s plan is great for replacing stable monthly income. Aviva’s product offers a wide range of protection, including coverage for multiple illnesses.   In any case, the “best plan” for you is the one that meets your specific needs. If you prefer the best term plan with return of premium, double-check that your chosen insurer has that option or a similar variant. If you have big expenses on the horizon, like a home loan or sending your child abroad for university, a high sum assured is wise.   Term insurance doesn’t have to be confusing. The key is to figure out how much coverage you need, what budget you can handle, and which insurer you trust. With that in place, you’ll have a policy that safeguards your family’s future in a cost-effective way.   Standard T&C apply   Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale. Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions. ]]> https://biospectrumindia.com/reports-white-papers/21/25874/term-insurance-vs-life-insurance-key-difference-explained-.html https://biospectrumindia.com/reports-white-papers/21/25874/term-insurance-vs-life-insurance-key-difference-explained-.html Mon, 24 Mar 2025 00:00:00 +0530 Among the various types of insurance available, Term Insurance vs Life Insurance is a standard comparison that often confuses buyers. Both policies provide financial security, but they cater to different needs. Understanding the difference between Term Insurance and Life Insurance can help you make an informed decision. What is Term Insurance? Term Insurance is the simplest form of Life Insurance, providing coverage for a specific period. It is designed to offer financial protection to the policyholder’s family in case of an unfortunate event. Unlike other Life Insurance plans, Term Insurance does not offer maturity benefits. The policyholder pays regular premiums, and if they pass away within the policy term, their nominee receives the sum assured. Types of Term Insurance Plans   There are primarily five types of term insurance plans available: Level Term Insurance Plan – The premium remains the same throughout the policy duration. Increasing Term Insurance Plan – Coverage increases as you age to meet rising financial needs. Decreasing Term Insurance Plan – Coverage decreases over time and is often suited for covering liabilities like loans. Convertible Term Insurance Plan – Allows policyholders to convert their term plan into a Life Insurance policy. Term Insurance Plans with Riders provide additional benefits, such as critical illness coverage and accidental death coverage. What is Life Insurance? Unlike Term Insurance, Life Insurance provides financial protection and is a savings instrument. A portion of the premium provides death benefits, while the other part is saved or invested to generate returns. Life Insurance policies generally offer maturity benefits, making them an excellent choice for individuals seeking financial growth and security. Types of Life Insurance Plans There are primarily six types of life insurance plans available: Whole Life Insurance Plan – Coverage extends throughout the policyholder’s lifetime. Endowment Assurance Plan – Offers maturity benefits if the policyholder survives the policy term. Money-Back Plan – Provides periodic payouts instead of a lump sum at maturity. Child Plan – Designed to secure the child’s financial future. Unit-Linked Insurance Plan (ULIP) – A combination of Life Insurance and investment. Pension Plan – Provides a steady income post-retirement. Key Differences: Term Insurance vs Life Insurance Features Term Insurance Plan Life Insurance Plan Coverage Provides only death benefits to the nominee Offers both death and maturity benefits Maturity Benefits No maturity benefits Provides savings and investment benefits Term Period 10 to 35 years 5 to 30 years (whole life plans available) Flexibility Allows riders for additional coverage Offers loans, partial withdrawals, and riders Policy Surrender Policy lapses if premiums are not paid Early withdrawals may lead to deductions Which One Should You Choose? When to Choose Term Insurance? If you need a pure Life Insurance plan without investment benefits. If you want higher coverage at affordable premiums. If you are looking for financial protection for your family in case of your untimely demise. When to Choose Life Insurance? If you want a combination of life cover and savings. If you need financial security for your dependents along with wealth creation. If you are planning for long-term financial goals such as child education, retirement, etc. Buying Insurance Online Today, purchasing Term Insurance vs Life Insurance online has become more convenient. Various insurers offer online policy comparisons, making selecting the best plan suited to your needs easier. Before finalising a policy, compare coverage, benefits, and premium costs to make an informed decision. Conclusion Understanding what is the difference between Term Insurance and Life Insurance is essential before purchasing a policy. While Term Insurance provides pure protection at an affordable cost, Life Insurance offers security and investment benefits. The choice depends on your financial goals and coverage needs. Ensure you analyse different policies, assess your requirements, and select the best insurance plan for your financial well-being.   **Tax benefits are subject to change in prevalent tax laws. Disclaimer: Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.   ]]> https://biospectrumindia.com/features/21/25812/andhra-pradesh-government-approves-rs-25-lakh-health-insurance-coverage-for-every-family.html https://biospectrumindia.com/features/21/25812/andhra-pradesh-government-approves-rs-25-lakh-health-insurance-coverage-for-every-family.html Tue, 11 Mar 2025 00:00:00 +0530 This initiative aims to provide comprehensive medical coverage, ensuring that families do not face financial burdens due to medical expenses. Announced by Minister for Health, Family Welfare, and Medical Education, Satya Kumar Yadav, this scheme fulfils a key election promise made by the NDA government. The cashless insurance model will enable seamless access to healthcare services at network hospitals across the state. Under this initiative, 3,257 medical procedures that were previously covered under the Dr NTR Vaidya Seva scheme will be included, with the possibility of additional treatments being added. The government has adopted a hybrid model for implementing the insurance plan, involving private insurance companies to manage claims and service delivery. The main objective is not only to ensure financial viability but also to enhance the efficiency and transparency of the healthcare system. Key features of the health insurance scheme Coverage of Rs 25 lakh per family per year for medical expenses Cashless treatment at network hospitals across the state Inclusion of 3,257 medical procedures covered under Dr NTR Vaidya Seva scheme Reduction in pre-authorisation time for medical treatments from 24 hours to 6 hours Faster claims processing and fraud detection to ensure transparency Introduction of a hybrid insurance model involving private insurers The state government has carefully designed this policy to ensure that families receive timely and quality medical care without financial stress. By partnering with private insurers, the administration aims to improve claim settlement processes and hospital service efficiency. Government’s vision for the scheme The Andhra Pradesh government envisions a healthcare system where no family is left without medical coverage. Chief Minister N Chandrababu Naidu has emphasised the importance of making quality healthcare accessible, especially for economically weaker sections. According to Minister Satya Kumar Yadav, this initiative is not merely an election promise but a well-planned effort to streamline health insurance operations and reduce administrative delays. The hybrid insurance model is expected to distribute financial risk between the government and private insurers, ensuring that the scheme remains sustainable in the long run. Additionally, the initiative is expected to boost public confidence in government healthcare schemes, encouraging more people to opt for state-funded medical services rather than private insurance policies. How the scheme will improve healthcare accessibility The launch of this statewide health insurance programme will significantly improve access to quality healthcare in Andhra Pradesh. Some of the key areas where this scheme will make a difference include: Affordable medical care – Families will no longer have to worry about high medical expenses, as hospitalisation and treatments will be covered under the scheme. Better healthcare facilities – With assured government-backed payments, hospitals are expected to provide better care and upgrade medical infrastructure. Reduction in administrative delays – Claim processing times will be minimised, enabling faster access to treatments. Enhanced trust in public healthcare – Citizens will be encouraged to use government healthcare services instead of relying on expensive private hospitals. With faster pre-authorisation times, hospitalisation and emergency medical care will become more accessible. This is expected to reduce out-of-pocket healthcare expenses, particularly for low-income families. Financial structure of the scheme The financial framework for this health insurance programme has been carefully planned to ensure its long-term sustainability. According to Minister Yadav, the funding structure involves both government contributions and private sector participation. The scheme has provisions for: Refunds to the government if the total claims are lower than the agreed-upon premium Insurance companies covering up to 15% of excess claims beyond the premium amount The remaining excess costs being shared between the government and insurers Additionally, the government is working on premium structures for Above Poverty Line (APL) individuals to ensure that all sections of society have access to affordable family health insurance. Faster claims processing and fraud detection One of the most significant advantages of this scheme is the emphasis on faster claims processing and fraud prevention. The pre-authorisation time for hospital services will be reduced from 24 hours to 6 hours, ensuring that patients receive medical attention without unnecessary delays. The introduction of private insurance companies will also help in: Strengthening fraud detection systems to prevent misuse of the scheme Ensuring timely and hassle-free claim settlements Encouraging hospitals to provide better services through assured payments The streamlined claim process will enhance hospital trust in government-backed insurance, making more healthcare institutions willing to participate in the scheme. Potential impact on the healthcare system The Rs 25 lakh health insurance scheme is expected to significantly strengthen the public healthcare system in Andhra Pradesh. With more families gaining access to free and cashless medical treatment, the state aims to achieve: Increased hospital admissions in government and network hospitals Encouragement of preventive healthcare practices, reducing emergency cases Improved infrastructure in hospitals due to timely and guaranteed payments Increased public confidence in the state-sponsored healthcare system The scheme’s hybrid model also means that insurance companies will be actively involved in monitoring the efficiency of service delivery, making the entire system more accountable and transparent. Conclusion The Andhra Pradesh government's Rs 25 lakh family health insurance scheme is a groundbreaking initiative aimed at making quality healthcare accessible to every family. With its cashless treatment model, reduced claim processing time, and fraud detection measures, the scheme is expected to transform healthcare delivery across the state. By integrating private insurance companies, the government has ensured efficient claim processing, hospital payments, and transparency. This scheme not only provides financial security to families but also strengthens public healthcare services in Andhra Pradesh. As the government finalises the implementation plan, this initiative is set to become a model for state-sponsored health insurance across India, providing affordable, efficient, and quality healthcare to millions of people. ]]> https://biospectrumindia.com/views/21/25799/transformation-of-sustainability-claims-in-cosmetics-industry.html https://biospectrumindia.com/views/21/25799/transformation-of-sustainability-claims-in-cosmetics-industry.html Fri, 07 Mar 2025 00:00:00 +0530 The European Union's Green Claims Directive (GCD) is set to transform sustainability claims in the cosmetics industry. This regulation mandates scientifically backed, independently verified environmental claims to combat greenwashing, a widespread issue where brands make misleading statements about their products’ ecological benefits.  For cosmetics manufacturers, ingredient suppliers, and private-label brands, this directive presents both compliance challenges and strategic opportunities. Companies that align with the GCD will enhance their credibility, secure B2B partnerships, and future-proof their market access across the EU. Understanding the Green Claims Directive: What It Means for Cosmetics Businesses  The GCD is designed to ensure accuracy, transparency, and accountability in environmental claims made by companies. It requires that all green claims be substantiated with data, verified by an independent third party, and comply with EU-wide labeling standards.  The directive stems from alarming findings by the European Commission: A Commission study from 2020 highlighted that 53.3% of examined environmental claims in the EU were found to be vague, misleading or unfounded and 40% were unsubstantiated (European Commission, 2021). 80% of webshops, webpages, and advertisements contain ‘green claims’ and 56% of EU consumers have encountered misleading green claims (EU Factsheet, 2022). The GCD’s impact is far-reaching, affecting not only cosmetics manufacturers but also raw material suppliers, distributors, and retailers. Businesses that fail to comply risk financial penalties, market exclusion, and reputational damage.   Key Requirements of the Green Claims Directive for B2B Cosmetics Companies Scientific Substantiation of Environmental Claims  The most significant change under the GCD is the requirement for comprehensive, data-driven validation of environmental claims. Companies must prove sustainability benefits across the entire life cycle of a product, covering: Raw material sourcing (supply chain emissions, impact on biodiversity) Manufacturing processes (carbon footprint, water consumption, energy use) Packaging materials (recyclability, biodegradability, carbon impact) Distribution & disposal (transport emissions, product end-of-life impact)  For instance, a claim like “biodegradable packaging” must include scientific evidence confirming how the material decomposes under real-world conditions.  Compliance Challenges for B2B Companies: Ingredient suppliers must provide full traceability and verified sustainability reports for raw materials. Manufacturers need to conduct Life Cycle Assessments (LCA), which can cost €10,000 - €40,000 per product, depending on complexity. Private-label brands must align claims with third-party verified supplier data to maintain EU market access. Mandatory Third-Party Independent Verification  To eliminate unsubstantiated greenwashing, all environmental claims must be reviewed by an EU-accredited third-party certification body before they can be used in marketing or product labeling.  Financial and Operational Impact: Verification costs range from €5,000 to €15,000 per product, depending on the scope of the claim. Large cosmetics companies may incur compliance costs exceeding €1 million per year due to extensive product portfolios and aggressive marketing claims. Contract manufacturers and suppliers must integrate verification processes into production workflows to maintain credibility in B2B transactions. Risk of Non-Compliance: Companies making unverified claims face fines up to 4% of annual EU turnover. Retailers and distributors may blacklist non-compliant suppliers, prioritizing partners with verified sustainability credentials.  The verification process results in an EU-wide Certificate of Conformity, allowing compliant companies to market their products across all 27 member states without country-specific approvals. Standardisation of Sustainability Labels  The GCD also restricts the use of environmental labels unless they meet EU-approved criteria. Eurobarometer survey found that 27% of European respondents were aware of the EU Ecolabel. Additionally, 32% stated that ecolabels significantly influence their purchasing decisions. Among those familiar with ecolabels, 30% reported having purchased a product bearing the EU Ecolabel, and 78% expressed trust that such products are environmentally friendly. A more recent Eurobarometer survey, conducted between February and March 2021, revealed that 22% of European respondents had purchased products with an environmental label. These findings highlight the important role labels play in shaping European consumers' purchasing behavior.  Companies must revise their labeling and branding strategies to comply with harmonized EU standards, preventing legal disputes and costly rebranding efforts. Ban on Generic or Unverified Green Claims  The directive strictly prohibits vague, unsubstantiated terms like:  “Eco-friendly”  “Sustainable”  “Climate-neutral”  “Green”  Instead, companies must use quantifiable, data-backed claims. For example: ❌ “Sustainable Packaging” → NON-COMPLIANT ✅ “Packaging made from 85% post-consumer recycled plastic, reducing CO₂ emissions by 35%” → COMPLIANT This shift forces cosmetics companies to redesign marketing strategies, requiring closer collaboration between R&D, compliance teams, and marketing departments.   Financial and Strategic Impact of GCD on the Cosmetics Industry  Compliance Costs vs. Long-Term Benefits  While compliance introduces significant costs, companies that align early will gain a competitive advantage through: Enhanced credibility in B2B partnerships (retailers & distributors favor verified suppliers). Access to all EU markets under a single certification system. Stronger consumer trust and higher market share due to transparent sustainability reporting. Strategic Compliance Roadmap for Cosmetics Businesses To successfully align with the GCD, cosmetics companies must: Conduct Comprehensive Life Cycle Assessments (LCA) Implement real-time sustainability tracking tools. Collaborate with suppliers to obtain verified carbon footprint data. Engage with Accredited Third-Party Certifiers Partner with EU-recognized sustainability auditors. Obtain Certificates of Conformity for all green claims. Standardize EU-Compliant Labeling Eliminate ambiguous claims and adopt data-backed metrics. Train marketing teams on GCD-compliant communication strategies. Educate Internal Teams and B2B Partners Align R&D, legal, and marketing teams with new sustainability standards. Provide clear compliance guidelines for contract manufacturers and ingredient suppliers.  Conclusion: A Strategic Opportunity for Sustainability Leadership  The EU Green Claims Directive represents a paradigm shift in sustainability marketing. While compliance requires significant investment, it also creates long-term competitive advantages. Companies that act now will be better positioned to build trust, secure B2B partnerships, and expand market access across the EU. By imposing stricter rules on how environmental claims are substantiated and communicated, the GCD seeks to rebuild consumer trust and reduce the prevalence of greenwashing. While the costs of compliance may be high, especially for smaller companies, the long-term benefits of aligning with these standards include enhanced credibility, consumer loyalty, and potential market share growth. Companies that invest in transparent, verifiable sustainability practices will be better positioned to thrive in an increasingly regulated market.   Sandesh Ramesh Tetgure, Assistant General Manager, Regulatory Strategic Services, Freyr Solutions ]]> https://biospectrumindia.com/views/21/25768/biopharma-chromatography-segregating-opportunities-of-all-sizes.html https://biospectrumindia.com/views/21/25768/biopharma-chromatography-segregating-opportunities-of-all-sizes.html Sat, 01 Mar 2025 00:00:00 +0530 Chromatography systems play a critical role across different industries, in processes like drug development, nutritional analysis, toxin detection, pollutant analysis, among others. This being one of the most preferred methods for the separation and purification of compounds across the aforementioned industries, its market share is worth $10+ billion as of 2025. Approximately 30 per cent of this market is driven by biopharma, making it a cornerstone industry for chromatography systems.  Biopharma Chromatography Market   Ever since the outbreak of COVID-19, the world has been on its toes regarding healthcare operations. Governments and the public have become more alert towards healthcare facilities and 2020 can be seen as a landmark year that reshaped several trends within the healthcare sector, including chromatography. To tackle COVID-19 at its peak, the year 2020 saw the highest increase (>10 per cent higher compared to 2019) in global healthcare spending and the Biopharma sector saw its highest ever ~130 per cent increase in funding from $58 billion in 2019 to ~$134 billion in 2020. For chromatography systems specifically, the pandemic led to an increased usage of single-use systems (SUS) to avoid cross-contamination and to support the then-necessary rapid vaccine production. As a result, the acceptance of SUSs in different clinical and commercial production processes has increased from an average of ~50 per cent in 2019, to ~70 per cent in 2024.   The trend though, in terms of the selection of the media type has been rather unaffected by the major shifts and Liquid Chromatography (LC) still reigns over Gas Chromatography (GC) by a significant factor. The dominance of LC can be mainly attributed to its compatibility with a wide range of biomolecules and currently, the industry is rapidly adopting more advanced LC techniques like High-Performance Liquid Chromatography (HPLC) and Ultra-High-Performance Liquid Chromatography (UHPLC).  According to reports, the top 5 players in the Biopharma Chromatography Market namely Thermo Fisher Scientific Inc., Shimadzu Corporation, Waters Corporation, Danaher Corporation, and Agilient Technologies Inc., capture >60 per cent of the market, and all of them have a strong portfolio for LC systems. But, as of January 2025, only two of them offer single-use systems.  It should also be noted that three out of the above-mentioned five leading players are US-based and that, combined with the United States’ $180 billion annual healthcare R&D budget, positions the US as the leading player in the Biopharma Chromatography Market. While the US is expected to maintain its dominance in the market for another decade, if we look at the immediate next five years, not the US or China, but India is expected to be the fastest growing country, according to Stratview Research. Presence in Indian Market  The demand for biopharma chromatography systems in India will emanate both from domestic as well as international needs. As per the India Brand Equity Foundation (IBEF) India has the largest number of the United States Food and Drug Administration (USFDA)-compliant pharmaceutical plants outside the US and currently supplies over 50 per cent of the global demand for various vaccines, 40 per cent of generic demand in the US, and 25 per cent of all medicine in the UK. This is primarily because of the presence of a skilled workforce, in combination with cheaper operations. Conducting clinical trials in India is anywhere between 40 and 70 per cent cheaper as compared to the US and Europe, and the manufacturing of drugs is also 30-35 per cent cheaper. Thus, India already is one of the most preferred hubs for pharmaceutical process outsourcing, in the West.  Moreover, recent policies like the US Biosecure Act, which was introduced in 2024 and restricts US pharma companies from doing business with certain Chinese companies, will open even newer avenues for the Indian market. Since chromatography systems are critical in both clinical trials as well as drug testing and manufacturing operations, an increase in the number of Contract Manufacturing Organisation (CMO) and Clinical/Contract Research Organisation (CRO) deals with India will drive significant demand for chromatography systems.  Apart from the external demand, there are several factors that will drive the market internally. In the past 5 years, India’s biotechnology R&D expenditure has increased >3x, from ~$300 million in 2020 to $1 billion in 2024 and, the Common Healthcare Expenditure (CHE) as a  per cent of GDP has also been increasing consistently for the same period. Additionally, several schemes like the Strengthening of Pharmaceutical Industry (SPI), the BIO-E3 biotechnology policy, and the PRIP (Promotion of Research and Innovation in Pharma MedTech Sector) further strengthen the development of the pharmaceutical industry in India. The BIO-E3 biotechnology policy announced in 2024 for instance, is the nation’s 1st ever Biotechnology policy and has been given Rs 1000 crore to further accelerate innovations in biotechnology, demanding advanced analytical techniques.  The PRIP scheme, proposed by the Department of Pharmaceuticals in 2024 has a budget outlay of Rs 5000 crore and aims at transforming the Indian pharmaceuticals sector by strengthening the research infrastructure in the country.  The supporting government policies and the increasing number of CRO and CMO contracts from overseas will act as the primary drivers behind India’s strong positioning in the market and according to Stratview Research, India will generate a demand for 1000+ biopharma chromatography systems annually, every year, starting 2028. Next Step is Integration    The direction in which the industry is headed currently, is the direction of integration, automation, and collaboration. Integrating blocks like mass-spectrometry into chromatography operations helps achieve improved separation of more complex mixtures and not to mention, automating the process leads to an increase in sample throughput and the overall efficiency thus.  AI, just like every other domain, has found application in bioprocessing systems as well. Integrating AI technology in autosamplers allows for streamlined workflow and when combined with cloud-based data management systems, allows better collaboration between researchers and analysts. For instance, in 2024, Waters Corporation announced the launch of the HPLC CONNECT software, which is an all-in-one software platform enabling full digital synchronisation between HPLC/UPLC systems and multi-angle light scattering instruments (MALS) – vital instruments for complex and critical biopharmaceutical processes. The software enables users to control and monitor HPLC modules including pumps, column ovens, UV detectors, and autosamplers from a single dashboard view.  The penetration of AI has seen such a surge that in 2023 alone, combined deals worth $12 billion were announced between life sciences and AI companies, which is worth ~4x the deals announced in 2022.  As AI, automation, and cloud-based solutions become increasingly central, they will not only enhance efficiency but also foster unprecedented levels of collaboration and adaptability. This integration marks the beginning of a new era, where technology and science will converge to address complex challenges and unlock the full potential of biopharmaceutical processes.   Aditya Joshi, Co-Founder and Marketing Head, Stratview Research ]]> https://biospectrumindia.com/views/21/25496/key-skills-salary-trends-in-healthcare-pharma-for-2025-healthcares-tech-transformation-reshaping-skillsets-for-a-digital-future.html https://biospectrumindia.com/views/21/25496/key-skills-salary-trends-in-healthcare-pharma-for-2025-healthcares-tech-transformation-reshaping-skillsets-for-a-digital-future.html Tue, 31 Dec 2024 00:00:00 +0530 Evolving Skillsets The healthcare and pharmaceutical industries are undergoing profound transformations, led by the adoption of artificial intelligence (AI), telemedicine, automation, and data analytics. These innovations are reshaping the workforce, creating demand for roles like data scientists, AI specialists, and platform engineers. A recent report forecasts that these technological shifts will generate 2.7 to 3.5 million new jobs by 2027, even as they replace about 23 per cent of existing positions. The integration of advanced technologies requires professionals with robust digital literacy and problem-solving abilities. For instance, telemedicine platforms depend on developers and cybersecurity experts, while virtual health assistants demand proficiency in AI and natural language processing. Alongside technical skills, healthcare professionals must also refine soft skills like patient communication and cultural competence to navigate an increasingly globalised ecosystem.   Salary Trends When it comes to salaries, the healthcare and pharma industries have shown steady growth in salaries over the past five years. Between 2020 and 2024, salaries for fresher roles in these sectors increased from Rs 1.7 lakh per annum to Rs 2.2 lakh per annum, while lateral roles saw stable compensation levels around Rs 9.9 lakh per annum. Technology-specific roles such as AI engineers, machine learning experts, and data scientists have witnessed higher growth in salaries, with entry-level positions starting at Rs 9.6 to 10.2 lakh per annum and senior positions commanding over Rs 24 lakh per annum. However, despite a general salary increase of 9–10 per cent annually, disparities remain. Factors like company size, location, and specialisation play crucial roles in determining compensation. Urban hubs like Bengaluru and Hyderabad offer higher salaries, reflecting their status as tech-driven healthcare hubs.   Challenges in Talent Acquisition While technological integration is advancing at an unprecedented pace, a notable skill gap poses significant challenges for organisations. Many professionals lack hands-on experience with advanced medical technologies, and communication gaps hinder seamless interactions in global settings. According to recent studies, there is an envisioned shortage of over 2.36 lakh medical technologists and nearly two lakh surgical professionals. Bridging this gap means focused efforts from all sides. Healthcare institutions must collaborate with educational institutions to align curricula with industry needs. Furthermore, reskilling programmes targeting mid-career professionals can help fill critical gaps, ensuring a steady pipeline of talent capable of driving innovation.   Upskilling  Healthcare and pharma organisations are adopting multifaceted strategies to upskill their workforce. AI-driven learning platforms are personalising training modules, enabling professionals to acquire cutting-edge skills in data analytics and machine learning. Partnerships with EdTech companies like Coursera are expanding access to specialised training in areas such as robotic process automation and IoT. Today, certification programmes addressing regulatory compliance are becoming standard, equipping employees to navigate complex data privacy frameworks. Moreover, companies are investing in employee-centric initiatives like flexible work arrangements and career growth pathways to attract top talent.   From Roadblocks to Opportunities Technology adoption brings both challenges and opportunities. One of the primary concerns is data security. The rise of digital health records has increased vulnerability to breaches, necessitating robust cybersecurity frameworks. Meanwhile, regulatory complexities, especially in cross-border operations, demand agility and adaptability. However, these roadblocks create ample opportunities. Enhanced data analytics capabilities empower healthcare providers to offer personalised care, while AI-driven diagnostics improve operational efficiency. Emerging technologies like quantum computing and 5G promise to revolutionise patient care, creating an interconnected Internet of Medical Things (IoMT) ecosystem.   A Tech-driven Future Looking ahead, the demand for advanced technical skills is set to accelerate. Expertise in AI, genomics, telemedicine, and cybersecurity will be indispensable as the industry moves toward a digitally integrated model. With this shift, salaries for niche roles are projected to increase significantly, particularly in high-demand areas like automation and personalised medicine.  As the healthcare and pharma industries continue to adopt cutting-edge technology, candidates with an interdisciplinary skill set, combining technical acumen with empathy and strategic thinking, will thrive. The emphasis will not only be on individual expertise but also collaborative problem-solving within dynamic, tech-driven teams. Healthcare and pharma are at the cusp of a tech revolution, presenting unparalleled opportunities and challenges. Addressing the skill gap, driving innovation, and creating inclusive workplaces are critical for sustaining growth. By prioritising upskilling, embracing digital transformation, and leveraging data-driven insights, these sectors are poised to redefine healthcare delivery and pave the way for a healthier, more connected future. Simply put, they are shaping the future of health and wellness, where technology and humanity meet to redefine the very essence of care.   The Outlook  The digital health market is expected to expand from $12.20 billion in 2023 to $25.64 billion by 2027. Medical devices and digital applications collectively contribute revenue of up to $4.9 and $5.2 billion to the overall digital health market. The setup of more medical colleges as planned in the Budget 2024-25 will boost the rise of ambitious youth in healthcare, it will also help transform the existing women workforce in healthcare as compared to any sector towards Digital health jobs and health tech segments.  The aim to increase the Tech Talent from the current 1 to 2 per cent in this sector is crucial. Heavy technology investments, better investments in devices and R&D schemes are awaited from the government to advance telemedicine, virtual assistants and data analytics that are expected to create 2.7-3.5 million new technology jobs with demand for talent like data scientists and AI specialists. Budget 2024-25 was also expected to impact the overall healthcare ecosystem that not only is core to delivery but disrupted by other facets such as hygiene, sanitation, water, environment & infrastructure gap, blended funding and financing models are needed to attack the rising chronic diseases, coverage for all income groups and accessibility to all.    Munira Loliwala, VP, Strategy and Growth, TeamLease Digital   ]]> https://biospectrumindia.com/views/21/25406/hiv-prevention-remains-elusive.html https://biospectrumindia.com/views/21/25406/hiv-prevention-remains-elusive.html Sun, 01 Dec 2024 00:00:00 +0530 On December 1, the world gathers every year to commemorate World AIDS Day, which serves as an important reminder that we must remain steadfast in our commitment to prevent new HIV (Human Immunodeficiency Virus) infections and provide essential services to all people living with HIV globally. In 2024, the 37th World AIDS Day opens with the theme, “Collective Action: Sustain and Accelerate HIV Progress.” According to reports by the World Health Organisation (WHO), approximately 39.9 million people were living with HIV at the end of 2023. To be specific, an estimated 1.3 million people became infected with HIV in 2023. While there has been marked progress in sub-Saharan Africa, for the first time, in 2023 more than half of the new HIV infections occurred outside of sub-Saharan Africa. Within the South East Asian region, an estimated 4 million people were living with HIV in 2023, of which 78 per cent knew their status, and 66 per cent were receiving treatment. Speaking of India, reports suggest that in 2023, 68,000 people were newly infected with HIV. As HIV continues to be a major global public health issue, claiming 42.3 million lives so far, in 2023, 630,000 people died from HIV-related causes globally. It must also be noted that the global HIV epidemic claimed 69 per cent fewer lives in 2023 since the peak in 2004. The scientific advances and tools available have changed the way we look at this infection, both epidemiologically, in terms of preventing new diseases, and therapeutically, with highly effective and well-tolerated treatments. But if 1.3 million people continue to acquire HIV every year, the response will become more challenging, more complex and more costly in the years to come, and we must act on it urgently. Long-acting technologies like pre-exposure prophylaxis (PrEP) continue to play a major role in preventing new infections, but access is limited to only a few countries. Further, new HIV prevention products in the pipeline such as long-acting injectable cabotegravir (CAB-LA) and most recently, lenacapavir, are raising expectations due to their convenience and high efficacy. However, the key challenge is accessibility and affordability. The WHO, hence, is now training sights on vaccine development  to prevent HIV infection. In November 2024, the WHO published a new study naming 17 pathogens, including HIV, as top priorities for new vaccine development. This study is the first global effort to systematically prioritise endemic pathogens based on criteria that included regional disease burden, antimicrobial resistance risk and socioeconomic impact. However, the complex biology of HIV makes the virus a tough target to tackle, because of which we still do not have a vaccine candidate ready with us. While the wait is still on, we do see hopeful projects reaching a stage of culmination which might just bring in the desired results very soon. For example, Immuno Cure BioTech, a clinical-stage biotechnology group based in Hong Kong Science Park, has recently completed the first-in-human novel therapeutic HIV vaccine, ICVAX, Phase I clinical trial with encouraging findings of exceptional safety and promising immunogenicity profiles.  The company is now communicating with the National Medical Products Administration (NMPA), the Chinese regulatory authority, for the upcoming Phase II clinical trial, anticipated to commence in mid-2025. As another major development, eight African countries including Nigeria, South Africa, Zambia, Zimbabwe, Tanzania, Uganda, Kenya, and Mozambique, have begun a groundbreaking, African-led HIV vaccine research and development project, offering hope for a vaccine tailored to the needs of the region’s population. Although in some parts of the US, testing is underway for mRNA-based HIV vaccines as well, the final breakthrough remains elusive. Even if an effective solution for HIV prevention is developed, optimum policy implementation and minimising patient stigmatisation needs to be addressed as well.    Dr Manbeena Chawla Executive Editor BioSpectrum India ]]> https://biospectrumindia.com/features/21/25335/how-medtech-startups-are-transforming-diabetes-landscape-in-india.html https://biospectrumindia.com/features/21/25335/how-medtech-startups-are-transforming-diabetes-landscape-in-india.html Sat, 09 Nov 2024 00:00:00 +0530 Nowadays, an insulin pen or daily injections are not the only options; devices like the insulin infusion pump are becoming a popular alternative for monitoring diabetes. Insulin is administered more accurately via insulin infusion pumps, which also lessen discomfort and stop large variations in blood glucose levels. Meal timings are not important while using these pumps. As a result, patients find infusion pumps easier to use. Continuous subcutaneous insulin infusion (CSII), another name for this insulin therapy, is a flexible and efficient method of delivering insulin. The insulin pump is currently more advanced and reliable than it was some years ago. Numerous technological advances have been made in CSII technology, one of which is the pump's incorporation of continuous glucose monitoring. Insulin pumps have the ability to control the algorithm that analyses blood glucose data and automatically distributes insulin. As diabetes treatment is becoming the need of the hour, a trend in rise of insulin devices is seen over the years. ‘InSul’ Insulin Pump by AgVa Healthcare, based in Delhi is being marketed as ‘the most affordable, high-quality insulin pump that is presently offered in India’, that can help manage diabetes more economically. The product is all set to launch after the CE certification is complete, by the end of 2024. It is currently available for pre-order and the pricing starts at Rs 24,499. Open MedLabs, affiliated with Bengaluru-based Indian Institute of Science (IISc) is developing InsuFlo, an affordable insulin pump for type-1 diabetes, designed for vulnerable populations. The product aims to tackle the problem of making an affordable insulin pump that is ‘accessible to patients at the base of the economic pyramid and is designed for such users as opposed to an imported device.’ Already two years in the making, InsuFlo is one of the national winners of ASME ISHOW India 2022, making patients anticipate its arrival. Further, with the emergence of cutting-edge glucose monitoring devices like wearable sweat analysers, semi-invasive skin patches, and one-prick glucometers, diabetics may now check their blood sugar levels considerably easily. A Hyderabad-based startup, BlueSemi has designed Eyva, a completely non-invasive glucose monitor. Priced at Rs16,650, Eyva aims to allow monitoring of 6 key vitals including blood glucose levels by only placing thumbs on the gadget. A similar product, Ezlyf by the startup VivaLyf Innovations, in Hyderabad, which also came in Shark Tank last year, is currently undergoing pre-clinical trials is expected to come to the market sometime in the future. The startup has also been endorsed by the Research and Innovation Circle Hyderabad (RICH) which is the Science and Technology cluster of the Telangana government. Adding on, Ayati Devices is a medtech startup based in Bengaluru, which is set to commercialise scientific research into viable products with a major focus on diabetes & its complications. Their product VIBRASENSE Lite can monitor foot neuropathy which is a diabetic complication. Currently, it can be booked for a free demo session. BeatO CURV, developed by Health Arx Technologies Private Limited, based in South Delhi, is India's first USB-connected smartphone glucometer. It uses plug-and-play concept, connects via USB to your smartphone, where users insert a strip into the glucometer for sugar readings displayed on the BeatO App and saved in the cloud. It is also the 2021 winner of the #StartUpIndia Initiative by the Govt of India. It is currently available in the market for a sale price of Rs 399. As many innovations approach their market debut, it promises to bring new advancements to the field of diabetic medical devices, potentially offering enhanced features and benefits compared to currently available technologies.   Avantika Sanjay, Freelancer ]]> https://biospectrumindia.com/features/21/25304/confronting-genetic-disorders-with-technological-innovations-medical-advancements.html https://biospectrumindia.com/features/21/25304/confronting-genetic-disorders-with-technological-innovations-medical-advancements.html Thu, 31 Oct 2024 00:00:00 +0530 Within India genetic medicine is gaining popularity, yet the size of the market for next-generation sequencing (NGS) remains relatively small. Valued at $22.02 billion in 2024 in India, the NGS market is projected to grow to $33.45 million by 2030. Industrial innovation is essential to this medical advancement- the scaled production of the technologies developed for DNA Extraction (manual and automated), Quality Checks using NanoDrop spectrophotometer, gel electrophoresis, and Qubit fluorometer, the process of Library Preparation from precapture to postcapture processes, and the bioinformatic analysis of sequence files collected will make disorder-specific testing accessible to all in the near future. In fact, the cost for WES is already falling as it becomes more widely used, with running a single WES costing about £382 per exome, which is ∼3.5 factor lower compared to the lowest cost estimate for WGS using HiSeq: £1,312. NovaSeq 6000 is the largest possible sequencer that is able to sequence a total of 384 samples in one run which lasts approximately 44 hours. Each machine has ‘flow cells’ which are slides that contain the samples. This flow cell has four lanes which allows for 96-plex per lane. Smaller sequencers, which can process fewer samples at a time, but run faster include the MiniSeq, NextSeq 550 and IonGeneStudio. They all function on the same premise, with flow cells that put the samples into the sequencer. MiniSeq can be used to analyse both DNA & RNA making it versatile, whilst NextSeq 550 performs whole genome sequencing in short run times. The IonGeneStudio leverages semiconductor sequencing to complete small sample sequencing in less than 24 hours, with maximum 45 minutes hands-on involvement. These machines increase the affordability of WES, making it progressively more accessible to the public. Each of these machines come with kits that contain assay information, and data analysis guidance. As a whole these machines represent individually packaged & self-sufficient testing systems for finding rare genetic disorders and classifying them. The data from this technology is classified into variants of pathogenic genetic disease strains, which is incredibly useful for developing genome libraries and enhancing knowledge about certain conditions. It’s also extremely helpful in cases of life-threatening conditions, which can be prevented by finding out in the neonatal or foetus stage of pregnancy when termination is still an option. The strategic combination of data analysis and raw processors allows these machines to be useful in remote locations to produce detailed gene sequences and their interpretations. Its practical value is made evident by real-world clinical cases demonstrating its impact on diagnostics. In one instance during our research work at LifeCell International, WES identified Neurofibromatosis Type 1 (NF1) and a pathogenic DMD variant using the IonGeneStudio sequencer, allowing for early diagnosis and additional testing through Multiplex Ligation-dependent Probe Amplification (MLPA). In another, a foetus showing signs of chondrodysplasia punctata was diagnosed with the help of the NovaSeq 6000, which enabled further testing like Sanger sequencing and parental segregation analysis. Similarly, WES and mitochondrial genome sequencing were used to diagnose Rauch-Steindl Syndrome in a fuetus with growth restriction, despite no family history of genetic disorders, while the MiniSeq sequencer facilitated additional genetic analyses and the NextSeq 550 rapidly diagnosed a Noonan syndrome-like disorder with loose anagen hair-1 after other tests failed to provide insights. These examples demonstrate how NGS delivers rapid, accurate diagnoses for rare/ otherwise undetected genetic disorders, informing decision-making by parents and clinicians alike. There is, moreover, an increasing need for genetic counseling which can be attributed to the rapidly advancing technologies for testing, and their increasing accessibility. The primary aim of genetic counseling is to educate and support families who require genetic tests and/or those who have been diagnosed with genetic disorders, outlining the risks and benefits of opting for a genetic test and providing support throughout the process. In India, it comes with the added caveat of not being able to reveal the foetus’s gender. Genetic counselors must present information objectively, avoiding strong suggestions while discussing potential next steps, and remaining unbiased and unattached throughout sessions. All in all, innovations in DNA isolation and sequencing have revolutionised the diagnosis of rare genetic disorders. This article provides a comprehensive overview of the industrial advancements in the genetic testing process from DNA isolation, to sequencing, to patient interaction. These highlight the importance of WES and NGS in diagnosing complex genetic disorders, and demonstrate the high quality, speed, and accessibility of WES, as a result of industrial innovations.   Shivika Gupta & Pranati Kompalli ]]> https://biospectrumindia.com/views/21/25273/ai-healthcare-now-beyond.html https://biospectrumindia.com/views/21/25273/ai-healthcare-now-beyond.html Thu, 17 Oct 2024 00:00:00 +0530 There are already a number of research studies suggesting that artificial intelligence (AI) can perform as well as or better than humans at key healthcare tasks, such as diagnosing disease. According to Morgan Stanley, biotechs are implementing AI and machine learning to drug development, potentially creating dozens of new medicines and a $50 billion market over the next decade. For instance, one of the leading COVID-19 vaccine developers and pharmaceutical companies, Pfizer, uses the IBM Watson Machine Learning platform to improve drug discovery quicker, cheaper, and effective. The global artificial intelligence in the healthcare market was valued at $16.3 billion in 2022 and is expected to grow at a CAGR of 40.2% to reach $173.55 billion by 2029. North America has a dominant position in the healthcare artificial intelligence market. Second-largest region in the AI healthcare market is Europe. Further, the AI expenditure in India increased by over 109 percent in 2018, amounting to $665 million, and is anticipated to reach $11.78 billion by 2025, going on to contribute $1 trillion to India's economy by 2035. Currently, the most common roles for AI in medical settings are clinical decision support and imaging analysis. Clinical decision support tools help providers make decisions about treatments, medications, mental health and other patient needs by providing them with quick access to information or research that's relevant to their patient. The challenges that the COVID-19 pandemic created for many health systems also led many healthcare organisations around the world to start field-testing new AI-supported technologies, such as algorithms designed to help monitor patients and AI-powered tools to screen COVID-19 patients. Machine learning models are being used to observe the vital signs of patients receiving critical care and alert clinicians if certain risk factors increase. While medical devices like heart monitors can track vital signs, AI can collect the data from those devices and look for more complex conditions, such as sepsis. One IBM client has developed a predictive AI model for premature babies that is 75% accurate in detecting severe sepsis. “After the Industrial Revolution and the dot-com boom, AI stands as the next monumental shift transforming every industry. Unlike previous revolutions, AI's impact is already widespread across sectors such as healthcare, HR, media and entertainment, and law. Remarkably, we are merely in the initial phase of this revolution. As AI evolves rapidly, we will soon transition to Phase 2, eventually reaching the stage of Artificial General Intelligence (AGI), where AI will independently think, make decisions, and innovate. Given this trajectory, it's crucial for humans, the creators of AI, to embrace and advance with this change. AI won’t replace people, but those who leverage AI will surpass those who don’t. Despite this, many remain skeptical about AI, exhibiting strong resistance to its adoption. Through my daily research on AI's impact across various industries, I’ve observed a spectrum of acceptance. The medical field, for example, is quite receptive, with AI and computer vision systems being tested and implemented to tackle complex medical issues and even assist in surgeries. However, psychological sciences have been more hesitant, said Da Sachin Sharma -Founder- X DOT AI. Today, algorithms are already outperforming radiologists at spotting malignant tumours, and guiding researchers in how to construct cohorts for costly clinical trials. However, for a variety of reasons, we believe that it will be many years before AI replaces humans for broad medical process domains. “Deep learning algorithms have shown exceptional skill in analysing medical images for cancer detection, grading, and classification, particularly in histopathology sections, where they can identify and categorize cancerous lesions. Despite obstacles such as the need for manual annotation of large datasets and the challenge of understanding unknown histopathological features by algorithms, the potential of deep learning in pathology is clear. For cancer detection, pathologists rely on histopathological biopsy images, which involve observing the microscopic tissue structure of the patient. A digitised image is obtained through a capture process using a whole slide imaging (WSI) scanner. A WSI image is created by digitizing a glass slide at an extremely high resolution, approximately 0.25 μm/pixel, equivalent to 40x magnification on a microscope. A crucial step for automatic tumor detection from these high-resolution images is the generation of a heatmap, which indicates the corresponding probability scores. Once the tumour is detected, the most tumorous patches are extracted, and the top-K patches are passed to the grading module to predict the grade. Computer-aided nuclei grading aims to enhance pathologists’ efficiency and reduce misdiagnosis rates by automatically identifying tumour nuclei grades within histopathological images. Achieving this goal requires precise instance segmentation and accurate classification of the nuclei” said Dr Abin Jose, Research Scientist, Institute of Imaging and Computer Vision, RWTH Aachen University, Germany. One major advantage of deep learning is that AI algorithms can use context to distinguish between different types of information. For example, if a clinical note includes a list of a patient's current medications along with a new medication their provider recommends, a well-trained AI algorithm can use natural language processing to identify which medications belong in the patient's medical history. There are numerous ways AI can positively impact the practice of medicine, whether it's through speeding up the pace of research or helping clinicians make better decisions.   Hradhaya Bhushan Parchure, Freelancer ]]> https://biospectrumindia.com/views/21/25250/indian-biopharma-malaria-elimination-goal-where-do-we-stand-.html https://biospectrumindia.com/views/21/25250/indian-biopharma-malaria-elimination-goal-where-do-we-stand-.html Thu, 10 Oct 2024 00:00:00 +0530 India has played a pivotal role in the development, production, and distribution of RTS,S/AS01, the world’s first malaria vaccine targeting the Plasmodium falciparum parasite, a significant global health threat. Developed by GlaxoSmithKline (GSK) in collaboration with the PATH Malaria Vaccine Initiative, RTS,S/AS01 received World Health Organization (WHO) approval in 2021. It marked a groundbreaking advancement in malaria control, particularly for Sub-Saharan Africa, where the majority of global malaria cases occur. India's involvement began early in the vaccine’s development, contributing significantly through its participation in clinical trials. These trials were conducted in malaria-endemic regions of the country, providing a valuable setting to test the vaccine’s efficacy across diverse environmental, genetic, and socioeconomic contexts. The data generated from these trials were crucial in establishing the vaccine’s effectiveness and safety for broader populations, supporting its approval for international use. India’s biopharmaceutical industry also played a crucial role in scaling up the production of the RTS,S/AS01 vaccine. Renowned for its generic drug manufacturing capabilities, India has become a global hub for vaccine production, and Indian biopharma companies, particularly the Serum Institute of India (SII), have expanded capacity to meet the demand for the RTS,S/AS01 vaccine.  This is especially important for low- and middle-income countries where malaria remains a significant public health challenge. The Serum Institute’s ability to produce millions of vaccine doses at an affordable price has been a game-changer for making the RTS,S/AS01 vaccine accessible globally, particularly to malaria-endemic regions in Africa and Asia. The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine. R21/Matrix-M, developed by the University of Oxford and the Serum Institute of India, is for the prevention of malaria in children. Earlier this year, Serum Institute of India marked a significant milestone with the shipment of its first set of R21/Matrix-M malaria vaccine to Africa.  The R21/Matrix-M malaria vaccine, developed through collaboration between the Jenner Institute at Oxford University and the Serum Institute of India leveraging by Novavax’s saponin-based adjuvant technology, received support from the European and Developing Countries Clinical Trials Partnership (EDCTP), the Wellcome Trust, and the European Investment Bank (EIB). As per reports, Serum Institute of India has manufactured 25 million doses with a capacity to scale up to 100 million doses annually. However, reports have also revealed that approximately half of malaria burden in India is due to Plasmodium vivax, which has its own challenges and cannot be resolved with this Plasmodium falciparum vaccine. Epidemiologically, India does not have exclusive P. falciparum or P. vivax areas in the country but rather has a mix of multiple species including Plasmodium ovale and Plasmodium malariae. The introduction of malaria vaccines, such as R21/Matrix-M, has indeed sparked renewed optimism in the global fight against malaria. But experts are of the opinion that a vaccine that may target both P. falciparum and P. vivax in all age groups and prevent transmission will be more fruitful for the malaria elimination goal.   Samika Jain, Freelancer ]]> https://biospectrumindia.com/views/21/25194/the-economic-and-healthcare-impact-of-hepatitis-c-treatment-in-india.html https://biospectrumindia.com/views/21/25194/the-economic-and-healthcare-impact-of-hepatitis-c-treatment-in-india.html Wed, 25 Sep 2024 00:00:00 +0530 India's efforts to combat hepatitis C are primarily embodied in the National Viral Hepatitis Control Programme (NVHCP), launched by the Ministry of Health and Family Welfare in 2018. This programme aims to provide widespread access to hepatitis C testing and treatment, focusing on reducing transmission rates and improving patient outcomes across the country. One of the key components of the NVHCP is the provision of affordable DAAs, particularly Sofosbuvir, which has revolutionised hepatitis C treatment. DAAs offer a high cure rate of over 90% and are associated with fewer side effects compared to older treatments, such as pegylated interferon and ribavirin. The Indian government has made these drugs accessible by partnering with pharmaceutical companies to lower costs and promote local production.A notable aspect of India's approach is the collaboration with local manufacturers to produce generic versions of DAAs at significantly reduced prices. For example, while the cost of a Sofosbuvir-based regimen is approximately $84,000 and $94,500 in the USA, the price in India is reduced to approximately $161 and $312 per 28-tablet pack, thanks to generics and government subsidies (Iyengar et al. 2016). This initiative has been crucial in making treatment affordable for the millions of Indians affected by hepatitis C.   New Research and Advances in Hepatitis C Treatment and Vaccine Development Recent advancements in research may further impact India’s treatment programmes, both economically and medically. Emerging studies are exploring the use of pan-genotypic DAAs, which are effective across all hepatitis C genotypes. Cure rates of 95% to 99% after 8 weeks of treatment have been reported in people with hepatitis C who took glecaprevir and pibrentasvir. Shorter treatment durations can lead to significant cost reductions, as they lower the overall expense of drugs, monitoring, and associated healthcare services. Additionally, researchers are focusing on drug resistance and combination therapies to improve efficacy and reduce the risk of resistance developing. Newer drugs like Sofosbuvir, Velpatasvir and Voxilaprevir are designed to target patients who have failed previous DAA treatments. Incorporating these options into India’s public health programme could improve outcomes for patients with resistant strains, although they might initially be more expensive. There is also ongoing research into developing an effective hepatitis C vaccine. While no vaccine is currently available, several candidates are in clinical trials, such as those utilising mRNA technology similar to COVID-19 vaccines. If a vaccine were developed and introduced, it could drastically change the economic dynamics of hepatitis C treatment by preventing infections altogether, thereby reducing the long-term burden on the healthcare system.   Ongoing and Future Initiatives Curing hepatitis C has substantial long-term economic benefits. By effectively treating and curing patients, India reduces the incidence of chronic liver disease, cirrhosis, and liver cancer, which are associated with high medical costs. The prevention of these severe outcomes translates to lower healthcare costs over time and contributes to a healthier and more productive workforce. Public awareness campaigns have also played a critical role. By educating the population about hepatitis C, its transmission, and the availability of treatment, the government has encouraged individuals to get tested and seek treatment, leading to earlier diagnosis and better health outcomes. For example, in Tamil Nadu, the integration of hepatitis C treatment into the primary healthcare system has resulted in higher screening and treatment rates, demonstrating how local adaptation of national programs can enhance effectiveness. By continuing to adapt and innovate, India is well-positioned to further mitigate the burden of hepatitis C and serve as a beacon for global health initiatives.   Samika Jain, Freelancer ]]> https://biospectrumindia.com/views/21/25108/strengthening-ecosystem-for-medical-tourism-in-india.html https://biospectrumindia.com/views/21/25108/strengthening-ecosystem-for-medical-tourism-in-india.html Wed, 04 Sep 2024 00:00:00 +0530 India's prominence in the global medical tourism industry is underpinned by a blend of cost-effective treatments, advanced medical technology, and a highly skilled healthcare workforce. The country has rapidly become a sought-after destination for international patients seeking high-quality healthcare services at a fraction of the cost compared to developed nations. This strategic advantage is reflected in the comprehensive medical care and cutting-edge technological solutions offered by Indian healthcare providers. With the industry poised for significant growth, reports suggest that over 7.3 million medical tourists will visit India in 2024, surpassing pre-pandemic levels. The appeal of India as a medical tourism hub is further enhanced by the initiatives and programmes launched by major healthcare organisations and startups, aimed at attracting international patients and advancing the country’s medical tourism infrastructure. Apollo Hospitals, one of India’s most recognised healthcare providers, has been at the forefront of medical tourism with its "Apollo International Patient Services" programme. This initiative is designed to provide seamless and comprehensive care for international patients. Additionally, Apollo Hospitals has established telemedicine centres in various countries, allowing potential patients to consult with specialists in India before making travel decisions.  Fortis Healthcare, another major player in India’s medical tourism sector, has developed a robust "International Patient Services" programme aimed at catering to the unique needs of medical tourists. Fortis has set up specialised centres of excellence in fields such as cardiology, orthopedics, oncology, and neurosurgery, which are equipped with state-of-the-art technology and staffed by internationally trained doctors. The hospital chain’s commitment to quality care and patient-centric services has made it a preferred destination for patients from across the globe, particularly from the Middle East, Africa, and Southeast Asia. Further, Max Healthcare, a leading healthcare provider in India, has developed several innovative programmes aimed at enhancing the experience of international patients. For instance, the "Max@Home" service is particularly noteworthy, offering post-treatment care and recovery services in the comfort of the patient's own accommodation, be it a hotel or a serviced apartment.  Adding on, Medanta - The Medicity, a renowned multi-specialty medical institute in India, has established its "One-Stop International Patient Care" programme, which is specifically designed to cater to the needs of international patients. This programme provides a single point of contact for all patient needs, from pre-arrival consultation and travel planning to post-treatment follow-ups.  The impact of these programmes on India's economy is substantial. Medical tourism not only contributes significantly to the country’s GDP but also drives the expansion of healthcare infrastructure and the adoption of new technologies. As revenue from international patients continues to grow, it supports the development of state-of-the-art medical facilities and stimulates growth in ancillary industries such as hospitality, transportation, and retail. The influx of medical tourists also leads to job creation within the healthcare sector and related industries, further bolstering economic activity nationwide. The growth of India’s medical tourism sector is further bolstered by government initiatives and public-private partnerships aimed at enhancing the industry’s infrastructure and regulatory framework. The Indian government has implemented several policies to facilitate medical tourism, including the introduction of medical visas and the development of medical tourism promotion boards. With an aim to improve medical tourism in the country, the Ministry of Tourism formulated a National Strategy and Roadmap for Medical and Wellness Tourism in 2022. The Ministry of Health and Family Welfare has also launched India’s official portal for Medical Value Travel (MVT) for those who want to avail medical treatment in India. This portal helps streamline the information and patient journey of international medical travellers to India. These efforts are complemented by private sector initiatives, where healthcare providers and startups collaborate to innovate and streamline services for international patients. By addressing challenges related to regulatory compliance, infrastructure scalability, and service quality, these partnerships are key to sustaining India’s leadership in the global medical tourism market.   Samika Jain, Freelancer   ]]> https://biospectrumindia.com/features/21/25080/effectively-addressing-growing-rare-diseases-burden.html https://biospectrumindia.com/features/21/25080/effectively-addressing-growing-rare-diseases-burden.html Sun, 01 Sep 2024 00:00:00 +0530 The Central Drugs Standard Control Organisation (CDSCO) stated recently that certain categories of drugs which have already been approved in specified developed countries such as US, UK, EU, Canada, Japan and Australia, can be directly launched in India without local clinical trials, including orphan drugs for rare diseases. Considering the fact that many crucial drugs have been launched 10-20 years after being approved in the US and European Union, it might be a very positive step in the direction of promoting collaboration between local and global pharma majors to manufacture, market or distribute the drugs locally. This can particularly prove fruitful for the Indian pharma sector to address the growing burden of rare diseases in the country. With a staggering 400 million cases worldwide, rare diseases seem anything but rare. India alone accounts for some 72-96 million such patients. This means one in every 20 Indians suffers from a rare disorder. Additionally, individuals with rare diseases face numerous challenges, including late diagnosis and misdiagnosis, improper or no response to therapies, and lack of accurate monitoring tools. Misdiagnosing rare diseases is a significant obstacle that can lead to worsened symptoms along with the development of other health problems. As a result, with the third consecutive term win of the government, rare disease patients and their caregivers are now writing to the newly appointed Union Health Minister JP Nadda to draw the Ministry’s attention to the critical gaps that remain in the implementation of the National Policy for Rare Diseases (NPRD) 2021. For instance, the lives of many patients (mostly children) suffering from chronic rare genetic disorders, such as Lysosomal Storage Disorders (LSDs), are still fraught with uncertainty due to the lack of sustainable funding and delays in the effective utilisation of the allocated funds. While the recent development by CDSCO might turn out to be a good development, the industry and academia researchers must still continue their search for novel and innovative drugs to treat rare diseases. And to support the ecosystem in this search, artificial intelligence (AI) can make a big difference, in both diagnosing and finding treatments for rare diseases. The ability of AI-based technologies to integrate and analyse data from different sources such as multi-omics, patient registries, etc. can be used to overcome the challenges associated with rare diseases. To give an example, investigators from Harvard Medical School and Brigham and Women’s Hospital have developed a deep learning algorithm that can teach itself to learn features that can then be used to find similar cases in large pathology image repositories. Known as SISH (self-supervised image search for histology), the new tool acts like a search engine for pathology images and has many potential applications, including identifying rare diseases and helping clinicians determine which patients are likely to respond to similar therapies. On the other hand, researchers from Canada's London Health Sciences Centre (LHSC) and Lawson Health Research Institute are using a technology called EpiSign that leverages AI to measure a patient’s epigenome, which is a unique chemical fingerprint that is responsible for turning genes on or off. EpiSign can currently be used to help diagnose over 100 genetic diseases that were previously difficult to diagnose. Using this technology, the researchers are currently studying and developing biomarkers for over 700 rare disorders. Another kind of interesting work is being done by a Bengaluru-based startup called Peptris. This AI-based drug discovery company is focusing on helping develop drugs for muscle-related rare diseases like Duchenne muscular dystrophy (DMD), a genetic disorder characterised by progressive muscle degeneration and weakness. With AI making significant strides in furthering our understanding of different diseases, this might be the right time for the industry to invest more into the technology, with support from the government, to improve diagnosis and treatment of rare diseases.   Dr Manbeena Chawla Executive Editor manbeena.chawla@mmactiv.com ]]> https://biospectrumindia.com/views/21/24957/preemptively-combating-chandipura-virus-.html https://biospectrumindia.com/views/21/24957/preemptively-combating-chandipura-virus-.html Wed, 31 Jul 2024 00:00:00 +0530 An emerging pathogen that causes rapidly progressing influenza-like illness and acute encephalitis often leading to coma and death of the human host, Chandipura vesiculovirus (CHPV) is back again claiming lives in Gujarat and Rajasthan.  First identified during a 1965 outbreak in Chandipura village, Maharashtra, the virus has probably been endemic in this region for decades, and might have been responsible for several earlier outbreaks of encephalitis that have been recorded in India since 1954.  However, the first evidence for the Chandipura viral association with human epidemics was obtained during the monsoon season in 2003, when this virus was identified in patient samples during an outbreak in central India as a determinant of the acute encephalitis with a high fatality rate claiming more than 300 lives, mostly children, in Andhra Pradesh, Maharashtra and Gujarat. Later, cases have also been documented in Nagpur, Muzaffarpur and Warangal. The medical examination of patients recorded high-grade fever, occasional vomiting, rigours, sensorium, drowsiness leading to coma and death within 48 hours. Subsequently, another outbreak of this infection with more than 75 per cent fatality rate was reported in the eastern region of Gujarat, in 2004. The virus belongs to the rhabdovirus family, and has a single-stranded RNA and five genes. It travels through arthropod vectors like sand flies and mosquitoes. The virus reaches the salivary gland of the insect and is transferred to the mammalian host through bites. Animal studies showed that the virus affects only neurons and causes neurodegeneration. The virus upon entering the neurons triggers cellular stress factors and release of reactive oxygen species (ROS). The granules produced in response to cellular stress have been implicated in viral replication and ROS generation, which stimulates neuronal death. Both these phenomena cohesively explain the neuropathogenesis and neurodegeneration following the viral infection. However, the geographical distribution of the virus might extend well beyond India. It has also been detected in sand flies in Senegal and Nigeria. The viral detection in sand flies of the African continent indicates a high risk of its spread causing an epidemic in more parts of the globe. Given these forewarnings, it is of paramount importance to comprehensively understand viral biology and make efforts in the direction of developing antiviral measures. Though CHPV was first isolated in 1965, it was considered as an orphan virus due to low pathogenicity to cause infections in man and domestic animals. No efforts were, therefore, made to develop diagnostics or prophylactics. However, post-2003 outbreak in central India, it garnered global attention as a human pathogen of public health importance. For instance, researchers have demonstrated the application of sandfly and mosquito cell lines for early detection of the infection as the virus antigen could be detected within 2 hours of inoculation using immunofluorescent antibody technique. Also, according to studies, two candidate vaccines against this virus are under development, and awaiting trials.  Providing much needed hope, virologists at the Institute of Medical Sciences, Banaras Hindu University are studying the pathogenic processes of the virus and will be helpful in diagnosis and drug formulation in times to come. This study highlights the important role of microRNA-155 in restricting CHPV multiplication inside the host which can then be used in microRNA based therapy. Recently, researchers at the National Institute of Virology (NIV) explored the repurposing of the antiviral drug Favipiravir against CHPV. Owing to its use during COVID-19, Favipiravir has emerged as a promising candidate, and its unique characteristics and clinical efficacy have garnered significant attention and demonstrated considerable potential in the fight against viral diseases. NIV has now gathered enough evidence of the antiviral activity of Favipiravir against CHPV infection, and further clinical evaluation may alleviate the associated mortality. Combined efforts from all stakeholders including virologists, neurologists, paediatricians and the government are warranted to address this public health concern.   Dr Manbeena Chawla Executive Editor manbeena.chawla@mmactiv.com ]]> https://biospectrumindia.com/reports-white-papers/21/24915/oops-they-did-it-again-indian-pharmas-frequent-flyers-on-fdas-naughty-list.html https://biospectrumindia.com/reports-white-papers/21/24915/oops-they-did-it-again-indian-pharmas-frequent-flyers-on-fdas-naughty-list.html Thu, 18 Jul 2024 00:00:00 +0530 One of the FDA's key regulatory actions includes issuing warning letters to pharmaceutical companies that fail to comply with current good manufacturing practice (CGMP) regulations. These letters alert companies to significant violations and demand corrective actions to prevent potential health risks to consumers. Indian pharmaceutical companies, which play a major role in the global drug supply chain, have been recipients of such FDA warning letters. The Indian pharmaceutical sector has witnessed many warnings issued by the FDA in 2023-2024. These letters typically address issues related to quality control, data integrity, manufacturing processes, and compliance with CGMP standards. Indian firms, including prominent manufacturers, often face scrutiny due to the scale of their operations and their critical role in supplying affordable generic medications worldwide. The FDA's oversight ensures that these companies maintain high standards to protect patient health and safety, and non-compliance can result in significant consequences, including product recalls, import bans, and delays in drug approvals.   Recent FDA Warning Letters Natco Pharma Date: April 8, 2024 The FDA conducted an inspection of Natco Pharma Limited's drug manufacturing facility in Kothur Village Rangareddy, Telangana, India, from October 9 to 18, 2023. The inspection revealed significant violations of CGMP regulations for finished pharmaceuticals. These violations included inadequate cleaning, maintenance, and sanitation of equipment, leading to contamination risks. The response from Natco Pharma was deemed insufficient, and the FDA required a comprehensive assessment and corrective action plan. Natco Pharma has committed to temporarily suspend production of all drugs intended for the U.S. market while addressing the CGMP violations. Insight: Natco Pharma's situation underscores the critical importance of robust cleaning protocols and comprehensive responses to regulatory findings. Temporary suspension of production can significantly impact revenue and market presence, emphasizing the need for proactive quality assurance measures. Sun Pharmaceuticals Date: June 18, 2024 An inspection of Sun Pharmaceutical Industries Limited, located in Dadra and Nagar Haveli, revealed significant CGMP violations. These included inadequate cleaning and maintenance of equipment, leading to contamination risks. The FDA noted repeated violations at multiple sites within Sun Pharmaceutical's network, indicating inadequate management oversight. The company was given 15 working days to respond with corrective actions and plans to prevent recurrence. Insight: Sun Pharmaceuticals' recurring issues across multiple sites highlight systemic challenges within the company's quality management system. Addressing these requires not only localized fixes but also a top-down reevaluation of corporate governance and quality culture. Dr. Sankunni’s Ayurvedic Research Foundation Private Ltd. Date: April 18, 2024 The FDA issued a warning letter to Dr. Sankunni’s Ayurvedic Research Foundation regarding serious violations related to the drug listing information submitted for multiple products. These discrepancies rendered the products misbranded, and the FDA emphasized the importance of accurate listing for patient safety. Immediate corrective actions were required, with a detailed response expected within 15 working days. Insight: The case of Dr. Sankunni’s Ayurvedic Research Foundation highlights the critical role of accurate documentation and transparent communication with regulatory bodies. Misbranding not only jeopardizes patient safety but also erodes trust and market credibility. Kilitch Healthcare India Limited Date: March 28, 2024 Kilitch Healthcare's facility in Navi Mumbai was found to be operating under insanitary conditions, leading to adulteration of drug products. Violations included inadequate facility maintenance, poor aseptic practices, and deficiencies in the quality control unit's oversight and data integrity. The FDA demanded comprehensive remedial actions and a detailed plan for data integrity remediation. Insight: Kilitch Healthcare’s violations emphasize the need for stringent aseptic practices and robust data integrity protocols. Ensuring a clean and controlled manufacturing environment is fundamental to maintaining product quality and patient safety. Madhu Instruments Private Limited Date: February 1, 2024 An FDA inspection of Madhu Instruments Private Limited revealed significant deficiencies in the manufacturing environment and equipment maintenance. The response to the FDA's Form 483 was deemed inadequate, and the FDA emphasized the necessity for robust corrective measures. The facility was placed on Import Alert 66-40, meaning products may be detained or refused admission into the United States unless compliance is confirmed. Insight: Madhu Instruments’ situation illustrates the severe consequences of failing to maintain sanitary conditions and appropriate maintenance protocols. Import alerts can severely disrupt business operations and market access, necessitating immediate and effective corrective actions. Patcos Cosmetics Pvt. Ltd. Date: December 15, 2023 Patcos Cosmetics Pvt. Ltd. faced significant CGMP violations, including failure to conduct proper identity tests for high-risk components susceptible to contamination. The FDA placed the firm on Import Alert 66-40 and required prompt corrective actions and a detailed response within 30 working days. Insight: Patcos Cosmetics' failure to conduct identity tests for high-risk components underscores the critical need for thorough quality control testing. Ensuring the safety of ingredients is paramount to prevent harmful contamination and maintain consumer trust. Intas Pharmaceuticals Limited Date: November 21, 2024 An inspection of Intas Pharmaceuticals Limited's facility in Ahmedabad revealed significant CGMP violations, including data integrity issues and failures in investigating discrepancies. The FDA demanded detailed remediation plans and effective executive management oversight. Insight: Intas Pharmaceuticals’ data integrity issues highlight the essential role of accurate and reliable record-keeping in pharmaceutical manufacturing. Addressing these issues requires a comprehensive overhaul of data management systems and enhanced oversight from executive leadership. Cipla Limited Date: November 17, 2024 Cipla Limited’s facility in Indore faced significant CGMP violations, including inadequate investigations into quality defect complaints and media fill contamination incidents. The FDA requested comprehensive corrective actions and independent assessments of their investigation system and CAPA program. Insight: Cipla Limited's case underscores the importance of thorough investigation and resolution of quality complaints. Effective CAPA programs are vital to prevent recurring issues and ensure continuous improvement in manufacturing practices. Global Pharma HealthCare Private Limited Date: October 20, 2023 Global Pharma Healthcare faced significant CGMP violations, including failure to conduct Antimicrobial Effectiveness Testing and inadequate cleanroom practices. The FDA requested a comprehensive risk assessment and remediation plan addressing all contamination hazards. Insight: The failure to conduct critical testing, such as Antimicrobial Effectiveness Testing, at Global Pharma Healthcare highlights the risks associated with inadequate product safety evaluations. Implementing rigorous testing protocols is essential to safeguard public health. Sun Pharmaceutical Industries Ltd. (Halol Facility) Date: October 16, 2023 An inspection of Sun Pharmaceutical’s Halol facility revealed significant CGMP violations, including inadequate aseptic practices and cleanroom design. The FDA required a comprehensive action plan and the engagement of a CGMP consultant. Insight: Sun Pharmaceutical’s Halol facility underscores the complexity of maintaining aseptic conditions in drug manufacturing. Comprehensive action plans and external consulting can provide valuable expertise to address systemic issues. Jubilant Generics Limited Date: March 6, 2019 The FDA inspection of Jubilant Generics Limited’s facility revealed significant CGMP violations, including inadequate investigation of batch failures and insufficient quality control. The FDA recommended hiring a qualified CGMP consultant to ensure compliance. Insight: Jubilant Generics' recurring CGMP violations highlight the need for sustained improvements in quality management systems. Engaging external consultants can provide the necessary expertise to achieve compliance and enhance operational standards. Medgel Private Limited Date: July 20, 2023 Medgel Private Limited faced significant CGMP violations, including inadequate investigation of batch failures and poor data integrity practices. The FDA requested a detailed plan to address these deficiencies and improve CGMP systems. Insight: Medgel's violations demonstrate the critical importance of thorough batch failure investigations and maintaining data integrity. Addressing these issues is fundamental to ensuring product quality and regulatory compliance. Centaur Pharmaceuticals Private Ltd. (Pune Facility) Date: July 25, 2023 An inspection of Centaur Pharmaceuticals’ Pune facility revealed significant CGMP violations, including inadequate cleaning procedures and insufficient quality control. The FDA required a comprehensive remediation plan and independent evaluation of cleaning effectiveness. Insight: Centaur Pharmaceuticals’ Pune facility highlights the necessity of maintaining rigorous cleaning procedures and quality control measures. Independent evaluations can provide objective assessments to identify and rectify deficiencies. Centaur Pharmaceuticals Private Ltd. (Ambernath Facility) Date: June 5, 2024 Centaur Pharmaceuticals’ Ambernath facility faced significant deviations from CGMP for active pharmaceutical ingredients, including inadequate document control and cleaning practices. The FDA requested a detailed corrective action and preventive action plan. Insight: Centaur Pharmaceuticals’ Ambernath facility underscores the critical role of document control and cleaning practices in ensuring compliance with CGMP. Detailed CAPA plans are essential to address root causes and prevent recurrence of violations.   Cleaning Up Their Act: Indian Pharma’s Brush with FDA Reality Check – Will They Finally Learn?   The recent series of FDA warning letters issued to Indian pharmaceutical companies highlights ongoing compliance challenges in the industry. Prominent firms, including Natco Pharma, Sun Pharmaceuticals, and Cipla Limited, have faced significant violations of CGMP regulations. These violations encompass inadequate cleaning procedures, insufficient quality control, data integrity issues, and non-compliance with aseptic processing standards. The FDA's rigorous inspections and subsequent warnings underscore the necessity for these companies to enhance their manufacturing practices and ensure adherence to regulatory standards. The emphasis on corrective and preventive actions (CAPA) and the engagement of qualified consultants illustrates the FDA's commitment to safeguarding public health. Failure to address these deficiencies could lead to severe consequences, such as import bans, delayed drug approvals, and potential legal actions. This situation calls for robust improvements in quality systems, executive management oversight, and sustained efforts to maintain compliance. Moreover, these incidents highlight the need for a proactive approach to regulatory compliance. Pharmaceutical companies must invest in advanced quality management systems, continuous training programs for staff, and regular internal audits to preemptively identify and address potential issues. Establishing a culture of quality and compliance is essential to mitigating risks and ensuring the consistent delivery of safe and effective pharmaceutical products. In the move, the persistent regulatory scrutiny by the FDA serves as a critical reminder of the stringent standards required in pharmaceutical manufacturing. Indian pharmaceutical companies must rise to the challenge by implementing comprehensive corrective actions, enhancing transparency, and fostering a culture of continuous improvement. By doing so, they can not only meet regulatory expectations but also strengthen their position in the global pharmaceutical market, ultimately contributing to better health outcomes worldwide.   ]]> https://biospectrumindia.com/views/21/24832/leveraging-space-lab-for-novel-rd.html https://biospectrumindia.com/views/21/24832/leveraging-space-lab-for-novel-rd.html Sun, 30 Jun 2024 00:00:00 +0530 Microbes continue to puzzle us by growing in the most challenging conditions. One such challenging condition is the space environment. The harsh environment of space proves to be ideal for the acquisition of adaptive mutations, particularly in microbial organisms. Adaptive evolution plays a major role in the appearance of new phenotypes in nature and is of key importance in biomedical research, including the onset of carcinogenesis and in the emergence of drug-resistant microorganisms. A recent study by researchers at the Indian Institute of Technology Madras and NASA’s Jet Propulsion Laboratory (JPL) is focused on exploring the presence of multi-drug resistant pathogens on the International Space Station (ISS), which could have key applications for astronauts’ health as well on earth. The knowledge gained from this study could shed light on microbial behaviour, adaptation, and evolution in extreme, isolated environments that allow in designing novel countermeasure strategies to eradicate opportunistic pathogens, thus protecting the health of astronauts. The ISS has previously been used to detect the presence of many bacteria and even fungi in order for scientists to understand the impact that residing and traveling through outer space can have on microorganisms and humans. This is just one of the many research studies being done within the space environment. For instance, space is also helping scientists find new treatments through stem cell research. Scientists are taking advantage of the space station’s microgravity environment to study the properties of non-embryonic stem cells. The University of California San Diego Sanford Stem Cell Institute has recently launched several new nano-bioreactor experiments onto the ISS via the second Axiom Space Private Astronaut Mission, to expand research on human stem cell ageing, inflammation and cancer in low Earth orbit. Increasing evidence shows that microgravity conditions can accelerate ageing, inflammation and immune dysfunction in human stem cells. Understanding this process is not only helpful for keeping astronauts healthy, but it could also teach us how to better treat cancer on Earth. Another research project in the US is examining the effect of gravity on a type of stem cells derived from bone marrow known as mesenchymal stem cells, or adult stem cells with growth factors and healing potential. They play a key role in tissue repair and regeneration. The experiment could have implications for future space flights that include taking humans to Mars. Further, to unlock insights into protecting our brains from cognitive decline, a team of researchers in the US are probing the effects of space conditions on the human brain to inform potential applications for treating and preventing late-onset diseases like Alzheimer’s and dementia. The research team is leveraging the unique space environment to study how microgravity, radiation, and other factors influence the brain’s ageing process at the molecular level. Not to forget, 3D printing stands at the forefront of transforming space exploration, offering unprecedented on-demand and rapid manufacturing capabilities. To date, 3D printing has revealed promising opportunities across diverse space applications, including the production of space devices and food, advancements in space biomedicine, repairs of electronics and sensors, and the recovery and utilisation of space resources. While global space leaders have recently explored 3D printing technologies in space, the field is currently in the early stages of technology validation, requiring extensive foundational research and key technological advancements. But since space exploration began decades ago, it has over the years led to new technology and medical advancements. As a result, scientists across the globe are focusing on multiple projects such as studying bone and muscle loss in microgravity, which impacts care of patients with back pain, osteoporosis or limited mobility; developing new terrestrial and spaceflight applications for ultrasound-based bone health diagnostic tools; conducting first-of-its-kind genomics work on the International Space Station, with many more to come.   Dr Manbeena Chawla manbeena.chawla@mmactiv.com ]]> https://biospectrumindia.com/reports-white-papers/21/24780/the-essential-role-of-biomarkers-in-advancing-cancer-diagnosis.html https://biospectrumindia.com/reports-white-papers/21/24780/the-essential-role-of-biomarkers-in-advancing-cancer-diagnosis.html Mon, 17 Jun 2024 00:00:00 +0530 Types of Biomarkers Used in Cancer Diagnosis The International Agency for Research on Cancer projects that the incidence of this disease, which is already one of the leading causes of death worldwide, will become even more widespread, with cases expected to reach 29.9 million by 2040. However, the number of cancer survivors is also expected to grow, reaching up to 22.5 million by 2032. While the increase in the cancer survival rate is determined by numerous factors, advancements in diagnosis and treatment techniques, including biomarker testing, play a significant role in the battle against this debilitating condition. A tumor marker test often aims to detect the presence or absence of a specific biological molecule signaling an abnormal process in the body. Currently, medicine relies on several categories of biomarkers. The most common of them are discussed in this article. Proteomic Biomarkers As the name suggests, these tumor markers are proteins synthesized in the body affected by cancer. These proteins can vary depending on a specific type of cancer. For instance, women suffering from ovarian cancer tend to develop Cancer Antigen 125, known as CA-125, which is produced by the affected organs such as ovaries, fallopian tubes, and peritoneum. While many proteomic biomarkers indicate the presence of cancer, this category also includes proteins found in healthy individuals. For instance, prostate-specific antigen (PSA) is produced not only by malignant cells of the prostate gland but also by normal cells. However, elevated levels of PSA in the blood can be an early indicator of the disease. Genomic Biomarkers Genomic tumor markers represent a broad spectrum of gene expressions, chromosomal alterations, and DNA sequences. The presence of some of these markers in the body, such as BRCA1 and BRCA2, can significantly increase a patient’s risk of developing certain cancers. Furthermore, many biomarkers in this category help doctors conduct precise diagnoses. For example, genomic biomarker testing of patients suffering from lung cancer can identify specific mutations, facilitating differentiation between lung cancer variations such as squamous cell carcinoma and adenocarcinoma. Meanwhile, the detection of amplified amounts of certain genes, including HER2, common in some types of breast cancer, indicates a higher probability of faster disease progression. Additionally, certain genomic biomarkers can also provide insights into the potential sensitivity of some cancers to selected treatments. Thus, the increase in HER2 markers allows doctors to estimate the possible response to breast cancer therapy based on trastuzumab. Epigenetic Biomarkers While also related to genes, epigenetic biomarkers are chemical modifications of DNA, RNA, and histones rather than molecules with altered underlying DNA sequences like genomic markers. One such epigenetic modification is chromatin remodeling, which affects the structure of chromatin — a complex of DNA and proteins responsible for packaging long DNA sequences into dense and compact structures, thereby streamlining gene expression and DNA replication. Modifications in certain chromatins, including SWI/SNF chromatin remodeling complex mutations, are factors that increase the probability of cancer development. Metabolic Biomarkers The metabolic processes in the body are constantly releasing products of chemical reactions known as metabolites. Some of these metabolites appear when cellular metabolism is affected by cancer. Thymidine kinase, a phosphotransferase enzyme, plays a crucial role in DNA replication and repair by catalyzing the phosphorylation of the thymidine nucleoside, a building block of nucleic acid monomers. It is often classified as a metabolic biomarker. Proliferating cells require increased DNA synthesis for cell division, which in turn elevates levels of thymidine kinase. This is a common scenario for cancer, which often causes uncontrollable cell proliferation. By measuring thymidine kinase activity in serum, doctors can evaluate the severity of tumors and disease progression. The levels of this enzyme can also indicate the body’s response to the current anti-cancer treatment. Another example of a key metabolic biomarker used in cancer diagnosis is lactate, a protonated form of lactic acid. Cancer cells often experience the Warburg effect, a phenomenon of lactic acid fermentation, which is normally an anaerobic process, even in the presence of sufficient amounts of oxygen. This often makes high lactate levels in blood and tumors an indication of cancer, usually with a poor prognosis for treatment.   The four key groups of cancer biomarkers frequently used by doctors today are genomic, epigenetic, metabolic, and proteomic. For some cancer biomarkers, their mere presence in body tissues or fluids indicates the existence of cancer. For others, increased levels of biomarkers facilitate cancer detection, or can signal cancer proliferation and poor response to treatment. Some cancer biomarkers can also be used for disease prediction, indicating greater risks for an individual to develop a certain type of cancer, while others help doctors to specify the exact nature of the cancer. Biomarker testing allows doctors to tap into a rich source of crucial information on the specifics of tumors, helping them prescribe more effective personalized treatments to patients, minimize adverse effects, and even develop methods to prevent cancer. ]]> https://biospectrumindia.com/views/21/24679/revisiting-benefits-vs-risks-of-covid-19-jabs.html https://biospectrumindia.com/views/21/24679/revisiting-benefits-vs-risks-of-covid-19-jabs.html Fri, 31 May 2024 00:00:00 +0530 A potential disruption has recently emerged in many parts of the world, in the form of a new family of COVID-19 sub variants, being dubbed as the ‘FLiRT’ variant. As per the Centers for Disease Control and Prevention in the US, this Omicron offshoot which is being called FLiRT is based on the technical names for the amino-acid mutations, i.e. amino phenylalanine (F) replaces leucine (L), and arginine (R) is replaced by threonine (T).  In particular, KP.2 which is one of the several variants being referred to as ‘FLiRT variants’, is dominating the COVID-19 infections lately. While medical experts in the US are not raising much concern over this new development, the government in Singapore has issued a health advisory asking people to wear masks again. According to news reports in India, infections have recently become dominant in Maharashtra with over 70 per cent of samples tested for genome sequencing found to have KP.2 variant, with the reports having been shared with the central and state health departments for further action. If we consider this new situation to be a ‘summer wave’ of COVID-19, one does wonder if another shot of vaccine would be required to calm this down. Amidst this uncertainty, another round of news is flashing that multinational pharmaceutical company AstraZeneca is withdrawing sales of its COVID-19 vaccine globally, since there is a surplus of more updated vaccine options that target new variants of the virus. While the company states that this is a business decision, a response to the declining sales of the older vaccine since other options are more relevant, it comes at a time when the vaccine has come under scrutiny for causing side effects. Researchers have found that the AstraZeneca vaccine, sold in India under the brand name Covishield by Pune-based Serum Institute of India (SII), is linked to  Vaccine-Induced Immune Thrombocytopenia and Thrombosis (VITT), a blood clotting disorder. According to the scientists from Flinders University in Australia, who recently shared their study in the New England Journal of Medicine, VITT emerged in 2021 during the pandemic, particularly after the use of the Oxford-AstraZeneca vaccine, which is based on adenovirus vectors. According to media reports, soon after AstraZeneca announced the global withdrawal of its COVID-19 vaccine, SII gave the statement that the firm had stopped the manufacturing and supply of additional doses of Covishield since December 2021. In fact, to shift the focus from these ongoing concerns on the COVID-19 vaccine and its related side effects, AstraZeneca has apparently gone ahead to announce the launch of a new COVID-19 prevention drug. Covaxin is also under the scanner, based on a recent study by Banaras Hindu University (BHU). Nearly one-third of the individuals who received Bharat Biotech's Covaxin reported 'adverse events of special interest,' or AESI, according to a one-year follow up study conducted by a team of researchers at BHU. Nearly 50 per cent of 926 participants in the study complained of infections during the follow-up period, predominated by viral upper respiratory tract infections.  In response to these findings, the Hyderabad-based vaccine manufacturer found this study to be inconsistent, marred by lapses. Bharat Biotech has been asserting that its COVID-19 vaccine has demonstrated ‘excellent safety track record’ in several studies. After reviewing multiple cases of side effects post vaccination, doctors in India have been urging the government to review the science behind all the COVID-19 vaccines, including Covishield and Covaxin.   An active surveillance and monitoring mechanism appears to be a ‘need of the hour’ to ensure vaccine adverse events are identified as early as possible, and not ignored.   Dr Manbeena Chawla Executive Editor (manbeena.chawla@mmactiv.com) ]]> https://biospectrumindia.com/views/21/24649/cure-for-multiple-sclerosis-ms-still-elusive.html https://biospectrumindia.com/views/21/24649/cure-for-multiple-sclerosis-ms-still-elusive.html Tue, 21 May 2024 00:00:00 +0530 World Multiple Sclerosis Day, falling on May 30 every year, invites dialogue on the disease between different stakeholders across the globe. The fact that symptoms flare-up and subside for many people with multiple sclerosis (MS), combined with the wide variety and unpredictability of symptoms, has made MS a difficult disease to recognize, define, and treat – right from the start. MS exists in India, but the prevalence is lower than in European and American populations. The phenotypic presentation of MS in India appears to be very similar to that of the West, and some of the genes in Indian patients are also similar to those found in the Western patient population. In 2022 alone, the Global Multiple Sclerosis Drugs Market size was valued at $24.64 billion and is poised to grow from $25.40 billion in 2023 to $32.43 billion by 2031, at a CAGR of 3.10% during the forecast period (2024-2031). While there is no cure for MS, there are treatments that can reduce the number and severity of relapses and delay the long-term disability progression of the disease. For instance, corticosteroids, such as intravenous (infused into a vein) methylprednisolone, are prescribed over three to five days. Roche Pharma, a global leader in healthcare, announced introduction of a groundbreaking therapy for MS in India on 27th February 2024. Ocrevus (Ocrelizumab) has been launched as the first approved treatment for both Relapsing-Remitting Multiple Sclerosis (RRMS) and Primary Progressive Multiple Sclerosis (PPMS). Ocrevus is a monoclonal antibody designed to destroy B-cells, a type of immune cell with a central role driving inflammation in MS. However, cost is a major challenge here. This treatment is priced somewhere between 9 and 12 lakh. Thus, limited affordability and access to expensive MS drugs can restrict their adoption and limit market growth, particularly in regions with lower healthcare budgets or inadequate insurance coverage. Another observation is that the introduction of new oral drugs like Siponimod (BAF312), Tecfidera, Laquinimod, and Ozanimod is driving the segment's growth. But due to their greater efficacy and convenience, injectable medications are becoming more and more preferred over oral ones.  Hence, there is an urgent need to understand the underlying mechanisms of MS to develop affordable and effective solutions to treat this condition. Recent studies conducted by researchers at institutions such as the Indian Institute of Science (IISc) and the All India Institute of Medical Sciences (AIIMS) have shed light on potential biomarkers for MS progression, opening up new avenues for early diagnosis and targeted intervention. In a recent development, Multiple Sclerosis Society of India (MSSI), a non-profit organisation, is set to collaborate with the Sudha Gopalakrishnan Brain Centre at the Indian Institute of Technology (IIT) Madras for advanced research into the cause of the chronic immune system disorder. Through innovative research, collaboration, and technological advancements, companies and researchers in India can push the boundaries of science and bring hope to millions of people affected by this debilitating disease.   Samika Jain, Freelancer ]]> https://biospectrumindia.com/views/21/24046/suffering-from-gigo-turn-to-grds-instead-for-better-healthcare-innovations.html https://biospectrumindia.com/views/21/24046/suffering-from-gigo-turn-to-grds-instead-for-better-healthcare-innovations.html Fri, 05 Jan 2024 00:00:00 +0530 Here’s the Problem… Let me get straight to the point. Many pharma and life sciences companies that dove into the Generative AI space are now dealing with a significant problem: GIGO. For the uninitiated, that means “garbage in, garbage out.” It’s an old computing term that has taken on new life amid healthcare’s burgeoning AI enhancements. Very simply, it means training your artificial intelligence models on bad data means you’ll get bad answers in the end. Seems obvious, doesn’t it? So why do so many pharma companies fall into that trap? Was it the excitement to get on the GenAI train? Was it budgeting reasons? No matter why they did it, healthcare companies are now finding out that their GenAI setups are suffering from hallucinations, and their output isn’t quite good enough for guiding next-best-actions for field reps or chatbot responses to potential clients and patients. It's very simply a matter of incomplete data at the onset. The idiom is “garbage in, garbage out,” but the reality is that the data you put in is massively valuable. It is in no way garbage; it’s just incomplete. You may be using structured data like those found in Excel sheets, customer databases, clinical trial results, and a myriad of other sources. But you’re missing out on the gold mine of results and insights: unstructured data. This includes doctors’ notes, recordings from patient exams, image scans, wearable data streams – any data that simply doesn’t fit into a neat spreadsheet. You need to find a way to get that treasure trove of information into your GenAI setup. And you do that by turning it into “generative AI-ready datasets” or GRDs.   Generative AI-Ready Datasets By converting data into the kind that’s ready for AI analysis, you can have GRDs that become far superior for applications like natural language generation and creative work. GRDs allow generative models like ChatGPT to learn and craft content that resembles the input data. In the pharmaceutical space, GRDs have the potential to revolutionise research and advance personalised medicine. From an operational standpoint, GRDs can help build the template for future custom training models. They can help refine models already in use. And they can bolster bespoke medicine by using individual patient preferences and health information. Of course, this is all done with the utmost adherence to privacy and ethical guidelines.   Sounds Familiar, But It’s Not Introducing natural language interactions provides real potential, from faster data retrieval to a laser-like focus on a topic to time saved. The upside is limited only by your creativity. But simply adding a fancy chatbot to your framework won’t cut it. None of these benefits will be possible if your information assets aren’t prepared. You need to turn them into generative AI-ready data. We know that GenAI and the large language models (LLMs) that power it are prone to inheriting biases from the training data. Those biases are two-fold. First, it can only report on the information it was fed. If your statistics were flawed, if you had the wrong dates, if you underestimated the number of prescriptions, whatever your mistakes were at the start – those mistakes will carry over to the results. But the second and more capacious bias is the style of answer those models will give. If you’re not feeding it the unstructured data, you can’t expect it to provide similar results. In other words, to paraphrase the idiom at the start of this piece: “human in, human out.” If you train your GenAI model with doctor’s notes, you can give results the way a doctor would say it. Feeding it the “human touch” will make the responses far easier for us in the physical world to understand.   Conclusion It’s not a suggestion at this point. To get the most out of your expensive AI setup, you must feed it the best information possible. That means no longer ignoring the hard-to-analyze unstructured information. You must convert it to generative AI-ready datasets. All data is valuable, so why leave half of it on the table? Use it, and you’ll uncover the hidden gems of insights you already possess. Forget “GIGO.” With GRD, you’ll have “insights in, better patient results out.” And that gives us all a brighter future for healthcare innovation.   Jassi Chadha, President and CEO, Axtria ]]> https://biospectrumindia.com/views/21/23976/women-of-northeastern-region-facing-severe-healthcare-challenges.html https://biospectrumindia.com/views/21/23976/women-of-northeastern-region-facing-severe-healthcare-challenges.html Tue, 19 Dec 2023 00:00:00 +0530 The Northeastern Region (NER) of India, with its unique geography, diverse terrain, and rich socio-cultural fabric, is making strides in socio-economic development of the country. However, a deep-seated healthcare crisis continues to afflict the region, with both communicable and non-communicable diseases (NCDs) affecting the day-to-day lives of the people. The health challenges faced by women in NER encompass a spectrum of issues, including but not limited to maternal health, malnutrition, and infectious diseases; ignorance, limited access to healthcare facilities in remote areas amplifies these concerns, leading to a higher prevalence of health disparities. In women healthcare, NER is weaker than any other state of the country. The factors responsible for poor rural healthcare services are:   Menstrual health Issues Menstrual health among women is intricately tied to a complex interplay of cultural, social, and economic factors. Fortunately, various initiatives and awareness campaigns have been implemented to tackle these issues. These efforts aim not only to break the silence surrounding menstruation but also to empower women with accurate information and access to essential hygiene resources. Additionally, educational programmes are being conducted to dispel myths and foster a more supportive environment for women's menstrual health.   HIV and other infectious diseases North eastern states of India have higher number of HIV cases than any other part of the country. According to the NACO report Manipur has more than 25,000 registered people living with HIV and their children whether affected or not usually avoid getting tested for AIDS, for the fear of social ostracism. One of the major reasons for the increase in the cases of AIDS is drugs. Mizoram shares two international borders, one with Myanmar, the golden triangle in the east and Bangladesh in the west, a haven for drug traffickers, who often use infected syringes leading to its fast spread, affecting both men and women equally. According to the NACO Mizoram has acquired the dubious distinction of becoming one of the leading states that registered an average of 5 to 6 positive cases in a day. Manipur and Nagaland are not too far behind in the race.   Cancer According to the ICMR reports, the probability of developing cancer over a lifetime is as high as 1 in every 4 males and 1 in every 6 females in Assam. Among women, breast cancer was found leading with 14.5 percent followed by cervix uterus 14.2 %. According to the cancer incidence DAR for 2012 -2016 the highest incidence of cancer in women in India was in the North Eastern region, with Aizwal and Kamrup leading the cancer incidence rates.   Peculiar Dietary Habits Almost negligent availability of fruits and vegetables, highly spicy food, limited water intake, over dependence on hot beverages and consuming fermented pork, dried and salted meat and fish using soda as food additive, raise the risk of cancer. The prevalence of H pylori infection which may act as carcinogen is very high in these regions. The practice of betel nut chewing was found to be one of the major reasons for oesophageal cancer. Mizo women, particularly from Aizwal district, have the highest incidence of lung cancer due to excessive tobacco use, cigarette smoking, and inhalation of second-hand smoke. About 22.8% women suffer from tobacco related cancer, of which Tripura leads in tobacco consumption. In breast cancer, Aizwal recorded the highest incidence among all North Eastern states. Cervical cancer, another leading type of cancer, caused by persistent infection with HPY 16 and 18 is prevalent among women.   Other conditions Maternal health remains a significant concern, with inadequate antenatal care and unskilled birthing assistance contributing to heightened risks during pregnancy and childbirth. Cultural norms and societal taboos surrounding menstruation continue to influence women's experiences in the region. These norms can contribute to a lack of open dialogue about menstrual health, leading to misinformation and stigma. Infectious diseases, such as malaria and waterborne illnesses, pose additional threats to the well-being of women in the region. Economic disparities also play a role. Many women have to struggle to afford sanitary products, leading to improvised solutions that may compromise hygiene. Efforts to address these issues involve a multi-faceted approach, combining improved healthcare infrastructure, community health education, and targeted interventions for maternal and child health. Collaborative initiatives between governmental and non-governmental organizations are essential to alleviate the agonies faced by these women.   Disease Burden and Healthcare Utilisation Study A comprehensive study was conducted by Manali Swargiary and H. Lhungdim which aimed to understand the disease burden and healthcare utilization in the North Eastern Region of the country. The findings were shocking. The study revealed that Sikkim and Mizoram reported the highest prevalence, while Meghalaya emerged as the 'healthiest' state with the least reported prevalence. The prevalence of infectious diseases was highest, followed by other ailments and NCDs. Notably, NCDs, including vaginal, menstrual, and reproductive health issues, have been gradually expanding in the region, warranting urgent attention and preventive measures. A survey conducted by Gynoveda in the eight states of Northeast India highlighted the staggering health challenges faced by women in the region. A staggering 98% of women reported grappling with health issues.    Over the years, the Government of India has implemented various healthcare infrastructure and policies to bridge the gap between the need and the feed in these underserved areas. However, despite an increase in expenditure in recent years, the region still lags behind the rest of the country.  The prolonged isolation, marginalization, increased cross border movements and insurgency in the region have hindered development. To improve women healthcare and establish primary medical and diagnostic facilities for the women in this region, a collaborative effort of the public and private sector is needed. Other than Government PSUs and Corporates have a crucial role to play in bridging the healthcare gap and build a better diagnosis and treatment facility by spending CSR funds here. Which can really make a difference.   CSR Funds and Healthcare in North East India A critical analysis of CSR spending in the Northeast reveals that it constitutes a mere 0.91% of the total CSR funds spent in India, as per the Ministry of Corporate Affairs. While there is a growing trend in the absolute amount, the percentage share remains disproportionately low. Education, health, and rural development emerge as the top recipients of CSR funds, but the challenges persist due to a lack of awareness, insufficient infrastructure, and difficulties in identifying and implementing projects.   Rural Development and Healthcare The Census data underscores the unique challenges faced by the Northeast, with 84% of the population residing in rural areas, surpassing the national average of 70%. The region, constituting 8% of India's total geography and home to 4% of the population, grapples with severe developmental challenges. Poverty rates in the region are significantly higher than the national average, standing at 34.28%. Despite government schemes, the Northeast continues to face developmental challenges, with limited CSR funds spent in these crucial areas such as healthcare.   Challenges and the Way Forward The healthcare challenges faced by women in Northeast India are deeply intertwined with the overall development and healthcare infrastructure of the region. Limited CSR funds spent, coupled with challenges such as lack of awareness, infrastructure deficits, and difficulties in project implementation, exacerbate the healthcare crisis. The agonising healthcare challenges faced by women in Northeast India demand immediate attention and concerted efforts from both the public and private sectors. The region's unique socio-cultural fabric, coupled with the burden of diseases and inadequate healthcare infrastructure, necessitates a comprehensive approach. Increased CSR funds spent in focused manner, awareness campaigns, and strategic healthcare interventions are crucial to empower women, enhance healthcare access, and alleviate the suffering of the Northeastern population. Only through collaborative efforts can the region overcome its healthcare challenges and pave the way for a healthier and more prosperous future.   Dr Rupinder Mahendra Murjani, Chief Medical Advisor, Superceuticals ]]> https://biospectrumindia.com/news/21/23895/a-growing-problem-in-india-is-binge-eating-a-mental-disorder.html https://biospectrumindia.com/news/21/23895/a-growing-problem-in-india-is-binge-eating-a-mental-disorder.html Thu, 30 Nov 2023 00:00:00 +0530 A recent study found that as obesity and lifestyle disorders continue to grow, binge eating is becoming a common problem, with around 50% of young people showing signs of binge eating tendencies, as well as almost 37% of cases being classed as severe.   That’s a worrying statistic, and a clear sign that more people in the country are requiring binge eating disorder treatment by the day. Before that, though, more understanding of what it actually is is undoubtedly needed to.   In India, the escalating concern of binge eating has raised questions about its classification as a mental disorder. Binge eating, characterized by consuming large quantities of food in a short period, often accompanied by a lack of control, has become increasingly prevalent. This behavior transcends mere indulgence and is now being scrutinized for its potential ties to mental health. Many experts argue that binge eating may be indicative of underlying psychological issues, such as stress, depression, or anxiety. The societal pressure to conform to certain body standards and the availability of high-calorie, easily accessible foods contribute to the problem. As the conversation around mental health gains momentum in India, addressing the potential classification of binge eating as a mental disorder becomes crucial for developing effective intervention strategies and promoting overall well-being   The intricate relationship between binge eating and mental health in India underscores the need for a nuanced understanding of this phenomenon. Beyond its physical implications, binge eating is increasingly recognized as a coping mechanism for individuals grappling with emotional challenges. The stigmatization of mental health issues in the country exacerbates the problem, often leading individuals to turn to food as a source of solace. This behavior, however, can create a vicious cycle, as the consequences of binge eating contribute to further emotional distress. Recognizing binge eating as a potential mental disorder is a pivotal step in dismantling the stigma surrounding mental health in India and fostering a more compassionate and holistic approach to well-being. As the nation grapples with this growing issue, initiatives to raise awareness and provide accessible mental health support are crucial components of a comprehensive strategy to address the multifaceted nature of binge eating. Defining Binge Eating Disorder So, what exactly is binge eating disorder? Well, it is officially recognised as a mental health condition and essentially involves those suffering enduring recurrent episodes of consuming an excessive amount of food, often to a point of discomfort or sickness.   What distinguishes it as a disorder is the lack of control that comes alongside it, which can be incredibly problematic for those going through it. Symptoms of Binge Eating Disorder That uncontrollable nature of binge eating disorder is the most common sympton. However, you often find that they also eat a lot quicker than normal during those episodes, even if not physically hungry.   Emotions such as guilt, shame and distress are notable during binge eating episodes, which can lead to further mental health conditions such as depression. Causes of Binge Eating Disorder But what causes it? Well, that’s a complex question and the answer is rather multifaceted. Things like family history and other mental health issues can contribute, while the environment we find ourselves in, alongside the stress we’re under can also be a factor.   Body dissatisfaction is also a common reason people find themselves developing an eating disorder, particularly during an age where social media heaps pressure on young people to look a certain way. Getting treatment Naturally, binge eating disorders have a huge impact on a person’s health, and can cause a number of physical health conditions, habing an impact on your cardiovascular system, cholesterol levels and more.   Recognising the problem is key to getting help, with many rehab centres now available to treat people and help people manage their disorder. It’s hugely important to take such a step, improving your health and future for a healthier and happier lifestyle. ]]> https://biospectrumindia.com/views/21/23841/education-must-for-early-detection-of-breast-cancer.html https://biospectrumindia.com/views/21/23841/education-must-for-early-detection-of-breast-cancer.html Wed, 15 Nov 2023 00:00:00 +0530 Breast cancer (BC) is the most diagnosed type of cancer claiming the lives of more than 0.5 million women every year globally. Breast Cancer has become so common in India that we are bound to know a friend or a family member suffering from it. Thanks to the scientific and technological advances in oncology, early detection and treatment have helped increase survival to almost 95%, reduce morbidity and lower cost of care. However, even literate people are unaware of this or shy about accessing early breast cancer detection methods. Constant efforts are needed to increase breast cancer awareness among doctors as well as women and the public.     Breast Cancer Disparities in Low- and Middle-Income Countries The World Health Organization (WHO) recommends that countries commit to a holistic, 3-pillar public health approach, including health promotion, timely diagnosis and comprehensive treatment, and supportive care. Mortality due to breast cancer has dropped by 40% in high-income countries because of access to early detection and treatment facilities. Yet, this is not the case in low- and middle-income countries like India, pushing several families to poverty and financial hardships, social instability, and suffering. For countries with dense/remote populations with limited resources, cancer awareness and early detection of breast cancer are sustainable ways to reduce incidence and mortality. The National Cancer Control Programme was started by the Government of India in the 1970s. However, breast cancer screening is yet to become a part of national health monitoring systems in every district.     Early Detection and Diagnosis Early detection methods (EDM) mainly include breast awareness, clinical breast examination and mammography. Imaging techniques including MRI, PET, ultrasound, molecular markers and traditional tissue pathologies are further employed for confirmation and staging. Research on newer digital imaging techniques and molecular diagnostics is underway to provide affordable and accessible diagnostic methods. Studies on cultured, ex vivo and in vivo breast cancer cells are contributing to furthering fundamental understanding of the erratic behaviour of cancer cells. Emerging Artificial Intelligence-based solutions for breast cancer are awaited. Early detection methods (EDM) can be classified as those that can be handled at the individual or community level and others that require access to a facility or an expert. Trained ANMs (Auxiliary Nurse Midwife) and ASHA (Accredited Social Health Activist) workers, and physicians (Medical, AYUSH) play a pivotal role in early detection and referrals at the community level. Studies have shown that creating awareness among the public about breast health and risk factors, and training women in self-examination, had a significant increase in the early-stage BCs reported. This in turn helps in quick and effective management.   Medical Education and Interdisciplinary Collaboration The medical curriculum of the Indian National Medical Council delves into various cancer and tumour types including BC. Continuous medical education and skill-based fellowships can provide doctors and students of medical and allied professions the necessary exposure and skills to adapt to the changing S&T scenarios. Innovative early detection methods can be arrived at through the trans-disciplinary collaboration of medical doctors, health scientists, technologists, and sociologists. Government policies and programmes that prevent environmental damage and enable lifestyle improvement are long-lasting solutions to reducing breast cancer cases.   Dr Padma Venkat, Dean, School of Health Sciences & Technology, UPES, Dehradun  ]]> https://biospectrumindia.com/views/21/23832/addressing-monumental-challenges-for-rapidly-increasing-ageing-population.html https://biospectrumindia.com/views/21/23832/addressing-monumental-challenges-for-rapidly-increasing-ageing-population.html Fri, 10 Nov 2023 00:00:00 +0530 The global population is growing as well as ageing. Globally, there are 1.1 billion persons aged 60 years or above in 2022, comprising 13.9 percent of the total population of 7.9 billion. Over the next three decades, the number of older persons worldwide is expected to double to 2.1 billion by 2050, with the share rising to 22 percent of the total population. This increase in the number and share of older persons will be visible across all regions of the world. In more developed regions, the share of older persons will increase from 26 percent in 2022 to 34 percent in 2050, while in less developed regions, it will increase from 11.5 percent to 20 percent during the corresponding period. India is not an exception to this phenomenon. There are 149 million persons aged 60 years and above in 2022 (as on 1 July), comprising around 10.5 percent of the country’s population. By 2050, the share of older persons will double to 20.8 percent, with the absolute number at 347 million. This unprecedented rise in the ageing population will have significant implications for health, economy and society in India. As seen in Japan and in European countries, this inverted aging pyramid will lead to 3 distinct challenges Increase in the load and burden on the Healthcare system Necessity to increase working age groups to maintain nation building activities Social Security and benefits related impact on the government India is currently poorly equipped to manage this transition both from infrastructural and resource availability. We are short by 0.12 million beds and more than 5 million trained medical and paramedical personnel as per WHO standards. Looking into the aspect of healthcare challenges alone we have 4 specific and monumental challenges with respect to the rapidly increasing ageing population: Care for Chronic illness and frail elders Accessibility for acute illness management Managing costs for Hospitalisation and Medication Wellness and Quality of life management for Healthy Elders   Care for Chronic illness and Frail Elders This segment includes bedridden elders and those who are unable to perform their activities of daily living. Taking into account the incidence of these (approx 0.25% of total population based on the index of frailty used) these account for nearly 3.5 million people who require either full time or part time caregivers. Home healthcare services provide this gap and over the past decade there is a shift from unorganised to organised home healthcare services with few organisations like HCAH, Portea etc leading the way. However, the home healthcare industry is plagued with critical challenges with availability of trained resources for the providers and at price points varying between Rs 20000 per month to Rs 1,50,000 per month based on the services needed brings forth significant affordability challenges in an environment where insurance is almost unheard of.  Where affordability is a constraint, this effectively means that for every elder who requires caregiving one family member remains unemployed to take care of them. Most home healthcare organisations are now migrating to assisted living models where resource availability concerns are being addressed to a certain extent. With the market growing at over 25% annually we have still not penetrated more than 3% in this space.   Accessibility for acute illness management Currently this is well addressed in Metros and Tier 1 cities with a mushrooming of private hospitals, however lack of geriatricians and trained nursing staff continues to impact the elder care space. Corporate hospitals guided by lower ALOS (average length of stay) metrics and pressure to increase ARPOB (average revenue per occupied bed) lead to early discharges with almost no transitionary care or continued care facilities available to ensure better outcomes. Once you are outside the metros and Tier 1 cities accessibility is a major challenge both from the availability of hospital beds and trained doctors and nurses. Covid as well as seasonal issues like dengue show the vulnerability of our system with severe shortages in bed availability, medicine availability and high mortality rates The goal of care for elders is still very transactional right now in hospitals rather than a preventive and holistic care cycle.   Managing costs for Hospitalization and Medication India has one of the lowest insurance penetration for senior citizens. With out-of-pocket payments continuing to be around 60-70% of healthcare expenditures, falling sick is becoming a financial nightmare for many families. Low sum insured also contributes to this with an average of under 3 lakhs per person. This effectively means that insurance struggles to cover more than 5-6 days of stay or 1 major procedure (hip/knee replacement etc) for the elders.  However, we have seen that the insurance space is growing at over 30% per annum in the age groups of 60 and above especially with progressive companies offering insurance for the parents of their employees. The critical challenge is the penalty for pre-existing diseases with ensures that a large number of medical issues remain unaddressed for anywhere between 1-3 years of the policy, which again feeds the vicious cycle of out-of-pocket payments and co-payment.   Wellness and Quality of life management for Healthy Elders This is currently the most under served area with fragmented services. Between clinics/diagnostic centres/health camps, these services are offered in bits and pieces without synergy. We feel that this is an area where a country like India needs to invest significantly, as this will reduce the burden of disease and frailty and bridge the gap between life span and healthy lifespan (around 16% of lifespan today). The core tenets of early identification, appropriate management and regular tracking is a space that is sorely absent in the country today. The healthcare system today is rewarding transactional care over holistic care and evolved into fragmented ownership of the patient’s outcome among various healthcare channels instead of consolidating the same and re-visiting the family physician concept. Basic screening+ diet+ fitness+ medication management is missing and this will be the differentiator between a healthy country and an unhealthy country. The onus should be on reduction of hospitalisation especially for preventable causes like malnutrition/ physical fragility and medication mismatch rather than rewarding hospitalisation among the private and governmental institutions.      About the author- Dr Harsha Guduru is the founder of Restory and a passionate physician in the space of geriatrics and quality of life in elderly. He has over a decade experience in the geriatrics space across Home Healthcare, Critical care and Hospital management.     ]]> https://biospectrumindia.com/features/21/23446/augmented-intelligence-shaping-the-future-of-healthcare-through-ai-advancements.html https://biospectrumindia.com/features/21/23446/augmented-intelligence-shaping-the-future-of-healthcare-through-ai-advancements.html Wed, 09 Aug 2023 00:00:00 +0530 Explore how augmented intelligence, including Biological AI, Generative AI, and Emotion AI, is shaping the future of healthcare through enhanced decision-making, diagnosis, and treatment. Discover the transformative potential and challenges of AI integration in healthcare. In a world where technological breakthroughs are transforming industries at an unprecedented pace, the realm of healthcare stands poised to witness a revolutionary evolution with the integration of augmented intelligence. Bob Samuels and Sean Markin will be engaging in a live candid conversation with Steve Ardire, a seasoned Strategic Advisor, to delve into the potential of augmented intelligence in healthcare on “Candid with Bob”. This discussion will shed light on how emerging fields like Biological AI, Generative AI, and Emotion AI are set to revolutionize the healthcare landscape, enhancing decision-making, diagnosis, treatment, and overall patient experience.   Augmenting Human Intelligence in Healthcare   At the core of this transformation lies the augmentation of human intelligence through the power of AI. The integration of AI technologies can lead to more accurate and data-driven decision-making processes. Healthcare professionals can harness the vast capabilities of AI algorithms to analyze extensive datasets, uncover hidden patterns, and assist in diagnosing complex medical conditions. This augmented intelligence does not replace human expertise but rather amplifies it, leading to more informed medical interventions and improved patient outcomes.   Biological AI: Nature's Blueprint for Innovation   One of the remarkable breakthroughs that will be discussed in the conversation is the concept of Biological AI. Inspired by the intricacies of nature and biology, this branch of AI aims to replicate and harness natural processes to solve complex problems. By mimicking the efficiency of biological systems, researchers and healthcare practitioners can develop novel solutions that were previously unimaginable. This could lead to the creation of advanced prosthetics, organ replacements, and even regenerative therapies, ushering in a new era of personalized medicine and enhancing the quality of life for countless patients.   Generative AI: Unleashing Creativity for Better Outcomes   Generative AI, another exciting facet of the conversation, has the potential to transform the healthcare landscape by creating new data, content, and models. This technology holds the key to addressing data scarcity, a common challenge in medical research. Through generative AI, researchers can simulate scenarios, generate synthetic datasets, and develop predictive models, thereby accelerating drug discovery, treatment optimization, and disease understanding. The ability to create vast amounts of diverse data can drive innovation and lead to breakthroughs that were previously hindered by data limitations.   Emotion AI: Enhancing Empathy and Well-being   One of the most intriguing aspects of the conversation centered around Emotion AI. This cutting-edge field enables machines to comprehend and influence human emotions and behaviors, paving the way for improved patient experiences and enhanced empathetic interactions. Emotion AI could be integrated into wearable devices to monitor patients' emotional states, assist in mental health assessments, and even deliver personalized interventions. By understanding and responding to human emotions, healthcare providers can establish deeper connections, ultimately fostering a more holistic approach to patient care.   Navigating Challenges and Risks   While the potential of augmented intelligence in healthcare is awe-inspiring, it's important to address the challenges and risks associated with its adoption. Data privacy, ethical concerns, and the need for stringent regulations remain key areas of focus. Ensuring the security and privacy of patient data, establishing transparent AI algorithms, and maintaining a balance between human judgement and AI-driven insights are vital steps toward successful implementation.   In conclusion, the live candid chat between Bob Samuels, Sean Markin, and Steve Ardire will underscore the transformative potential of augmented intelligence in healthcare. The fusion of Biological AI, Generative AI, and Emotion AI has the capacity to revolutionize medical practices, enabling better decision-making, diagnosis, and treatment. As the healthcare industry continues to embrace AI-driven advancements, the prospect of a future where technology and human expertise harmoniously coexist appears brighter than ever before plus, you will get a chance to ask Steve your questions and get his insights on the future of AI in healthcare. So, mark your calendar for August 17, 2023 and register yourself for this informative yet “candid” webinar! ]]> https://biospectrumindia.com/views/21/23221/post-partum-depression-in-men.html https://biospectrumindia.com/views/21/23221/post-partum-depression-in-men.html Sun, 18 Jun 2023 00:00:00 +0530 Although most of us—men and women alike—are socialised to think of men as providers of support during the perinatal period and early parenthood, a wealth of research shows that 10 per cent of new dads experience paternal postpartum depression (PPD) (50 per cent when mom is depressed!) and tend to need support of their own. However, the stigma against experiencing difficulties in early parenthood is even higher for men than for women. Society views men as stoic, self-sacrificing, and above all, strong. When men feel none of those things as new fathers, they don’t want to admit it or seek help. For this reason, Postpartum Support International (PSI), an enthusiastic supporter of International Fathers’ Mental Health Day (IFMHD) on June 19, a day after Father’s Day (this year it falls on June 18 otherwise celebrated on third Sunday in June in the United States, United Kingdom, Canada, India, and a number of other countries around the world), as a means to take a whole-family, father-inclusive approach by shedding light on the best practices and related resources for dads, their partners, and those who support them. Paternal postpartum depression is often defined as an episode of major depressive disorder (MDD) occurring soon after the birth of a child. It is frequently reported in mothers but can also occur in fathers. There are no established criteria for PPD in men, although it could present over the course of a year, with symptoms of irritability restricted emotions, and depression. Risk factors include a history of depression in either parent, poverty, and hormonal changes. It might be associated with anxiety disorders and can adversely affect the father, family unit, and developing child. Treatment includes psychotherapy and pharmacotherapy. Clinicians are encouraged to screen for depression in men during the first year postpartum and to offer treatment or treatment referral if depression is present. Paternal postpartum depression has only been studied by a small number of researchers, so it is not surprising that there is a long list of questions yet to be addressed. It is important to identify at-risk groups of fathers for paternal PPD, such as fathers with lower incomes, fathers of very young or old age, or ethnic minority background. It is also important to study fathers in non-traditional settings, such as stay-at-home fathers, nonbiological fathers (e.g., stepfathers) or single fathers, in order to understand unique risk factors that may increase the risk for paternal PPD. It would provide us with a better picture to develop more accurate diagnostic tools and treatment programs for fathers with different backgrounds. To mark the Father’s Day and International Fathers’ Mental Health Day we will be covering a case study where Deepak Gopakumar, Managing Director, Vijayalakshmi Medical Centre, Kochi is sharing his views on paternal postpartum depression and suggests creating awareness and more research on PPD.   As long as I can remember, I have always wanted to be a dad. Maybe it was because I shared a pretty healthy relationship with my parents (as healthy as a 90s Asian parent child relationship can be), especially my dad. Marriage wasn’t necessarily a top priority for me growing up. Even after I passed out of college and when my friends started falling like dominos to the marriage reaper, I still didn’t feel any urge. But as you know these things tend to change when that one special person decides to waltz into your life. And so did mine after my wife (then girlfriend) and I started dating back in 2010. We decided to tie the knot in 2016 and 4 years later during the first Covid lockdown my baby girl Akeria was born. I was the 4th person to hold her as I was waiting in the post operative room right outside the operating theatre. Despite what most people might tell you, a lot of these supposed big moments in your life don’t seem all that remarkable or epiphanic and in that moment while I held her all I felt was apprehension at possibly dropping this tiny fragile thing. In the following days, after my wife was discharged, we came home and things started settling down, our entire lives revolved around the baby. Its funny its almost as if in a matter of a few days you can’t even remember how you lived before this new tiny person came into your life. Things weren’t always peachy, there were plenty of sleepless nights, issues with feeding, and the dreaded post-partum depression. We were informed plenty prior to the delivery about post-partum depression and how sometimes it can be quite scary and while my wife did go through certain bouts of what seemed like moodiness, anxiety and paranoia, it was relatively peaceful. My mother, an Ob-gyn who has seen and heard of plenty of similar and much worse cases, was always present and on standby. While my wife was doing fine it was a few months later, around 5 to 6 months in, that I noticed some things weren’t necessarily alright with me. While I hadn’t really experienced a euphoric burst of love for my daughter when I first held her, every day after that I felt my feelings towards her increased. But now suddenly 6 moths in I started feeling a little distant, not just to my daughter, but my wife as well. I felt low, unenthusiastic and highly irritable with no real urge to go to work or do anything. I didn’t want to talk to my friends or family or even spend any time with my child. That’s when the alarms went off in my head. I realized something was terribly wrong and I started doing a bit of research on my own and came across Paternal Postpartum Depression. In the initial few months after a child is born and, in some cases, even up to a year, the mother is the primary care giver especially when it comes to nursing and soothing and the father normally takes a more behind the scenes role of changing diapers, doing other work around the house etc and while this is in no way the rule, it is often the case in most heterosexual new parents. This often can cause a lot of friction between the partners and for me there were plenty of times I felt almost useless when it came to the day-to-day matters of the baby. Furthermore, research has shown that men’s testosterone levels are known to drop in preparation of arrival of the baby. Testosterone levels start to decrease at least a few months before the childbirth and maintain low levels for several months after the childbirth. Several researchers suggest that such decrease leads to lower aggression, better concentration in parenting, and stronger attachment with the infant. Interestingly, recent studies on older men show a significant correlation between low testosterone levels and depression. Men aged 45 to 60 who are clinically depressed also exhibit lower testosterone levels than normal men. Upon realising that I actually have a problem, I started researching in ways that can remedy it. The logical course of action at this point was to seek therapy or to “talk to someone about it”. While this is a very standard and routine treatment for most individuals suffering from any form of depression, I however, have always found a certain flaw in this method when it comes to men. Most women when they experience pain, look for comfort with other people. They are extremely durable and adaptable so they would endure and power through that pain with the connections they have built with others. Men are taught all their lives not to be a burden on anyone or this world. For them reaching out to someone to deal with the pain sounds exactly like being a burden on someone else. Men need to know there is a reason and a solution for the pain. Talk therapy may help individuals find a deeper insight into what’s troubling them and maybe feel loved or heard, but most male depression stem from a feeling of powerlessness or helplessness and men tend to equate this post therapy love with pity rather than actual problem solving. If a solution cannot be found then the discussion is pointless and in fact may even aggravate the issue even further. This treatment gap has resulted in a higher dropout rate in men when it comes to therapy. Data from outpatient populations suggest that approximately one in four individuals who seek therapy for mental health problems drop out prematurely. I spoke to a lot of other men who have attended therapy sessions with most of them coming back with the same response, i.e it was just a lot of talk with no solution in sight, or the therapist told me the answer lies within me or other similar catchphrase. I however was lucky to have a strong sense of duty instilled in me by my dad. He would always say, you may have the best of days or you may have the worst of days but regardless, always dress up and show up. I approached fatherhood with a newfound sense of duty. This new tiny human was my responsibility and while I may not necessarily love the late nights or the lack of sleep, I will perform this duty to the best of my ability. Along with this I restarted working out and eating healthy as the dad-bod I had developed in the past few months wasn’t doing my self-esteem any favours. The overall improvement in my fitness level along with clean eating really boosted my testosterone levels and overall happiness. While I had the presence of mind to understand and help myself, not every other man is as fortunate. While maternal postpartum depression is widely discussed and recognized as a serious health issue, it’s often hard for people to take seriously the idea of a man having similar problems. Overall, depression rates in men are about half those of women. Yet men exhibit significantly higher rates of substance use and account for three-quarters of suicides. There is some evidence that new fathers are especially at risk for the latter. This discrepancy suggests that many men are experiencing depression, but not addressing it. In fact, men are half as likely to seek help for mental health concerns compared with women as unlike women, men are often socialized to value independence, dominance, stoicism, strength, self-reliance and control over their emotions, and many see weakness as shameful. Couple this with the huge gulf in treatment modality and the general lack of understanding of the male psyche from a psychotherapy point of view, what we have is a very silent but potent epidemic. I personally believe that while a deeper study into this gap between the treatment and the disorder among men is warranted and alternate treatment methods are found, smaller steps such as counsellors in schools and colleges just paying a little extra attention to the boys or even clinical psychologists attending to women suffering from postpartum depression just ask the fathers if they’re doing alright and educate them of the symptoms of Paternal postpartum depression, can go a long way. Even though I may be from the healthcare industry, I myself am a non-medico and while I cannot speak intelligently about the research that needs to be done, I believe creating awareness seems like a smart first step.   There are still bad days, but they are far and few in between. My quality of life has greatly improved as is my bond with my family. My daughter is my world and the bond we share is unique and undoubtedly the greatest joy of my life.   Deepak Gopakumar, Managing Director, Vijayalakshmi Medical Centre, Kochi   ]]> https://biospectrumindia.com/views/21/23142/biotech-dreams-within-reach-5-insider-tips-and-tricks-for-success.html https://biospectrumindia.com/views/21/23142/biotech-dreams-within-reach-5-insider-tips-and-tricks-for-success.html Sat, 27 May 2023 00:00:00 +0530 The field of biotechnology holds immense potential for innovation and discovery. As the industry continues to advance, staying ahead of the curve is crucial for professionals. Whether you're a scientist, entrepreneur, or simply passionate about biotech, this article will provide you with five insider tips and tricks to help you succeed. Let's explore how you can turn your biotech dreams into reality!   Foster Multidisciplinary Thinking: Biotechnology is a multidisciplinary field that blends biology, chemistry, computer science, and engineering. Embracing multiple perspectives will broaden your thought process and allow you to approach challenges from multiple angles. Seek opportunities to collaborate and learn from experts in different fields, as this will improve your problem-solving skills and lead to new solutions.   Continuous Education and Career Development: The biotechnology industry is evolving rapidly with new discoveries and emerging technologies. To stay relevant and competitive, lifelong learning and professional development are essential. Attend conferences, seminars, and workshops to expand your knowledge and collaborate with experts. Additionally, explore online courses, books, and research papers to deepen your understanding of specific biotech topics.   Embrace Emerging Technologies: Technology plays a pivotal role in shaping the future of biotechnology. Stay updated on advancements such as gene editing (CRISPR-Cas9), artificial intelligence (AI), and advanced scanning techniques. Understand their applications and relevance in the industry. Effectively utilizing these technologies can enhance research, streamline processes, and enable the development of novel solutions.   Build Effective Networks: Building effective networks is critical in the biotech industry. Connect with like-minded individuals, attend industry events, and engage in biotechnology discussions online or through social media groups. Actively participate in discussions, share your insights, and seek guidance from experts. A strong network can provide educational opportunities, collaborative partnerships, access to funding, and potential career prospects.   Entrepreneurial Mindset and Perseverance: Biotechnology thrives on innovation, often requiring an entrepreneurial mindset and perseverance. Embrace the adventure and be open to exploring various job opportunities in different regions. Develop your business acumen, understand the regulatory environment, and learn how to effectively present your ideas to investors. Furthermore, be resilient in the face of disappointment and failure. Success in biotechnology is often achieved by those who persevere and learn from their experiences.   Embarking on a career in biotechnology or business is an exhilarating journey full of possibilities. Remember that success in this field requires a combination of skills, business acumen, and ethical responsibility. By following these insider tips and tricks, you can position yourself for a strong and prosperous future in biotech.   Dr Asha Rajiv, Director – IQAC & School of Sciences, JAIN (Deemed to be University)   ]]> https://biospectrumindia.com/features/21/23137/a-quick-guide-to-understanding-individual-health-insurance-comprehensive-coverage-at-a-minimal-premium.html https://biospectrumindia.com/features/21/23137/a-quick-guide-to-understanding-individual-health-insurance-comprehensive-coverage-at-a-minimal-premium.html Wed, 24 May 2023 00:00:00 +0530 As the awareness about investing in a Health Insurance plan is growing, many people from different age groups, especially the younger generations, take steps to secure their health and finances with Health Insurance.  Health Insurance plans can be broadly categorized under two sections - Individual Health Insurance and Family Health Insurance. As the name suggests, Individual Health Insurance plans provide coverage on an individual basis whereas a family of self, spouse, children and parents can be covered under a Family Health Insurance plan. Based on age, requirements and family commitments, one can invest either in Individual or Family Health Insurance.  Against popular belief, Health Insurance is an essential investment for young people. Individual Health Insurance is a feasible investment option to secure one’s health if they are single and just starting their career. This type of plan has a single Sum Insured and offers coverage up to the maximum coverage limit. Below are some of the perks of Individual Health Insurance.  Low Premium Individual Health Insurance plans provide coverage for an individual under a single Sum Insured. Unlike Family Floater Health Insurance, where a fairly large Sum Insured is required to cover the medical needs of the family members, individual plans can be opted for with a small Sum Insured. This reduces the premium. Moreover, if you are young and single, consider purchasing an individual plan as you can opt for it at a much less premium.  Cumulative Bonus Cumulative bonus, otherwise known as a no-claim bonus is a common feature in many Health Insurance plans. If a policyholder does not make a claim during a policy year, then a certain percentage of the Sum Insured is offered as a bonus. This will be added to the overall Sum Insured, thus, one can get extended coverage at times of need. This is an attractive feature, especially when it comes to Individual Health Insurance plans where the probability of making a claim is low compared to the Family Floater plans.    Flexibility One of the reasons that you can consider investing in Individual Health Insurance without much thought is that you can always convert most of the individual plans into Family Floater Health Insurance plans. During renewal, you convert your existing individual plan into a Family Floater plan by adding your family members like spouse, dependent children, etc., at an additional premium. You can also opt for a higher sum insured for covering the medical needs of all the added family members. Some policies allow you to add new family members even in the middle of a policy year. This feature is called Mid-Term inclusion. With this, you do not have to wait until the renewals to add your family members.  Discount Health Insurance policies offer a variety of discounts. One such discount is the long-term discount. If you purchase a medical insurance policy with a policy term of more than one year, then you can avail yourself of a certain percentage of discount on your premium. This will be highly beneficial with Individual Health Insurance plans. Since individual plans have less premium, you can opt for such plans with a term of more than one year. This further reduces your premium and helps you get comprehensive coverage at an affordable rate.  Individual Health Insurance is the best choice to secure your health if you are young and single. While planning out for your future, it is advisable to add Health Insurance to your list as you can get comprehensive coverage at an affordable premium.  _+_ ]]> https://biospectrumindia.com/views/21/23097/science-communication-social-media-can-make-or-break-it.html https://biospectrumindia.com/views/21/23097/science-communication-social-media-can-make-or-break-it.html Wed, 17 May 2023 00:00:00 +0530 The shape of science and public health communication has never been the same since the COVID pandemic. After all, a lot of people outside the scientific, medical, and public health community now understand the terms like quarantine or booster dose or know what flatten the curve means. It was the science stuff going viral this time. Major credit for this is certainly attributed to social media and the endless number of posts - informative ones, of course. The ease of it all played the biggest factor as unlike other sources of media, there are limited barriers with social media; after all, it does not take that long to tweet, and just about anyone can do so. Unfortunately, this also means it can all turn dangerous if not used wisely, more so when you are locked in and your dominant source of information is the internet. And we know when it comes to social media, it can go wrong rapidly, with the information multiplying exponentially. So while on the one hand, social media contributed to generating awareness and educating people, on the other, it also created panic through the plethora of misinformation, disinformation, and misleading content floating around[[1]]. There was no escape from the misinformation and myths, and in countries like India people struggled to understand the science, to differentiate between right and wrong information. It was not a drill, people were not trained for this, and the pandemic was a reality they were not prepared for. Social media was the source they turned to for health information, but not everything on social media could be trusted - it raised serious concerns among the public health sector. Both seeing this and anticipating the horrors of social media, the experts themselves stepped in and possibly offered a solution to the problem. It was not just the journalists, media houses, and government press releasing information and talking about the virus, the symptoms, and ways to prevent it, etc it was also the healthcare workers, the scientists at the labs, public health experts, epidemiologists, and data scientists busting myths, making sense of the complicated data and epidemiological terms, and bringing logic to the chaos. Although the content generated by these experts does not gather as much attention as from the entertainers and influencers, sometimes the tweets about viruses go viral! When Wiles and Morris collaborated to make the famous flatten the curve more “clear and visually engaging,” they did not realize the GIF they would create and share on social media would end up allowing “a wide range of publics, scientists, and health officials to comment on, share and adapt the communications for other audiences.”[[2]] This portrays one of the perfect examples of collaboration between science and creativity. The key is to strike the right balance and get the best results by involving both sides - the experts & professionals and the creative communicators.[[3]] There are similar examples of collaboration that may not have gone viral but did create a significant impact locally or nationally, mainly with amplified from the public officials and administrators. When it comes to pandemics or similar public health emergencies, what we need going forward is to reach the general public and/or specific community groups through fun and creative content with visuals (that are inclusive for people with color blindness) that do not compromise on the core public health message, and what better than receiving data-driven information from the experts/ specialists in the field. Getting the perfect blend of content and visuals ready is step one of the process. No matter the number of experts involved in the content creation process, it is pertinent to ensure quality assurance before the information goes out on social media - to check for the accuracy, credibility, and tone of the message. The public health messages that are easy to understand without the need to Google a bunch of heavy words, decomplexify the science, are backed by evidence, and are obtained from trusted sources generate a higher likelihood of people accepting the information and acting on it. The need of the hour is for localised level platforms and sources that can generate this kind of information and keep it brief, non-panicky, and just interesting enough to let the reader absorb it fully. COVID has given a chance to many such platforms to disseminate information on social media the edutainment way, and if they continue to use it right, it can go a long way in contributing towards prevention and preparedness for the next public health emergency.   Sabhimanvi Dua, Communication Lead, Precision Health, Swasti   [1] Social Media, Public Health, and Community Mitigation of COVID-19: Challenges, Risks, and Benefits. [2] Going viral: A science communication collaboration in the era of COVID-19 and social media. [3] Exploring Health Experts' and Creative Communicators' Focus in Pandemic Video Communication: A Qualitative Study. ]]> https://biospectrumindia.com/views/21/23014/oral-cancer-awareness-month-raising-awareness-taking-action.html https://biospectrumindia.com/views/21/23014/oral-cancer-awareness-month-raising-awareness-taking-action.html Thu, 27 Apr 2023 00:00:00 +0530 One of the most concerning trends in oral cancer is the rise in the number of cases being diagnosed each year. Globally, oral cancer is the sixth most common type of cancer with India contributing almost one-third of the total burden and the second country having the highest number of oral cancer cases. In India, around 77,000 new cases and 52,000 deaths are reported annually. As compared to the west, the concern of oral cancer is significantly higher here since around 70 per cent of cases are reported in the advanced stages. Because of detection in the late phase, chances of cure are very low, almost negative; leaving five-year survival rates around 20 per cent only. This trend highlights the urgent need for increased awareness and prevention efforts. There are several common causes of oral cancer including tobacco use, betel-quid chewing, alcohol consumption and human papillomavirus (HPV) infection. These risk factors can increase the likelihood of developing oral cancer and it is important for individuals to be aware of them and take steps to reduce the risk. This can include quitting smoking, reducing alcohol consumption and practicing safe sex to reduce the risk of HPV infection. Detecting cancer in its early stages is crucial in preventing additional physical, psychological and financial harm to the patient. By identifying it early, appropriate treatment can be administered promptly, potentially increasing the patient's survival rate to 90 per cent. While anyone can develop oral cancer, there are certain populations that are at increased risk. This includes individuals over the age of 45, men and those with a family history of cancer. Additionally, individuals who use tobacco and alcohol as well as those with a weakened immune system, are also at higher risk. The most vulnerable section of the society is underprivileged and lacks access to healthcare services. Many times, these individuals do not have the resources to get the necessary screening and care for oral cancer, making them more susceptible to the disease. The State of Kerala displays the lowest occurrence of oral cancer, whereas West Bengal records the highest. In the western regions of Maharashtra, oral malignancy is most prevalent in individuals aged 60 years or older, followed by those between 40 and 59 years old, with males being affected twice as frequently as females. An association based on gender has been observed in cases of oral cancer, with males exhibiting a high prevalence of cancer related to tobacco use. To address these risk factors and promote oral cancer prevention, it is important to prioritize regular screenings and check-ups with a healthcare professional. This can help to detect oral cancer in its early stages when it is most treatable. Additionally, individuals can take steps to reduce the risk by adopting healthy habits such as regular exercise, a balanced diet and good oral hygiene. Early detection is crucial in the successful treatment of oral cancer. It is important to know the signs and symptoms of oral cancer which can include persistent mouth sores, white or red patches in the mouth, difficulty chewing or swallowing, and a persistent sore throat. If any of these symptoms are present, it is important to consult a healthcare professional immediately. Performing self-examination is regarded as one of the most efficient ways to detect oral malignancy at an early stage. Utilizing a visual screening method is a practical approach that can lower the mortality rate and potentially prevent roughly 37,000 deaths caused by oral cancer worldwide. Additionally, Artificial intelligence (AI) devices using different AI algorithms and techniques can analyse the images of the oral cavity. This can play an important role in detecting pre-cancerous lesions and predict the development of oral cancer which can significantly improve the chances of successful treatment and recovery. The Government of India has taken several initiatives to address the rise in cases of oral cancer. This includes providing free screening and treatment services for oral cancer as well as launching campaigns to raise awareness about the importance of early detection and prevention. In 2020, India devoted close to Rs.2,386 Cr towards the treatment of oral cancer which was funded through various means including insurance schemes, Government and private sector expenditures, out-of-pocket payments and charitable contributions or a combination thereof. Assuming no inflation in treatment costs, this is anticipated to result in an economic burden of Rs.23,724 Cr on the country over the next decade. Addressing the burden of oral cancer in India necessitates a focus on prevention, early diagnosis and prompt treatment. Raising public awareness regarding the causes and fatality of oral cancer, the harmful effects of tobacco and alcohol consumption, as well as the significance of maintaining good oral hygiene is crucial. As we observe Oral Cancer Awareness month, let us come together to raise awareness about the disease and take proactive steps to prevent it. By working together, we can make progress in reducing the incidence and impact of oral cancer and ensure that individuals receive the care and support they need to live healthy, fulfilling lives. ]]> https://biospectrumindia.com/features/21/22842/rising-number-of-job-opportunities-for-women-in-biotechnology.html https://biospectrumindia.com/features/21/22842/rising-number-of-job-opportunities-for-women-in-biotechnology.html Fri, 24 Mar 2023 00:00:00 +0530 The percentage of women in the field of biotechnology varies by country and region. According to a 2020 report by UNESCO, the global average of women working in science, technology, engineering, and mathematics (STEM) fields, including biotechnology, is around 28% and according to a report by the Association of Biotechnology Led Enterprises (ABLE), the percentage of women in the biotechnology industry in India is estimated to be around 30%. This percentage includes women who are working in research, development, manufacturing, sales, and management roles in the biotechnology industry. The job prospects for women vary significantly depending on the industry, country, and cultural context. In India, the job prospects for women have improved in recent years due to a number of factors, such as increased education and training, government policies promoting gender diversity, and greater awareness of gender equality issues. We are seeing a good spike in the ratio of women pursuing higher studies. Women are now seen in leadership roles more as compared to the past. Also, organisations promoting gender diversity and inclusion has added to the women workforce into their systems.   Rising opportunties Research and Development: According to a report by the Indian Brand Equity Foundation, women constitute approximately 30% of the total workforce in the research and development sector in biotechnology. Pharmaceutical and Healthcare: The pharmaceutical and healthcare sector in biotechnology is another significant employer of women. According to a report by the Confederation of Indian Industry, women constitute approximately 40% of the total workforce in the pharmaceutical and healthcare sector in biotechnology. Agriculture and Environment: The agriculture and environment sector in biotechnology is also emerging as a significant employer of women. According to a report by the National Biotechnology Development Strategy, women constitute approximately 30% of the total workforce in the agriculture and environment sector in biotechnology. Academia and Education: Academia and education is another sector where women are increasingly finding job opportunities in biotechnology. According to a report by the Indian Journal of Science and Technology, women constitute approximately 40% of the total faculty in biotechnology departments in various academic institutions in India. Overall, it can be concluded that the biotechnology industry in India is offering numerous job opportunities for women across different sectors, and the trend is expected to continue in the coming years.      Adding support & flexibility Here are some ways in which addressing the needs of women can improve work-life integration- Providing flexibility can help women to balance work and family responsibilities more effectively. Creating a supportive work culture which includes initiatives such as mentorship programs, diversity and inclusion training, and family-friendly policies. Addressing gender bias and stereotypes in the workplace can help to create a more equitable and supportive environment for women. Providing opportunities for career development Biotech industry requires multidisciplinary knowledge and managing skilled professionals. Providing opportunities like mentorship, coaching to be assertive, training in leading and managing within organisations is important for both personal and professional growth. Even organisations like BIO has now come up with BIOequality Agenda to support women in Biotech and Health Industry.   ]]> https://biospectrumindia.com/views/21/22790/close-the-care-gap-role-that-each-of-us-can-play-to-combat-cancer.html https://biospectrumindia.com/views/21/22790/close-the-care-gap-role-that-each-of-us-can-play-to-combat-cancer.html Mon, 13 Mar 2023 00:00:00 +0530 The first case of Cancer was reported in the 16th and 17th centuries, and while there has been tons of research done on the subject including advancement in the treatment, the ‘C’ word still creates a sense of fear, uncertainty, and helplessness for most people. Today unfortunately, almost all of us know of someone affected by cancer or undergoing treatment. Many of us have lost our loved ones too to this dreadful disease. The statistics have only worsened in the last few years with research stating that 1 in 10 Indians is likely to get cancer once in their lifetime. As per research by World Health Organisation, National Institute of Cancer Prevention and Research and National library of medicine and Lancet Global health journal: About one in every five, or 21 per cent, cases of cervical cancer globally are reported from India Breast Cancer is the most common cancer for women in India and 1 woman is detected of Breast Cancer every 4 minutes Mortality due to tobacco use in India is estimated at upwards of 3500 persons every day and oral cancer is the most prevalent for men  These figures are scary and definitely alarming. In addition to this the economic burden in terms of GDP for the country, is estimated to be in the range of US dollars 36 to 40 billion by 2030 considering the potential productive life lost. Why am I writing about it? The most important data point is that the number of deaths due to cancer in India as compared to USA and other developed countries is almost 50% higher. This is not due to lack of healthcare facilities or treatment but due to late detection. Like most things about health, we have a reactive approach to cancer.  Experts tell us that a very large number of cancers are curable if detected early and thus it is high time that we adopt a proactive approach to cancer and build in a discipline of regular and consistent check-ups irrespective of family history or symptoms. On one hand where we expect work to happen on making cancer treatment affordable and accessible and the relevant stakeholders are working in the area, there is room for each of us to make an impact. Each of us can play an active role in ensuring that we spread awareness and conduct timely tests for ourselves and our loved ones. As leaders in organisations, we can build these into annual health checks for our employees. It is great to see many corporates recognising the importance of preventive action and also role of caregivers. Most progressive organisations have policies to support and provide flexible working options for caregivers. Moving from intent to action, requires a mindset change and if each one of us commit to take action, it will result in a significant multiplier impact. Let us take a pledge to take at least one action that impacts our sphere of influence.   Preeti Malhotra, Co-Owner & Practice Head - Wellness, Great Place to Work® India ]]> https://biospectrumindia.com/views/21/21189/returning-mothers-upskilling-their-way-in-their-career.html https://biospectrumindia.com/views/21/21189/returning-mothers-upskilling-their-way-in-their-career.html Sun, 08 May 2022 00:00:00 +0530 Whether you are a mother who has been out of the workplace for one year or ten years, the thought of restarting your career can be daunting. The skills you might have learned might be outdated in the fast-evolving biotech industry, making it harder and being one of the biggest challenges for women who want to return to work after sabbaticals. Arya, a mother of the 8-year-old Avanthika, who is currently pursuing the industry-oriented certificate program in Biosciences at Biocon Academy says, "People often tell that if a girl is married and becomes a mother even before building up her career, then that’s the end of her career. I totally disagree with this statement. Neither women have to sacrifice their careers if they are mothers, nor do they have to sacrifice their motherhood to build a career. We can do both at the same time and I am a prime example of that." After getting married during the second year of her bachelor's degree, Arya soon realized she is becoming a mother! "Completing my course and starting a career were my biggest concerns," says Arya who took her 2-month-old daughter along with her to attend her examinations. She later completed her master’s degree and worked for two years, and is currently on the way back to pursue a career she always dreamt of. She also says, "Based on what I learned from my entire experience, we usually grow only when we are faced with challenges. I was discouraged by many that I will not be able to study once I got pregnant, but here I am today, standing in front of everyone after completing my master’s and pursuing Biocon KGI Certificate Program in Biosciences after having a wonderful baby girl." Arya is just one of the many such examples among the alumni of Biocon Academy. While most women want to return to work, skill mismatch and job readiness is an apparent question that haunts them, and many have been trusting Biocon Academy, a CSR initiative of Biocon and the Centre of Excellence for Advanced Learning in Applied Biosciences, to match themselves with the current skills that are in demand in the industry. A student of Batch 19 of the Biocon KGI Certificate Program in Biosciences, Vandana says, "I'm a mother of twin girls. Building a career for myself was important to me because of them. This is why I chose to join Biocon Academy. The quality of education provided at the academy was crucial to achieving my goal." This interest in upskilling themselves helps mothers like Arya and Vandana who are on a career break to enable them to regain confidence by connecting with fellow students, top-class faculty and industry experts, and best-in-industry curriculum. Over the last couple of years, Biocon Academy has been seeing a steady growth in the number of mothers who are showing interest in rebuilding their careers and applying to various certificate programs offered by the academy. The first batch of Biocon JSS AHER Certificate Program that was launched in August 2021 had three mothers out of the total of 19 students. In just last one year, Biocon Academy has had 7 students who are mothers, with more and more applications being received for the upcoming batches. Bindu Ajit, Program Dean, Biocon Academy says, “With the right upskilling opportunity and having the belief in oneself, there's no boundary to what a person can achieve in their career. Since the inception of Biocon Academy, we have been increasingly witnessing more and more mothers who are willing to get back on track in their careers with an ardent willingness and capabilities to manage both careers and families. And we at Biocon Academy, understand this very much and support mothers as much as possible in each batch.” "When I wanted to get back into the workforce after a break in my career, I realized that the number of options to bounce back seemed limited, as every potential employer focused on my career gap without looking into my skill set and knowledge. Then I planned to upgrade my skills by pursuing the Biocon JSS AHER Certificate Program in Global Regulatory Affairs," said Aruna Pathak, an alumnus of Biocon Academy. She also added, "Initial days of the course were quite challenging for me to make a balance between managing my household chores, kids, and this newly joined course. But within a few days, I found myself to be a totally changed individual, high in confidence and back to the same groove which existed once when I was a working professional. I am grateful that I had great people around me. The support and motivation from family, friends, my fellow batchmates, and a very encouraging faculty helped me to strive harder to achieve my goal." Another Global Regulatory Affairs Batch 1 student Sangita Mishra said, "The journey in itself was both exciting and exhausting, but the learning never stopped. It was challenging to manage both education and motherhood. Being a mother of a 5-year-old daughter the task felt uphill in the beginning. There were times when I felt demotivated. But the support that I received from Biocon Academy, my batchmates, professors of JSS College of Pharmacy, and my family along with my own resolution to achieve my goal not only helped me in finishing my education but also inspired me to pursue a Ph.D. in Pharmaceutical Regulatory Affairs." Anjali, a student of BITS Biocon Certificate Program in Applied Industrial Microbiology, Batch 8, who recently got placed in the placement drive, mentions that she was worried about managing her family along with the course. She says, "I couldn't stay at the hostel since I am a feeding mother. I had to take care of my baby and I was really worried about the emotions of being far away from my child. I thought it will not be possible. But my husband stood with me, and my in-laws helped me in managing my responsibility as a mother. And after a few days, it was a part of my routine. There was constant support from the faculty of Biocon Academy who always encouraged me during my studies." A recent report published by Genpact Centre for Women’s Leadership mentions that 50% of working women who are around 30 years of age in India leave their jobs to take care of their children. In today’s fast-moving industrial scenario, this break in a career often comes with its own challenges, and Biocon Academy along with addressing the current skill deficit that exists in the biotech industry in India also supports mothers in rebuilding their careers with the right industry-oriented skills.   ]]> https://biospectrumindia.com/news/21/9394/services-that-can-help-your-start-up-.html https://biospectrumindia.com/news/21/9394/services-that-can-help-your-start-up-.html Fri, 13 Aug 2021 00:00:00 +0530 Bill provider comparison companies This one is a bit of an odd one to start off on, but here’s the thing: you spend a lot of money on your bills. Electric, water, heating: it all adds up to a really large chunk out of your budget. This is why it is good to look at bill provider comparers to help you figure out where you need to save money. In addition, using services that can run an energy business comparison can help you find special deals for your business and help you figure out exactly what you should be paying for your utility, which can be a great aid later on in your business running experience.  Project management software This can be good if you are working with a team of people. Not only can this help you all work together far better as a team, but it can also help your timings and communication. By using easy-to-manage software such as Gantt charts and Slack, you can effectively work together both in the same room or over long distances. This can help if you are still not in an office and working remotely due to the recent global pandemic.  Outsourced IT Support Outsourcing your IT department to an IT Support service can be a good way to get your business well supported and far more secure. It can help your business when it comes to looking out for cybersecurity threats and can help when it comes to making sure that all of your equipment is well looked after. It can also be useful for when your team begins to grow, as then you know that everyone has got enough support. It’s also a good way to guarantee professional services and always be able to reach someone who might be able to help with a problem. In conclusion When it comes to finding the right services for your business start-up, it can feel like you are spoilt for choice. The truth is, some of the companies presented to you first might not be as reliable as they claim, and some others will provide things your business might not need.  However, using utility bill comparers, project management software, or outsourced IT support to make sure that you have the right amount of security for your business should be top of your list and are generally businesses that you should look at investing in above some others that might just waste your time and money.  ]]> https://biospectrumindia.com/views/21/19326/fertility-struggles-with-covid-19.html https://biospectrumindia.com/views/21/19326/fertility-struggles-with-covid-19.html Fri, 13 Aug 2021 00:00:00 +0530 With ongoing studies and research there is enough evidence that COVID-19 does have an impact on male and female fertility, especially those patients with co-morbidities. The damage, whether permanent or temporary, cannot be ascertained as the studies are still ongoing. According to a study published by researchers at the Postgraduate Institute of Medical Education and Research, Chandigarh, there is presence of various SARS-CoV-2 entry receptors in the male and female reproductive organs. The angiotensin-converting enzyme 2 (ACE2) enzyme, which has been established as the functional host receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current devastating worldwide pandemic of coronavirus disease, is widely expressed in ovaries, uterus, vagina and placenta. ACE2 has also been shown to play a role in spermatogenesis. Fertility being a major concern for people who want to have children, Crysta IVF with centres across 18+ cities in India has been conducting a longitudinal study on male/female fertility on participants who have recovered from COVID-19. Dr Rakesh Maurya, Senior Reproductive Health Strategist, Crysta IVF, said, “In females there is no specific answer, as basic infertility is linked to failure to implant the embryo. Embryo implantation is a long process and it takes time to study those aspects. Hence, that is why there are no studies till date. I feel that it is going to affect embryo implantation which is a very complex process. We will be studying that to see how COVID-19 has impacted female infertility.” According to another study being conducted by Crysta, semen volume is being impacted, motility of the sperm has been affected and the sperm count has gone down. There are inflammation markers in the testes, which leads to cell death and this is a very tricky condition. There is an ongoing longitudinal study to find out if this condition reverses in the next six months or not.  Such studies once widely conducted can provide deeper insights into female & male fertility and whether the damage is temporary or permanent and how it can be overcome for people wanting to have children in the post COVID-19 world.   prabhat.prakash@mmactiv.com         ]]> https://biospectrumindia.com/views/21/19171/mental-health-needs-more-candour.html https://biospectrumindia.com/views/21/19171/mental-health-needs-more-candour.html Wed, 04 Aug 2021 00:00:00 +0530 The number of people suffering from mental health illnesses and disorders, such as anxiety and depression, is going up globally. According to WHO, depression is the single largest contributor to global disability and also a major contributor to suicide deaths. And, with the outbreak of the Covid-19 pandemic all over the world, the mental health crisis has accentuated. India is amongst the most depressed countries in the world. According to a study by the India State-Level Disease Burden Initiative, the disease burden in India owing to mental health illnesses and disorders increased from 2.5 per cent in 1990 to 4.7 per cent in 2017 in terms of DALYs, or disability-adjusted life years. The study also showed that India was the leading contributor to YLDs, or years lived with disability, contributing to 14.5 per cent of all YLDs in the country. In India, mental health illnesses and disorders are highly stigmatized. This results in cases of depression, anxiety, and other mental health disorders going largely unreported. Additionally, most people diagnosed with mental health illnesses do not seek any kind of treatment. The stigma associated with mental health disorders as well as the lack of awareness, access, and affordability of mental healthcare has caused large gaps in treatment. Additionally, seeking treatment for mental health disorders places a considerable economic burden on those suffering from the illness. This has been known to drive families to economic hardships. This burden is more pronounced on middle-aged individuals, who are also the most affected by mental health disorders, as it affects their productivity resulting in an amplified burden on the individual as well as the economy.   Current Scenario According to WHO, the mental health workforce in India is not up to the required standard with a huge shortage of psychiatrists and psychologists in the country. In India, per 100,000 population, there are only 0.3 psychiatrists, 0.12 nurses, 0.07 psychologists, and 0.07 social workers. This is far below the recommended level of at least 3 psychiatrists per 100,000 people.   In 1982, with the recommendation of WHO, The National Mental Health Programme (NMHP) was introduced to provide mental health services as a part of the general healthcare system. While the program improved mental healthcare access at the community level, insufficient infrastructure and resource constraints resulted in limited impact. The Mental Healthcare Act, 2017 made several provisions to improve the state of mental health in the country. The Act stated access to mental healthcare as a ‘right’. It also instituted Central and State Mental Health Authorities, or SMHA, who would focus work on building a strong infrastructure that includes registration of mental health practitioners and implements service-delivery norms. However, as of 2019, only 19 out of 28 states have constituted SMHA. As of 2021, only a few states have included a separate line item towards mental health infrastructure in their budgets. After passing The Mental Healthcare Act in 2017, the budget estimates for the NMHP increased from Rs 3.5 million in 2017-18 to Rs 5 million in 2018-19. In 2019-20, this budget estimate was reduced to Rs 4 million and has remained at the same level in the following years. This includes 2021-22 when the Covid-19 pandemic reported worsening of mental health issues. With the rising need to address mental health concerns, new advancements are taking place all-around and digital drive have accelerated a transition to telemedicine or telehealth. This is expected to aid towards the adoption of telepsychiatry. The burden of mental health illnesses in India is large and yet understated. Healthcare institutions, such as Veda Rehabilitation & Wellness, operating with a team of world-class professionals, are a thriving tool in providing high-quality mental healthcare. Because it’s time to acknowledge, address and treat mental health concerns with responsibility!   Shaili Mehta Sonani, in-house psychologist, Veda Rehab & Wellness ]]> https://biospectrumindia.com/views/21/19060/how-are-doctors-gearing-up-for-the-3rd-wave.html https://biospectrumindia.com/views/21/19060/how-are-doctors-gearing-up-for-the-3rd-wave.html Wed, 30 Jun 2021 20:50:00 +0530 As with any emergent disease, there is always a sense of apprehension regarding the unknown. We have gone through multiple drug regimens and trials. We have added drugs, taken them off, repurposed and reintroduced them. But since the beginning of the pandemic, the importance of COVID appropriate behaviour has been reiterated multiple times. And this is our only way forward. The natural course of the infection cannot be prevented, but we need to take the responsibility of limiting the spread into our hands.   There has been no change in our protocols on the management nor the prevention of COVID. Because we are not afforded that luxury. The minute we drop our guard, this invisible foe surges ahead. Vaccinations are the topmost priority. All ages who have been approved, should go ahead and get vaccinated as soon as possible. We have been trying to counsel and encourage people to do the same. Vaccinating 1.3 billion people is a huge goal, so in the time being, we have to follow all covid appropriate behaviours to the T.   We have become more vigilant in screening patients for covid. Every and all symptoms are scrutinised keeping covid in mind. More Nasopharyngeal Swabs for RT PCR are being prescribed. Non-emergent surgeries are discouraged, and relatives are cautioned against accompanying the patients unless they have a negative report. Proper screening of OPD patients with prior appointments is being done.   Strict PPE protocols are being followed with social distancing in common areas. Constant vigilance especially in cases of children as we are expecting more cases to come up. Awareness regarding the new variants, their characteristics and common presentations are being constantly disseminated amongst the medical community. Full-fledged public awareness campaigns regarding any new symptoms and populations that could be affected have been put into effect.   Amidst all this, we are mentally gearing ourselves for this challenge. Focusing on our mental health in this time so that we can provide the strength that is required for our patients. At the end of the day, I wish I could end this on a positive note but I’m unable to. All I can do is urge people to put their masks up, get their shots and stay away from each other. With all our combined efforts, I hope we don’t get caught in the eye of the storm.     Dr Janu Santhosh Kumar, Resident - Department of Internal Medicine, Jaslok Hospital ]]> https://biospectrumindia.com/views/21/18717/improving-enhancing-the-medical-resources-.html https://biospectrumindia.com/views/21/18717/improving-enhancing-the-medical-resources-.html Mon, 24 May 2021 00:00:00 +0530 It is laudable that our Honourable Prime Minister is putting all possible efforts to enhance the medical resources. Resources include primarily the Men and the Material. While the industry has been given a push to meet the demands, it is absolutely essential to manage our skilled man power too. One way is to pool all health man power from possible sources such as doctors, nurses, medical students, nursing students, paramedics and even the volunteers. It is nice that such important decisions are in discussions right now. Equally important task is to sustain and retain the manpower. Looking after them should be our bigger responsibility as a National resource. Though “Universal precautions” are being talked about for many years, hardly they have been put into practice uniformly in our country. Time has come that we guide them particularly the young graduates appropriately, to make the pool stronger and work better. The country should not loose such valuable resources at any cost and should not leave any stone unturned to achieve this goal. Minimum basic standards should be defined and should be enforced all across the country. I think the medical colleges must take the lead role, in such a way to define our “National standards”. All seniors should take active role setting the standards and teaching. Minimum standards for all Health Workers during the Pandemic:   Dress code- to wear simple scrubs, while on duty (avoid street clothes) Standard Face mask Compulsory Face shield Treatment gowns for wards Standard PPE for Critical care units Facility to frequent hand wash and sanitation of hands Clinical protocols to deliver the responsibility with minimum exposure Distribution of man power to minimise the duration of exposure to reduce the viral load Ensure adequate supply, not to compromise the protocol No personal gadgets, all official gadgets including phones, properly maintained while on duty Allocation of different categories of work based on experience and seniority Immediate treatment and isolation at the earliest on suspicion of contracting the disease. Off course it goes without saying about vaccination of all of them on priority.   All these will help avoiding self-contamination and also spread to others either through contact or fomites (clothes, gadgets, bags, utensil etc). On the other hand, it can enhance the overall ability and sustainability for longer times. The present virus in circulation is not exempting the younger generation. This certainly helps in avoiding the spread also indirectly to their families or friends. Such systems are the need of the hour, across the country in order to protect our valuable human resources. Hopefully it should be implemented as soon as possible for the effective management our own system.   Dr. NK Venkataramana, Founder Chairman & Director Neurosciences, Brains Hospital, Bangalore ]]> https://biospectrumindia.com/views/21/18648/the-new-biology-of-21st-century-can-india-innovate-in-these-interesting-times.html https://biospectrumindia.com/views/21/18648/the-new-biology-of-21st-century-can-india-innovate-in-these-interesting-times.html Mon, 17 May 2021 00:00:00 +0530 Dr Nirmalya Kumar (see London Business of Economics-Talk-You Tube) in his famous 2012 TEDx talk claimed that India innovates invisibly in all walks of Business including Pharma and Biotech. Our experience has been that Modern Biology broken down as academic research and Translational sciences poses two different Challenges for India. Indian Academia is not fine tuned to churn out Quality PhDs to research and develop Translational Sciences like Modern OMICS and Integrated OMICS. Increasingly in MNC Pharmas in West and smaller Biotech firms serve as discovery nerve centers, which get acquired over a period of time or the Regeneron and SanofiFrance type of Collaboration that lead to Blockbusters like Eyelea. Indian Experience has been after several billion dollars of Investment in Pharma and Biotech, No new NCE or NBE has emerged in the forefront of Global Drug Discovery Value Chain. Yet, do not discount. Contract Research Firms in India who have embarked on Preclinical Testing, and Services in Chemistry and Biology have nowhere to go next in India except to Innovate. The drug companies in India has reached a saturation stage in Generics, rather than fighting peers in the west on Patents, They better start to Innovate. Thus as Dr Nirmalya Kumar points out, for our test case Biotech in India is at a Cross roads for Innovative ideas. Make in India Programs from Indian soil have nurtured many Biotech Programs, but still remain nascent. What is then the solution. Tech parks, Industrial Collaborations, ecosystems like Silicon Valley. In a notable book by Gary Pisano Harvard Professor of Business of Biotech, says that he sees biotech has nobody has seen as a Vibrant and Most innovative industry in the world. Yet in 40 years, it has hardly taken shape in the whole world. In his famous book Science business, he says if you remove the top performers in term of revenues of the publicly listed companies in the America, rest are bleeding. That tells you something to think about. Here in India Professors hardly come out of their shells to start New ventures in Biotech, barring a few exceptions. India to become a Global Biotech enterprising country first needs global research hubs like USA. We should have State and Central Science institutions which will innovate just expecting nothing out of it, as President Obama puts it we will innovate like nobody and 50 years down the lane that basic Fundamental research will start to yield Tesla's of Biotech. In Genomics India is a laggard. Genomics is a Purely a fundamental science and NIH has initiated an Integrated OMICS institute. Without OMICS doing drug discovery today is like walking without legs. Having said that, Indian OMICS enterprises are just sequence hubs. While discovery programs are just Reengineering shops, OMICS programs are just to Sequence and Bioinformation boutiques. We have really lagged behind China and South Korea who have taken lead in forming large Enterprises like Beijing Genome Institute, and other well known companies like Macrogen.  Where does then India stand in Biopharmaceuticals Biosimilars development, Novel New Biologics, RNA and DNA based Therapeutics and Genomics based Drug discovery and development. We have to start at some point innovating atleast invisibly thru our CROs pitching in for Globally Competetive Projects. NEW BIOLOGICS have to be developed in India as Biosimilar Play will be not sufficient for India to Edge past the Western Competition. Novel Biologics today will cost 2 Bn US dollars and OMICS technologies are churning out disease data far faster than ever. India has two inherent strong fundations.Math and Stat. Computer Science is in the heart of the Indian, IT cannnot be avoided ever. Thus in the interdisciplinary science of Genome Informatics, India can become a leader help Drug discovery And develpment programs and Contribute in Discovery Chemistry-and Biology. You cannot in fact get success without failures assures Naubar Afeyan, the biggest lead investor boston based firm. In india, barring a few investments again none of them brought to bearing the risk appetite. RISK is inherently woven in the Biotech. Prof. C .V. Raman did in India, out of curiosity and not monetize it. Let us do it in our homeland, Make in India, it is possible only with qualified leadership at the helm of the companies who are visionaries.   M V Ramanujam, Managing Director, Propinquity Sciences-Consulting, Bengaluru     ]]> https://biospectrumindia.com/news/21/18376/world-health-day-2021-the-issue-of-mental-wellness.html https://biospectrumindia.com/news/21/18376/world-health-day-2021-the-issue-of-mental-wellness.html Tue, 06 Apr 2021 05:00:00 +0530 It has been more than one year since the pandemic started and a significant number of our lives have been flipped around. With World Health Day being praised on April 7, 2021, we need to raise more awareness encompassing mental health and dependence. Your mental wellness impacts how you think, feel, and carry on in everyday life. It also influences your capacity to adapt to pressure, beat difficulties, build connections, and recover from life's misfortunes and difficulties. Solid mental health isn't only the shortfall of psychological well-being issues. Being intellectually or genuinely sound is considerably more than being liberated from sorrow, uneasiness, or other mental issues. Maybe the shortfall of mental sickness, emotional wellness alludes to the presence of positive qualities. Taking everything into account, as indicated by World Health Organization, in India, about 7.5 percent of individuals experience the ill effects of some mental problem. WHO additionally predicts that by end of this current year around 20% of India will experience the ill effects of psychological instabilities. In numbers, roughly, 56 million Indians experience the ill effects of sadness and another 38 million Indians experience the ill effects of tension issues, states WHO. Adding to the issue, the labor force expected to address mental well-being in India simply doesn't make any sense. There is a huge lack of specialists and therapists in the nation when contrasted with the number of individuals experiencing emotional wellness issues. WHO expresses that in India, per 100,000 populace there are 0.3 specialists, 0.12 medical attendants, 0.07 clinicians, and 0.07 social laborers, while the attractive number is anything over 3 therapists and analysts for every 100,000 populace. Following certain self improvement steps such as- Focus on friendly association—particularly eye to eye; Remaining active is as good for the brain; Find purpose and meaning in life; and Eat a healthy diet to support strong mental health; will in any case profit you. In reality, contribution from an expert can regularly help motivate us to care more for ourselves   Dr. NK Sharma Director Reiki Healing Foundation, New Delhi ]]> https://biospectrumindia.com/views/21/18311/testing-positive-for-tuberculosis-research.html https://biospectrumindia.com/views/21/18311/testing-positive-for-tuberculosis-research.html Wed, 24 Mar 2021 00:00:00 +0530 With India accounting for about 26% of the tuberculosis (TB) cases in the world, the Indian governments and researchers alike have been tirelessly propagating research in this field, in hopes of reducing the number of cases and curbing this potentially lethal attack on one’s lungs. While campaigns like the ‘TB free India Campaign’ have been implemented to curb this disease in a mere 5 years, this aim can only be met with the appropriate technologies to detect tuberculosis, allowing one to begin medication as soon as possible. Recently recognised by the World Health Organisation was Truenat MTB, developed by Molbio Diagnostics, based in Goa. With the help of the Foundation for Innovative New Diagnostics, this test was made available to the masses as a means to test pulmonary and extrapulmonary TB and rifampicin-resistant TB. Typically test included sputum smear microscopy, which has only 50% sensitivity to the bacteria. Comparatively, this novel test has 89% sensitivity. Unlike other tests, Truenat MTB uses a battery, is portable and does not require special medical knowledge to operate, making it conducive for widespread use even in rural facilities. Complementing its small size is its reduced time for diagnosis. By needing only 25 minutes to take DNA and 35 minutes for detection, it is an efficient method of identifying those who require medical assistance at the earliest. Recently, a collaboration between The Foundation for Innovative New Diagnostics (FIND) and Cepheid, Inc, California, has lead to the development of the Xpert® MTB/XDR test which is able to detect strains of the bacteria that are resistant to common TB drugs. By detecting several mutations in the genes of only one sample, this test reduces the time taken for diagnosis from around 16 weeks to just 90 minutes, thus allowing doctors to prescribe the appropriate medicine before the disease develops to an extreme degree. This test is currently awaiting the dossier created by the World Health Organisation. Once in this review, these companies will be able to expand their reach to countries with high rates of TB such as India and China by increasing production and including this test in their national policies In light of the recent pandemic, medical attention has been largely placed on the COVID-19, while other dangerous diseases like TB rose. To prevent this, the health department has focused to “integrate their TB case finding activities with COVID preventive measures”. This includes emphasising on bi-directional TB and COVID-19 screening, testing for these diseases in patients with ILI and SARI and using CBNAAT and TrueNaT machines. A large focus has also been placed on the development of molecular technology which can be used in devices with chips or cartridges to improve diagnosis. To further the impact of these measures, the government has increased the number of medical facilities to 953 which have been encouraged to accept a larger number of people to be tested. Furthermore, the Union Minister of Health & Family Welfare Dr. Harsh Vardhan has introduced the country’s first mobile I-Lab, used for the diagnosis of infectious diseases. This mainly aims to reach the rural part of India and provide medical tests at a rapid rate. With the capacity of performing 25 COVID-19 RT-PCR tests, 300 ELISA tests, additional tests for TB, HIV in one day, this lab hopes to improve the recovery rate of patients and eliminate these respiratory diseases as soon as possible. Only with these revolutionary approaches to a simple tuberculosis test will the government be able to achieve its goal of eliminating this contagious disease. The field of research is constantly churning out faster, smaller and cheaper products designed to cater to the Indian population, with the aim of swift treatment and a tuberculosis free India.   Nysa Adurkar, Mumbai ]]> https://biospectrumindia.com/views/21/17950/impact-of-sensitive-and-reliable-kits-for-covid-19-testing-at-a-scale-.html https://biospectrumindia.com/views/21/17950/impact-of-sensitive-and-reliable-kits-for-covid-19-testing-at-a-scale-.html Mon, 18 Jan 2021 00:00:00 +0530 In May 2020, 15 of the 25 samples tested by Government Villupuram Medical College, Villupuram, Tamil Nadu, turned negative in the confirmatory test. It came hours after the lab technicians had confirmed that the screening tests were positive. Another incident in November 2020- Telugu superstar, Chiranjeevi, announced on Twitter, that he had tested positive earlier due to a faulty kit.    In the case of the Government Villupuram , experts said it could be a problem based on multiple reasons: insufficient sample, technical issues with the kits or inexperienced staff running the test. A significant aspect of SARS-CoV-2 is that it can be transmitted while a host is asymptomatic. Epidemiologic evidence has demonstrated that pre-symptomatic and asymptomatic transmission of virus has driven the current epidemic.  In such setting, the best test is not necessarily one that determines whether a person has any evidence of SARS-CoV-2, but one that quickly and accurately identifies individuals who are capable of transmitting the infection to others.   The different types of testing: Currently, there are three major types of testing.    Rapid Antigen Testing: This looks for the presence of the SARS-CoV-2 virus in the body by testing the fragments of proteins that are found within the virus. It can be analyzed at the point-of-care in a process that can take as little as 15 minutes. However, the trade-off for the speed and convenience of an antigen COVID-19 test is its specificity and reliability   RT-PCR tests: The RT-PCR tests are considered the gold standard for COVID-19 testing as it provides a more definitive result because of its high level of specificity and sensitivity Here samples are tested for genetic material of the virus.   Serological Assay: For ramping of tests, apart from molecular test, quantitative measurement of immunoglobulin G (IgG) antibodies raised against the spike protein of the SARS-CoV-2 virus will provide a better understanding of a person’s immune response after being exposed to the Covid-19 virus.    The impact of false negatives and false positives False negatives can lead to disastrous consequences. It can not only endanger the life of the person who has been deemed virus free, but also possibly set off a cascading chain of infections.  In many cases, infected people are asymptomatic and hence are not isolated. They can subsequently rapidly infect others. Similarly, a false positive can erroneously lead to unnecessary quarantine and contact tracing exercises, as well as significant stress for the concerned individual and family.  Today a major point of concern for most healthcare bodies is the availability of reliable and consistent tests in the country. In October 2020, Maharashtra’s health minister, Rajesh Tope, pointed out that the state had 12.5 lakh faulty RT-PCR test kits in circulation. Purchased from a private company, the test kits were found to have a lower positivity rate.  In September 2020, the Delhi High Court has also suggested to the Delhi Government to use of reliable testing strategies to control the outbreak. As the COIVID pandemic required companies to manufacture and scale their capacities, approvals were fast-tracked to enable a quick response. These incidents clearly highlight the need for a strict follow-up on the quality and reliability of the test-kits  Importance of review assessment for test accuracy and clinical researchers    Given the varied experience of healthcare staff handling samples, it is critical to establish standard guidelines. First, tests must be sensitive and validated under realistic conditions. Regulators must also ensure that manufacturers must provide details of the clinical sensitivity of the tests and the specificity at the time of market authorization.  For people who have tested negative, it is important to again test the probability of infection using another method that will either confirm or deny the result.  Test kits must hence be subject to rigorous quality checks and must be ISO certified. It is also important to leverage emerging techniques such as mass spectrometry that can detect the presence of the SARS-CoV-2 virus accurately.    Features to look for in reliable test kits Some of the key capabilities and features that should be looked for from manufacturers of reliable test kits include:   Must be highly sensitive to detect the SARS-CoV-2 virus Ability to detect the presence of the virus at very low levels when used by a qualified lab according the strict requirements of the most current regulatory approvals  Must have the capability to produce more than huge number of tests per week to meet the rising demand  The test kits must be updated with the new techniques, depending on market and research developments Must include detailed instructions for use, with continuous and ongoing software support for updates. Large distribution to enable faster deliveries and training support to handle samples and operate instruments.  Testing as part of a coordinated strategy   Even as efforts continue to address public health testing challenges, health systems and government must place a greater emphasis on quality tests than procuring test kits because they are low cost and unreliable. In addition, acceleration of new and innovative assays that can screen asymptomatic patients and provide access to affordable surveillance testing that are easy-to-implement, deliver trusted quality and reliability would play a pivotal role in preventing further spread and in management of infectious diseases.  ]]> https://biospectrumindia.com/views/21/17710/the-multiplying-efforts-to-cure-aids.html https://biospectrumindia.com/views/21/17710/the-multiplying-efforts-to-cure-aids.html Fri, 04 Dec 2020 15:00:00 +0530 With about 2.1 million Indians tested positive for HIV, many pharmaceutical companies coupled with the government and academia have taken it upon themselves to help curb this deadly disease. Having pledged to stop the spread of AIDS or Acquired Immune Deficiency Syndrome by 2030 by achieving the ‘Three Zeros’ or zero new infections, death caused by AIDS and discrimination, the government has promoted novel research to emerge. Reducing its transmission will allow India to move closer to ending the third largest HIV epidemic in the world. Spread through bodily fluids, the human immunodeficiency virus (HIV) weakens one defense system while making one more susceptible to common diseases. Being a life-long disease, if medication is not taken at the appropriate time, one could develop AIDS, where the number of CD4 cells decrease to the extremely low concentration of 200 cells per cubic millimetre. Hence, the life-threatening nature of this virus has led to the urgent need to uncover more effective treatments. The severity of this disease can be seen by the 2.2 million people killed each year due to the contraction of HIV and tuberculosis (TB). Evidence proving that those with HIV are more vulnerable to TB prompted researchers the Indian Institute of Science (IISc) in Bengaluru to further investigate the interactions between the two viruses. While this virus can immediately infect immune cells causing them to produce copies of itself, the bacteria causing TB, Mycobacterium tuberculosis (Mtb), can cause even a dormant HIV virus to once again infect healthy cells. The team found exosomes in Mtb which allowed cell communication and altered the amount of chemicals, thus activating HIV and leading to more harmful symptoms. Based on the success seen in the London patient, i.e. the second patient to be cured of HIV, researchers at the University of Cambridge, UK, have made numerous strides in this field. Suffering from blood cancer, this patient’s only chance of survival was a hematopoietic stem cell transplant, where his blood was replaced with another’s. In this case, the donor’s blood revealed to have the CCR5 gene which strengthened the body’s defense against HIV. The concept of replacing one’s blood with that having the CCR5 gene allows one to develop a resistance towards HIV and AIDS. The team is further pursuing the use of gene editing to create new genes in one’s blood to eliminate the need for blood transplants. Moreover, researchers from the University of Miami in the US, have created a novel technique of administering an anti-HIV drug past the blood brain barrier. AZTTP, the drug being tested, is given in high concentrations by magneto-electric nanoparticles (MENs) to infected cells. Unlike the other treatments that mainly focus on organs such as the liver to lungs, this technique aims to deliver drugs first to the brain, followed by the remaining organs. This is done by combining the MEN with a macrophage (a type of immune cell) which is then attracted to the brain. As it approaches, a small electric current causes the drug to be released and taken towards the cells using magneto-electricity. With vast implications for administering drugs for other prevalent diseases such as Alzheimer’s or meningitis, researchers have moved into a more in-dept testing to be able to release it into the drug market. Recent research has also shown that early dosages of antiretroviral therapies (ART) reduces the effect of the virus on the body which could be potentially used to minimise HIV remission. In 2017, scientists discovered that the use of this therapy coupled with immunisation using HIV antibodies helped those already infected by reducing symptoms and preventing transmission. A team of scientists at IISc have created a mathematical model that proved the impact of ART by improving immune responses against the virus, thus providing evidence for a long lasting solution to this fatal disease. In light of this major epidemic, many pharmaceutical companies and NGOs have come together to help alleviate symptoms and improve the life expectancy of one with AIDS. Frequent testing accompanied with innovative medicines will help control the spread of HIV, thus reducing the instances of AIDS and achieving the government’s aim of the “Three Zeros”.   Nysa Adurkar, Mumbai ]]> https://biospectrumindia.com/views/21/17602/can-metabolic-surgery-tackle-diabetes-in-india.html https://biospectrumindia.com/views/21/17602/can-metabolic-surgery-tackle-diabetes-in-india.html Mon, 16 Nov 2020 12:55:00 +0530 India is witnessing a steady upsurge of lifestyle disorders of obesity and type 2 diabetes mellitus (T2DM), owing to genetic predisposition coupled with rapid urbanization, sedentary lifestyle and a westernized diet pattern. Today we rank third in the world for having the highest number of obese people. Unfortunately, 80% of these people, also suffer from diabetes. By 2030, diabetes is expected to take a toll on approximately 98 million people in the country. Ironically, we are also the global hotspot for type 2 diabetes. In most cases of T2DM, hyperglycaemia occurs due to insulin resistance and metabolic syndrome. In metabolic syndrome, excessive fat in and around the abdomen, and high blood pressure can trigger diabetes. Additionally, diabetes acts as a host to many other diseases related to the cardiovascular system and kidneys. Diabetes being a progressive condition, such patient can eventually end up with frequent insulin injections and a handful of meds. This can become a painful routine for diabetics and their quality of life may get compromised. For such people, metabolic surgery may be the sweetest news they have heard in recent years. Metabolic surgery is a breakthrough surgery because it helps not just to manage diabetes, but to treat numerous complications associated with it, the most common being heart disease. Metabolic surgery is a minimally invasive procedure and can effectively reverse symptoms in a person suffering from obesity and diabetes. In this surgical procedure, the person's stomach is made smaller so that he eats less. This in turn leads to weight loss and increases the sensitivity to insulin. Additionally, certain procedures of surgery affect the hormonal secretions in the gut and makes the person respond to food differently. Eventually, the changes brought in the way the patient’s body utilizes the blood sugars resulting in the reversal of T2DM. For many obese patients with uncontrolled blood sugar, surgery is considered the last option to tackle diabetes. For somebody who needs to lose about 40-50 kg or more weight, the traditional lifestyle approaches/medications to lose weight may not be sufficient. These people may find hope at the end of the tunnel through metabolic surgery which is a safe option and the results are seen much faster. In fact, many scientific bodies and guidelines recommend bariatric surgery in the early treatment of diabetes in appropriate patients as it yields much better short- and long-term results as compared to lifestyle modification and optimum medicines, including insulin. Lastly, but not least like any other surgery, bariatric surgery may be associated with risk related to anesthesia and the patient’s medical problems. However, if done in a well-equipped center by a good surgeon, it is extremely safe and the benefits associated with the surgery outweighs the risk in obese patients with diabetes. Considering the cost of lifelong medications for managing diabetes and its frequent complications in a developing country like India, metabolic surgery is a blessing in disguise for many. Most importantly this is a safe and cost-effective surgery that could be considered early on in the battle against this lifestyle disease.   Dr Sumit Talwar, HOD and Consultant Bariatric Surgery and Dr Karthik Prabhakar, HOD, and Consultant in Diabetes and Endocrinology, Manipal hospitals ]]> https://biospectrumindia.com/views/21/17589/aortic-stenosis-cannot-wait.html https://biospectrumindia.com/views/21/17589/aortic-stenosis-cannot-wait.html Thu, 12 Nov 2020 14:25:00 +0530 The human heart is a complex organ of the human body and is responsible for the circulation of blood to other various parts of the body. One of the great arteries, aorta, is responsible for the supply of oxygenated or purified blood to the whole body. As we grow old the aortic valve narrows due to the deposition of calcium on the leaflets of the aortic valve causing various symptoms, this narrowing of the aortic valve is known as aortic stenosis. A patient with aortic stenosis has declined cardiac output due to the narrowing of the aortic valve. The starts experiencing – Abnormal heart murmur, chest pain, fast heartbeat, fatigue, breathlessness, syncope, and eventually leads to heart failure. Heart failure is the failure of the heart to pump optimal blood for the normal function of the human body. Studies have shown that when a patient with aortic stenosis experiences symptoms, the risk of mortality or the death rate in simple terms is to the tune of 50%. Auscultation, a method for observing heartbeat rhythm is a very important diagnostic tool to determine and diagnose aortic stenosis. Therefore, it is of utmost necessity that once a patient crosses the age of 60 years, he/she needs to get this simple test done on a routine basis. 2D echo is mandatory to identify any underlying valvular disease. The heart murmur which is observed through auscultation has varying degrees of intensity based on which the treating physician would recommend a future course of action and other confirmatory tests like CT (Computed Tomography) scan. Severe aortic stenosis if left untreated becomes a serious health hazard as 50% of the sick patient in whom onset of symptoms is observed, die within an average of 2 years.   COVID-19 impact It has been observed by many healthcare experts that patients with cardiovascular diseases who contract Covid-19 have serious health implications. Data suggests that 65% of deaths due to Covid – 19 had pre-existing cardiovascular complexities. Patients with confirmed cardiac disease are highly vulnerable to complications when suffering from Covid-19. Patients who develop cardiac injury face a 4 times increased risk of mortality from Covid-19. In addition to mortality, delay in treatment of aortic stenosis. may result in sudden death, acute decompensated heart failure, irreversible myocardial injury. Indeed, it becomes of utmost importance for patients to consult their treating Physicians without any further delay. From the patient’s perspective transcatheter AVR is advisable to surgical AVR, due to the use of less invasive procedures as TAVR is performed via the transfemoral approach performed under conscious sedation and/or local anesthesia. This strategy may present an opportunity to minimize ICU and hospital stay, given shorter hospitalization and consequent exposure of patients to COVID-19 in hospital and rehabilitation centers. Moreover, TAVR procedures involving balloon-expandable valves have further shortened the TAVR procedure time to merely 45 minutes, further reducing hospital stay and exposure to the Covid virus. It is also documented that if patients diagnosed with severe symptomatic aortic stenosis are made to wait for Valve replacement – the death rate is 3.6% at 1month & 11.6% at 6 months. Patients must also be aware of the key indicators of poor outcomes if they are diagnosed with severe symptomatic aortic stenosis. They are as follows- Syncope (Fainting) or rapidly progressing dyspnea (shortness of breath, difficulty in breathing) Recent congestive heart failure Impaired LV function (EF<50%) Very severe AS (MG>=60mmHg)   Dr A V Ganesh Kumar, Head of Department of Cardiology, Dr L H Hiranandani Hospital, Mumbai ]]> https://biospectrumindia.com/views/21/17408/efforts-for-providing-relief-from-osteoporosis-.html https://biospectrumindia.com/views/21/17408/efforts-for-providing-relief-from-osteoporosis-.html Mon, 19 Oct 2020 00:00:00 +0530 With a prevalence of over 50 million cases in India, the study of osteoporosis has increased tremendously, leading to the development of new drugs, each working to restore bone strength. This condition causes the porous interior of a bone to increase, thus breaking down its structural integrity. While bones require vitamin D and calcium for the development of healthy bones, Indians suffer from severe vitamin D deficiencies which prevent the  effective uptake of calcium. Despite being a country blessed with plentiful sunlight, a major source of vitamin D, India has large instances of insufficient nutrition, lack of Vitamin D rich foods and “highly pigmented skin”, all causing this deficiency. Thus, the great rate of progression of this disease has spurred many researchers to develop new and highly effective drugs. Those suffering from osteoporosis are generally prescribed certain second line drugs, while newer drugs are being slowing introduced into the medical field. Some of these second line drugs would include denosumab, sold by Dr. Reddy’s Laboratories from Hydrabad, and teriparatide. Administered in the form of injections, these drugs have proven to increase bone mass density and allow the growth of bone matter similar to that produced under normal circumstances , thus reducing the chances of fracture or any other bone damage. Teriparatide, in particular, is a hormone that stimulates the growth and strength of bones, thus combatting osteoporosis. Produced by Cadila Pharmaceuticals in Ahmedabad, it aims to decrease the number of fractures a patient with this disease would face. These injections are manufactured in the form of a disposable pens, making it cheaper for the patients to utilise. An easier method of delivery without supervision of a doctor or nurse had persuaded many patients of the effectiveness of this drug. Majority of patients have expressed a concern for difficulties while taking drugs, hence Cadila is working to provide them with a convenient solution. Further research into this field has led to the emergence of new drugs such as abaloparatide, romosozumab, and calcitonin that can be used as a long term solution. Companies such as US based Radius Health, Inc. and Glenmark based in Mumbai have respectively pioneered the production of these drugs. In addition to being more effective, these medicines also have a lower rejection rate, making them readily used for the treatment of osteoporosis. For instance, Romosozumab, an antibody, prevents sclerostin, a protein present in the bone cells, from affecting the bone. This in turn, reduces the rate of bone resorption, but rather promotes its formation. Its effects have been seen in numerous men and women, by demonstrating a marked increase in the proteins able to detect nutrition levels which indicate healthier bones. Calcitonin, on the other hand, is taken through a nasal spray or injection. By stimulating the absorption of calcium in the bones, they are able to reduce the risk of fractures due to a diminishing structure. However, these drugs have a higher cost, making them less common that Alendronate, another newly developed drug. Apart from these drugs, some patients are administered corticosteroids which prove to be highly effective in some cases. Along with this, one is recommend supplements of calcium and vitamin D, regardless of differences in terms of doses and the time period. However, this method could lead to complications in patients with other risk factors that have been taking these drugs from a longer period of time. In such cases, antiresorptive therapy is also suggested as a means to improve bone structure.  In terms of still developing research, companies such as Glenmark Pharma are focusing on treating menopausal women with osteoporosis. Its recent USFDA approval has allowed the release of Norethindrone Acetate and Ethinyl Estradiol tablets in the drug market. Working to promote these drugs, Glenmark has quickly and efficiently distributed them across India, hoping to treat this disease which arises as a symptom of menopause. Suitable for those with severe to moderate symptoms, these drugs as a way to prevent osteoporosis from occurring in the future. Similarly, Zydus Cadila in Ahmedabad has developed a new treatment for osteoporosis in women after menopause. Risedronate Sodium delayed-release tablets hope to reduce the rate of bone degradation, thus improving its formation. This will lead to a decreased risk of fracture, and aide females suffering from this condition. Stemming from herbal medication, Shoolini University’s School of Pharmaceutical Science in Solan is working on developing drugs to help reduce the symptoms of osteoporosis. By discovering special proteins present in 3 species of pine found in the Himalayan region, scientists hope to provide a more natural means of strengthening weaker bones in post-menopausal women. Pharmaceutical companies and doctors, alike, are working tirelessly to alleviate osteoporosis in all Indians. Given the widespread nature of this disease, multiple drugs are currently available in the market, each with their own advantages and target patients. By making these medicines more accessible to the general public, one would expect a decrease in the great instances of osteoporosis and the difficulties it brings.   Nysa Adurkar, Mumbai   ]]> https://biospectrumindia.com/views/21/17362/an-outlook-on-rising-burden-of-colorectal-cancer-in-india.html https://biospectrumindia.com/views/21/17362/an-outlook-on-rising-burden-of-colorectal-cancer-in-india.html Fri, 09 Oct 2020 00:00:00 +0530 India is currently witnessing a rising incidence of cancer that is plagued with late detection, limited access to quality affordable care and high mortality. While the treatment scenario has also undergone a paradigm shift towards immuno-therapy and targeted biologics, it is limited to those who have access and can afford it. Immunotherapy is a treatment that helps patient’s immune system fight cancer using biologics such as vaccines, cytokines, and some antibodies among others. In advanced colon cancer immuno-therapy, small molecules are used rather than Chemotherapy. Broadly, cancer treatment encompasses chemotherapy, targeted therapy, hormonal therapy and immunotherapy amid newer efficient treatments that have precipitated a shift from chemotherapy along with heightened competition. Among Indian men, the rising incidence is seen in the colon and rectal cancer with annual incidence rates at 4.4 and 4.1 per 100,000 population while the incidence of colon cancer among women is seen at 3.9 per 100,000 population. Colorectal cancer is also known as bowel cancer, colon cancer, or rectal cancer, that affects the colon and the rectum in a person’s body. According to estimates by the American Cancer Society, around 1 in 21 men and 1 in 23 women in the United States will develop colorectal cancer during their lifetime, which is considered as the second leading cause of cancer death in women and third in men. While advances in screening techniques coupled with innovative treatments have led to better recovery from colorectal cancer, recent research work has indicated that its rise in over 90% cases occur in people after the age of 50 and incidence of its rise has been 1-3% annually. Signs and symptoms of colon cancer include a persistent change in your bowel habits, including diarrhoea or constipation or a change in the consistency of your stool, rectal bleeding or blood in your stool, cramps, gas or pain with persistent abdominal discomforts, weakness, fatigue with unexplained weight loss. Diagnosis of early symptoms would include a sample of the colonic inner layer & colon during sigmoidoscopy or colonoscopy followed by medical imaging to determine if the disease has spread. The factors that are seen responsible for rising incidence include genetic change, low-fibre, high-diet, sedentary lifestyle, increasing incidence of diabetes, obesity, smoking and alcoholism. Risk of colon cancer could be reduced by adopting a healthy lifestyle by moderating alcohol intake, stop smoking, regular work-outs, maintaining weight and modifying diet by eating a variety of fruits, vegetables and whole grains. In India, over 10 lakh new cases are diagnosed every year in a population of 130 crore due to lack of awareness, financial hardships, absence of a diagnostic network, late detection. According to a report by Edelweiss Securities, a domestic stock brokerage house, oncology, the branch of medicine for cancer treatment is currently witnessing a spend of about $10 billion (Rs 70,000 crore) annually and is expected to become 2.5 times by 2025 led by 7% growth in cancer incidence and 1-2% from improved penetration and 3-4% from healthcare inflation. On its part, the Indian government has embarked upon an initiative to address the issue of cancer by capping trade margins at 30% for 42 non-schedule oncology drugs in February 2019. Subsequently, in March 2019, the drug regulator National Pharmaceutical Pricing Authority published ceiling prices for 463 oncology brands that led to manufacturers bringing down prices for 426 brands. According to various media reports, the price cut would benefit 22 lakh patients with annual savings of Rs 800 crore. The amount looks minuscule or rather 1% of the total spend by oncology patients, nevertheless, it is a small beginning towards making the treatment for cancer affordable, which with disruption, technology, insurance like state-run Ayushman Bharat would be the way forward.   Dr Rahul S Kanaka - Specialist in Surgical Oncology and Robotic Surgery, MediBuddy, Bengaluru ]]> https://biospectrumindia.com/views/21/17338/targeted-therapy-for-ibd-is-the-future.html https://biospectrumindia.com/views/21/17338/targeted-therapy-for-ibd-is-the-future.html Tue, 06 Oct 2020 00:00:00 +0530 Inflammatory bowel disease (IBD) refers to an inflammation of the Gastrointestinal (GI) tract in which the immune cells of the body attack and destroy its own cells and tissues. In the clinical scenario this comprises of two diseases: Ulcerative colitis (UC) and Crohn’s disease (CD). There are significant overlaps between the two in their clinical presentation. However, the essential difference is that, CD is a transmural disease which can involve any part from the mouth to the anal canal, whereas the inflammation in UC is restricted to the colonic mucosa. The triggering factors for the auto-immune process remain identified but a genetic predisposition and an inappropriate inflammatory response against the host microbiota are important features in both UC and CD. In addition to the bowel symptoms both these diseases are associated with manifestations outside the GI tract which are collectively referred to as “Extra-intestinal Manifestations”. Typically, both these affects young adults in the age group between 20-40 years, but they can involve the pediatric and the geriatric age groups as well. IBD has a global presence but is more common in the West and in the developed countries as compared to the developing countries. The adoption of the western diet is considered as one of the putative factors for the rising trend of IBD in the developing countries. The dominant symptoms of CD are abdominal pain, vomiting, diarrhea and malabsorption if the disease is confined to the small bowel. Colonic involvement usually results in bloody diarrhea. As the disease is transmural, strictures, fistulas and intrabdominal abscesses are seen in a significant proportion of the cases. Perianal disease occurs in approximately 25 percent of the cases. In UC the rectal bleeding is the predominant symptom. The course and severity of the disease can be variable in IBD. Mortality is restricted to the patients with severe disease and its complications. Various indices have been devised to stratify the severity of IBD and the treatment is tailored as per the severity of the disease. There has been a paradigm shift towards the treatment of IBD in the last decade. The aim of earlier therapy was essentially to provide symptomatic relief. The current focus has now become mucosal healing which will not only ensure symptomatic relief but also result in prolonged remission which could result in a decrease risk of subsequent malignancy. There is also an attempt to change the natural history of the disease by the early introduction of biological therapy as has been shown in the case of Rheumatoid arthritis using the same group of drugs i.e. biologics. The treatment of both phenotypes of IBD is split into two phases: the initial induction phase followed by the prolonged maintenance phase. Corticosteroids (CS) forms the backbone of treatment during the induction phase for both CD & UC. Mild disease should not be treated with oral steroids which are reserved for patients with moderate to severe disease. In UC despite the introduction of so many drugs in the last 5 decades, none can match the efficacy of CS for the induction of remission in acute severe UC. At the time when they were introduced in 1955 there was reduction in the 12-month mortality of acute severe UC from 22% to 7%. 5-aminosalicylic acid (5-ASA) group of drugs are the mainstay of therapy in the maintenance phase of UC where they need to be given over extended period of time. Immunosuppressants (6MP & Azathioprine) are the most commonly used drugs for the maintenance of remission in CD. The 1990s saw the introduction of a new class of drugs directed against TNFa which were classified as “Biologicals”. This group of drugs proved to be a breakthrough in the medical management of CD as they were effective in management of fistulizing disease. Till the introduction of the Biologicals there was no effective medical/ non-surgical treatment of fistulizing CD and these complications were handled only by surgical methods with dismal results. Even in the case of UC, biological therapy proved to effective in the management of steroid refractory and steroid dependent UC. The overall impact of biological therapy has been a significant decrease in the number of surgeries for both phenotypes of IBD. These drugs are now considered the standard of care (SOC) for moderate to severe UC and IBD in the current era. The first-generation biologicals were chimeric in the sense that murine component was nearly 25% and the human component was 75%. Subsequent refinement of technology lead to the development of humanized monoclonal antibodies and finally the development of fully human monoclonal antibodies. Since TNFa plays an integral part in the formation of granulomas, their use was associated with the reactivation of TB, which became a major problem in developing countries where TB is endemic. At least two reports from India suggested that re-activation of TB occurs in approximately 10% of patients exposed to these drugs. This is perhaps one of the main reasons why physicians are reluctant to use these drugs. Further understanding of the pathogenesis of IBD lead to the understanding of the major role played by the T-lymphocytes in perpetuation of the inflammatory response after it has been triggered by a hitherto unidentified factor. The next group of drugs were monoclonal antibodies directed against integrins present on the surface of the T-lymphocytes. The prototype drug of this group, Vedolizumab has just been launched in India this month. The major advantage of this drug is that it does not lead to reactivation of TB. In Europe this drug is fast replacing Infliximab as the SOC for moderate to severe UC. The last several years have also seen the development of new drugs which are clumped under the umbrella term of small molecules for IBD. They comprise of Anti IL-12/IL-23 Monoclonal antibodies and JAK inhibitors like Tofacitinib. None of the small molecules has been licensed for use in India. As of now although the initial results are very promising there is limited data on the efficacy of these small molecules and larger trials are awaited. The net result of the added new classes of drugs means that the armamentarium available for combatting IBD with the physicians is constantly increasing. Current data supports this statement as there has been a steady decline in the number of surgeries for IBD. However, it must be stated clearly that despite all advances there would be a subset of patients with IBD who would still require surgery. One such subset would be those who develop colorectal cancer as a consequence of long-standing disease. The current therapeutic modalities are all directed against controlling the inflammation which has been triggered by the immune cells of the body directed against the gut microbiome. This is very evident in patients with Crohn’s Colitis who go into prompt remission if ileal diversion is done. Thus, the future therapy has to be directed against identification of triggers which set off the autoimmune process. Once these triggers are identified, early intervention can halt the progression of disease and prevent the occurrence of the dreaded complications like stricture formation and the development of fistulae in CD. To quote an old adage, a stitch in time saves nine. If this were to happen in the near future it would drastically change the way with which the physicians treat IBD.   Dr A S Puri, Director Professor and HoD Gastroenterology, G.B. Pant Hospital, New Delhi    ]]> https://biospectrumindia.com/views/21/17274/understanding-what-why-and-how-for-analytical-method-lifecycle-approach.html https://biospectrumindia.com/views/21/17274/understanding-what-why-and-how-for-analytical-method-lifecycle-approach.html Fri, 25 Sep 2020 01:05:00 +0530 USP<1220> and ICH Q14 are among most discussed topics today in analytical industry. With evolution of compliance and work-flow understanding, need to incorporate Quality by Design (QbD) principals in analytical methods has been long realized. Analytical life cycle management is holistic approach of implementing structured QbD approaches in analytical workflow (also segmented as stages I-II-III). To better understand this concept, we can consider evolution of wheel as an example. No doubts that initially, when wheel was invented, it was a great invention. It was a paradigm shift in movement of goods/ loads from one location to another. But, initially wheels were made of stone, it was very heavy weight, that added to lesser efficiency or more force required to pull. Later physicians designed wheels with wooden frame (to reduce weight) with outer circumference covered with metal ring (to provide strength).  In modern times, scientists worked on improving efficiency and created modern day metal frames, with rubber tyres. Is it the end of this evolution, definitely NO! as several researchers are continuously working on newer technologies to improve it further. In similar context, when I look at pharmaceutical products, evolution/ adoption of newer technologies is not so fast & easy. Considering its possible implications on human health, a detailed assessment is made mandatory by regulatory authorities. But this has made industry follow some old technologies/ approaches that gives repeated failures and (in some cases) even limits detection of poor-quality products. Recent recommendations from USP (United States Pharmacopeia) and ICH (The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) are in direction of providing a structured approach for design and development of these analytical strategies that support development of analytical methods with better control on variabilities. In simple words, we can say that Method lifecycle approach is preventive approach to control method variables and understand method parameters space better. Lifecycle management approach brings a shift from current segmented approach towards a holistic approach. In current workflow, Analytical development team develops methods and gains understanding on impact of variables on method performance in a very limited space/ scope. Also, another missing portion is transfer of this knowledge space to subsequent stages. Due to unstructured development approach many variables are not properly assessed. Later Validation as per USP<1225> is completed and a final method protocol goes (Analytical procedure transfer USP<1224>) for next stage (i.e. QC lab) for routine usage (Analytical Procedure verification USP<1226>). Now with proposed USP<1220> all these stages (Development, Validation and Routine monitoring/ usage) will be covered under single chapter/ section.  To understand this upcoming transformation in analytical methods handling, I would try to answer rationales of What, Why and How for Analytical Method Lifecycle approach.   What is Analytical Method Lifecycle approach? As defined in USP<1220>; The current concepts of validation, verification and transfer of procedure address portions of lifecycle but do not consider it holistically. The purpose of proposed new chapter <1220> is to fully address entire procedure lifecycle. Approach is based on Quality by Design concepts as described in International Council on Harmonization Q8 (R2), Q9, Q10 and Q11. The lifecycle management process provides a framework for defining the criteria for and development of an analytical procedure that meets the acceptance criteria. The procedure then becomes part of a continuous verification cycle to demonstrate that it meets the predefined criteria over the life of the analytical procedure. Why is adoption of Analytical Method Lifecycle important? During inspections, auditors find multiple instances of method failures as root cause for Out of Specification (OOS) results. OOS handling routes towards corrective and preventive actions (CAPA) for proper identification and correction for these attributes. But considering complexities in evaluation, many analysts initiate a development exercise i.e. push the method back to development team to understand problem and suggest solution/ modifications. Below are few audit observations that clearly indicate a lack of proper scientific decision making in handling analytical failures (Excerpts from warning letter issued by US FDA in 2016, 2017 & 2018). Observation-1: During the period between January 1, 2018 and October 15, 2018, there were approximately 175 events identified as “repeated incidences” from QC, including at least 19 events due to column conditioning and 15 poor column performances that resulted in aborted or invalid HPLC sequence runs. Based on your assessment and identified root causes, insufficient actions were taken by the Quality unit to ensure the robustness and suitability of the analytical test procedures and the equipment. Incident events with similar root causes were not thoroughly reviewed for historical trends and corrective actions were not implemented to reduce the occurrence of a typical events from similar root causes. Observation-2: Proper controls are not exercised over computerized systems used for analytical testing to ensure drug products meet their specified quality attributes. Your firm engages in extensive use of “Inhibit Integration” and other anomalous integration techniques for assessing US API’s such that unknown impurities are disregarded without scientific justification. Furthermore, unknown impurities are not accurately assessed or reported. A review of chromatograms from your firm’s last 30 batches of drug product revealed that unknown impurities are routinely integrated as a part of the desired API (Active Pharmaceutical Ingredient). Your firm’s officials failed to explain why impurities would be as a part of the desired API peak. Observation-3: Failure to ensure that all test procedures are scientifically sound and appropriate to ensure that your API conform to established standards of quality and purity. Firm failed to establish adequate test procedures. For example, analyst manually integrated a high-performance liquid chromatography test for API, despite the fact that the chromatogram lacked peak resolution. When a chromatogram lacks peak resolution, detailed methods and appropriate oversight are essential to ensure test results, considered by the quality unit in batch release decisions, are scientifically valid. Firm lacked an approved protocol for manual integration or quality oversight of the practice.   How to implement Analytical Method Lifecycle approach in laboratory? As mentioned in beginning; Analytical lifecycle approach comprises of 3 individual stage i.e. Stage-I (Procedure Design and Development), Stage-II (Procedure performance qualification/ Validation) and Stage-III (Continued procedure performance verification) and changes earlier segmented approach towards holistic approach of handling changes/ improvements. To begin with; first and most important aspect of lifecycle approach is setting objectives, here its referred as Analytical Target Profile (ATP). This defines/ stipulates the performance requirements for analytical method. ATP is derived considering requirements of analytical method and performance attributes associated in laboratory environment. Stage-1 is critical step towards analytical lifecycle management. It begins with ‘Knowledge Gathering’ approach to collate information about chemical structure, solubility, reactivity and stability of molecule/ compound. This information is helpful in selection of analytical technology and its suitability in achieving the ATP requirements. Second step is ‘Risk assessment evaluation and control’ to identify process variables and ascertain their impact on method performance. It is recommended to include some guiding tools in decision making e.g. Ishikawa Diagram & Design of Experiments (DoE). Ishikawa diagram helps in identifying all possible variables and DoE helps in understanding effect of variables on process. Next step in development is ‘Analytical Control Strategy’, which includes establishing controls based of outcomes of DoE studies. These controls determine the process variability and provide an opportunity to establish/ set process parameters in best suitable operating limits. Control of variables may include direct restriction/ control on variable or incorporate replicates to reduce/ control random assay variability. Next step is ‘Knowledge Management’ and reflects importance of information gathered during development to be passed to subsequent stages of method lifecycle for effective utilization. It includes systematic approaches to obtaining, understanding, retaining and transferring information to lifecycle stages for effective control strategies. Last step is ‘Preparing for Qualification’ that indicates a pre-assessment of experimental data to confirm absence of significant bias, before taking method for Stage-2. Next stage (After development) is ‘Procedure Performance Qualification’ with objective to confirm that the procedure generates reportable values that meet the ATP criterion and remain apposite for test method. To avoid random variabilities, its recommended that laboratory that will be using the analytical procedure for testing should conduct qualification study. Based on ATP; criterions for qualification protocol are established and analytical control strategies can be modified based upon experimental outcomes/ observations. Stage-3 ‘Continued Procedure Performance Verification’ is a continuous exercise to confirm the suitability or fitness of analytical method. ATP is used as reference point for monitoring performance of method. Monitoring may include trending of analytical results, system suitability, out-of-specification results, stability data and other results. Primary objective of this exercise is to identify potential performance issues in analytical method and identify changes required in analytical method.  Analytical method plays a very important role at all stages of pharmaceutical product lifecycle i.e. Right from product development stage, till final product batch release from production. Selection of appropriate method attributes plays a very important contribution in determining suitability of method for its intended purpose. Drug product quality is confirmed by associated control strategies including procedure controls, environmental controls, materials control and selection of instrumentation. With major analytical guidance documents being revised (to include guidance on systematic approach towards analytical method development, validation and performance monitoring), industries have the discretion either to retain conventional traditional development approach or adopt method lifecycle management principles in their routine work-flow. But looking at advantages of Analytical QbD work-flow, its difficult to avoid this approach for longer time. AQbD gives a structure to analytical method development and learnings gained are helpful is handling failures in systematic approach. Several researchers follow systematic design of experiments approach in development, but these learnings need to be handled in statistical approach for defining method operable range and should be transferred to later stages for effective utilization.  References [1] Proposed new USP General Chapter: The Analytical Procedure Lifecycle {1220}, USP Validation and Verification Expert Panel: Gregory P Martin et.al, 17 October 2016 [2] International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use. Final Business Plan; Q12 Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management, 28 July 2014   Kuldeep Sharma (Ph.D.); Product Manager- Waters (India), Bengaluru ]]> https://biospectrumindia.com/views/21/17236/hope-for-future-lies-in-early-prediction-of-alzheimers.html https://biospectrumindia.com/views/21/17236/hope-for-future-lies-in-early-prediction-of-alzheimers.html Mon, 21 Sep 2020 00:00:00 +0530 Alzheimer’s is a devastating Brain Disease that affects recent memory and learning mechanisms of the brain eventually debilitating an individual. Recent surge in the incidence has been attributed to an increase in the life span which is an average learning of 80 years today. Loss of memory disables by losing identity, personality and eventually losing the self of the affected. They can’t identify anything including the most loved ones leading to horrifying experiences to the persons affected and to their families. At present 50 million are affected in the world and the numbers are expected to rise rapidly leading to severe social,economic and global health challenges soon. It is estimated that 40% of people will be affected at the age of 80 years with this condition. Originally it was described in a patient named August Deter by Dr Alois Alzheimer. The memory store called Hippocampus (sea horse in Greek ) located in the temporal lobe of the brain gets affected first and eventually spreads to the rest of the brain. The loss of neurons and the synapses will set the progression of the disease. Normally the sensory information from the sense organs are received in the form of electrochemical energy and then the brain compiles and computes the data and projects it as information based on the stored memory and information. Due to the loss of connectivity in the brain , such computation fails and hence the failure of recognition. It can start with difficulty in remembering simple things, misinterpretations and eventually to serious failure of recognition and remembrance of everything. The neurons in the brain are riddled with beta amyloid plaques which eventually form tangles that kill the neuron itself. The cell death triggers an inflammatory reaction and the Microglial cells which normally do housekeeping and upkeep of the brain by removing the toxins, gets activated and turns against the brain cells itself. They will in turn destroy and clean up the entire neurons and axons progressively shrinking the brain structurally and functionally. Recently 30 new genes have been identified that are responsible for activating abnormal immune response by microglia as well as the Neuro inflammation. Advances in MRI imaging can identify the plaques in the brain very early. It takes nearly 10 to 15 years for the symptoms to manifest after the appearance of the plaques. Hence early diagnosis can help to identify and stall the onset of the disease. The only hope for the future lies in early prediction in those with strong family history and testing them for abnormal genes, early detection by MRI imaging and on suspicion treating Neuro inflammation aggressively. Recent research indicates that the beta amyloid protects the brain from the invaded microbial agents. It forms the plaque to trap the microbes to protect nerve cells from any subclinical infection. CD 33 gene has been found to be responsible for triggering Neuro inflammation. So future goals should be to prevent all subclinical infections that can affect the brain, understand the microbial relations with the brain, treat the tangles with appropriate interventions and control the inflammation in order to avoid Alzheimer’s. Lifestyle modification, good sleep for 7-8 hours, managing stress with meditation, healthy interactions with people, avoiding loneliness, walking with barefoot at least for 20 minutes in a day, good exercise, proper diet with high fibre and keep learning new things can go a long way in preserving brain health and preventing Alzheimer’s disease. In a bid to facilitate early diagnosis of Alzheimer’s and to provide comprehensive treatment, Brains has also started a unique "Memory Clinic". This step by Brains is to mark the World Alzheimer's Day (September 21st).   Dr. NK Venkataramana, Founder Chairman & Chief Neurosurgeon, Brains Hospital, Bengaluru ]]> https://biospectrumindia.com/views/21/17172/exploring-ngs-test-for-ophthalmic-diseases.html https://biospectrumindia.com/views/21/17172/exploring-ngs-test-for-ophthalmic-diseases.html Tue, 08 Sep 2020 00:00:00 +0530 The purpose of the genetic testing is to identify the underlaying genetic defect in the affected case or family. Firstly, it answers the cause of the disease. Second, if the disease casing mutation/gene is identified, it reveals the pattern of inheritance, autosomal or X-linked, dominant or recessive, thereby facilitating in risk prediction of the disease in the family. This opens the possibility of offering prenatal genetic diagnostics wherever appropriate. With time researchers and scientists are constantly evaluating the in-depth genetic information available to understand the progression and prognosis of the disease. Though most of the inherited ophthalmic diseases do not have a cure, the requisite for any patient to be eligible for gene therapy is to know the underlying genetic defect which can be known by genetic testing. In case of a patient who is diagnosed with cancer of the retina, genetic testing in retinoblastoma helps in prognosis of the disease to determine whether it is familial or sporadic. This information changes the recurrence risk of the disease in the family members and the next generation and in turn helps in disease management, surveillance, and follow-up. The benefits of next generation sequencing (NGS) based testing is that it offers targeted panel testing (only disease specific candidate genes are screened), clinical exome (all clinically significant genes), whole exome (WES) or whole genome sequencing (WGS) (currently more under research testing). The diagnostic yield of the NGS testing in ophthalmological diseases is about 50-70%. In earlier days, diagnostic genetic testing was not comprehensive because screening all the candidate genes for a given disease was time-consuming and expensive. With advancement in technology and innovation in science the process of NGS has evolved to offer comprehensive, affordable genetic testing with a very short turn-around time of 3-4 weeks. Though genetic testing for risk prediction of age related complex ophthalmic diseases like age related macular degeneration, glaucoma, diabetic retinopathy, is currently not available, case-control studies on very large cohorts across the globe over the years have generated vast data and polygenic risk score (PRS) for these diseases are slowly emerging which would be available soon.   Dr. N Soumittra, Disease Head, Ophthalmology, MedGenome, Bengaluru   ]]> https://biospectrumindia.com/views/21/17132/personalizing-human-body-temperature-with-wearable-sensors.html https://biospectrumindia.com/views/21/17132/personalizing-human-body-temperature-with-wearable-sensors.html Tue, 01 Sep 2020 00:00:00 +0530 Of the four vital signs, temperature is most consistent from person to person and across time. We’ve all been taught that a normal body temperature is 37°C / 98.6°F. While most people are aware that this is an average, the assumption is that it’s an average across the population. What surprises many is the fact this is also an average in time, as our body temperature is in a perpetual state of flux due to physical activity, circadian rhythms, hormonal changes, weight, and even age. With recent events, there’s been a surge in interest for wearable temperature sensors to quickly warn the wearer of illness or infection, giving them time to self-isolate and reduce spreading a contagion further. For the first time, wearable temperature sensors can also provide key insights to a wearer’s thermal cycles, allowing algorithms that personalize what is normal for an individual, and detecting changes that could indicate an illness even before hitting the threshold for a low-grade fever (38oC / 100.4oF). Before diving into wearable tech, it’s important to understand where the benchmark of 37°C / 98.6°F came from. First proposed in 1851, German physician Carl Reinhold August Wunderlich analyzed temperature across millions of axillary measurements for 25,000 patients. Factoring in all the variability mentioned above, he proposed the normal range for a healthy adult to be 36.2°C-37.5°C, the defacto standard even today.     However, a recent study from Stanford University questions whether 37°C is still a valid measure of normal body temperature. Analyzing records set back to 1860, Stanford researchers showed that average body temperature has steadily decreased by 0.03°C per decade of birth (adjusted for factors such as gender, age, height and weight). So yes … you are now officially cooler than your parents. With all this variability, let’s consider the implications. Take an 80-year-old man. Because of age, it would be pretty normal for his body temperature to be 36.2°C / 97.1°F. He wakes up at 6 a.m. and takes his temperature. Due to circadian rhythms, there could be a 0.5°C / 0.9°F drop in core temperature placing him at 35.6oC / 96.2oF. For him to even hit the standard threshold for a low-grade fever (38oC / 100.4o) his temperature would need to increase by 2.4oC / 4.2oF, which would be substantial. While a medical clinician would know to use a lower threshold, things could easily get more complicated if the man also had a thyroid issue elevating or lowering his temperature.   As wearable temperature sensors help enable the vision of the quantified self, the continuous tracking they provide could launch a new era of personalized medicine to more quickly identify deviations from what’s normal, indicating a potential infection, hormonal shift or disease.    Technology advancements, such as our TMP117 temperature sensor family, are enabling accurate, compact and low-power wearables for personal or clinical settings. The TMP117M sensor, designed specifically for medical applications, provides an accuracy of ±0.1°C from 30°C to 45°C, fully encompassing the American Society for Testing and Materials E1112 and European Standard 80601 specifications for electronic patient thermometers. Available in a 1-mm-by-1.5-mm package, the TMP117M sensor’s small thermal mass enables fast thermal response times and compact industrial designs to improve user comfort. Further enhancing the user experience is the minimal power consumption at less than 7 µW, enabling smaller batteries to optimize comfort and cost. The design illustrated in Figure 1 demonstrates the small form factor possible for wearable thermal monitoring applications. Connectivity options like Bluetooth® Low Energy unleash the true power of a wearable temperature sensor. As a parent of a child whose fever often exceeds 40°C (104°F) when she’s sick, it would be a huge relief to receive a notification on my smartphone that detects when her antipyretic medication is wearing off – before her temperature spikes to dangerous levels. Translating the same Bluetooth-enabled temperature solution to a hospital setting could bring a range of benefits, enabling patients to move more freely without being tethered to a patient monitor in their rooms, reducing the load on nursing staff to manually take temperature measurements, or improving triage in congested waiting rooms.   Daniel Mar, Product Marketing, Texas Instruments, US ]]> https://biospectrumindia.com/views/21/17088/going-deeper-into-the-skin.html https://biospectrumindia.com/views/21/17088/going-deeper-into-the-skin.html Mon, 24 Aug 2020 00:00:00 +0530 Even though we pride nature for creating a harmoniously functioning species - “humans”, it has left several millions across the world with its own defense system attacking itself, creating pain and discomfort while performing even the simplest of tasks. With autoimmune diseases tripling in the past few decades, the need for further research on these debilitating conditions is evident due to the lack of a cure and their recurring natures. One such disease that affects around 0.44% to 2.8% of the Indian population is Psoriasis. Due to certain signals sent to the immune system, skin cells are considered to be harmful leading to an increase in the production of cells, thus resulting in red, flaky and “silvery scaled” areas on the skin. To make matters worse, about 94% of patients experience relapses, ranging from two weeks to nine years, never being fully relieved from this painful condition. Even in the relatively mild winters in most parts of India, about 46% of patients experience a greater intensity of the patches due to the cold climate, while 43% seem to recover from the gentle heat of the summer season. While being mainly prevalent in males as compared to females, symptoms usually occur in one’s thirties or forties. Thus these extreme occurrences have fueled Indian research on psoriasis to mainly study the effect of the human leukocyte antigen, which in most cases helps the body differentiate between the human cells and those of pathogens. Furthermore, a greater importance has been given to comorbidities such as cardiovascular diseases and metabolic syndrome, which are factors that heighten the risk to the heart, mostly present in the the Indian society Genetic composition, with environmental factors, creates a need for a well structured and personalized treatment plan to help relieve the stress and discomfort associated with psoriasis not only for the patients but for their families as well. While modern medicine has greatly reformed the treatment, many physicians, mainly in the rural parts of India, advocate for ayurvedic and siddha influenced medical treatments  such as mixtures of a variety of herbs and Wrightia tinctoria oil, followed by deep massages. However, more research in this field has proved that this form of treatment could worsen the condition in most patients, especially in those prone to chronic recurrences, the most commonly experienced type of psoriasis in India.Thus patients are more often prescribed drugs including etanercept, infliximab,  itolizumab and secukinumab due to promising results in terms of alleviating symptoms over a long period of time. These drugs fall under the category of biologics and are recommended when a patient fails to respond to phototherapy or has reached a limit to the safe exposure to ultraviolet radiation. More widely used in past few years, they help treat cases where psoriasis is relatively severe. By binding with those molecules and cells that increase inflammation and aid the maturation of T cells, these drugs are proven to be more effective in Indian patients. Glenmark, based in Mumbai, was responsible for developing and releasing the first oral medicine for psoriasis in India. Prescribed to patients in a moderate or extreme condition, Apremilast or Aprezo proves to be safer and more effective without the need for patients to receive medical support while taking the drug.  Alzumab, a revolutionsing drug, has recently been released into the pharmaceutical market by Biocon, based in Bengaluru. By being injected rather than consumed, it allows patients to take fewer doses over a long period of time. Proving to be 50% cheaper than more commonly used drugs, Alzumab serves to be an effective method of decreasing treatment cost, thus making it more accessible for the public. Making a mark in the treatment of psoriasis, Cadilla, based in Ahmedabad, has introduced several new drugs into the market. This includes Fluocinonide cream which recently received approval for its sale by the USFDA. Having anti-inflammatory uses, this cream could be used to treat numerous skin diseases such as eczema, dermatitis and psoriasis. By partnering with Lipidor, based in Stockholm, these companies are developing a new drug, APK-02, to be released by 2022. Going into the third phase of testing this year, the drug has shown positive results on multiple patients with differing skin types in India. Psoriasis, a disease that has prevailed since the 19th century, has only recently been stressed on by Indian research companies in their effort to combat this autoimmune disease. New medicines move to replace the older, more traditional techniques, proving to be more effective and affordable for the general public. With no cure, one can only hope to lessen the symptoms and prevent relapses, thus allowing for a better quality of life and decreased economic burden.   Nysa Adurkar, Mumbai ]]> https://biospectrumindia.com/views/21/17071/pandemic-ignites-chaos-for-patients-seeking-palliative-care.html https://biospectrumindia.com/views/21/17071/pandemic-ignites-chaos-for-patients-seeking-palliative-care.html Thu, 20 Aug 2020 00:00:00 +0530 With over 12000 deaths and 3.6 lakh cases, Indian healthcare system is crippling due to COVID-19 outbreak and the resilience of the system will become even more pressing in the coming weeks as experts anticipate the worst phase to arrive in the upcoming months. As the country is focussing excessively on COVID positive patients, non-COVID patients are bearing the brunt of the entire situation. Nation-wide lockdown imposed as one of the measures to contain the spread of COVID-19 gave a harrowing time to these patients and also to the ones who needed emergency treatment for other diseases but contracted the virus by their hospital visits. The situation has worsened for patients suffering from chronic diseases such as renal failure, cancer, and tuberculosis (TB) as they require frequent in person doctor appointments. All over the country certain hospitals have been marked as designated COVID-19 facility centres. The step is laudable as COVID patients should not be mixed with non-COVID ones due to the latter’s compromised immuno-system owing to underlying conditions, hence they are at increased risk of fatality. But this has left the patients with other ailments who were earlier availing treatment from these hospitals in a lurch. According to a recent study by CovidSurg Collaborative, the global modelling study projected the impact of the COVID-19 pandemic on surgeries, 59.7 percent of cancer surgeries were postponed in India during the peak 12 weeks of disruption, translating to 51,100 postponed cancer surgeries.[1] This is alarming considering that delayed or postponed surgeries might result in tumour being upstaged which might move a lot of patients from curative to palliative stage. Similar is the story with people suffering from Tuberculosis (TB). India accounts for 26 lakh out of a crore TB cases worldwide and the disease killed 4.49 lakh people in the country in 2018.[2] With several labs being shut and many being used for COVID-19 testing, diagnosis of diseases like TB has become difficult. While focussing on the COVID-19 pandemic, let us not forget that TB kills 1,000 Indians every day.[3] Hence, consequences can be grave if TB patients are not tested or do not get treated in time. This is largely because the disease is infectious, and TB patients have destroyed lungs which makes them more vulnerable to contacting the virus. Experts worry that the number of TB cases might suddenly increase now with the easing of lockdown, considering the backlog. Post lockdown scenario Another critical crisis that we cannot ignore is the lack of availability of safe blood for patients with diseases like Thalassemia specially at a time when blood banks across some cities in India are running dry owing to the status quo. This is majorly happening because people fear contracting the virus while going out to donate blood. Hence, there is a dire need to reassess and ensure implementation of best practices and technologies related to quality and safety of blood collection and transfusions. People who had earlier delayed their tests and treatments are now coming forward to seek medical attention. With relaxations in lockdown, OPDs at hospitals have started seeing a rise in footfalls, according to reports. In this situation, we should look at patient safety alternatives such as home collection of blood samples and using different syringes or needles for testing of more than one patient. Patients with different ailments, will have an injection at some point in their lives to restore good health. But sometimes when injections are given in an unsafe and inappropriate way that is by using the same needle or syringe to give injections to different people, it can have adverse effects as they can lead to the transmission of life-threatening infections. This becomes crucial now as we are battling a deadly virus. Incorporating safe insulin practices and using auto-disable syringes can help. Hence, doctors and hospitals need to take certain precautions while treating non-COVID patients.[4] Hospitals have taken several precautional measures as they opened their doors to non-COVID-19 patients. To follow social distancing rosters are maintained for the staff, screening of all visitors is done at the entrance, people are not allowed to enter hospital premises without a proper mask and a distance of at least one metre is ensured between people at the OPD waiting area or at the billing counter. Hospitals and doctors are doing their bit, but self-vigilance is equally important. Following are a few things to keep in mind before visiting a hospital. As lockdown has eased-up, you are bound to find a queue at the OPD waiting area or at the billing counter. Before rushing to be first, ensure to keep a distance and your safety in mind. Make sure you sanitise your hands at the hospital entrance and wear your face mask. Some of the hospitals are only dealing with COVID-19 cases. Therefore, identify whether the hospital is a COVID-19 or non-COVID-19 and leave your house accordingly. To avoid standing in the queue, confirm your appointment online. Avoid moving out in cases where, telemedicine will suffice.   Dr. Virender K Sheorain, Senior Consultant, Medanta Division of Peripheral Vascular & Endovascular Sciences, Gurugram   [1] https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.11746 [2] https://www.who.int/tb/data/GTBreportCountryProfiles.pdf?ua=1 [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891128/ [4] https://www.who.int/infection-prevention/campaigns/injections/global-campaign/en/ ]]> https://biospectrumindia.com/views/21/17050/importance-of-telemedicine-laid-down-by-covid-19.html https://biospectrumindia.com/views/21/17050/importance-of-telemedicine-laid-down-by-covid-19.html Mon, 17 Aug 2020 00:00:00 +0530 We live in a fast-paced world where digital advancements have helped in the availability of health services without having to meet the patient face to face. The current pandemic has further increased the scope and laid down the importance of telemedicine. What is Telemedicine? Telemedicine is the practice of providing healthcare services to patients remotely. Only Registered Medical Practitioner (RMP) who is a doctor can consult patients or their caregiver via text message or audio-visual mediums be it in form of SMS, audio-video call, email or skype. How Telemedicine can benefit patients and caregivers? The main purpose is to promptly serve healthcare to patients virtually without making distance a hassle. Telemedicine has become an optimal solution to provide timely care to patients who cannot access healthcare services in person because of various reasons, be it their illness or their inability to move and travel to far places to visit a doctor. It is also cost-effective and saves time and effort by reducing the financial costs associated with travel and the inconvenience caused to both the patient and their family.  It creates a channel for accessibility and has now paved the roadmap for improved medical care in rural areas as well. Who can practice Telemedicine? As per the regulatory standards only a Registered Medical Practitioner (RMP) is entitled to practice Telemedicine who follows the same professional and ethical norms and standards laid out by the Board of Governors of the MCI. ‘Registered Medical Practitioner’ is a person who is enrolled in the State Medical Register or the Indian Medical Register under the IMC Act 1956. In this, the exchange of information takes place through different tools of communication be it mobile or landline phones and chat platforms like WhatsApp, Facebook Messenger or other mobile apps. It is also commonly perceived that the consultation process is free but that is not always true. As per the rules, the RMP is entitled to charge a fee which is declared from before- hand for the consultation as well as a follow up session provided to the patient. It is important to digitally maintain all records both by the patient and the RMP whether it is prescription, invoices or the investigation report of the patient as it helps in future follow up as well as takes care of medicolegal issues. Telemedicine in the current scenario As the global pandemic has brought life to a stand-still with social distancing and strict lockdown measures, it has led to the demand of Telemedicine for patients. It is recommended to opt for online consultations as far as possible during this pandemic. In case of an emergency however, it is advised to seek medical help in-person rather than go for teleconsultation as direct visualization of patients is necessary for any intervention. Doctors on teleconsultation have the scope to advise for first aid or do counselling in any emergency and suitably refer to relevant specialist. When to opt for Telemedicine? Patients may consult for diagnosis and counselling for his/her condition Patients may be advised about treatment for their condition and drug prescriptions maybe be generated as per rules For follow up sessions on on-going treatment Avoid tele consultation in emergency where the patients need to visit the doctor for any intervention Globally, Telemedicine has been recognized as a huge market while in India it is still developing and is bound to grow in the current situation. With a boost from the Ministry of health and family welfare, development of telemedicine and tele-health for medical care in remote areas also has a great future.   Dr. Madhuchanda Kar, Clinical Director, Department of Oncology, Peerless Hospital, Kolkata ]]> https://biospectrumindia.com/views/21/16997/diving-into-the-fascinating-space-of-genome-sequencing.html https://biospectrumindia.com/views/21/16997/diving-into-the-fascinating-space-of-genome-sequencing.html Thu, 06 Aug 2020 22:10:00 +0530 The idea of ‘untreatable’ diseases has always given humans the run for their money. In almost all phases of evolution, human health has been prioritized and it is only through innovations and health-IT that we do have ammunition for treatment at our disposal. The genome sequencing is one such healthcare concept that has opened up a whole new world of practicalities and possibilities. With applications in cancer treatment and potential in treating epidemics, future predictions are now pouring in rapidly. Among the myriad of fascinating concepts across the world, genome sequencing is listed above several other technologies. With massive investments in studies and research activities associated with this concept, the worldwide genomics market will cross $62 billion in seven years, as predicted by Fortune Business Insights in its latest report on ‘Genomics’.   Where it all began… As humans evolved, the standards of living were raised. Although it took an awful lot of time for us to realize we needed a civilized lifestyle to survive, we did eventually settle on a particular set of ‘rules’. In true retrospect, the civilized standard of living is what enlightened education and the concept of research and studies in general. It wasn’t until a few hundred years ago, that humans moved on from the hunched way of living. With further evolution, along came a few revolutionary innovations that truly defined the shape of the world. As humans discovered the way to maximize on technology, the world became a closer or ‘connected place’ as they say, but just like all other things, it did come at a cost. The idea of connected world or ‘globalization’ brought along a few negative traits. As people began to explore newer and untapped areas, they were naturally exposed to newer diseases. Globalization certainly amplified the spread of such diseases and with limited medical facilities at our helm; the resulting epidemics became the consequence of our own doing. But even the sheer advances in technology and healthcare weren’t enough. We realized that all human bodies are different and needed to be addressed in a specific manner. Some of us reacted to certain things and substances differently than others and this is when personalized or precision medicine came into fray.   What Exactly is Precision Medicine and what does Genome Sequencing have to do with this? It is evident that a large portion of common diseases and conditions are treated with the same medicines and therapeutic approach. Modern physicists are constantly striving to develop personalized medical approach that is more impactful and efficient for the patients they address. The concept of genome sequencing is a primary ingredient to this delicacy that is precision medicine. If there is any weightage to the early predictions, genome sequencing can, in a few years, bring precision medicine for all. With increasing practical theories and clinical studies, there is no shortage of evidence to support the role of genome sequencing and AI in personalized medicine.   Understanding Genome Sequencing… A normal genome sequence is nothing but a ‘sequence’ of letters that make up a human’s DNA. These letters are not just any letters but are used to denote the order of DNA nucleotides in the form of A, T, G, and C, referring to adenine, thymine, guanine, and cytosines respectively.  Confused Yet? Let’s put it this way… The human genome is made up of over 3 billion such genomic letters. Without a differentiable sequence, the genomes would be represented by a random combination of letters. This sequence helps scientists identify the genes or DNA of a human being or as they would say in technical terms, ‘decode’ the human gene. Among all variations in genome sequencing, the next-generation sequencing remains one of the hottest buzzword in the healthcare sector in recent years.   Where Exactly are these Sequences Used? As we have already established its meaning, let us take a look into where and how these sequences work. A set of pre-defined human genes can be used for a variety of purposes, including building personal or precision proteins, identifying long-lasting problems, and detecting severe conditions at an early stage. But the concept that has made headlines on several frontiers is the use of genome sequencing for study and treatment of complex diseases. This is mainly done by locating the ‘individuality’ of the disease as a whole; meaning to identify how a particular disease affects a particular human being and then coming up with ways to tackle it. The idea of ‘gene therapy’ through genome sequencing has opened up newer branches and studies in genetic engineering. What’s more is that these sequences are now being studied beyond just the bracket of treatment, and new ways are being developed to even prevent the disease in its entirety. To put it in a clearer context, genetic diseases such as diabetes can be detected and dealt with very early in life. Although it may sound complex, the general idea behind this concept is to study every human body in a different way and identify ways to tackle damaged genes or areas that are potentially exposed to further damage.   Beyond just A,C,G,T…Where we’re Currently Getting at with Genome Sequencing? The applications of DNA sequencing have been expanding rapidly over the past decade. From a scientists’ perspective, genomics has opened up a whole new world of ideas and we cannot really blame the extensive nature of research that is being going on in this field. With applications in regenerative medicine, the concept has gathered attention from healthcare industries across the world. Among a multitude of diseases that can be studied through genome sequencing, cancer has understandably made the front pages. Global organizations such as the National Cancer Institute (NCI) have carried out studies where-in the tumors in several individuals have been sequenced for the purpose of ‘genetic mutations’. Each of these individuals’ tumor is being studied and potentially be treated by ‘personalized’ or ‘precision’ genomic treatment. The recent scenario of genome sequencing, however, has been more exciting. We are already aware of the fact that this concept was used to study the spread of the infamous Ebola virus a few years back. Although we will not be getting into the detailed medical terms, what we can briefly say is that scientists used genome sequencing to identify microbes and track down the pattern of the outbreak and epidemic across the world. As far as we’re concerned, this was certainly a ‘win’ for genomic enthusiasts.   Unravelling the Mysteries Surrounding the COVID-19 Pandemic The coronavirus outbreak, that originated in Wuhan, China, has now spread all over the world and we can’t really pick who’s at fault. On one side, humans are responsible for the spread of the disease, but on the other hand, we are entering a state of hesitation for developing vaccination. It is clear that despite the awareness and the general idea of ‘containing’ and tackling a new disease within the originating area, the manner in which humans are going on about their life, gives us very little room to do so. It looks like we have settled on the idea that we will continue to live through constraints and the fact that we’re not going to stop travelling, despite the travel bans, a statement that represents much irony. On the positive side, the advances in healthcare and medicine have given us hope. Having said that, we haven’t yet tackled the riddle of the Covid-19 pandemic but signs are we might be finally on to something. Concepts such as genome sequencing can be used to track patterns of the epidemic, especially in densely populated countries such as India. The biggest challenge during a nearly uncontrollable epidemic is to identify the origin as well as the pattern of the spread of the disease and genome sequencing, along with other concepts, has certainly helped this cause.   Countless Possibilities Yet Very Few Practicalities; There’s Still work to do…. Although the revolutionary genome sequencing and DNA studies have sparked several innovations, there are, in all fairness, limited practical applications. The depth of existing applications is much more fascinating than the ‘number’ of applications itself. With genome sequencing finding its way into the ideology for coronavirus treatment, it is safe to say that concepts like these are leaving us with that subconscious safety cushion across several aspects of life. How we handle the ‘ethical’ side of genetic studies remains to be seen; but the promise and potential held by genome sequencing certainly overpowers such ethical barriers. With applications in areas that were previously deemed unattainable, genome sequencing might just be the answer to a few of our worst nightmares with respect to life-threatening diseases. We can be nothing but excited of what this concept has in store across other areas in healthcare in the coming years.     Author: Tanay Bhalla is an expert in embedded systems and health-IT sector.  ]]> https://biospectrumindia.com/views/21/16943/reduce-risk-of-severe-illness-in-covid-19-diabetes-with-insulin-.html https://biospectrumindia.com/views/21/16943/reduce-risk-of-severe-illness-in-covid-19-diabetes-with-insulin-.html Thu, 30 Jul 2020 12:00:00 +0530 With 15.8 lac confirmed cases and exponentially rising, India is facing exceptional struggles in combating with the COVID-19 pandemic. Throughout this rise, it has been observed that people living with diabetes are disproportionately affected by the infectious disease as they are at a 50% higher risk of meeting a fatal outcome than those without it. The extreme vulnerability of people living with diabetes during the COVID-19 pandemic calls for the need to maintain good metabolic control at home when health systems across the country are prioritizing treatment for COVID-19 patients and are inundated with challenges of increased social distancing and isolation. This may ensure prevention of a fatal illness from COVID-19 in people with diabetes. In this complex emergency, there is a strong consensus amongst endocrinologists that Insulin is a safe choice as it is the single most therapy for people with type 1 diabetes mellitus, and a better choice than most other anti-diabetic agents in people with type 2 diabetes mellitus, having poor metabolic control.   Maintaining Good Metabolic Control For maintaining good metabolic control (blood sugars, blood pressure, and lipids), treatment should be intensified to achieve metabolic targets whereby blood glucose is tested frequently, and ongoing medications are not discontinued. In cases where the blood glucose is high, insulin should be used to hasten and intensify control. Hesitation in the initiation of insulin is not advised at this time as Insulin ensures a safe and speedy rectification of blood sugars even in the unavailability of hospitalization and in-clinic care.  Type 2 diabetes is a progressive disease that typically begins as early as 15 years before diagnosis.[i] Most people living with diabetes, need various blood glucose-lowering medicines over a period of time to enhance their Insulin levels since the pancreatic beta-cell mass and function progressively diminishes over time and leaves patients with marginal capacity for secreting insulin[ii]. While some newly developed anti-diabetes therapies can limit the progression of the disease, insulin therapy becomes a necessity for most patients eventually.   Accessing Insulin in Lockdown For many people living with diabetes in India, access and affordability of life-saving Insulin are of utmost importance. With more than 77 million people living with diabetes in the country, the Ministry of Home Affairs, Government of India released guidelines in March 2020, stating that all known or diagnosed people with diabetes will receive regular supply of medicines for up to three months through ASHAs (Accredited Social Health Activists) or SHCs (Sub Health Centres) on prescription. This includes access to Insulin. Under the social obligations of this pandemic, people with diabetes should be mindful that diet and exercise although very useful, they alone cannot always help them in maintaining a good metabolic control. In the current situation, where faster control of glucose levels is desirable, early initiation of Insulin can significantly improve their condition. Moreover, the Insulins used today for treatment are very similar to the Insulin produced by our natural body and can help in restoring the body towards normalcy. Hence, people with diabetes should not shy away from Insulin and instead demand to know more about this life-saving drug from their doctors through tele-consultations and online appointments during the ongoing pandemic.     Dr. Rakesh Sahay, Professor & Head, Department of Endocrinology, Osmania Medical College & Osmania General Hospital, Hyderabad     [i] Tabák AG, Jokela M, Akbaraly TN, et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 2009;373:2215–21. [ii] Halban PA, Polonsky KS, Bowden DW, et al. β-cell failure in type 2 diabetes: postulated mechanisms and prospects for prevention and treatment. Diabetes Care 2014;37:1751–8. ]]> https://biospectrumindia.com/views/21/16865/juvenile-arthritis-fighting-ones-own-immune-system-.html https://biospectrumindia.com/views/21/16865/juvenile-arthritis-fighting-ones-own-immune-system-.html Fri, 17 Jul 2020 10:10:00 +0530 Joint pain, swelling, stiffness. While these conditions might be normally associated with old age, children below the age of 16 suffering from Juvenile Arthritis have to experience and manage these painful symptoms for several months, or even their entire lifetime. In India, out of every 1000 children only 1 suffer from this autoimmune disease. Severe degeneration due to attacks by one’s immune system on joints leads to this movement restricting condition, with an increasing early onset in recent cases. Unable to perform normal activities, children with juvenile arthritis are now able to receive treatment comprising of various drugs, supplied by many pharmaceutical companies in India. Thus, by reducing their symptoms, a sense of normalcy is restored, allowing them to maintain physical fitness painlessly. One of the most commonly administered drugs for juvenile arthritis are disease-modifying anti-rheumatic drugs or DMARDs. These are essential in patients suffering from more severe or different symptoms like rashes or swollen glands. By reducing inflammation and swelling, these drugs can help alleviate the symptoms over a long period of time. Instead of treating the underlying disease, these drugs mainly focus on controlling the immune response in order to prevent extreme degeneration of joints and tissues. However, this could also make one more susceptible to various infections due to the repressed immune system. The most commonly administered DMARDS are methotrexate and etanercept (which is a biologic drug). Currently, Mumbai based ICPA Health Products, in Ankleshwar, is the leading producer of these drugs as a treatment for arthritis across India. A more widely used therapy is the prescription of non-steroidal anti-inflammatory drugs or NSAIDS, whose production is largely dominated by IOL Chemicals and Pharmaceuticals Limited, which is based in Punjab. These can include relatively common drugs like ibuprofen or naproxen which allow one to reduce swelling and pain in the joints. However, an important limitation to consider is that they are only effective when treating a few joints. Since the only issue is whether or not the drug is available or if the patient responds to it, this drug is extremely popular in treating children for juvenile arthritis. In cases where the drug is unresponsive, they are coupled with newly developed and tested NSAIDS or are switched with another type of anti-inflammatory drug. Regardless, the effectiveness of this drug has been seen in numerous cases, making it the most commonly administered drug for juvenile arthritis. Another important contributor in the treatment of juvenile arthritis is Swiss firm Roche. Drugs such as Actemra® (tocilizumab) and Rituxan®/MabThera® (rituximab) were approved by the FDA in 2018 and are being used on patients with polyarticular juvenile arthritis and systemic juvenile arthritis respectively. Recommended for patients above the age of 2, these medications have shown less severe side effects, making it safer for these children. Moreover, they help reduce swelling by blocking interleukin 6, a cytokine known to cause inflammation especially in patients who did not make improvements while taking other drugs. To further the use of tocilizumab in treatments across India, Roche partnered with Cipla, based in Mumbai, in 2018. This merger was aimed at increasing the standard of healthcare and providing each citizen adequate treatment for their ailments. Noida based stem cell therapy company Advancells, a company dedicated towards treating patients with stem cell therapy, has made major advances in treatment for juvenile arthritis. With hospitals in New Delhi, Chennai, Bangalore and Mumbai, they aim to provide patients with a more viable solution for the years to come. While other drugs prove to be effective in relieving pain, this treatment focuses on eliminating the root of the problem. On injection of stem cells in one’s body, they are able to start the immune system and allow them to create new cells to replace the ones that previously degenerated. These cells, taken from the bone marrow, can develop into several kinds of tissue based on the extent of damage and pain in a particular patient. The production and delivery of the drugs can truly shape the treatment for juvenile arthritis, allowing a child to evade the crippling pain and lead a relative normal childhood. Each therapy works to lessen the symptoms at young age in order to prevent a worse onset later on in life. A stress on physical fitness can be seen in a majority of juvenile arthritis treatments and these drugs prove to play an important role in ensuring a better and more comfortable lifestyle for these young children.   Nysa Adurkar, Mumbai ]]> https://biospectrumindia.com/views/21/16434/robotic-assisted-surgeries-can-help-improve-patient-outcomes.html https://biospectrumindia.com/views/21/16434/robotic-assisted-surgeries-can-help-improve-patient-outcomes.html Tue, 12 May 2020 00:00:00 +0530 For a 52-year-old patient, life came to a standstill when he was diagnosed with prostate cancer. He knew that the disease management could come with side effects like trouble with urination, bowel problems and erectile dysfunction. When informed about the possibility of a robotic-assisted surgery (RAS) using the da Vinci surgical system, he was initially skeptical about undergoing the operation with a robotic- assisted approach, but chose to do so after hearing how it could potentially reduce the listed side- effects. After the robotic-assisted radical prostatectomy was conducted, he was discharged within 48 hours and resumed work in a week. Today, a few months after the robotic-assisted procedure, this patient is not only happy he chose this option but is also back to his fitness regime. In 20 years of my practice, I have seen many patients like him recover within days after a robotic- assisted surgery. Robotics have proved to be beneficial in challenging or complex cases where a minimally invasive approach is either required or preferable, providing excellent functional and at par oncological outcomes. I can confidently say that in my experience, robotic-assisted surgery is an important and reliable tool for a number of surgical cases. Robotic-assisted surgeries are bringing an incomparable degree of precision to minimally invasive surgeries. In my experience, it can result in quicker recoveries, shorter hospital stays, low levels of blood loss and minimal scarring. Robotic-assisted surgical systems make some of the most complicated procedures simpler with 3-D vision, magnification, depth perception and 7 degrees of freedom, precise dissection, and can in some cases decrease my operating time. A common myth associated with robotic-assisted surgeries is that they cannot be trusted as the robot controls the procedure. The surgeon is, of course, in control at all times – the robot is just a tool that the surgeon utilizes. Yet many patients are skeptical about the use of a machine over a surgeon’s hands. I would like to clarify that robotic-assisted surgery has been a part of medical science for over 20 years and the technology has only evolved over the years. Moreover, new generations of integrated systems as well as systems with single port capabilities that may be use in India someday have made robotic- assisted surgeries even more advanced. Let us understand how they work. Take, for instance, a system like the da Vinci surgical system. It comes with four thin robotic arms inserted into strategically placed small incisions, which are 1-2 centimetres long. One arm holds the camera, the other three have surgical instruments attached. Seated at a special console, we (surgeons) can easily operate the robotic arms and the camera with joystick-like controls. A computer will translate the exact movements of the surgeon’s fingers into precise movements of the surgical tools. We operate it by sitting at a console unit, using hand and foot controls, with a 3D high definition visualization of the anatomy. This approach avoids the physical trauma of large incisions required by open surgical procedures.  Earlier in my surgical career, I used to conduct 2D and 3D laparoscopic surgeries for prostate, kidney and bladder cancers along with advanced reconstructive surgeries. Traditionally, we would use rigid instruments through an incision in the body and the visualization was through an endoscope. We were able to see the anatomy on an external screen. Unlike traditional laparoscopic instruments, robotic- assisted surgical tools can rotate 360 degrees, giving more flexibility than human wrist. At the same time, a HD vision system provides a perfect view of the surgical area. We have come a long way since the first RAS procedure in India in 2002. Indian surgeons are now adopting it with over 70 installations of robotic-assisted surgical systems across the country. This number is expected to grow dramatically in the coming years with a growing interest in minimally invasive surgical options among patients. There was a time when laparoscopy was the gold standard in minimally invasive surgeries. Today, the da Vinci surgical system is not only enhancing our precision, but also flexibility and control during the operation in comparison to traditional techniques. I am excited to be a part of the growth of robotic-assisted surgery in India. I personally have performed and assisted in more than 400 robotic-assisted surgeries throughout my career – I had the opportunity to train with leading robotic surgeons, such as Dr. Mani Menon at Henry Ford Hospital in Detroit and Dr. I.S. Gill at University of Southern California. Recently I was able to apply that training by starting the robotic-assisted surgery program at Safdarjung Hospital in Delhi with the goal of making it a world class robotic-assisted surgery centre that will positively impact the lives of Indian patients. So far, results have been promising - I have performed more than 120 cases in Safdarjung in less than six months with good clinical outcomes. Additionally, I have performed 500 robotic assisted surgeries during my clinical fellowship in Advanced Robotics in USA. At a time when India is striving hard to fight the perils of a disease like cancer, with one in every 10 Indians likely to develop cancer and one in every 15 is expected to die of the disease, according to a recent WHO report, we need advanced tools to address the disease burden. We are living in times when India is making great economic progress, bringing with it socioeconomic changes with an increased risk of non-communicable diseases. The coming decades will demand smarter tools to manage patients to minimize recovery times, helping patients resume their normal life soon after the surgery. India must look to the future with technologies and techniques, like robotic-assisted surgery, that have thepotential to transform patient outcomes.   Dr Anup Kumar, Prof. & Head, Dept of Urology & Renal, VMMC & Safdarjung Hospital ]]> https://biospectrumindia.com/views/21/16407/blood-donation-blood-transfusion-during-covid-19-pandemic.html https://biospectrumindia.com/views/21/16407/blood-donation-blood-transfusion-during-covid-19-pandemic.html Sat, 09 May 2020 18:00:00 +0530 The novel coronavirus disease (COVID-19) is a highly contagious respiratory disease caused by the SARS-CoV-2 virus. WHO acknowledged the outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January and declared pandemic on 11 March 2020. By the mid of April 2020, over 20,00,000 cases have emerged  worldwide, with a mortality rate as high as over 6% of total infected. If we consider the number of recovered cases and deaths only, around 21% have lost their lives. The COVID-19, has created enormous anxiety, uncertainty, and disruption to our lives.  Much has already been talked and debated about shortage of sanitizers, face masks,  personal protection equipment (PPE), testing kits and testing labs but little has been said about life saving blood which is always in scarcity. Blood transfusions are an integral part of major surgeries and many medical conditions. Elective surgeries may be postponed but diseases like thalassemia, sickle cell disease and some cancers where survival depends upon regular transfusions, drying of blood banks may endanger their existence. As a doctor who is involved in the management of blood disorders, I also go to the extent of advising high-end screening techniques like the Individual Donor Nucleic Acid Testing Technology (ID-NAT) to screen the donated blood for Transfusion Transmitted Infections such as HIV, Hepatitis B and C. This results in better prevention from transfusion transmitted infections. The spread of COVID-19 has imperative effect on the number of blood donations, on blood supplies due to cessation of outdoor blood donation camps and reluctance of voluntary  donors to donate blood at hospital blood banks due to fear of catching Covid 19 infection. The SARS-CoV-2 has a long incubation period of 1-14 days (average, 5-6 days & longest reported, 24 days). Its asymptomatic infection in a large number of individuals poses a huge challenge in the recruitment of blood donors, and bloodsafety. Our nation's blood supply is essential to our health care security. In 2017-18 only 11.45 million units were collected against total requirement of 13.4 million units, approximately shortage of 2 million units. Blood donor organizations are encountering extra challenge in recruiting and retaining potential donors during Covid 19 lockdown period. Personal calls and popular social and messaging apps like Facebook & WhatsApp are implied to encourage the donors. The blood donors are invited to make an appointment to donate blood in slots to ensure appropriate social distancing. There are serious concerns in the minds of blood donors when to donate and when not. Person with confirmed Coronavirus infection and who has been in isolation must not donate. However persons who have been in isolation for at least 14 days since the first day of isolation & resolution of any symptoms (if relevant) then, if the donor remains well with no symptoms of Coronavirus infection, the donation may be accepted. If the donor has a history of contact with a confirmed case of Coronavirus infection and the donor has not been asked to isolate, he/she remain well with no symptoms of Coronavirus infection and agree to report any post donation illness, the donation may  be  accepted. Donors must be provided with information about contacting the blood service if they develop any illness after blood donation. It is only necessary to recall the donations from donors who report symptoms of Coronavirus infection if these symptoms start on or before the fifth day after donation. There is no evidence at present that coronaviruses can be transmitted by blood transfusion and therefore these measures are precautionary. According to the U.S. Food and Drug Administration (FDA), there have been no reported    or suspected cases of transfusion-transmitted COVID-19. No cases of transfusion- transmission were ever reported for the other two coronaviruses that emerged during the past two decades (SARS and MERS-CoV). Individuals are not at risk of contracting COVID-19 through the blood donation process or via a blood transfusion, since respiratory viruses are generally not known to be transmitted by donation or transfusion. We appeal to the public to come forward to replenish the empty coffers of blood banks.   Dr. J.S. Arora, General Secretary of National Thalassemia Welfare Society and Federation of Indian Thalassemics ]]> https://biospectrumindia.com/views/21/16071/bariatric-surgery-is-not-cosmetic-but-a-lifesaver.html https://biospectrumindia.com/views/21/16071/bariatric-surgery-is-not-cosmetic-but-a-lifesaver.html Mon, 30 Mar 2020 00:00:00 +0530 India, which has the second largest population of more than 1.3 billion people, is also home to the third highest number of people suffering from obesity in the world after USA and China. Recent decades have seen a rapid increase in levels of obesity in India. Recognizing and understanding the disease, along with being aware of the treatment options are key to tackling obesity. Obesity is a complex disease and not a cosmetic issue. There is an intricate play of genetics, hormones, diet and lifestyle. The primary goal of obesity treatment is to achieve and maintain optimal weight. Exercise and diet modification are crucial for the management; However, for morbidly obese patients these interventions are insufficient, bariatric and metabolic surgery have emerged as a valid option for treatment of clinically severe obesity. Despite the clinical evidence for bariatric surgery, surprisingly less than 1% eligible patients undergo bariatric surgery. The reason being the poor understanding of the procedure guidelines and who is eligible to undergo the surgery. In this regard, Obesity and Metabolic Surgery Society of India (OSSI) released its first position statement in 2013, to establish that bariatric/metabolic surgery is not a “cosmetic surgery”, but a “life-saving” one. Dr Aparna Govil Bhasker and Dr Praveen Raj, along with OSSI leadership, took a lead in preparing this draft as future guidelines for obesity treatment in India. In recent publication from OSSI in 2020, it is clearly laid out that “bariatric/metabolic surgery should be considered a treatment option for acceptable Indian patients with a BMI ≥ 35 kg/m2 , with/without presence of any obesity related co-morbidity” and “Bariatric/metabolic surgery should be considered a treatment option for acceptable Indian patients with a BMI ≥ 30 kg/m2 , in presence of two or more obesity related comorbidities”. These latest guidelines will help medical fraternity and society to better define the checks and balances for patient care. It is also critical to drive patient awareness on obesity and educate them on the right scientific treatment options. In this context, social media campaigns #IndiaFightsObesity and #FitIndiaMovement play a key role. All stakeholders, ranging from policy, government, hospitals and NGOs need to play a vital role in winning the war against obesity. ]]> https://biospectrumindia.com/views/21/15949/harmonious-approach-of-regulatory-data-migration-.html https://biospectrumindia.com/views/21/15949/harmonious-approach-of-regulatory-data-migration-.html Thu, 12 Mar 2020 16:00:00 +0530 In an evolving regulatory landscape where a ‘single source of truth’ is paramount, one needs to explore just how important data migration really is. We can look at how a life sciences organization can strategically take their data from disparate legacy sources to a centralized product database. Investing in this ‘single source of truth’ can help avoid the all too common data integrity challenges within internal operations which, as we know, not only cost but can heavily hinder an organization. The figure above provides a high-level data structure that is prevalent for a typical 1 API and 1 Product with two formulations. We would consider this data hierarchy as an inverted tree structure that addresses multiple occurrences relating to:   Markets Countries Doses Strengths Pack sizes Indications   We already know that compliance challenges exist owing to multiple markets and formulations, and these challenges must be addressed in order to meet Health Authority (HA) requirements. Further complications arise with the ownership of data. In most companies, we see a shift from central to local/affiliates, and vice versa. Whilst, this is okay, it needs to be fully documented and traceable. If done in a siloed fashion, as we know it often is, this puts added pressure on regulatory operations resource. Adding to this, there is a requirement to track the licenses, agency correspondence, market expansion, renewals, changes, to name but a few, hence the data sets held by regulatory operations are both exhaustive and multifaceted. The complications and challenges are clear for all to see, the answer? A holistic solution platform that can manage the complexities of regulatory operations.  Let’s take a look at that in a little more detail.   Regulatory Data availability situation As we have started to consider, the regulatory domain related data is multifaceted. To that end, there are multiple distinct Stakeholders who create and/or consume data in their preferred form in order to perform their day-to-day business functions. For example, medicinal product data values are captured and recorded at different stages; starting at the clinical stage, through to post-marketing, and beyond; right up until the last batch is made available in any specific market. At each stage, the Product data attributes are different with minimal overlap, with the data continuing to grow. Additionally, an Enterprise can have business functions dispersed globally, and using multiple systems to manage their day-to-day operations. This can lead to further complex scenarios when it comes to looking at holistic regulatory data. Such scenarios can include:   Data is globally dispersed (data pockets) with no single repository at the enterprise level Some of the final data is available with Affiliates If changes and/or variations are not properly managed, then local submissions can deviate from the Core Data Sheets in areas where that deviation is not wanted Data sits in different sources; paper, Microsoft Excel Open XML Spreadsheet (XLSX), databases (multiple envelopes) Capacity required to move data to a single repository (e.g. centralized Product database) not available   Data readiness for regulatory submissions Just because the data is available ‘somewhere in the organization’, does not entail that the data is submission ready. Any data that is identified for regulatory submission must go through a proper data lifecycle, to meet the requirements outlined below: A single source of truth for data originating from different/multiple sources must be identified The data identified must be fully traceable, with a timestamp for future reference Controlled revisions must be adhered to when making any changes to the data entry value These requirements are critical to safeguarding data integrity. Hence, data readiness for regulatory submissions must be handled with due attention and diligence to avoid data mix-up or version conflicts. Once the data is available in a harmonized form, the next step is to make the data ready for regulatory submission(s). This, in practice, means managing potential non-compliance situations which could have a significant impact on both brand and the economy. In our experience, it is rare that a situation(s) occur that have associated patient safety risks. In order to standardize data communication with HAs, there is a preference to submit data in an agency-prescribed format (e.g. eCTD, NeES, XEVMPD, SPL and, in future, IDMP etc.) as much as possible for data consistency and verification. HAs have their own automated parsers to decipher the formatted data submission and quickly let the pharma company know whether the data is readable and accepted in principle for processing.   The Challenge We appreciate that, at first glance, the data journey and its associated challenges can appear somewhat daunting. So often we hear: How do I start my data migration? There are duplicate copies of data sources, with different owners, across different locations. We need to shift from multiple data pockets to a harmonized data plane but, specifically, just how do I manage potential non-compliance situations? Not all data are in non-standard format, which greatly restricts automated data imports with manual quality checking being deployed post migration The indirect cost in duplicate data maintenance such as storage, manual time and effort to find the right source and right version, always ensuring data integrity is not tampered How can a company ensure a compliant, effective migration to a new database?   So, just how do you get ready for data migration? If a Pharma Company is looking to start the setting up of a centralized Product Database, our advice would be to aim for global compliance and long-term reduced data maintenance costs, rather than looking for the shorter-term benefits, which may initially look attractive, but don’t solve the real issues. For instance, don’t settle with localized solutions for global problems. This would quickly require periodic repair and upgrade costs.   Here are some key considerations to achieve a harmonized product data model: Align and form a Data-Cell Team to lead the data change management program with a clear goal of achieving centralized and harmonized Product Database. It may seem obvious, but the challenges are in the detailed preparation work towards building just that.   The Data-cell team to comprise of well-informed team members who have very good understanding of pharma operations and the associated product data in its expected form. Typically, the regulatory associates, publishers, and strategists become very critical to understanding, assessing and defining the Go-To Data Model components. This team should include local as well as global players   Centralized Product Data Model. The Data-cell is responsible for baselining (versioning) the Product Data Model as per organizational policy and procedures   Avoid and eliminate Duplicate data collection: The Data-cell team to ensure that data duplication is eliminated. The team need to identify the top three sources as Gold, Silver and Bronze to ensure that the duplication of data sources are graded appropriately and by default, Gold Source is considered as the ‘Single Source of Truth’. Whilst Silver and Bronze are referred to on a need basis for any reconciliation and mainly for review purposes.   Data mismatch: Quite often we run into a situation where the data that has been submitted locally is different from what it should be, based on Core Data Sheet, and the changes published globally. These potentially non-compliant situations need to be investigated, and appropriate resolutions need to be managed. Compliance-friendly data formats: The data stored, and its associated formats should be as close to HA compliant formats to avoid any gaps in compliance related data format transformation work. Any data that is a candidate for submission should be managed by the team who understand the HA based submission needs. This would ensure that the requirement for data migration from one form-to-another is met whilst keeping compliance in the mind.   Controlled Data Life Cycle Management: Any change or revision to published data must go through a proper change control process before effecting the change. This ensures that the changes are both well-planned and controlled.   Classify the overall data hierarchy into respective categories: Industry Standard Data (Global Term Store) HA specific data (Agency Term Store) Local Data (Local Term Store) Operational Data (data generated and maintained as part of internal operations) Feedback Data (In-bound data including: Safety changes, regulatory correspondences, Product Complaints, and Audit Observations)   Define organization standards for each data point on the following: Data Category Data Type Length Mandatory (Default or conditional) Native Formats (predefined formats, pre-fixes, suffixes) Data Privacy Data Source Submission Formats (if any) Data Version   Baselining and Publishing Data: For a specific data point, identify, enumerate and mark the multiple data sources such as Gold Source, Silver and Bronze so that the preference is always given to Gold Source of data and only on defined conditions, the other sources referred to. The data source can be manual, internal, or external system bound where in periodic data synchronization must be in place based on the frequency of data changes expected. Any data that is meant for consumption needs to be in published state. This is a well proven concept in terms of Standard Operating Procedure (SOP) management of Quality functions where in only published and effective SOPs are considered for operational consumption and, at any point in time, there will be only one published version.   The right Technology Option The potential technology solution for data migration is to look at a holistic approach towards data harmonization at Enterprise Level. The proposed solution to have the key features to facilitate easy data migration: A Built-in option of regulatory base product data model with potential extensions Capability to process multiple data sources with open architecture-based integration capability Ability to transform data from one or multiple sources to prescribed format Ability to map target data models against both internal and HA specific standards Ability to process data migration in batches (both time-based and event-based processing) Ability to track data changes, its associated versions and publish effective and baseline data only for consumption Data Migration process should have the below key aspects built in: Ability to pre-process data before migration Ability to post-process data after migration with dependency checks Ability to handle exceptions during migration   This article has, hopefully, addressed the key drivers to be considered by a Pharma Company when taking steps towards meaningful and successful data migration strategies with minimal surprises once the data is migrated. There is no single-stop solution for data migration. One needs to consider multiple factors, perspectives, and the right partner to make the data migration journey a smooth ride. Where are you in your data migration process?   Sathish Sundaramurthy, Head of Product Development, Safety and Regulatory Technology, Navitas Life Sciences (a TAKE Solutions Enterprise)  ]]> https://biospectrumindia.com/views/21/15422/understanding-the-basics-associated-with-sleep.html https://biospectrumindia.com/views/21/15422/understanding-the-basics-associated-with-sleep.html Thu, 26 Dec 2019 00:00:00 +0530 Getting quality sleep is almost as important as eating food and drinking water. Without proper sleep, it will be impossible to either maintain or form pathways within your brain, which are responsible for letting you learn as well as create memories. Also, you will find it difficult to concentrate as well as respond quickly. Sleep is crucial for several brain functions, including how your cells are going to communicate with one another. Sleep is one of the important biological processes that every individual requires.  What Is Sleep? Sleep is a dynamic and complex process, which is responsible for affecting how you function. Defining Sleep is important because people need to understand exactly what sleep is. Both your body as well as the brain can remain active when you are sleeping properly. Sleep can affect all the tissues as well as systems within your body, from your heart, lungs, brain, as well as metabolism and systems like mood, disease resistance, and immune function. Studies have also revealed that sleep deprivation can lead to disorders like diabetes, obesity, depression, cardiovascular diseases, and high blood pressure.  Anatomy Of Sleep Given below is a list of the brain structures that are associated with sleep.  Hypothalamus- This is a structure, shaped like a peanut, which is responsible for affecting sleep as well as arousal. Brainstem- The brainstem is responsible for communicating with the hypothalamus and it is capable of controlling the transactions that go on between sleeping and waking up. The brainstem is responsible for including important structures like the midbrain, medulla, and pons.  Thalamus- The thalamus is responsible for delivering information from your senses to your cerebral cortex. During the several stages of sleep, the thalamus is responsible for becoming quiet, which will help you to block the external world out.  Pineal gland- The pineal gland is located between the two hemispheres of the brain. This gland is responsible for increasing the production of melatonin, which guides you to fall asleep as soon as the lights start going down.  Basal forebrain- This is responsible for promoting both sleep and wakefulness. The cells within your basal forebrain are responsible for releasing adenosine, which helps in supporting the sleep drive.  Amygdala- This structure is shaped like an almond and is responsible for processing emotions. This structure becomes more active during the time of REM sleep.  How Much Sleep Is Required By An Individual? The need for sleep, as well as sleep patterns, keeps changing as you start aging. You need to know that there are no magic sleep hours, which are going to work for everyone based on their age. Babies sleep for 18 hours, which helps in boosting the growth as well as the development of the brain. School children and teenagers sleep for 10 hours every night. Adults require 7 to 9 hours of sleep. Elderly people prefer taking medications, which are responsible for interfering with sleep patterns.  Conclusion It is suggested that you get enough sleep every night so that you can function appropriately the following day. Ensure that you are cutting out any substance that can be responsible for sleeplessness.    ]]> https://biospectrumindia.com/views/21/15350/bringing-biohacking-culture-to-india.html https://biospectrumindia.com/views/21/15350/bringing-biohacking-culture-to-india.html Tue, 17 Dec 2019 12:15:00 +0530 Are technologies enough to solve real world problems? Are they really going to solve infectious diseases or environmental problems? Issues like multidrug resistant bacteria, air pollution, Dengue and cancer are increasing day by day.  Alone technology cannot solve such problems. Then what is needed to fulfil the gap to such problems? Answer is biology! Biology is changing the way we see the world. It is the next big thing. From storing information into DNA to preventing diseases like HIV, biotechnology is solving almost everything. Biotechnology market is growing year by year, it was valued at USD 399.4 billion in 2017 and according to the market survey , it is expected to witness 9.9% CAGR from 2018 to 2024. Investors are now moving towards biotech startups to invest and scale. Total investment made in biotech in past 5 years is around 2600 Million dollars. If biotechnology has this much potential, then why is it not coming up faster like other technology? Biology is not popular in India as much as IT or hardware. It is beyond people’s imagination to think of using and applying biotech. We are still in the 19th century where we used ancient techniques and still following ancient research topics. Experienced researchers are comfortable doing which is going on since ages. Where would young minds will go to learn new techniques which they can use to solve bigger problems. Recently, CRISPR technique was applied to remove multi- drug resistant bacteria and they were successful in the experiment. Likewise, people have engineered bacteria to reduce air pollution from the atmosphere. All these inventions are happening at different parts of the world. Why is it not happening in India? It is because most of the young generation do not know how these techniques work, and have little theoretical ideas of CRISPR but no experimental knowledge. Biohackathon can bridge the gap between theoretical knowledge and experiential learnings. It is the way to push young minds to think of a solution with biology and apply it in the real world. Biohackathon forces them to try different techniques and come up with workable solutions. Biohackathons are different than IT or hardware hackathons. This cannot be done in 48 hours, it requires a minimum of 3 months to come up with a tested solution to a problem. Such competition helps budding researchers to think out of the box, work on ideas and test the solution. Unfortunately, there are hardly any biohackathons in India which promotes innovation and give youngsters an opportunity to explore various techniques which can be applied in the real world. Biohackathons are a way to bring innovations, share knowledge and expertise, follow deadlines, promote documentation skills and find real solutions. We should have more such hackathons to promote experiential learning.   Bhavna Pandya, Innovation Catalyst at Riidl and Head of BioRiidl, Somaiya Vidyavihar ]]> https://biospectrumindia.com/views/21/15300/statistical-analysis-of-breast-cancer-in-india.html https://biospectrumindia.com/views/21/15300/statistical-analysis-of-breast-cancer-in-india.html Tue, 10 Dec 2019 12:25:00 +0530 Cancer is one of the most dreaded diseases known to man. Most people feel that getting cancer means that their days are numbered and that whatever they do to treat themselves, they have no hope of long term survival. This is far from the truth as recent advancements have drastically improved the survival of patients compared to maybe 2 – 3 decades ago. Breast cancer is one such disease, where advancements have now resulted in almost normal life post completion of treatment. In most advanced countries, the focus in breast cancer has slowly shifted from total survival of the patient (increasing the life expectancy of the patient) to disease free survival (preventing the recurrence of the cancer) to now reducing disease related morbidity and mutilation (era of breast reconstruction and breast conservation). This paradigm shift is also being observed in certain higher centres in India but a majority of the population is unaware of the same. Statistics show a breast cancer prevalence rate of 25.8 women per 100000 women in India. Considering the population of 1.3 billion Indians with half female population, this amounts to almost 350000 women living with breast cancer in India for all ages combined as per a study done in 2017. This is projected to increase to a staggering 1800000 by early 2020 as per predictions as there is increasing awareness and detection in the population. Thus this shows us the scale and magnitude of the disease and is the number 1 cancer among women in India surpassing cervical cancer with 25 – 32% of all cancers affecting women being breast cancers. Thiruvananthapuram, Chennai, Delhi and Mumbai have shown the highest prevalence of breast cancer in the Country. Studies have shown that 5 years survival rates are approx 90% in USA for breast cancer patients, while in India survival is approx 60%. Reasons stated include less awareness, lack of screening resulting in later stages of presentation. Also breast cancer should be treated in tertiary care centres by trained cancer specialists offering multimodality treatments and not lower centres. Breast cancer is a complex disease which needs proper planning and the involvement of all 3 modalities of treatment i.e. surgery, chemotherapy and radiation therapy. This planning of treatment should be ideally charted prior to initiation of any treatment to get the optimum results for the patient. A few other worrying statistics have shown that the incidence of breast cancer in populations below 50 years of age has doubled as compared to 25 years ago along with an increase in mortality (risk of death) of breast cancer by approximately 13% as compared to 5 years back. Almost 45-50 % of patients in India present in the advanced stages (Stage 3 and 4) as per another study.  All these facts and figures entail that India still has enormous scope to improve the detection and quality of treatment that can be given to breast cancer patients. So what can we do to tackle this menace? First step is acknowledging that breast cancer is one of the important health issues in the country. Second is increasing awareness about the disease especially in the rural populations. Third is ensuring implementations of proper screening programmes, all women above 40 years of age should be screened and educated about breast cancer this age should be earlier in women whose close relatives have had the disease or have been cancer patients. Cancer is a disease that I believe not only affects the patient but the entire family both emotionally as well as financially. The costs of treatment can result in severe financial constraints that can affect the other members as well resulting in severe compromises enforced on them. Early detection can not only improve the outcome but can drastically reduce the costs of treatment. The fourth and maybe the most important point is ensuring that the patient takes treatment from the correct specialist who is trained to tackle the disease and give the best possible treatment. This is truer in rural setups and maybe even in some urban setups. As mentioned earlier, proper planning of treatment should be done at the initiation of treatment. Taking haphazard treatment by doctors not fully trained in managing the disease can result in not only increased costs due to complications but also poorer overall outcomes. This is partly reflected in the 5 year survival rate of only 60% in India as compared to 90% in the United States. Hopefully over time this statistic will change.   Dr Prasad Kasbekar, Consultant Cancer Surgeon, Bhatia Hospital Mumbai ]]> https://biospectrumindia.com/views/21/15299/revolutionizing-healthcare-via-ai.html https://biospectrumindia.com/views/21/15299/revolutionizing-healthcare-via-ai.html Tue, 10 Dec 2019 12:20:00 +0530 Artificial Intelligence or AI is being used in many industries today, including banking, automobiles, agriculture and more. One field that it is showing great promise in is healthcare. AI in healthcare has multiple use cases and promises to offer more accurate diagnosis, smoother procedures and better preventive care. Here are a few ways in which artificial intelligence has been transforming healthcare.   Diagnosis AI has the ability to process huge amounts of data at one go. Thus, it can analyse the symptoms of the patient and correctly diagnose the problem. They use personal medical history and the medical knowledge fed into them to come up with the most likely cause of your symptoms. Of course, since this application of artificial intelligence is still in its nascent stage, you will require a final diagnosis from a doctor before receiving a prescription for the course of treatment.    Patient monitoring AI can be used for monitoring an individual and contacting doctors if any change is seen. A very basic example is the monitoring function in smart watches today, where it checks your heart rate and exercise daily. Change in vitals can lead to early detection of a disease, prompting early medical intervention. This has increased the potential of saving lives with early prediction of severe conditions.   Treatment monitoring With patients receiving treatment for their disease, AI can also help in monitoring if the treatment is actually followed and whether it is effective. This can alert doctors to cases of inaccurate usage of the drug in case a patient is not following it correctly. It can also notify doctors in case the current treatment isn’t effective and needs to be modified.    Developing new prediction and care techniques AI is increasingly being used to provide dynamic care. For instance, IBM’s Watson helps oncology departments by detecting cancer earlier and providing patient care. It goes through the patient’s medical file, clinical trials and data, medical journal entries, and finds patterns within them to come up with a complete treatment and therapy plan.   Training AI is being used in training surgeons by creating simulations and scenarios to perfect their skills. It helps track learning by mapping out individual strengths and challenges of each person, reducing the risk of error.   Benefits of AI in healthcare AI reduces human time spent on important tasks. It helps reduce the load of doctors and other medical assistants, letting them focus on critical cases. In cases of smaller hospitals with less expertise or bandwidth, it helps in diagnosis, treatment, and managing tasks more efficiently. This is especially useful in developing economies where there are fewer medical professionals and more patients. AI is also a very economical option as it reduces the time and cost of patient care, drug development, and training. It helps streamline the hospitals’ finances as well.   Challenges of AI in healthcare While there are many benefits of AI, some challenges that need to be tackled before using it to its fullest potential include:   Machine morality issue AI can discriminate based on discriminating data fed into it, or on arbitrary numbers and patterns that only it can see. Without individualized focus on patients and without looking at the picture, AI can easily cause wrong diagnosis or treatment. This might negatively impact patient healthcare.   Privacy issues An overhanging legal and moral question when it comes to AI is: who does it ultimately serve? AI can process big data and developers of AI can easily access and trade it. How much sensitive information can AI become privy to and who can it share this with?    Case Study In India, many patients often have to deal with congested commutes and long waiting times at the clinic when visiting a doctor. This can be very stressful for a patient who is already unwell. Understanding this obstacle to patient care, mfine developed an Assistive Intelligence app. This app allows patients to consult instantly with top doctors directly through the app over chat, video call or voice call.  mfine’s Assistive Intelligence AI gathers information about a patient’s symptoms and provides doctors with an initial diagnosis based on the available information. This helps doctors make a faster and more accurate diagnosis. The app also provides patients with a complete digital prescription and sets a reminder for when they need to take a certain medication.  The applications of AI in healthcare are extremely promising. As this field develops even further, we are likely to see an even more widespread use of AI in healthcare, and not just in a consultative capacity.   Goutam Singh, Marketing Manager, mfine ]]> https://biospectrumindia.com/views/21/15182/ovarian-cancer-a-silent-fatality-on-the-rise.html https://biospectrumindia.com/views/21/15182/ovarian-cancer-a-silent-fatality-on-the-rise.html Fri, 22 Nov 2019 12:55:00 +0530 Unhealthy lifestyles are a major concern in today’s time. Amidst hectic schedules, we often ignore our health, and diseases like Ovarian Cancer often gets ignored. Ovarian Cancer is one of the most fatal gynaecological cancer, as it tends to remain unnoticed , with some minor to no symptoms for a long time; almost three out of four women are diagnosed in the advanced third or fourth stage. It is the third most commonly detected cancers amongst Indian women. As per GLOBOCAN 2018 report, more than 700,000 women are “living within five years of an ovarian cancer diagnosis (5-year prevalence)”, the study predicts that by 2035 there will be a worldwide increase of 55% in incidence to 371,000, and an increase in deaths of 67% to 254,000. As per GLOBOCAN 2018      more than 36,000 cases of ovarian cancer were reported in India. Further, an article published in Lancet Oncology in 2018 for various cancer trends in India stated that the crude incidence rate of ovarian cancer was highest in Kerala, followed by Delhi, Arunachal Pradesh, and Punjab. i The symptoms  of ovarian cancer  are vague and may include bloating, pressure and pain in abdomen, fatigue, feeling full with little food, frequent urination, constipation, back pain and irregularities in menstruation. Average 5 year survival rates (percentage of patients remaining alive after 5 years of diagnosis) varies depending upon stage of disease during presentation. It may vary from more than 90% in stage (I) to less than 10% in stage (IV). These numbers signify importance of early diagnosis and treatment. Once disease affects the ovaries, it can spread to surrounding pelvic organs, followed by upper abdominal organs and other organs like lungs. It is commonly known to affect peri and post-menopausal females between age group of 40 to 70 years, although it may be present at a younger age group amongst the patients  with genetic predisposition. The risk of developing ovarian cancer depends on many factors including age, genetics, lifestyle and environmental factors. Advanced age, family history, obesity, and females who never got pregnant or never breastfed have an increased risk of ovarian malignancy.  Exposure to certain environmental agents such as talc, pesticides, and herbicides may contribute too.ii If diagnosed and treated as per standard recommendations a majority of early-stage and a significant number of stage (II)  and (III) cases can be cured. In advanced stages palliative chemotherapy and targeted therapy can significantly improve quality of life and survival. There are no standard screening guidelines for ovarian malignancy, but the disease can be detected in early stages if women, especially between the ages of 40-70 are vigilant. Persistent gastrointestinal issues are a major indication, which if paid attention to can lead to early detection. Patients with a proven genetic predisposition may undergo genetic counseling followed by surveillance programs consisting of transvaginal ultrasound and CA-125 testing although definite guidelines are lacking. Policies and media campaigns in India are focused on smoking and tobacco prevention while other modifiable risk factors like obesity, unhealthy lifestyles and pollution are not being addressed adequately. To address some of the socio-economic factors that lead to “stigma” around cancer care, there is an emerging need to “educate, encourage, engage and empower” the Indian population. While financial schemes/subsidies are available, these are not being availed by cancer patients due to lack of awareness of these financing options. Early intervention and diagnosis is the key element in the treatment of this disease; the government, the healthcare industry, with the help of media needs to take bold and concentrated steps to spread awareness around it.   Dr.  Atul Sardar Narayankar, Assistant Professor Medical Oncology, LTMMC & LTMGH, Mumbai ]]> https://biospectrumindia.com/views/21/15117/neuropsychology-the-lesser-known-specialisation-.html https://biospectrumindia.com/views/21/15117/neuropsychology-the-lesser-known-specialisation-.html Thu, 14 Nov 2019 16:45:00 +0530 Ask any student pursuing psychology how people respond to their career choice, and something along the lines of “Are you analysing me now?” would be a commonly heard rhetoric. There are however multiple specialisations within the realm of psychology, many of which have nothing to do with therapy, psychoanalysis or the stereotype of someone on a couch revealing their deepest, darkest secrets to a professional. Welcome to the world of neuropsychology. As the name suggests, neuropsychology is to do with our brains. Of course all psychology is to do with the brain in some way, shape or form. Neuropsychology in particular though pertains to cognitive and psychological functioning in individuals with an insult to the brain, be it acquired or developmental in nature. How does this differ from the more commonly known specialisation of Clinical Psychology? While the Clinical Psychologist primarily deals with mental illness and helping individuals cope with these disorders, the neuropsychologist is more interested in cognitive dysfunction and helping people deal with the aftermath of the same. They also play an important role in assisting individuals to manage these difficulties - either by working on improving their skills in the area, or by helping them develop alternative strategies to achieve the same goal in the absence of said skills. Not surprisingly then, while the Clinical Psychologist works more closely with a psychiatrist, a Neuropsychologist works more closely with neurologists. The neuropsychologist’s tool kit A neuropsychologist’s specialisation lies in their understanding of brain-behaviour relationships. Unlike brain scans which use sophisticated dyes and markers to indicate functionality of the different brain regions, the neuropsychologist makes inferences about cerebral functioning based on an individual’s performance on a number of paper-pencil or orally administered tasks. In other words, neuropsychological investigations are all non-invasive. An individual’s performance on these paper-pencil tasks is then compared to performance of other people of the same age, and where possible, the same gender and educational background. These data serve as a reference point for the clinician to then determine whether performance of the person in question is truly deficient, or simply reflective of other demographic variables (e.g. illiteracy or limited access to formal education). The clinician can then form an impression about a) which areas of the person’s cognition may be deficient b) whether specific neuroanatomical substrates may be contributing to these difficulties or alternatively c) what might any observed cognitive difficulties be attributed to (e.g. mood disorders, unfamiliarity with testing material etc). In many ways then, neuropsychology is like trying to understand the functional engineering of the brain. Are all the cogs and wheels doing what they are meant to be? If not, what in particular seems to be disrupting the process, why might this be occurring and lastly what can be done to help ensure that the system works as efficiently as is possible. What does a neuropsychologist do? Just as a mechanic works to ascertain the cause of an engine’s malfunction, and then strives to repair the same, the types of questions asked of a neuropsychologist can also be broadly divided into 2 main categories. There are assessment or diagnosis oriented questions, where the task is to clarify what the primary issue at hand is. Are we dealing with an early stage of Alzheimer’s disease or is this person experiencing late-life depression which is contributing to their memory difficulties? Given their current level of cognitive functioning, would this person be a good candidate for surgical control of their epilepsy? Does this individual have the cognitive capacity to change their will? The second set of questions fall in the realm of rehabilitation, where the clinician’s task is to aid the individual maximize their overall potential, improve their independence and enhance their quality of life. Scenarios in this domain may include developing a plan for an individual with a traumatic brain injury to improve their social skills, to help an individual who has experienced a stroke understand the extent of their cognitive issues, or even to guide people in the workplace regarding the needs of the individual with cognitive difficulties. Rehabilitation begins with goal setting and clinicians work in conjunction with the individual (and their family) to develop a way of achieving their goals. The rehabilitation process typically involves a combination of psychoeducation, compensatory strategies, cognitive training and behaviour management programs.  Is it for me? If you are excited by the brain, enjoy working with individuals of varying backgrounds, and like problem solving, then neuropsychology is definitely a choice to consider. It is a mentally stimulating but immensely rewarding line of work to engage in and new graduates of psychology should consider this as a viable area of specialization in their post-graduate studies.   Dr Deepa Bapat, Adjunct Faculty, FLAME University ]]> https://biospectrumindia.com/views/21/14934/role-of-ethnicity-during-blood-stem-cell-transplant.html https://biospectrumindia.com/views/21/14934/role-of-ethnicity-during-blood-stem-cell-transplant.html Thu, 17 Oct 2019 15:15:00 +0530 Ethnicity goes beyond just being a mark of our identity. Our ethnicity is indeed a lifesaving factor for people suffering from blood cancer or other blood related disorders. An individual diagnosed with such blood disorders usually requires a successful blood stem cell transplant to survive, which further requires a perfect HLA (Human Leukocyte Antigen) tissue match to conduct the transplant process. That’s when ‘ethnicity’ come into play. Human leukocyte antigen (HLA) typing is used to match patients and donors for stem cell transplants. HLA are proteins (or markers) found on most cells in your body which are used to recognize which cells belong in our body and which do not. Patients and donors of Indian origin have unique HLA characteristics. Indian patients mainly require an Indian tissue match for a stem cell transplant to take place. Take the case of Meena, who is an incredible mother of five-year-old twins from St Albans. Meena has been diagnosed of Acute Myeloid Leukemia and needs a blood stem cell transplant in her critical fight against Leukemia. Meena is currently on the lookout for finding a possible match. Though Meena stays in Britain, because of her Indian (Punjabi ethnicity), a successful transplant is possible by finding a donor of Indian ethnicity because of similar HLA type which is key for a successful transplant and in turn give her a second chance at life. Patients and donors of Indian origin have unique HLA characteristics that are severely under-represented in the global database, which makes the probability of finding a suitable donor even more difficult. Every year, of about the 80,000 donor searches initiated across the globe, India has one of the highest ratios of searches that do not result in blood stem cell transplant. Mainly because Indian patients require an Indian tissue match. There are thousands of HLA characteristics that exist (and more keep being discovered), which exist in millions of combinations. This makes finding matches really difficult. That's why it's so important to have more Indians become potential donors. In India only 0.03% of the total population are registered as blood stem cell donors, which is significantly lower than many other countries, including the US where 2.7% of the population are registered and Germany where 10% of `the population are registered. Hence, to increase the probability of finding a matching unrelated adult donor for an Indian patient, the number of potential blood stem cell donors with Indian origin has to be increased.   Patrick Paul, CEO, DKMS BMST Foundation India ]]> https://biospectrumindia.com/views/21/14645/relationship-between-exercise-and-the-brain-and-the-impact-of-fitness-on-learning.html https://biospectrumindia.com/views/21/14645/relationship-between-exercise-and-the-brain-and-the-impact-of-fitness-on-learning.html Tue, 10 Sep 2019 00:00:00 +0530 How exercise can improve learning The book entitled Spark: The Revolutionary New Science of Exercise and the Brain gives indisputable evidence to support the argument that exercise can help students do better in school. The book looks deeply at the relationship between exercise and the brain. It strongly supports that aerobic exercise improves the brain for great performance. The writer, Dr. John J. Ratey, Harvard Medical School’s associate clinical professor of psychiatry, notes that exercise enhances learning in three ways: It makes your mindset better, thus enhancing alertness, attention, and motivation. It prepares and promotes binding together of nerve cells, facilitating logging of new information It encourages the development of new nerve cells from the hippocampus Experiment to prove that exercise improves learning One school set out to prove the point that exercise improves learning. The school started an early morning exercise program that they called Zero Hour whose aim was to determine if working out before school could improve students reading ability and other learning areas. The school registered improved performance in wellness as well as academic performance. Speaking of improved wellness, athletes can also improve their wellness by incorporating steroids in their routine to supplement their diet and workouts. To reap the maximum benefits from the steroids, it is critical to buy them from reliable sellers like Steroids Evolution to be sure that they get quality products. Exercise may enhance students’ mental health Dr.Rattey’s research also brings out another dimension by showing that exercise can help to prevent a significant number of health issues that can interfere with students' learning ability. Some of those issues that exercise helps to deal with include: Stress Students experience significant stress from their workload, peer pressure, and other factors, and this can affect their performance. Exercise not only regulates the physical and emotional effects of stress but also works at the cellular level. Physical activities help to naturally prevent the negative effects of chronic stress and reverse them. People who are active in physical activities also tend to be more socially active, thus improving their confidence and helping to start and keep social connections. Depression Those who manifest depressive symptoms can benefit from aerobic exercise. According to studies, exercise stimulates the production of endorphins, and they contribute to an overall feeling of wellbeing. Workouts also boost the production of dopamine, which is responsible for good moods, and jump-start the concentration span. Students with depressive moods can benefit a great deal from thirty minutes of moderate exercise several days a week. Anxiety and panic disorders While anxiety is a natural response to threat, anxiety disorder is worrying despite there being no real threat to the point of becoming dysfunctional. On the other hand, a panic is an extreme form of anxiety. Students suffer panic attacks during tests and other situations in their school life. A significant number of studies show that aerobic exercise significantly minimizes the effect of anxiety disorder. Attention deficit hyperactivity disorder (ADHD) Exercise is also beneficial to students suffering from attention deficit hyperactivity disorder (ADHD) who find school a difficult environment due to the need to sit motionlessly, face one direction, and listen. These students can benefit from structured exercises like martial arts, ballet, gymnastics, and skateboarding. Conclusion Exercise has a close connection with the brain and plays a crucial role in learning. Giving students challenging fitness programs has many benefits. They help the student to build social relations, learn to mix up activities and stick to a routine, all of which are necessary for a healthy body and brain that promotes learning. ]]> https://biospectrumindia.com/views/21/14638/5-e-cigar-facts-you-need-to-know.html https://biospectrumindia.com/views/21/14638/5-e-cigar-facts-you-need-to-know.html Mon, 09 Sep 2019 00:00:00 +0530 To shed more light on e-cigs, here are some facts about them that you should know:       They work by vaporizing e-cig liquid E-cigarettes are typically battery-operated and contain e-juice in the cartridge. The e-cig liquid or juice usually contains propylene glycol and nicotine (some do not contain nicotine) and come in various flavours like cola, menthol, and watermelon, among others. When in use, the atomizer is powered by the battery to vaporize the liquid in the cartridge so that the user inhales the vapour. Besides their basic parts, e-cig devices vary widely in relation to construction, e-liquid ingredients, and battery voltage.       E-cigs are less harmful than conventional smoking While traditional cigarette burns tobacco to emit smoke and toxins that the smoker inhales, e-cigs vaporize e-juice containing nicotine and other things to produce vapour that the user inhales. Although it is not yet clear about the chemicals in e-liquid, the fact that there is no burning of tobacco means that the users avoid the toxins produced while smoking, so it is less harmful.       Nicotine in e-cigs causes addiction The e-cig liquid has varying levels of nicotine, the addictive and stimulating compound, and can range between 0 and 72 mg. per milliliter of the liquid. Ordinary cigarettes contain 10-15 mg. of nicotine. The use of e-cigs containing nicotine will lead to nicotine addiction, just as is the case with traditional cigarettes, but e-cigs protect users from toxins that result from smoking.       E-cigarettes can harm your health Nicotine, which is common in both e-cigs and conventional cigarettes, is very addictive, making smokers crave the smoke or else they will suffer withdrawal symptoms. It is also a harmful substance because it spikes adrenaline and makes the heart beat faster, which raises the risks of suffering a heart attack. The long-term effects of using e-cigarettes are not yet so clear and are being studied. Furthermore, since e-cigs lack proper regulation, for example by the FDA, the ingredients of the e-juice are not well known. This is especially the case when it comes to less known manufacturers and it poses more health risks to users. For this reason, it is advisable to buy e-cigars and their supplies and accessories from reputable manufacturers like ePuffer.       E-cigs can be used as a smoking cessation tool E-cigars can be a preferred smoking substitute when used exclusively instead of the traditional cigarette and only by smokers who have not managed to give up smoking using medically approved methods. But there is a raging debate on whether e-cigs help to quit or reduce smoking. Those against their use as smoking cessation aid are of the view that the nicotine in them may perpetuate addiction and even make it more difficult to quit smoking. All the same, e-cigs can help smokers to avoid the toxins from smoking if used instead of ordinary cigarettes. They can also gradually cut the level of nicotine intake by consuming lower nicotine e-cigars and eventually stop smoking. E-cigars are safer than smoking because they do not involve burning tobacco, which produces many toxins. They may or may not contain nicotine. Those that contain nicotine can lead to nicotine addiction. They can also be used as smoking cessation aids, but there is some debate on their efficacy. ]]> https://biospectrumindia.com/views/21/14487/break-the-taboo-around-depression.html https://biospectrumindia.com/views/21/14487/break-the-taboo-around-depression.html Tue, 20 Aug 2019 22:10:00 +0530 Depression nowadays is a term used frequently and yet very few people actually understand the complexity of the disorder. Dr Anuj Khandelwal, a celebrated Psychiatrist from Surat says, “Depression is a mood disorder that might last for a few days to months to some years. A person suffering from depression usually suffers through a feeling of persistent sadness and hopelessness. This is different from people being upset about a small event in the day. These feelings are so strong that they hamper the patients’ daily activities such as work, social life, daily chores, recreation etc.” Surprising Facts about Depression: In the year 2017, around 264 million people experienced depression, globally. Women are twice more likely to experience depression than men. People suffering through trauma, stress, life changes or have a history of depression in their family have a higher chances of developing depression. Children, even though they might seem happy, can also suffer from depression. Academic backwardness & refusal to go to school should be taken as serious markers of depression in children. Untreated depression might lead to suicide. According to the Substance Abuse and Mental Health Services Association (SAMHSA), 90 percent of those who commit suicide are suffering from some sort of mental illness. Recently we lost a diversified billion-dollar man Mr VG Siddhartha who committed suicide. Behind the massively successful man with a calm demeanor was a hidden storm, which made him feel like a failure. His death clearly points towards the silent mental health crisis in the society. “Therefore it’s important to reinforce the message that we should talk if something is wrong in our lives. And if life is treating us well, we need to keep a sensitive ear open for those not as lucky as we are. They may badly want to say something. We must not shy away from taking professional help, as depression is treatable. With simple treatment methods, we can manage depression and help a person lead a normal life,” says Dr Khandelwal. How to manage Depression: Don’t be afraid or embarrassed to consult a doctor. They will provide professional help that will assist you fight depression. Antidepressants act on brain neurotransmitters so as to balance them. They are not sleeping pills and hence are not habit forming. Psychotherapies like Rational Emotive Behavior Therapy (REBT) helps the person to identify and replace the irrational & pessimistic thoughts with more rational & optimistic ones. Electroconvulsive Therapy (ECT) is recommended for patients with active suicidal risk and resistant depression. “With plenty of discussions about depression, we can aim to mitigate the disease. The biggest challenge is to break the taboo around it. People suffer more because they feel they have no one to talk to. By talking openly, proper help can be provided and every individual can have a chance to lead a normal, depression-free life!” concludes Dr Khandelwal. Dr Anuj Khandewal, Key Opinion Leader, Cadila Pharmaceuticals ]]> https://biospectrumindia.com/views/21/14411/transfusion-transmitted-hepatitis-should-you-be-concerned-.html https://biospectrumindia.com/views/21/14411/transfusion-transmitted-hepatitis-should-you-be-concerned-.html Thu, 08 Aug 2019 16:40:00 +0530 Recently, a young man got admitted in our hospital for a surgery. As it was a complicated one, he required blood transfusion. As per usual protocol, a request for 4-5 units of blood was sent to our department by the operating surgeon. While going through the formalities, I happened to meet his wife, who was understandably tensed and looked pale. To my surprise, the first question she asked when we met was “Doctor, I am scared as my husband requires blood transfusion. Is it safe enough?”  On asking why she felt so, she mentioned an article about patients getting Hepatitis and HIV through unsafe blood transfusion. It took me by surprise that she knew about the possibility of risks associated with blood transfusion. Blood transfusion is common in many simple to complex medical procedures. Although life-saving for many, it can have its own share of possible risks, which can even cost lives. The Government of India has taken steps to ensure blood safety. However, Transfusion Transmitted Infections (TTIs) like HIV and Hepatitis, continue to be a major health concern in India. The major challenge lies in the inability of screening assays to detect early stage infections, also called as window period infections. The government has mandated the use of serology-based tests that are dependent on the body’s immune response, for detecting an infection.  Window period infections, especially the ones associated with slow replicating Hepatitis B, may manage to escape detection by serology-based tests. The challenge is not only to detect window period infections but also ‘occult’ Hepatitis B. Occult infections are characterized by the absence of Hepatitis B Surface Antigen (HBsAg) and detectable amount of HBV DNA.  Such infections are clearly missed by serology, thus leading to Transfusion Transmitted Hepatitis B (TTHBV). India has high prevalence of HBV as compared to HIV and HCV. Still, the sensitization around Hepatitis B is not up to the mark. Many are not even aware that it can be transmitted through blood transfusion. Every now and then, media reports incidents of TTHBV, but there is no Government-led regulatory body to keep a record of such cases. Other than making efforts to spread awareness, advanced and highly sensitive blood screening techniques need to be adopted by blood banks across the country. Nucleic Acid Testing (NAT) is the solution for window period as well as occult hepatitis infections, as it directly targets the nucleic acid of the virus. Unlike serology-based assays, NAT does not depend on the body’s immune response for viral detection. Many countries across the world have mandated NAT, but in India, only around 100 blood banks are currently using this technique. Published data from NAT users across the country highlight the high prevalence of HBV in blood donors and how NAT has been able to avert TTHBV infections to a large extent. NAT, especially if done in Individual Donor format is proven to be most sensitive for TTI screening. Most of the countries with higher prevalence of TTIs have mandated ID-NAT. After hearing her concern, I was glad to know that there is some awareness about such less talked about issues. I comforted her saying- “Don’t worry!  In our hospital, we provide an additional layer of safety to our patients, through the highly sensitive ID-NAT (Individual Donor Nucleic Acid Testing) technique”.   Dr Smriti Prasad, Chief Medical Officer, Clinical Pathologist, JN Medical College & Hospital, Aligarh Muslim University ]]> https://biospectrumindia.com/views/21/14335/healthcare-delivery-in-india-holistic-wellbeing.html https://biospectrumindia.com/views/21/14335/healthcare-delivery-in-india-holistic-wellbeing.html Tue, 30 Jul 2019 17:15:00 +0530 Today, healthcare is one of the largest growing sectors in India, both in terms of revenue and employment. It is expected to reach a whopping $372 billion by 2022. However, our healthcare delivery system suffers from major inadequacies. With the increase in population from 760 million in 1985 to 1.36 billion in 2019, the healthcare services are inadequate to address the needs in qualitative, effective and holistic way. While there are wide range of issues within the sector, there are few amongst those which have the largest impact on the quality of healthcare.   The skewed distribution of healthcare facilities The distribution of quality services which is hopelessly skewed in favour of those who have higher purchasing power has been the greatest challenge when it comes to healthcare industry. In a nation, where close to 70% of the population habitats in rural area has only 30% of the country’s hospitals and doctors, with compromised quality and hygiene factors. This skewed distribution means the rural population has to spend an inordinate portion of their income to access quality healthcare facilities, which are often far from where they live. Technology has partly emerged as a solution to these challengeswith the invent of telemedicine and video consultations, to name a few. India is experiencing a growth of 22-25% in medical tourism, with the industry expected to reach US$ 9 billion by 2020. However, for transformation at a grass-root level, Government led initiatives need to align with the private organisations to promote more participations in rural healthcare. The Indian government spends just 1.02% of its GDP on healthcare, which is not only far below developed countries (the United States, for instance, spends 17.9% of their GDP on healthcare) but other developing economies as well. Unless this goes up either directlyor indirectly through incentives and Public-Private partnerships, we won’t see a significant improvement in healthcare delivery.   Poor Quality control With the end loosened at the level of quality control, the private players have taken undue advantage and made healthcare into a money minting business. This has been severely aided by the lack of awareness about the quality parameters and the challenge of spending capabilities in the rural population, who seek for the most affordable option. As a result, the bulk of small hospitals, private clinics, and diagnostic centres are now available across the country with less to no regard to quality. In fact, just 1% of India’s hospitals even apply for NABH accreditation.   Inadequate Drug Regulations Since most Indian consumers have to spend a significant amount on healthcare from their pocket, the Government’s focus has been on achieving a reduction in out-of-pocket expenditure on drugs. In the past few years, the government has increased the scope of price control of both drugs as well as devices notified as drugs (stents, knee implants, et.al.). Apart from these policies, the focus is now on establishing public pharmacies that dispense generic medicines. The trouble with such a unidimensional regulatory structure is, on one hand it discourages research and innovation and on the other the availability of cheap, generic medicines means that doctors have a tendency to overprescribe medicines. India is known as the antibiotic capital of the world, and antibiotic resistance leads to the death of 58,000 Indian children every year. Unless drug regulations are made less myopic and more forward-thinking, these issues will continue to occur.    No focus on traditional healthcare systems India is home to one of the richest and most ancient systems of medicine - Ayurveda. Ayurveda has been known to provide long-term, sustainable solutions for major lifestylediseases. In India, more than 60% of the population is now dying from non-communicable, lifestyle-based diseases. Ayurveda has a pivotal role to play in holistic healthcare delivery. In the past few years, the ministry of AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) has undertaken a series of measures to mainstream these alternative systems of medicine. For instance, a number of ministries, including labour, railways, and defence have collaborated with the Ministry of AYUSH to set up wings for these systems within allopathic hospitals run by them. Similarly, there are many schemes to promote private investment in these sectors. For instance, AYUSH wellness centres and hospitals can now avail soft loans and interest subsidies. Though these steps are phenomenal towards strengthening these systems, but a lot needs to be done to sustain the momentum. The healthcare sector in India is on the cusp of revolution, with access to cutting-edge technologies, global demands, and massive untapped potential. Yet, unless systemic changes are made within the system at the grass-root level, healthcare delivery will continue to be broken and will benefit only to the financially-abled section of the society, and not the population at large.   Surendranath Chilamkurty, Co-Founder, Ayuriti (A product of HealthSignz) ]]> https://biospectrumindia.com/views/21/14208/is-talc-really-as-harmful-as-its-stated-to-be.html https://biospectrumindia.com/views/21/14208/is-talc-really-as-harmful-as-its-stated-to-be.html Wed, 17 Jul 2019 00:00:00 +0530 Does talc cause cancer? With the recent lawsuits against Johnson and Johnson baby talcum powder claiming that  long term use of talc on genitals can cause ovarian cancer, the talc has been under the radar. Another concern was a plausible link between cancer in and around the lungs on inhalation of asbestos which is a substance found in the natural form of talc. However recent studies have found no link between talc and ovarian cancer. In spite of the Johnson and Johnson baby powder cancer link, the company still continues the use of talc in their products as repeated tests have reaffirmed the safety of their products. Even in India, the Johnson & Johnson baby powder cancer news made headway with the regulator asking the company to stop using huge quantities of their raw materials at their Baddi plant in Himachal Pradesh and Mulund plant in Mumbai, until tests proved that their talc was free of asbestos. With the government tests confirming the absence of asbestos in their products, quashing the Johnson baby powder cancer allegation yet again, the company has resumed production in both the plants.   So what is talc? Talc is basically a mineral that comes from rock deposits all over the planet. It is mined like any other mineral.  Talc is one of the softest minerals available and only the highest quality talc is used for baby talcum powder. Talc is an inert ingredient which means it doesn’t generate any chemical reaction when ingested or used on the skin. The main uses of baby talcum powder include It absorbs excess moisture Eliminates friction Leaves a refreshing and lingering fragrance Keeps a baby cool and comfortable   What kind of talc should I use for my baby?   It is recommended to use only pharmaceutical grade of talc. The talc must be of high purity and should be mined in certified locations from select deposits to relatively large non respirable particle size. It must meet the USFDA standards and be absolutely free of carcinogens like asbestos and asbestiform fibers. It must be dermatologically tested and hypo allergic. The ingredients in baby powders like that of Johnsons & Johnsons have been evaluated by scientific and medical experts. They have been found to meet all the above standards without compromising on the efficacy and potency of the product, thereby negating the Johnson baby powder cancer connection.   So should you use talc? My answer to this question is- why not?  While talc may not necessarily be needed to dry out your baby’s skin after a bath, which a soft towel can do well enough, it must be used with discretion.   When we buy any product, don’t we always read the instructions on how to use the product? The same goes for talcum powder as well. For those who may have actually skipped this part, I have mentioned them below Hold the container away from your baby and tip a little on your hand. Rub the powder between your palms and dab it on your baby’s skin. Never sprinkle the talc directly from the container on your baby’s body. Keep the container at a safe distance away from your baby, while drying after a bath. You don't want it to accidentally fall over your lil one and shower your baby with talc. Once you finish with talc, close the container tightly and keep it out of reach. Talcum powder does not protect against nappy rash, hence do not apply the same around your baby's intimate areas. Instead, use a barrier cream. While we know that all moms want the best for their babies, as mothers we also need to be equipped with the right information so that we are not actually propagating a chain of incorrect facts. I hope this article has helped allay the concerns you had in mind regarding the Johnson & Johnson baby powder cancer link.   ]]> https://biospectrumindia.com/views/21/13907/advances-in-total-hip-replacement-.html https://biospectrumindia.com/views/21/13907/advances-in-total-hip-replacement-.html Fri, 14 Jun 2019 16:15:00 +0530 Total Hip Replacement (THR) has been described as the operation of the century (Learmonth et al, Lancet 2007) as it has completely transformed the management of elderly patients suffering from hip arthritis. The hip consists of ball and socket joint; THR involves replacing both the ball as well as the socket with an artificial joint. Common indications for THR in Indian patients include Osteonecrosis (death of bone tissue) of the Femoral Bead (the ball), Osteoarthritis, and hip fractures among others. Outcomes after THR are significantly influenced by the surgical approach, implants, and rehabilitation protocol; all of which have seen tremendous advancements over the last couple of decades. SURGICAL APPROACH: Traditionally, the hip joint was approached either from the side (lateral approaches) or from the rear (posterior approaches) for performing a THR. The classical versions of both these approaches involved detaching some muscles around the hip joint which affected postoperative results and recovery. While the posterior approaches increased the risk of hip dislocation, lateral approaches often resulted in postoperative limp. In order to overcome these problems and improve outcomes, several other approaches have been explored. A special mention must be made of two minimally invasive approaches viz. the Mini Posterior Approach (mPA) and the Direct Anterior Approach (DAA) which is currently very popular. The mPA like the classical approach, enters the hip from the rear. However, it has the advantage of a smaller surgical incision and lesser muscle damage, as compared to the standard approach. There is evidence to show that it results in lesser postoperative pain, early recovery and fewer complications. In the DAA, the hip is approached from the front. This minimally invasive approach is muscle sparing and has the purported advantages of lesser pain, rapid recovery and reduced dislocation risk. IMPLANTS: Implants play a vital role in the longevity of a hip replacement. Often, implant failure is due to the artificial head wearing out the socket from repetitive motion and loading. Latest bearings like ceramic-on-ceramic and ceramic-on-polyethylene have significantly greater resistance to wear compared to the standard metal-on-polyethylene bearings. They are particularly useful in younger patients, where a longer lasting implant is highly desirable. Another mechanism adversely affecting implant longevity is failure of fixation between the implant and the bone. Based on the method of fixation, THR can be cemented or un-cemented. Superior implant designs, specialized surfaces and bioactive coatings like Hydroxyapatite have led to enhanced fixation of un-cemented implants to the bone. Similarly, fourth generation cementing techniques have helped to optimise fixation of cemented artificial joints to the bone. Complex or Revision (re-do) THR cases are often associated with bone defects which can be particularly challenging, and were often fraught with sub-optimal outcomes. Availability of anatomically shaped augments and buttresses have simplified the management of bone defects and significantly improved outcomes. Also, advanced materials like Trabecular Metal (Tantalum) which have superior fixation characteristics, especially against weak bone, have made it easier to tackle difficult surgical situations. The size of the artificial ball (head) influences hip stability and Range of Movements (ROM) after THR. Large heads which provide greater stability against dislocation and enhanced hip ROM have resulted in substantially superior function, especially in younger patients. Along the same lines, Dual Mobility Liners have helped tackle the dreaded complication of dislocation especially in high risk patients. In short, advancements in bioengineering have given us high-class implants with exceptional longevity. ENHANCED ‘FAST TRACK’ RECOVERY AFTER SURGERY (ERAS): ERAS protocol is a multi-modal, multi-disciplinary (Surgeon, Anaesthetist and Rehabilitation specialist) care pathway for patients undergoing surgery, in order to accomplish early recovery. It can help shorten hospital stay, improve results and reduce complications. Specific practises like Minimally Invasive Surgery (MIS), avoidance of surgical drains, optimum anaesthetic & pain management, sensible fluid administration, early mobilisation and allowing patients to drink and eat on the same day of operation are implemented to facilitate fast track recovery. Now-a-days, THR patients are allowed to walk as soon as the anaesthesia wears off (few hours after surgery) and are discharged within 24-48 hours after surgery. In contrast, with the classical approach which is still followed, patients usually stay in the hospital for five to seven days after surgery. Also, patients are now allowed to take full weight on the operated leg immediately after surgery, as against the erstwhile practice of partial weight bearing for 6 weeks. Traditionally, THR patients were advised to follow hip precautions like not bending forwards beyond 90° or crossing their legs in order to avoid hip dislocation for the rest of their life. However, with Minimally Invasive Surgery and superior implants, hip precautions are generally not required beyond 3 months, allowing patients to do more. Advances in surgical approach, implants and rehabilitation protocols over the years have revolutionised the results of THR making it one of the most successful reconstructive operations in orthopaedic history!   Dr Siddharth Shah, Joint Replacement Surgeon, SL Raheja Hospital, Mahim-A Fortis Associate ]]> https://biospectrumindia.com/views/21/13617/addressing-the-supply-chain-problems-in-the-healthcare-industry.html https://biospectrumindia.com/views/21/13617/addressing-the-supply-chain-problems-in-the-healthcare-industry.html Mon, 13 May 2019 15:40:00 +0530 Recent is the time when the wave of health consciousness and awareness took place and catalyzed the healthcare industry to pull up the socks. The rise in income level, high risks of lifestyle diseases and easy accessibility of the life insurance plans have also made it a whole lot simpler for people to opt for regular health checkups and diagnostics, leading to the strong demands for affordable healthcare facilities all across the nation. With projects as influential as Ayushman Bharat and heavy capital investments in diagnostics and pharmaceutical sectors made in 2018, the growth of the healthcare industry is projected to reach $280 billion by the end of 2020.  Looking at the performance of the industry and the attractive and tremendous opportunities for both public and private healthcare delivery systems, India is all set to become the biggest hub for world-class healthcare services. However, they are largely dominated by some of the challenges, which might appear trivial at prima facie but are major roadblocks. The GST regime, introduced two years back, had influenced the entire supply chain in the healthcare sector—from manufacturing to transportation and warehousing. The stringent regulatory frameworks with a lack of clarity and quality issues are also the existing concerns with which industry has to deal with. As the healthcare services, medicines, equipment, and other products are running high in demands in response to the therapeutic needs of the population, the hospitals, pharma companies, and diagnostic centres are in a pressure to attain operational and supply chain efficiency. But, it is the fragmented and underdeveloped supply chain infrastructure that results in poor supply chain efficiency. It's quite important to understand the fact that if the Indian healthcare industry is to grow and provide the population with the best health care, addressing the supply chain problems is paramount. Forecasting demands & supply with respect to changing demographics: As people are becoming more prone to lifestyle diseases such as cancers and cardiovascular ailments, all the players in diverse sectors of the healthcare industry have to double their efforts and upgrade their services.  This means that there is an increased demand for manufacturing plants, warehouses, newer technologies, and competent supply chain infrastructure for pharma companies and manufacturers of medical devices and equipment. But, because a larger portion of the industry still relies on traditional statistical methods and limited IT tools to forecast the demands, and lacks the access to relevant data and customer insights, the supply chain is not planned in a way it should. Therefore, the wide-scale use of smart technologies and tools in planning the optimal supply chain is the need of the hour. There should always be the scope of having sufficient resources to meet the urgent or last-minute demands efficiently and effectively. Varying regulatory frameworks: Indian pharmaceuticals market, the third-largest in terms of volume, has emerged as the hub for global manufacturing and research. Though the industry is growing at a CAGR of 22.4%, the post-market issues in the pharma industry are the roadblocks in maintaining a safe and swift growth ahead. The complaints, rejections, and returns of the products impact the product storage, handling, and warehousing while increasing the transportation costs. Factors such as the failure of cold storage at vendor sites or the non-compliance of necessary regulatory requirements bear an additional charge on manufacturers’ part. In case of exporting/importing the goods and material to/from multiple foreign countries, the quality compliance and regulatory policies, and export formalities are headed by different authorities and therefore, they differ across the export/import markets. From packaging to labeling, the material needs to be customized according to the varying guidelines and instructions, which not only increases the number of runs on the same goods and materials, but also the stock-keeping units. For dealing with such challenges, there should be specific governing bodies which not only keep a stringent check on quality but also maintains complete clarity and transparency across manufacturing practices and transportation. On the other hand, the production of pharmaceutical ingredients by local manufacturers should be backed up by appropriate initiatives. Need for improved supply chain infrastructure: As weak and incompetent infrastructure has long been hindering the prospective growth of the Indian logistics industry, the healthcare sector has to walk an extra mile for preparing itself to handle the challenges such as poor road conditions, inadequate seaports and railways, and underutilized air means. Particularly in pharma, the lack of a robust cold chain network has widened the gap in the healthcare supply chain. The specialty products which have a definite lifespan such as drugs and medicines, or fragile equipment must be monitored across all the stages and phases of supply chain management so as to deliver it to the destination site on time. But, the current infrastructure makes the product visibility and tracking oblivious for the companies as they are not able to get the complete details and assurance from the supply chain participants whether the products are stored or transported in required conditions or not. The products which were in the proper state at the time of shipping can get easily damaged before even reaching the destination site due to bad road condition or improper handling of the consignment, which can also make it riskier for the patients. Following the trail of the consumer goods industry, the healthcare sector should focus on building an efficient and transparent supply chain.        Lack of transparency and visibility: The supply chain in healthcare is complex because it calls for active participation and proper measures from each of the players involved at every stage to avoid causing any threat to the life of the patients. But, more the players are involved, lesser becomes the visibility and impossible becomes the traceability of the consignment as it moves across the supply chain network. There is a dire need of facilitating seamless communication between manufacturers, suppliers, distributors, and customers in the healthcare sector through the systematic supply chain management system. The latest technologies such as A.I., Blockchain, and IoT should be used to make relevant data and insights available for all the stakeholders in the industry so that each of them can improve on their services and processes. This step can have a greater impact on the industry’s compelling growth as well as improved patient care.   Sandeep Sharma, CEO & Founder, Cogent Transware Solutions ]]> https://biospectrumindia.com/features/21/13550/will-telemedicine-be-the-future-of-healthcare.html https://biospectrumindia.com/features/21/13550/will-telemedicine-be-the-future-of-healthcare.html Mon, 06 May 2019 16:25:00 +0530 Telemedicine, unlike recent healthcare innovations, has been around for over forty years now. Today, it uses modern technologies in telecommunications, mobile technology and consumer electronics to bring quality medical diagnoses and care to individuals across the globe. As the United Nations calls for universal healthcare by 2030, telemedicine is tackling most challenges in dealing with access to healthcare. A recent report from The Business Research Company shows that the global market for telemedicine technology, currently worth $31.8 billion, will reach $77.2 billion by 2022.   Global trends in telemedicine   Rapid advancements in connected care technology, big data and analytics are continuing to move telemedicine into the mainstream. The proliferation of smart devices coupled with democratisation of the internet is making teleconsultations much more convenient, eventually leading to the emergence of consumer-to-provider telemedicine. The increasing use of smart and connected fitness wearables and telehealth applications such as Practo, Portea, Lybrate and the like is a clear sign of the market moving beyond the peripheries of basic healthcare access. While countries such as Sweden, The Netherlands and Singapore already have high a rate of adoption of connected care technology, other developing markets such as India, Russia and Brazil are moving towards development of better electronic health record (EHR) and clinical decision support systems (CDS) to make headway into the industry.   Impact of telemedicine on patient life and experience   Telemedicine reduces the need for long travel or in-person hospital visits for patients and hence, holds promise in solving the problem of access to quality healthcare at all times and at the patient’s ease and convenience. A patient-centric way to provide quality healthcare services, telemedicine has yielded an opportunity for standardization and equity in the provision of healthcare, both within countries and across continents. In addition to remote access, telemedicine also allows doctors to consult among themselves and also reach out to specialists irrespective of geographical locations. It also acts as a key driver for patient engagement, by helping patients maintain check-up appointments and care schedules. This enhances patient care and leads to reduced costs for the healthcare service provider as well as the patient. Enrolment of patients in remote monitoring programs, use of mobile applications, video conferencing and emails for virtual consultation and treatment are the most common practices followed in telemedicine today.   Driving the telemedicine industry towards growth Traditionally, telemedicine has been associated with providing better healthcare access to under-served communities and rural populations, low-income groups, and regions with limited infrastructure, where its applications were primarily used to link healthcare providers with specialists, referral hospitals, and tertiary care centres. Even though low-cost telemedicine applications have proven to be feasible, clinically useful, and sustainable in such settings, there are a few concerns that need to be addressed to enable scaled adoption of these applications. ICT literacy and the ability to use the equipment effectively as per schedule and patient’s requirements are essential to provide effective and seamless telemedicine services. Further, documenting usage, treatment procedures and outcomes is also necessary to ensure a structured and fool-proof system. Hence, training personnel to effectively deliver telemedicine services, and the set-up and maintenance of telemedicine equipment, will further the penetration of the industry. Secondly, tackling human and cultural factors such as resistance from patients and healthcare workers towards adopting services that differ from traditional approaches or indigenous practices is the need of the hour. This can be done by educating and spreading awareness about the benefits of these technological advancements and the changing landscape of healthcare. The lack of an international legal framework and internal policies of different governments to allow health professionals to deliver services in different jurisdictions and countries is another issue that obstructs the widespread adoption of telemedicine. An international effort is being expended to address legal and policy-driven issues as well as investment and reimbursement, adoption and cyber-security concerns, to make telemedicine market trends more prominent in the future. In India too, with the introduction of Ayushman Bharat Scheme, the biggest health financing scheme by the Government of India, followed by NITI Aayog getting established in multiple states throughout the country, and the support of ISRO for cutting-edge satellite technology - there is a big push towards better reach and practice of patient care.   The future of telemedicine is the future of healthcare   With improved internet speeds  (4G, broadband) and growth in disruptive technologies, the world is moving towards a more connected future that entails quicker, easier and more personalised delivery of all services. Healthcare is no exception to this sea change. In the future, extensive research and technological advancements will pave way for a deeper look into emergency treatment and speciality medicine such as teleophthalmology, OB-GYN and mental health. The integration of augmented and virtual reality, 3-D printing, robotics, and advanced IoT and AI capabilities will lead to enhanced value-based care for consumers and more personalised and customised user experience. Hence, it is safe to say that in this hyper-connected world, the application of telemedicine and related technologies will transform the way healthcare services are delivered and help to achieve an integrated and seamless healthcare experience for everyone.   Suhas Tamras, Global Head, Medical Devices and Healthcare Practice, Tata Elxsi ]]> https://biospectrumindia.com/views/21/13440/5-reasons-b-pharmacy-admission-is-right-for-you.html https://biospectrumindia.com/views/21/13440/5-reasons-b-pharmacy-admission-is-right-for-you.html Wed, 24 Apr 2019 10:10:00 +0530 Pharmacy is a great career option that has a strong scope with many lucrative opportunities. The pharmacy industry is massive in India and was valued at $33 billion in 2017. The projection is that the pharmacy industry will reach $55 billion at a CAGR of 22.4% by 2020. With such strong numbers, B Pharmacy admission makes up for a lucrative career for students. It’s a 4-year degree program that is spread across 8 semesters. Here are 5 reasons why B Pharmacy admission is right for you You Want to Work With Patients Once you get your B Pharma degree, you will be able to work in a lot of different settings. However, patients will be the primary people that will surround you. As a pharmacist, you will find your role across different healthcare settings including ambulatory, inpatient, and community. There are so many different and diverse roles available for a pharmacist that they work in multiple settings involving people. As a pharmacist, in addition to providing medicines, there are other services that you would provide. Pharmacists provide asthma care, cholesterol screening, blood pressure monitoring services, smoking cessation consultation, diabetes disease management, bone density scans and more. You Like Helping People It may not come off as obvious, but pharmacists help patients to feel better. Since pharmacists are medication specialists, they are best equipped to make patients feel better about their situation. Pharmacists also play a crucial role in improving medication adherence. The cultural competence of pharmacists such as lifestyle, language, diet, and much more helps them to evaluate and make patients take medicines as prescribed by the doctor. You Want to Have Diverse Career Opportunities Yes, you’re reading it right. Pharmacy is a diverse career with many opportunities in scientific research, development, patient care and entrepreneurship. There is a huge variety of job roles available for pharmacists after B Pharmacy admission and degree completion. The most obvious choice for pharmacists is working in retail pharmacy, either in a healthcare facility or community. In this role, they provide over-the-counter (OTC) and prescription medications along with counselling to the patients. They can even work in the pharmaceutical industry, teach at university or conduct research. Here’s how a list of careers you can choose after B Pharmacy admission: Community Pharmacists Hospital Pharmacists Hospice/Palliative Care Health-Care Administration Pharmaceutical Companies Production Chemist Medical Representatives Regulatory Affairs Scientific Writing Medical Scripting Clinical Research Pharmacovigilance Higher Education – M. Pharmacy, MBA, Law, Patent Agent After B Pharma, pharmacists can take the above roles and then move to key leadership roles across different aspects of the healthcare system. You Want to Be an Important Part of Healthcare Team Pharmacists play a critical and important role across all healthcare teams. There have been numerous studies on pharmacists, and the results have been consistent to show that they are one of the most important members of the healthcare team. If you choose to pursue B Pharma, you would be an important part of the healthcare system and provide medication for management of various illnesses. You Want a Stable yet Flexible Career A bachelor’s degree in pharmacy will provide stable employment throughout your career. With a degree, you would be able to work as a licensed pharmacist across the country. Also, you have the privilege of choosing your work hours. For instance, you want your pharmacy to operate 24x7 – you can do that! Alternatively, if you want to work a night shift or in the emergency wing – you can do that too. Since the need for pharmacists is vast, there’s much flexibility in this career. If the five reasons mentioned above align with your goals, get B Pharmacy admission to make your dreams come true. B Pharmacy admission in universities like UPES allows students to pre-enrol before appearing for 12th boards if they have a minimum of 50% in class 10th. The university is also rated QS 5 Stars for employability and is the first Indian university to receive this rating. ]]> https://biospectrumindia.com/features/21/13422/awareness-of-ems-services-in-india-a-need-of-the-hour.html https://biospectrumindia.com/features/21/13422/awareness-of-ems-services-in-india-a-need-of-the-hour.html Mon, 22 Apr 2019 15:45:00 +0530 With a population of more than 1.3 billion people, India is among the most populated countries in the world. However, while it has come a long way from being regarded only as “transport vehicles for patients”, emergency medical services (EMS) in the country are still in a fragmented stage, compared to foreign counterparts. Every year, close to 33% of road accident victims and 99% of cardiac arrest victims lose their lives, in India, compared to 2% and 70% in the US. The majority of such outcomes materialise because of the lack of available EMS services and awareness regarding them, as a result of which, patients fail to receive the critical, life-saving emergency care within the “Golden Hour”. While most states in India operate various models of EMS supported by the National Health Mission (NHM), the 108 helpline is the most widely used model, which provides emergency medical services to patients requiring urgent critical care, as well as trauma and accident victims. However, awareness regarding the helpline continues to be abysmally low, as a result of which, most first responders fail to provide help within the stipulated time. The lack of awareness regarding the same among rural communities, which constitute over 70% of the Indian population, also proves to be a major challenge in establishing an organised EMS system in these areas. The situation is further worsened by the plethora of overlapping helplines that exist in the country, on a national, as well as state level. For instance, 102 is the number to dial to obtain emergency ambulance services as well, while 104 is the medicaladvice helpline number. There is a lot of disparities regarding the national emergency helpline number. Even though, 112 has been announced as the nationonal helpline numer, 108 is still operational in several states. In order to clear this confusion, the Government has been trying to consolidate 112 as the unified national helpline number for India, especially since 112 is actually the GSM standard for an emergency number, besides also being the standard emergency helpline number in the majority of the European Union,as well asseveral other countries around the globe. The reason behind this is that users can dial 112 and reach the helpline service even without an active mobile connection, as long as the mobile phoneis connected to a GSM network. In light of this, the need of the hour right now is to take active, aggressive steps to raise awareness regarding this helpline number, not just among the urban population, but also the rural one. In order to make that possible, the Government needs to legally establish 112 as the country’s designated national emergency helpline number through legislation and accreditation,to address all kinds of distress calls such as police, fire, and emergency ambulances. Following that, steps must also be taken to increase awareness regarding the same, in consultation with the Telecom Regulatory Authority of India (TRAI). This can be done through a range of advertisement campaigns, as well as rural awareness drives. Efforts must also be made to make people aware of the various laws and regulations which have been designed to make emergency medical services more accessible and available. Earlier, a majority of Indians would also be afraid of coming forward to help victims of accidents for fear of interrogation regarding the incident, obligatory court appearances, and more. To provide a solution to this, laws have also been passed to protect the interests of helpful bystanders who try to assist the victim and call the emergency service number in case of such a situation. The chief among these is the Good Samaritan Law, which prevents first responders to an accident from being harassedby the police. The need for collaborative steps to improve awareness regarding the same, by stakeholders in EMS services, members of academia, activists, lawmakers, and the Government, is more than ever. This will not only help bring down the number of avoidable fatalities in the country, but also lead toa wide-scale evolution of the EMS sector in India.   Manish Sacheti, COO, Ziqitza Health Care ]]> https://biospectrumindia.com/features/21/13179/medicine-turns-to-cold-chain-warehouses-for-its-storage-needs.html https://biospectrumindia.com/features/21/13179/medicine-turns-to-cold-chain-warehouses-for-its-storage-needs.html Mon, 25 Mar 2019 11:50:00 +0530 A cold chain is a temperature-controlled supply chain which is required to preserve and maintain perishable products like food items, chemicals and now, pharmaceutical products. It involves constant refrigeration of the product from the time of its production, through its transportation, handling and storage, right up to delivery. Pharmaceutical cold chain management is an important aspect of the supply chain in the healthcare industry. The cold chain logistics services help the pharmaceutical and healthcare industries maintain a continual stockof drugs from suppliers and distributors across varied locations. Historically the pharmaceutical industry was not a big consumer of cold chain logistics. This was becausea majority of its drugs did not have to be stored or transported in a temperature controlled environment. It is only in the recent past that there has been an eruption of cold chain activities due to the growing acceptance of a new class of drugs called biologics. Even though biologics have recently been introduced in the world of medicine, they have already taken the market by storm. Biologics excel not only in terms of their treatment capability, but also in terms of the demands they are placing on the pharmaceutical supply chain as most biologics require both temperature and time-controlled distribution. The warehousing and logistics sector is greatly benefittingfrom the introduction of Goods and Services Tax (GST). As a result, logistics companies are now planning to build and own warehouses instead of just leasing them. The Indianpharmaceutical industry is even expected to see 100% growth in this sector by 2021. Warehousing will not only reduce the transportation cost but will also lead to efficient inventory management which drives economies-of-scale. Better warehousing will facilitate exponential growth by creating a lean distribution channel. Cold storage for pharmaceuticals requires high-tech equipment to meet the needs of different drugs. Demand for large warehousing facilities is set to increase in the pharmaceutical industry. In 3-5 years, smaller developers are expected to concede their market share to bigger players thereby bringing about a structural shift.  In the long run, warehousing will evolve into an organized segment, ready to compete in the same league as its global counterparts. We also need to consider the fact that manufactured drugs have evolved to contain more high-value ingredients. They have a shorter shelf life and stricter temperature requirements for storage. Thus, the need for temperature control and monitoring through the entire supply chain has increased. Even drugs that are safe at room temperature may need protocols to avoid the risks associated with transportation at ambient temperatures. Logistics providers are beginning to receive more requests for Controlled Room Temperatures (CRT) which include the use of insulated containers, refrigerants, thermal blanketing and temperature-monitoring electronics. For pharmaceutical shipments with temperature-controlled products that are handled multiple times from supplier to end user, quality assurance requires a combination of temperature controls, monitoring tools and coordinated actions throughout the supply chain. They face a number of challenges to achieve this. The biggest challenge within cold chain is to maintain the 2°C - 8°C range throughout the delivery cycle, which is the most common range for the pharmaceutical industry. As the pharmaceutical cold chain industry expands its reach, manufacturers, logistic providers and carriers will need to continue to coordinate actions to address the ongoing challenges of cold chain logistics. A number of e-commerce players have also started entering the ‘Online pharma retail’ market in India. Ministry of Health and Family Welfare issued a draft policy for regulating this sector in June. It promises better clarity for the online medicine-delivery space. Hyper-local player are looking forward to enter this space, as it would help them do a better utilisation of their on-ground fleet. The current pharmaceutical supply chain scenario in India is extremely complex. The presence of more than 55,000 retail pharmacies which are spread across India is one of the main reasons for this complex supply chain environment. Poor infrastructure and transport facility is a big obstacle for cold chain supply. About 1/3rd of the revenues generated by drug companies is spent on transportation. The problem of poor supply chain management becomes even more severe when temperature sensitive drugs, such as, Polio vaccines,are required to be transported to remote areas. Hence, the presence of a proper supply chain management - which includes temperature controlled vehicles and warehouses - have become important for the pharmaceutical industry of India. Vaccines require the support of temperature controlled environments right from the point of their initial stage of production, up to their final distribution. This indicates the unexplored potential for both the domestic, as well as, international players who are present in the cold chain management system. With an increase in awareness,companies as well as the government have started taking initiatives to storethe medicines in such a manner that the drug or vaccine reaches the target area without losing its efficiency. Industry estimates suggest that India’s pharma exports could reach heights of $20 billion by 2020. At the moment, the nation exports around $16 billion of pharmaceutical products to 200 countries. Upgrades to the country’s regulatory position have enabled this growth. The logistics industry is one of the country’s predominant trades which demands a spend of 13% of Good Distribution Practices (GDPs) towards its framework improvement. India’s cold chain management in general, however, is in need of some organizing with lacking infrastructure and disjointed supply chains hindering the market’s growth. It is noted that a logistics revolution could be on the horizon for India, where supply chain efficiency is going to be imperative to support this growth, and reduce the threat of bottlenecks.GDP will be beneficialwhen it comes toincreasing growth, as the country is taking efforts to reduce the gap between its volume and value levels. Temperature management in cold chain is currently being done in various ways. The most basic process involves packing discreetdevices called temperature data loggers along with the shipment. They help to recordthe temperature of the product which can then be manually uploaded into a system. While some may have GPS capability, and the possibility of real-time tracking and reporting, a few can communicate via RFID to make it easy to gather information. Rapidly evolving software platforms are being developed for end-to-end tracking. Informatics will have a central role to play in efficient data generation and monitoring. Package-based temperature control solutions are also available. Some of them are passive and maintain pre-specified temperature conditions. While some are active and have the capability to heat or cool the product as is necessary. Thus, we can conclude that the pharmaceutical industry in India is in for some radical changes when it comes to cold chain management.   Manoj Pant, Regional Business Manager - West, Snowman Logistics ]]> https://biospectrumindia.com/features/21/13090/women-at-higher-risks-to-uti.html https://biospectrumindia.com/features/21/13090/women-at-higher-risks-to-uti.html Wed, 13 Mar 2019 17:20:00 +0530 Urinary tract infections (UTIs) is a very common infection of the urinary system that mostly affects women. It affects up to 60 percent of women as well as men and children. It generally affects the part of the urinary system- the kidneys, the ureters, the bladder and the urethra. The bacteria from the large intestine escapes the anus and invades the urethra and can even travel up to the bladder. If the infection is not treated, the bacteria can reach the kidney. Women are more prone to the infection because of the shorter urethras which allow bacteria quick access to the bladder. A report from WHO says, “Urinary tract infections are considered to be the leading cause of morbidity and health care expenditures in persons of all ages. Around 50% of women have reported of having had a UTI at some point in their lives.” As the severity of the infection rises, people still remain unaware of the causes and the serious complications that it can have. Why Women Stand a Higher Risk? Most common culprit for UTI is the E-coli, a bacterium that is excreted with the human feces. In women, the proximity of the urethra and anus facilitate easy passage of the bacteria into the urinary tract. It is important to note that young sexually active women are more prone to UTI as sexual activity is the cause of 75–90% of bladder infections. UTI is a very commonly seen in newly married women and has been aptly termed "Honeymoon cystitis". Taking Precaution during Pregnancy UTIs are more common during pregnancy, due to the changes in the urinary tract. When the uterus, sitting right above the bladder grows, it increased weight can block the drainage of the urine from the bladder, causing an infection. A kidney infection during pregnancy can increase the complications and may lead to premature birth or pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures). Symptoms of UTI A strong persistent urge to urinate Lower back and abdomen pain A burning sensation while urinating Strong- smelling urine Pelvic pain, especially in the centre of the pelvis and around the around the area of the pubic bone Strong-smelling urine When treated promptly, the infection can rarely lead to any complication. However, if avoided, it can lead to serious complications like permanent kidney damage or chronic kidney infection, increased risk in pregnant women in delivering premature infants and sepsis which is a life-threatening complication especially if the infection works its way to the urinary tract and to the kidneys. Prevention of UTI Drink plenty of fluids, especially water- Drinking water ensures that the urine is diluted and the person urinates more frequently allowing bacteria to be flushed out of the urinary tract before an infection begins Empty the bladder frequently, and make sure that you have emptied the bladder completely Avoid using feminine products like deodorant sprays, powders in the genital area which can irritate the urethra. Wipe from front to back after urinating and after bowel movement since it prevents the bacteria in the anal region from spreading to the vagina and urethra. Keep the genital area clean by wearing loose clothes. Tight clothes can trap all the moisture and creating a perfect environment for the growth of bacteria. Treatment Head to the doctor if you suspect a urinary tract infection, depending on the severity of the infection, the duration of the treatment can be short or can last for longer than a week. Ensure that you finish off the cycles of medicine completely even if you start feeling better. Severe infections, for those affecting the kidneys may require a longer course of oral or intravenous antibiotics. Drink lots of water, and eat foods high in Vitamin C which ensures better immunity response. Lastly, Consuming unsweetened cranberry juice can also support the normalization of the kidney function.   Dr Mohan Keshavamurthy, Director- Urology, Uro oncology, Andrology, Transplant, Robotic surgery,  Fortis Hospitals, Bengaluru ]]> https://biospectrumindia.com/features/21/13038/common-pcos-myths-busted.html https://biospectrumindia.com/features/21/13038/common-pcos-myths-busted.html Fri, 08 Mar 2019 15:45:00 +0530 There is a lack of awareness of a lot of diseases which are considered as taboo until some inspiring celebrity opens up about it. Like in recent past, a lot of actors have come out in the open to share their stories and made the disease discussion more acceptable. Be it Sonali Bendre, rising up with her personal struggle of cancer diagnosis and side effects of chemotherapy, or Angelina Jolie changing the scenario of BRCA genetic testing, or more recently Sara Ali Khan, a young actor opening up about health struggle with Polycystic Ovarian Syndrome (PCOS). This International Women’s Day, we, are making an attempt to bring more awareness and acceptance of this disease by clearing some myths attached to it. Polycystic Ovarian Syndrome (PCOS) is characterized by elevated androgen levels, seen in 5%-10% of women between 15 – 44 years. The symptoms include irregular menstrual cycle, hirsutism, acne, excessive weight gain or difficulty in losing weight, darkening of skin, infertility and pelvic pains.  Myth #1”If Your Menstrual Cycle Is Irregular, You Have PCOS” Fact: There are many causes of irregular menstrual cycle and PCOS is only one of them.  A normal cycle is anywhere from 21 to 35 days. Outside of that, breastfeeding, extreme dieting or over-exercising, pelvic inflammatory disease, uterine fibroids, and thyroid disorders are potential causes for a cycle that’s out of whack. Myth #2 “PCOS is caused by your ovaries” Fact: PCOS is primarily an endocrine disorder characterized by chronic hyper-androgenism (elevation of serum testosterone or other androgens) and chronic anovulation (absence of ovulation). The actual polycystic ovaries are merely a symptom. Myth #3 “Women with PCOS are infertile” Fact:  Women with PCOS can have difficulty getting pregnant, but the infertility associated with PCOS is often easy to treat. Women who have PCOS and are overweight can often begin to ovulate regularly with very modest weight loss of even 10% of their body weight. 50% of women with PCOS will conceive with medication. Myth #4 “PCOS does not happen to lean women” Fact: This is a false perception that PCOS is only related to weight gain and hence only obese women can be affected. Even if you are lean and have painful or irregular periods or other symptoms or infertility, you should consult a doctor. Myth #5 “PCOS is irreversible” This myth about PCOS needs to be busted! Many women balance testosterone levels, lose body fat, resolve acne and facial hair growth, and regain their menstrual cycles through a mixture of diet, supplements, and lifestyle changes including stress reduction and better sleep.   Harish Natarajan, President & COO, Strand Life Sciences ]]> https://biospectrumindia.com/features/21/12902/the-targeted-way-of-treating-blood-cancer.html https://biospectrumindia.com/features/21/12902/the-targeted-way-of-treating-blood-cancer.html Fri, 22 Feb 2019 14:25:00 +0530 Multiple myeloma is a type of blood cancer that develops in the bone marrow. The bone marrow is home to various type of cells like red blood cells, neutrophils, lymphocytes, plasma cells and platelets. Plasma cells are a type of white blood cells that make antibodies to fight infections. When this circuit goes haywire, there will be an unregulated production of plasma cells. A cancerous or malignant plasma cell is called a myeloma cell. Myeloma is called “multiple” because there are frequently multiple patches or areas in bone where it grows. There are about 2, 30,000 people living with myeloma worldwide, and 1, 14,250 new cases are diagnosed yearly. It is the 2nd most common blood cancer in the world. The age standardized rate for myeloma incidence in India is 0.7/1, 00,000 population amounting to about 6,800 new cases a year. Men are 1.5 times more likely than women to develop multiple myeloma. The disease is most frequently diagnosed in 65-74-year-olds, and it is twice as common in people of African descent. In India, the median age of onset of myeloma is 1-2 decades lower at 52-61 years. Many factors have been implicated in the development of multiple myeloma Exposure to toxic chemicals, atomic radiation, anything that interferes with the immune system, or infection with cancer-causing viruses have all been implicated as causes or triggers of myeloma. Toxic chemicals that have been identified include: benzene, dioxins (such as those found in Agent Orange), agricultural chemicals (such as defoliants and pesticides), solvents, fuels, engine exhausts and cleansing materials. Myeloma can also be hereditary. First-degree relatives of people with myeloma have a higher risk of developing myeloma or its benign (non-cancerous) precursor, monoclonal gammopathy of undetermined significance (MGUS). In 70% of patients, the most common symptoms of myeloma are back or bone pain. Patients with myeloma may also have low haemoglobin levels leading to excessive fatigue and difficulty in performing strenuous tasks. An often missed presenting feature of multiple myeloma is kidney dysfunction. Patients with unexplained kidney failure are often tested and found to have multiple myeloma. For an accurate diagnosis of myeloma, the patient may need to undergo a variety of tests, including blood tests, urine tests, imaging studies, bone marrow aspiration, or a core biopsy. With advances in diagnostics, genetic studies to detect chromosomal alterations are being done to determine the prognosis as well as guide the treatment of multiple myeloma. Newer imaging modalities like whole body PET-CT are being employed to exactly determine the sites of bone involvement. When myeloma is diagnosed, the stage of the disease varies from patient to patient. The most commonly used clinical staging system, the Durie-Salmon Staging System, demonstrates the correlation between the amount of myeloma and the damage it has caused, such as bone disease or anemia. Innovations like targeted therapy and immunotherapy have revolutionised the treatment of multiple myeloma. Most patients these days, undergoing first line treatment for myeloma receive chemotherapy free regimens. In the past 15 years, nearly 10 new therapies have been approved in management of multiple myeloma. Most treatment protocols nowadays include 4 to 6 cycles of induction treatment followed by consolidation therapy with Autologous Bone Marrow Transplantation. Radiation therapy also has an important role to play in the management of multiple myeloma. If the disease is confined to a single location, then radiation can be used as a primary treatment modality. Another commonly used indication for radiation therapy is treatment of painful bone lesions. Autologous bone marrow transplant is a procedure in which, stem cells are removed from a person before the patient receives high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer. After high-dose chemotherapy or radiation treatments, the patient’s stems cells are put back into the body to make normal blood cells. This process is also called as stem cell rescue. With advances in supportive care and stream lining of treatment protocols, the mortality rates associated with this intensive procedure has been brought down to 1-2%. Patients with multiple myeloma who experience disease relapse, also have multiple options with regards to salvage treatment. Monoclonal antibody therapy has improved the salvage rates in multiple myeloma to nearly 65%. CAR-T cell therapy is being tried out in clinical trials in patients with multiple myeloma who have become refractory to all lines of therapy. Advances in therapeutics have transformed the management of multiple myeloma, turning this once deadly blood cancer into a chronic condition where multiple treatment options are available. Awareness, early diagnosis and appropriate treatment can help patients with multiple myeloma achieve nearly a 50 % long term survival.   Dr. N Aditya Murali, Consultant, Medical & Hemato Oncology, Aster CMI Hospital ]]> https://biospectrumindia.com/features/21/12688/are-you-genetically-predisposed-to-cancer.html https://biospectrumindia.com/features/21/12688/are-you-genetically-predisposed-to-cancer.html Thu, 31 Jan 2019 18:15:00 +0530 Cancer is becoming ubiquitous around the world. Every year 12.7 million people gets diagnosed to cancer and out of which only 7.6 million people survive. Although numerous initiatives and awareness campaigns are organized on a regular basis to educate people on the causes and symptoms of cancer, there is a very little knowledge on how you could be genetically predisposed to it and how you could reduce your risk, if there is high risk. We all heard about the American actress, Angelina Jolie who underwent double mastectomy surgery after realizing she could be genetically predisposed to cancer because of her family history. Later, she even removed her ovary to prevent cancer. What is cancer? Cancer is not one disease; it’s a group of related diseases and the failure of apoptosis (natural cell death). Normally body cells grow and divide over a period of time until they eventually die. However, cancer cells continue to grow and divide, therefore the explosion of cells creates tumor in the body. As the cells divide in an uncontrolled manor, it spreads. Tumors are lumps that can interfere with the body's normal processes. There are two types of tumors: Benign and Malignant tumors Benign tumors are non-cancerous in nature and they are not life threatening unless they occur in any vital organ of the body. This type of tumor grow slowly and generally does not spread into other parts of the body. After getting removed by surgery, this tumor usually does not reoccur. Malignant tumors are cancerous and life threatening in nature. They vary in shape and size and can grow abnormally in any part of the body and interferes with the body functions. Malignant tumors are lethal if not identified and treated early. What is genetic predisposition? A genetic disposition is how you are genetically vulnerable to something. You might be well aware of some hereditary health problems in your family which you blame it on the genes you share with them. Though these term, Hereditary and Genetic are closely inter-related still they are slightly different. Genetic disposition may cause diseases that are not heritable. We inherit genes from both our parents. If a parent has a gene fault then each child has a 1 in 2 chance (50%) of inheriting it. So, some children will have the faulty gene and an increased risk of developing cancer and some children won’t. If a person is born with an inherited faulty gene it doesn’t mean that the person will definitely get cancer, however, they will have a higher risk of developing particular types of cancer that existed in their family than other people. Also, they are more likely to diagnose to cancer at a younger age. It is not necessary that people with inherited faulty genes are more vulnerable to cancer, most cancers also develop because of a combination of lifestyle and the environment, and Genetics specialists estimate that only about 2 or 3 in every 100 cancers diagnosed (2 to 3%) are linked to an inherited gene fault. How to know if you are genetically predisposed to cancer? There cannot be obvious reasons for getting diagnosed to cancer. However, genetic predisposition is one of the factors behind cancer diagnosis. Every human being has 19,000-20,000 protein coding genes, cancer develop when six or more gene faults found in a cell causing a mutation. Sometimes, one get cancer because of external factors which is not inherited called ‘Sporadic Cancer’. Though it is not necessary that there should be cancer in your family to develop cancer, families with multiple cancer patients in the family are considered high risk families. The risk is especially high when the family members have developed cancer at an young age. These people should undergo genetic counselling and genetic testing. Genetic Counselling and testing Genetic counselling involves a trained counselor discuss with you and understand your risk by making a detailed family profile. Based on that analysis a blood test is performed check presence of the genetic tumor in your body. If there is a mutated gene the avenues to reduce the risk would be discussed with you. Keeping it at bay If you think you have belong to a high risk cancer family, do get your genetic test done. According to your results, you can opt for constant screening, medications or surgery. However, changes in your lifestyle can have positive impact as well. You having faulty gene is a chance but you letting it not affect you is of choice. Dr Sandeep Nayak, Senior Consultant Surgical Oncologist, Laparoscopy & Robotic Onco Surgery, Fortis Hospital, Bengaluru ]]> https://biospectrumindia.com/features/21/12526/loud-impact-of-noise-pollution.html https://biospectrumindia.com/features/21/12526/loud-impact-of-noise-pollution.html Thu, 17 Jan 2019 15:00:00 +0530 By definition, noise pollution takes place when there is either excessive amount of noise or an unpleasant sound that is unnatural in volume or source, that causes temporary disruption in the natural balance of our lives. The Impact- Hearing Problems: Any unwanted sound that our ears have not been built to filter can cause problems within the body. Man made noises such as industrial or construction machinery or aircraft engines are too loud. Constant exposure to loud levels of noise can easily result in the damage of our ear drums and inner ear nerves, and causes loss of hearing and ringing in the ears. It also reduces our sensitivity to sounds that our ears pick up unconsciously to regulate our body’s rhythm. Ultra low frequency sounds cause feelings of fear or awe or presence of something supernatural . Health Issues: Excessive noise pollution in working areas can influence psychological ill health. Studies show that the occurrence of aggressive behavior, disturbance of sleep, constant stress, fatigue and hypertension can be linked to excessive noise levels. These in turn can cause more severe and chronic health issues later in life. Obesity , stroke, high blood pressure, children born with birth defects or low birth weight due to hormonal disturbances in mothers caused by noise and contraction of blood vessels all over the body due to noise are some of the more dangerous effects of noise. Cleft lip , cleft palate and spine deformities in newborns are commonly caused by noise pollution. At cellular level the body’s cells do not repair as they should and die off when exposed to loud noise on a regular basis . Immunity to infections falls and diseases increase frequency of headaches, fatigue, stomach ulcers, and vertigo all linked to noise exposure. Sleeping Disorders: Poor sleep due to noise disturbance causes irritation and uncomfortable situations. This leads to low productivity, constant tiredness and exhaustion , accidents on road or workplace due to poor concentration , and anger and aggression in social interactions. Cardiovascular Issues: Blood pressure levels, cardio-vascular disease and stress related heart problems are on the rise. Studies suggest that high intensity noise causes high blood pressure and increases heart beat rate as it disrupts the normal blood flow, by contracting blood vessels all over the body. Fairly typical roadway noise levels are sufficient to cause this. Trouble Communicating: Due to noise disturbance conversations may be misunderstood or poorly understood. Constant sharp noise can give you severe headache and can disturb your emotional balance. In children , this causes speech and reading difficulties, trouble with understanding words, poor school performance, writing difficulties (dysgraphia), and raised heart rates and anxiety.   Treating the side effects of noise pollution is done by doctors and healthcare providers. In case there is hearing loss or heart or blood pressure problems and a noisy environment is causing it, treatment of the medical problem by doctors and taking steps to avoid or reduce the noisy environment is the only course of treatment.    Dr Dillon Dsouza , Consultant ENT and Head and Neck surgeon, attached to Jaslok hospital, Breach Candy hospital and Desas hospital ]]> https://biospectrumindia.com/features/21/12491/all-you-need-to-know-about-urinary-stone-disease.html https://biospectrumindia.com/features/21/12491/all-you-need-to-know-about-urinary-stone-disease.html Mon, 14 Jan 2019 17:20:00 +0530 Urinary stone disease is a very common problem nowadays. Urinary stone prevalence is estimated at 3% in all individuals, and it affects up to 12% of the population during their lifetime. Urinary stone recurrence rates approach 50% at 10 years and white males have the highest incidence in the U.S. In India It has significantly increased over the past few years. Unless treated properly with adequate counter measures to prevent further stones this can be a continuous problem which can even lead to renal failure. Formation of kidney stones – Kidney stones can form when substances in the urine—such as calcium, oxalate, phosphorus, and uric acid etc.—become highly concentrated. Stones are solutes that occur in amounts too high to stay dissolved in urine. The body uses food for energy and tissue repair.  After the body uses what it needs, waste products in the bloodstream are carried to the kidneys and excreted as urine. These substances get accumulated in the kidney as small crystals initially at the urine secreting sites of the kidney. When they are not washed off due to decreased water intake or due to certain factors causing adherence the crystals accumulate and enlarge to form stones of different sizes. Diet is one of several factors that can promote or inhibit kidney stone formation.  Certain foods may promote stone formation in people who are susceptible, but scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.  Other factors that affect kidney stone formation include genes, environment, body weight, and fluid intake. Types of kidney stones – Four major types of kidney stones can form  Calcium stones are the most common type of kidney stone and occur in two major forms:  calcium oxalate and calcium phosphate.  Calcium oxalate stones are more common.  Calcium oxalate stone formation may be caused by high calcium and high oxalate excretion.  Calcium phosphate stones are caused by the combination of high urine calcium and alkaline urine, meaning the urine has a high pH. Uric acid stones form when the urine is persistently acidic.  A diet rich in purines—substances found in animal protein such as meats, fish, and shellfish—may increase uric acid in urine.  If uric acid becomes concentrated in the urine, it can settle and form a stone by itself or along with calcium. Struvite stones result from kidney infections. The most common pathogen being Proteus mirabilis. Less common pathogens include Klebsiella, Enterobacter, or Pseudomonas. Eliminating infected stones from the urinary tract and staying infection-free can prevent more struvite stones. Cystine stones result from a genetic disorder that causes cystine to leak through the kidneys and into the urine, forming crystals that tend to accumulate into stones. There are other less common stones, including xanthine and drug-related stones as well.   Clinical symptoms The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin or scrotum. As the stone descends in the ureter, pain may localize to the abdomen overlying the stone. Renal and ureteral colic are often considered among the most severe pain experienced by patients. As the stone approaches the urinary bladder, lower abdominal pain, urinary urgency, frequency, and dysuria are common. Haematuria, Nausea and vomiting can also be present. Features of recurrent urinary infection with fever can also be present. Some large stones fixed in the kidneys may not cause any of these symptoms and are diagnosed incidentally on diagnostic evaluation.   Diagnostic tests Blood tests to check infection, Uric acid and Renal function. A basic ultrasound of the abdomen and X-ray kub can be done. Plain CT KUB is the ideal confirmatory investigation of choice. All Types of stones can be seen, the exact size and location identified and the degree of obstruction to the kidneys can be made out. Ultrasound may miss lower ureteric calculi and some stones are not visible on the xray. If a person can catch a kidney stone as it passes, it can be sent to a lab for analysis. Blood and urine can also be tested for unusual levels of chemicals such as calcium, oxalate, and sodium to help determine what type of kidney stone a person may have had.   Management- Prevention - An important step in preventing kidney stones is to understand what is causing the stones to form. This information helps suggest diet changes to prevent future kidney stones. For example, limiting oxalate in the diet may help prevent calcium oxalate stones but will do nothing to prevent uric acid stones. Some dietary recommendations may apply to more than one type of stone. Most notably, drinking enough fluids helps prevent all kinds of kidney stones by keeping urine diluted and flushing away materials that might form stones. People can help prevent kidney stones by making changes in fluid intake and, depending on the type of kidney stone, changes in consumption of sodium, animal protein, calcium, and oxalate. Drinking enough fluids each day is the best way to help prevent most types of kidney stones. We recommend that a person drink 2.5 - 3 litres of fluid a day.  People with cystine stones may need to drink even more. Though water is best, other fluids may also help prevent kidney stones, such as citrus drinks. People who have had a kidney stone should drink enough water and other fluids to produce at least 1.5 litres of urine a day. Citrus drinks like lemonade and orange juice protect against kidney stones because they contain citrate, which stops crystals from growing into stones. The risk of kidney stones increases with increased daily sodium consumption. The U.S. recommended dietary allowance (RDA) of sodium is 2,300 milligrams (mg). Meats and other animal protein—such as eggs and fish—contain purines, which break down into uric acid in the urine. Foods especially rich in purines include organ meats, such as liver. People who form uric acid stones should limit their meat consumption to 6 ounces each day. Animal protein may also raise the risk of calcium stones by increasing the excretion of calcium. A diet chart is usually available with every urologist for stone prevention.   Medical management – This is possible only in small stones usually less than 6mm in size.. The ureter which transports urine from the kidney to bladder is only 5-6 mm diameter in size. The stones move from the kidney to the ureter and get blocked. The stones are tried to be flushed out with medicines. The medicines dilate the ureter and promote stone expulsion. However, a ureteral stone that has not passed within 1-2 months is unlikely to pass spontaneously with further observation or medicines. Potassium magnesium citrate, soda bicarbonate etc are few medicines for stone dissolution.   Surgical management – Ureteric stones - stones in the ureter upto 2 cm are usually treated by (URS). In this procedure a small scope is placed through the natural orifice into the ureter and the stone is broken with laser. The Laser breaks the stone into a fine powder and it is cleared completely. A stent is placed for 3 weeks. It’s a single day procedure under anaesthesia. Stones more than 2 cm is usually cleared by laparoscopy (key hole) where the ureter is opened and the whole stone is removed in toto. Kidney stones- Small stones above 6mm upto 1.5 cm can be broken with ESWL (shock wave) lithotripsy. Here the stone is focused with a shockwave under ultrasound guidance and broken in one to three sittings. It is done in a procedure room without anaesthesia. Each sitting takes about half hour and the patient can go home the same day. The stone fragments pass down naturally via the ureter and is expelled in the urine. But the clearance rate of the stones is less with this method. RIRS (The Latest in Kidney stone management) is a procedure in which a flexibleureteroscope is placed via the natural orifice into the kidney and with the help of laser, stones of any size upto 3cm ,multiple or single can be fragmented completely. complete stone clearance can be achieved in a single sitting. PCNL – This is a procedure for large kidney stones where a small 1cm incision is made on the abdomen side through which instruments are placed to reach the kidney stone under x ray guidance, The stone is completely broken and the fragments are removed through this small incision and we can achieve complete clearance of the stones. 3D Laparoscopy (keyhole) – This is keyhole surgery for very large and multiple stones involving the whole of kidney. Here the kidney is bivalved and opened up , All the stones are removed completely. Then the 2 halfs of the kidney is closed with sutures and the kidney again functions as a normal kidney Pulse 100H Holmium laser has significantly improved the management of stones, providing a less invasive and more effective treatment. It performs faster fragmentation and superior dusting of stone due to its technological advancements. The high frequency applied in dusting minimizes retropulsion. Holmium lasers and associated fibers effectively fragment stones of any composition or size throughout the urinary tract. Holmium lasers are used in urology procedures such as percutaneous nephrolithotomy (PCNL) and ureteroscopy. Patients benefits from the shorter treatment time, no bleeding & reduced cost due to less number of re-treatments. Patients who get treated for kidney stones by whatever means have 50% chance of recurrence of stones. Hence they need to be on long term medication for stone prevention and adequate and follow up with an urologist is required for a safe and healthy kidney!!   Dr Datson George P, Consultant Urologist, Endourologist and Transplant surgeon, VPS Lakeshore Cochin ]]> https://biospectrumindia.com/features/21/12452/the-know-how-of-renal-biopsy.html https://biospectrumindia.com/features/21/12452/the-know-how-of-renal-biopsy.html Wed, 09 Jan 2019 12:20:00 +0530 Biopsy is an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease. A renal biopsy is a procedure used to extract kidney tissue for laboratory analysis. The word “renal” describes the kidneys, so a renal biopsy is also called a kidney biopsy. The test helps a doctor to identify the type of kidney disease a patient has, how severe it is, and the best treatment for it. A kidney biopsy involves taking one or more tiny pieces (samples) of your kidney to look at with special microscopes. The microscopes make it possible to see the samples in greater detail. The biopsy sample can be taken in two methods: Percutaneous biopsy: a needle placed through the skin that lies over the kidney and guided to the right place in the kidney, usually with the help of ultrasound. Open biopsy: the kidney sample is taken directly from the kidney during surgery. The kidney sample is then sent to a doctor (pathologist) who looks at it with microscopes and checks for any signs of disease. Why Renal Biospy is required - Some kidney complications can be detected by blood and urine tests, special tests sonogram and along with symptom of patient. But for certain patients with sometypes of kidney disease, and patients who have to  undergone a kidney transplant , with improper functioning of the graft kidney a correct diagnosis can only be made with a Renal biopsy. Precise reason to do a kidney biopsy is- Nephrotic syndrome and glomerular disease which happens when the filtering units of the kidney are damaged Blood in the urine Protein in the urine Uncharacteristic blood test results Severe kidney disease with no clear cause A Renal biopsy can help doctor understand: If a disease is getting better with treatment or if it is getting worse, know a problem that cannot be cured, but can be slowed down by other therapy How much permanent damage has happened in the kidney, Why a transplanted kidney is not working well Helps the doctor to decide on further treatment Presence of a kidney tumor If a certain treatment is hurting the kidneys It is essential that the doctor prescribing the Renal Biopsy make the patients understand why the procedure is required and why it is necessary. After the kidney sample is taken, it is sent to specially trained pathologists who will read and interpret your kidney biopsy. It often takes three to five days to get the full biopsy results. In some cases, you may have a partial or full report within 24 hours or less. A report given by the pathologist is important for Nephrologist to decide on the future line of treatment.   Dr RadhaSagar, Consultant Pathologist, Aware Gleneagles Global Hospital, Hyderabad ]]> https://biospectrumindia.com/features/21/12451/sporting-an-acl-injury.html https://biospectrumindia.com/features/21/12451/sporting-an-acl-injury.html Wed, 09 Jan 2019 11:50:00 +0530 An injury- a physical trauma to the body can occur unexpectedly at any point, it can either be a temporary one or might hold on for long. A sportsperson, considering their professional occasional suffer physical injuries as their profession highly depends on physical activities. These injuries have to be dealt properly with proper guidance, if not, it could further restrict movement and cause hindrance in day to day activities. Our bones are connected to each other by ligaments. There are four ligaments in the knee joint which holds the knee bones together and provide stability to the knee joint. The two side ligaments are called the collateral ligaments ( medial and lateral) which provides the sidewards stability to the knee.  The two ligaments inside the knee joint which cross each other in the form of an “X” are called the cruciate ligaments, the front – Anterior Cruciate Ligament (ACL), the behind Posterior Cruciate Ligament PCL. The cruciate ligaments control the back and forth movement of the knee joint. The ACL runs diagonally in the middle of the knee, it prevents the tibia from sliding out in front of the femur, also it provides rotational stability to the knee joint. The ACL could be damaged during sporting activities, road accidents or twisting injury to the knee joint. About half of the ACL injuries occur in association with other injuries to the knee like – meniscus injuries, cartilage injuries, or collateral ligament injuries. Partial injuries to the ACL is rare, most ACL injuries are complete or close to a complete tear. When ACL is injured one could feel a pop sensation, or a giving away sensation in the knee joint, there could be swelling, pain and decreased movement of the knee joint. A person would experience discomfort and loss of stability while moving the knee joint. If neglected, one might experience repeated twisting/ buckling of the knee while running down the stairs or playing sports. Such repeated buckling episodes would subject the knee to other internal damages and eventually early wearing of the knee ( early Arthritis). An MRI imaging is usually suggested to confirm the diagnosis and rule out other injuries associated with the knee. Treatment: Treatment of an ACL tear will vary from patient to patient as per the severity. Younger individuals usually require surgery to safely return to their pre injury activities and sports. Elderly individuals performing light activities should go in for a non-surgical treatment like bracing and physical therapy. A torn ACL will not heal without a surgery, it is usually reconstructed with a new ligament by an Arthroscopy (keyhole) procedure, which could be done on a daycare basis with minimal pain and discomfort to the patient. People with ACL are also at a higher risk of developing osteoarthritis. However, it is important to consult a doctor and take proper care of the injury. Proper training, exercises and therapies can also help reduce the risk of ACL.   Dr. Chirag Thonse, Specialist in sports injuries and joint replacement surgeries, Fortis Hospital, Bengaluru ]]> https://biospectrumindia.com/views/21/12356/e-clinics-facilitating-all-in-one-healthcare-delivery-with-technological-evolution.html https://biospectrumindia.com/views/21/12356/e-clinics-facilitating-all-in-one-healthcare-delivery-with-technological-evolution.html Thu, 27 Dec 2018 11:45:00 +0530 Health is wealth – this proverb has been a major stronghold in thorough development of civilization and society. Today, healthcare has become the epicenter of growth models of economies across the world. As per Statista, the global expenditure on medicine has already crossed USD 1.14 Trillion in 2017. The continuous innovations and inventions in the field of medicine have facilitated the progress and last decade has seen the emergence of E-Clinics and E-Health. The development of E-Clinics is encompassing the entire healthcare process with the help of continually developing technologies. Transforming healthcare in remote areas with ICT Information and Communication Technology (ICT) has become the backbone of the health-tech evolution of present era. ICT equipped Mobile Healthcare Delivery is the latest stage of healthcare evolution across the world. IBEF has speculated that the Indian hospital industry will reach USD 132.84 Billion by 2022 and E-clinics will take a greater share in the future expansion. The day-to-day operations of medical practice and doctor consultation have reached the farthest corners of geographies through the concept of E-clinics. People from distant rural areas to tier-II and tier-III cities have gained access to specialist doctors in metro cities. With an increase in internet access and greater network coverage, telecommunication between doctors and patients through E-clinics have not just facilitated quality healthcare but have also led to cost reduction in healthcare expenses. The concept of telemedicine through E-clinics is making lives healthier across the country. Apart from the ambitious government project of ‘Ayushman Bharat’, a lot of private players have also entered the healthcare industry, availing teleconsultations for patients in the comfort of their residing areas.     Regular primary checkups and post surgery follow-ups Whether it is Regular Medical checkup for identification of CDs and NCDs in primary stage or Post surgery follow-ups for a complete cure, E-clinics have turned as one of the most beneficial medical innovation in the last decade. Both communicable diseases (CDs) and non-communicable diseases (NCDs) can be monitored and treated from E-clinics through advanced medical diagnosis equipment. In a scenario, where people are devoid of quality healthcare infrastructure, E-clinics are taking telemedicine, teleconsultation, e-prescribing, mHealth, and healthcare informatics under purview to deliver quality medical facilities to patients living in remote areas. Today, regular health checkups at E-clinics can help in early diagnosis and timely treatment of various ailments. In fact, the patients undergoing surgical treatments are also relying on E-clinics for post-operative care and saving themselves from travel burdens. Recording health vitals on EHRs for precision medicine E-clinics and mobile health units have become the most efficient tools in recording health vitals on EHRs for precision medicine.The medical history of patients recorded on Electronic health records (EHRs) will help doctors in analyzing the diseases and prescribing treatment with greater accuracy. E-clinics have also strengthened with various technological tools viz. clinical decision support, patient engagement tools, computerized provider order entry, laboratory and medical imaging information systems, health information exchanges, and advanced medical diagnosis devices. Effective, preventive, safe and easily accessible healthcare from specialist doctors Direct interaction between doctor and patient through E-clinics not just ensures privacy but also avoids risks of infections. The expert advice from best doctors or multi-specialty hospitals in metros can reach patients in remote areas through telemedicine facility at E-clinics. This can be a real life-saver for people looking for quality healthcare services. The processes have been proven successful in helping patients in a safe and secure environment. Efficient treatment and patient satisfaction have notably increased in the past few years with an increase in E-clinic services across the world. Another advantage of E-clinics is the safety of patients and doctors from communicable infections, which are common at community health centers and large hospitals because of large crowds. Future of E-Clinics with technological evolution While E-Clinics have started changing the healthcare industry since its emergence, there is still scope of development in the healthcare field. The continually churning wheels of tech innovations are driving healthcare advancements also. The new concepts of cybermedicine and innovations of self-monitoring healthcare devices and wearable healthcare devices will bring a new dawn in the healthcare domain. Economies are also working on a public-private partnership to increase health education and patient education for self-diagnosis. Inspired by their motto, “Committed to Excellence”, VBRI is dedicated to providing an integrated intelligent healthcare delivery system to serve the common people of India by offering them an accurate and cost-effective treatment procedure at their home. The evolution of health IT tools and other medical breakthroughs will further facilitate quality treatment through E-clinics. E-clinics are surely going to be at the forefront of future healthcare, helping humanity to lead quality lives. ]]> https://biospectrumindia.com/features/21/12295/parkinsons-which-treatment-works-best-for-you.html https://biospectrumindia.com/features/21/12295/parkinsons-which-treatment-works-best-for-you.html Tue, 18 Dec 2018 12:10:00 +0530 Parkinson's disease is a common neurological disorder. It is no more an unknown disease to the public. With the increased availability of health care facilities, patient education services, multimedia etc., patients often report to the Neurologist with self made proper diagnosis of Parkinson's disease. It is to be kept in mind that all trembling hands are not Parkinson's disease. Symptoms such as shaking or stiffness of limbs, slowness of actions are features of a group of disorders called parkinsonism. And again, all parkinsonisms are not Parkinson's disease; though it is one of the most common causes of parkinsonism. In a significant proportion of patients it is difficult even for an experienced Neurologist to pin point the diagnosis of parkinsonism and its cause. The Neurologist will examine and may take the help of several investigations to arrive at a proper diagnosis. Interestingly, the response to the conventional anti-parkinsonian medicines will also help the Neurologist in this regard. Once the diagnosis is made, then it opens up the basket of medical and surgical options. With the current availability of medical information, almost every patient of Parkinson's disease and their caregivers know about the pills used in this condition. When it comes to Parkinson’s disease, what is not very well known or common is about the surgical options. Currently in eligible patients who are not tolerating the medicines have Deep Brain Stimulation (DBS) surgery as a life changing option. This surgery is intended to reduce the dose of conventional medications and hence their related adverse affects particularly the abnormal incontrollable movements, what is called as dyskinesia. DBS is not very popular in India because of its cost. But it is a well accepted mode of treatment in the western world. As with the medications, this works well for tremors and to a certain extent for slowness and stiffness. It is a procedure with not many complications. In this simple procedure the stimulating electrodes are inserted into the specific part of the brain and connected to the battery device placed under the skin over the upper part of the chest which can be turned on and off. The intensity and frequency of stimulation can also be adjusted depending upon the clinical response. The patient himself can switch it on or off depending upon his requirements. The life of the battery depends upon the company make and the intensity/frequency of stimulation. Not many centres in India perform this procedure due to many factors. It is the time now to upgrade our armamentarium for Parkinson's disease. There is a need of collective efforts from the government and non-government organisations to make it available and affordable. With the huge disease burden in India it is essential that all of us become aware of the available treatment options and choose them rationally. For those affected with Parkinson’s disease it is best to consult your Neurologist to know if DBS works for you.   Dr. Aravinda RV, Consultant Neurologist, Brains Hospital, Bengaluru   ]]> https://biospectrumindia.com/features/21/12242/the-heart-longs-for-warmth-indeed.html https://biospectrumindia.com/features/21/12242/the-heart-longs-for-warmth-indeed.html Tue, 11 Dec 2018 13:50:00 +0530 The winter season is quite unforgiving for a weak Heart. Cardiovascular Disease is the number one cause of death worldwide representing 30% of all global deaths. In all parts of the world, low temperatures often caused serious repercussions for those suffering with pre existing Cardiovascular Disease and Congestive Heart Failure. This is linked with multiple risk factors, such as temperature, physical activity, air pollution, infections, and food habits. This phenomenon likely contributes to the numbers of deaths occurring in winter. The Gloom of Cold Days Though it is common throughout all seasons, various studies have shown that the peak of winter oftentimes spells danger for the Heart. Hypertension This causes added complications in cold climate. Heart Failure In patients with symptomatic Congestive Heart Failure, cold exposure decreases exercise capacity and increases the already raised systemic adrenergic activation. As increased ‘plasma nor-epinephrine’ concentrations are associated with increased risk of death from progressive heart failure this may, in part, explain the increased mortality in winter. Atrial fibrillation Seasonal variation in the occurrence of atrial fibrillation has been documented, with peaks typically occurring in the winter-autumn and troughs in the summer. It seems that the above observations may be rationally explained by the effects of specific factors such as air temperature, humidity and atmospheric pressure, in particular with concomitant ischemic heart disease or arterial hypertension as well as in the elderly. Ventricular arrhythmias The seasonal variation of ventricular arrhythmias (VA) has been assessed in studies. Angina pectoris AP has been found to correlate with a combination of critical values of low temperatures and   humidity, although it seems different according to the gender. Acute myocardial infarction An increase in mortality from acute myocardial infarction (AMI) has been observed in the winter months. When You Are Too Cold!! Hypothermia means the body temperature has fallen below 35 degrees Celsius or about 95 degrees Fahrenheit. It occurs when your body can't produce enough energy to keep the internal body temperature warm enough. Symptoms include lack of coordination, mental confusion, slowed reactions, shivering and sleepiness. Children and the elderly are at special risk because they may have limited ability to communicate or impaired mobility. Elderly people may also have lower subcutaneous fat and a diminished ability to sense temperature so they can suffer hypothermia without knowing they're in danger. During winter, it’s important to know the effects of cold weather on your body, and the risks for your heart health.    FACTORS INFLUENCING CARDIOVASCULAR HEART DISEASES IN WINTER   Temperature - The cold causes blood vessels to contract, which can raise blood pressure, increasing the risk of heart attack and stroke. Angina, or chest pain due to coronary heart disease, can also worsen in winter when coronary arteries constrict in the cold. Furthermore, your heart has to work extra hard to maintain a healthy body temperature, and winter wind can make this even more difficult because it causes the body to lose heat more quickly. Another potentially important seasonal risk factors such as seasonal variation in the plasma level of fibrinogen, cholesterol, hormones and vasoactive substance including vasopressin (AVP), nor epinephrine (NE), epinephrine (E) and angiotensin II, aldosterone and catecholamine which tends to rise in the winter.   Infections - During cold weather, the chance of catching the flu (seasonal influenza) increases. The flu can be more serious for people with Heart conditions due to strain. Studies have shown that death from the flu is more common among people with Heart disease than any other chronic condition. A number of microbial agents have been implicated in the pathogenesis of atherosclerosis, including Chlamydia pneumoniae, Helicobacter pylori, and Influenza virus.   Vitamin D levels - Significant seasonal Vitamin D level variations were observed in several communities, which reveal a variation of values for 25-(OH) D, increased during summer and spring, while gradually decreasing in autumn and winter. Vitamin D deficiency has been to be associated with CVD risk factors such as hypertension and diabetes mellitus, with markers of subclinical atherosclerosis such as intima-media thickness and coronary calcification as well as with cardiovascular events such as myocardial infarction, stroke and congestive heart failure. Several studies have demonstrated lower levels of vitamin D metabolites in subjects with Coronary heart disease (CHD) and hypertension. The association between vitamin D levels and CHD has been shown to be independent of smoking, body mass index, treatment for hypertension, vigorous leisure activity, total serum cholesterol and a previous history of angina or MI. Experimental data suggest that 1,25(OH) D affects cardiac muscle directly.   Coagulation factors – Evidences have shown that the elevated plasma fibrinogen levels and factor VII clotting activity (FVIIc) a strong and consistent association with cardiovascular disorders such as Ischemic Heart Disease. Interestingly, seasonal variability with peak concentrations during cold months was shown for fibrinogen and FVIIc. Fibrinogen may contribute to athero-thrombogenesis by several mechanisms. An increase in these factors generates a “hypercoagulable state,” which may lead to a rise in cardiovascular morbidity and mortality.   Physical activity In both sexes, overall levels of physical activity are significantly higher in summer than in winter. Physical inactivity is strongly positively associated with CVDs. One of the primary mechanisms through which physical activity is thought to affect CVDs is through improved endothelial function. Exercise causes increases in blood flow leading to increased shear stress, which is found to improve endothelial function. Air pollution Air pollution is a heterogeneous, complex mixture of gases, liquids, and particulate matter. Studies have demonstrated a consistent increased risk for cardiovascular events in relation to both short- and long-term exposure to present-day concentrations of ambient particulate matter (PM). Exposure to Passive smoking increases platelet activation and causes rapid deterioration in endothelial function, which promotes atherosclerotic plaque development. Diet and Obesity  Dietary intake in summer and winter is different as well as body mass index (BMI) and serum cholesterol. Several epidemiological studies have demonstrated the link between CVDs and overweight, high blood pressure and increased serum total cholesterol. Acute Myocardial Infarction (Heart Attacks) and winter An increase in mortality from acute myocardial infarction (AMI) in the winter months was first reported in the 1930s. Since, these initial observations, numerous studies have reported an increased morbidity and mortality from AMI during the autumn and winter.     An association between seasonality and AMI morbidity and mortality was found in most age and sex groups, with men consistently exhibiting a stronger seasonality pattern. High Risk factors influencing MI in winter are – Inflammation can trigger MI by making atherosclerotic plaque less stable Flu and respiratory infection causes significant inflammation Flu season peaks in winter months in concern with peak incidences of MI in winter People eat more due to increase in BMR, exercise less, smoke more, have more stress and gain weight during winter season Spasm Of Arteries: When a person gets exposed to cold weather, the body’s automatic response is to narrow the blood vessels to the skin so that heat is retained. But, for people who already have arteries filled with plaque; the narrowing of the blood vessels raises the risk that it will become blocked, triggering a heart attack. The problem is higher in India as we do not live in artificially regulated temperatures as in the West.   Increased blood pressure due to the narrowing leading to strain on the Heart: This has the effect of a double whammy- not only the heart has to work harder but its blood supply is reduced. While this may be tolerated well by a normal heart, in a diseased heart it can precipitate an attack.   Thicker Blood: In cold weather, blood platelets appear to be more active and stickier and, therefore, more likely to clot. In fact, even the levels of cholesterol rise during winter.   Do’s and Don’ts in Winter Do’s - Limit cold exposure Get a flu shot Stick to a heart-healthy diet. Be sure to exercise regularly. Don’ts – Avoid skipping meals and medication Don’t over-exert Avoid getting overheated   Dr Sai Sudhakar, Chief Interventional Cardiologist & Chief Cardiac Transplant Physician, Gleneagles Global Hospitals ]]> https://biospectrumindia.com/features/21/12230/scientific-documentation-of-indias-first-ivf-baby.html https://biospectrumindia.com/features/21/12230/scientific-documentation-of-indias-first-ivf-baby.html Mon, 10 Dec 2018 17:25:00 +0530 Infertility is a multifactorial disease in which couples are unable to achieve a pregnancy even after being sexually active and not using any contraception. Since the birth of the world’s first ‘test tube baby’, Louise Brown, 40 years ago, 6 million babies have been conceived worldwide through Assisted Reproductive Techniques. The inception of in vitro fertilisation in India happened many years ago, when we were working under the aegis of Institute of Research in Reproduction of the Indian Council of Medical Research (ICMR) and Kings Edward Memorial Hospital (K.E.M) in Mumbai. Inspired by the success of Dr Patrick Steptoe and Dr Robert Edwards, we started testing the therapeutic and surgical procedures initially on laboratory animals. Success in them was followed by extensive work for an attempt to successfully achieve IVF in humans with the permission of Scientific Advisory Committee and Ethics Committee of both institutes. From August to December 1985, a number of cycles were taken up for IVF-ET. We tried hard and learnt more and more from each of these failures. Each cycle of failure taught us what could be further improved in our methods and techniques. Patient, Maniben was then 23 years old and married, whose fallopian tubes had been damaged due to tuberculous infection and subsequent surgery. Consolidating the lessons that we learnt from previous patients, we followed the following procedure. Ovaries of women contain millions of eggs since birth, and number of eggs start growing in each menstrual, one egg matures in a single cycle and releases eggs (oocytes) for the purpose of fertilisation. For in-vitro fertilisation, we needed that the ovaries should release more than one egg. Hence, the ovaries were stimulated by giving Oral medication namely, (Clomiphene citrate 100mg) from Day 3 to Day 7 of her menstrual cycle. The oral medication was supported by administering injection Human menopausal gonadotropin which was also given intramuscular daily from Day 5 to Day 10 of the cycle in a dose of 75 IU per day. The number and size of growing follicles was monitored by doing transabdominal sonography. The growth of these follicles suggested that multiple eggs were maturing in the ovary. We correlated this with blood estradiol levels which is a hormone released by the growing follicles. An increase in the level of this hormone levels mean that ovaries are responding to the treatment and the eggs were growing. In this manner we were able to see at least four growing follicles in each of the ovaries of the patient. When the follicles were adequately grown, then Inj. Human Chorionic gonadotropin (hCG) 10,000 IU  was administered to  the patient on Day 13 to mature the egg within the follicle. This was in order to make the egg the ready for fertilization. Thirty four  hours after hCG, the eggs were retrieved. Using an abdominal approach, the ovaries were seen and a needle was inserted in each follicle to remove the fluid collected in the follicles . This fluid was screened under microscope for presence of oocytes / eggs. In this way we found 5 mature eggs and 3 immature eggs. Simultaneously the semen of the husband was taken, washed and centrifuged. This helped us to isolate the best and most rapidly motile sperm from the sample for fertilisation. The eggs that were retrieved were combined in a laboratory dish with her husband’s sperm. The eggs were seen After 24 hrs for penetration of sperm in egg.  After 48 hours and 72 hours for further growth i.e. 2-4 cell and 6-8 cells. On November 30 1985, we transferred the embryos into the patient Maniben’s uterus.  On December 18 we did BhCG testing which indicated a positive pregnancy test and subsequently confirmed the pregnancy by redoing the BhCG test on 26 December 1985. Ultrasound was done on January 6, 1986 which showed a healthy growing pregnancy. The first scientifically documented IVF baby Harsha, was thus born on 6th August 1986 by Ceasarian section in KEM hospital, Mumbai. Now Harsha herself is a mother to two children, a boy and a girl. The entire process of conception to the delivery was documented by us and lies documented in store with the Institute for Research in Reproduction now called NIRRH-National Institute for Research in Reproductive Health Today, IVF is considered a mainstream medical treatment for infertility. In India alone, every year a significant number of babies are being born out of IVF. IVF has revolutionised the field of reproductive technology, providing hope, faith and a chance at parenthood to so many childless couples, having numerous causes including male factor,who struggle with various medical and social aspects of  infertility.   Dr Indira Hinduja, Gynaecologist, Obstretician and Infertility specialist, P D Hinduja Hospital and INKUS Clinic ]]> https://biospectrumindia.com/features/21/12164/intervention-of-yoga-for-treating-cancer.html https://biospectrumindia.com/features/21/12164/intervention-of-yoga-for-treating-cancer.html Mon, 03 Dec 2018 10:40:00 +0530 Lung cancer is the most common type of cancer world-wide with over 2,093,000 cases reported in 2018. This accounts for 12.3% of all diagnosed cases of cancer during the same period internationally. Statistically speaking, it is considerably more likely to afflict men than women. However, with changes in women’s lifestyle, coupled with the deteriorating air quality in many metropolitan areas, it’s only a matter of time before the gender gap reduces. Hence lung cancer is a growing concern for both genders. There are four main types of lung cancers, of which the two most common are Adenocarcinoma and Squamous Cell Carcinoma which account for 40% and 30% of all cases respectively. While lung cancer is treatable to a much greater degree than in even the recent past, detecting the ailment in its early stages is vital to achieving a positive outcome. Symptoms of the disease include, but are not limited to, persistent coughing for more than two weeks, aches in the arms, shoulder, neck and back, shortness of breath, weight loss, blood in the sputum, and general lethargy. The fight against cancer has led allopathic researchers to look to a rather unexpected form of alternative healthcare, one that is thousands of years old and originated right here in India; called yoga. This begs the question, what possible value could an ancient therapy like yoga add to lung cancer treatment that the current system lacks? The answer, rather surprising; is a lot, at least according to a test conducted by the U.S. National Institutes of Health on 26 patients (treated with chemotherapy and radiation therapy) and caregivers. The study observed that those subjects who regularly practiced yoga i.e. 15 sessions of yoga lasting one hour each, especially exercises which stretched the chest area and emphasised on taking deep breaths, performed better in a walking and endurance test than those subjects in the control group i.e. those who did not practice yoga. Many of the participants were so satisfied with their results that they continued to practice yoga upon the completion of the experiment and 96% rated the programme as ‘very useful’. Another study conducted in 2017 by University of Texas analysed the effect of Yoga therapy on 32 patients with lung cancer. The study included administering physical, breathing and stretching exercises along with meditation. The findings revealed that yoga therapy not only improved the physical functioning of the patients but also improved their mental health. Yoga has a relaxing effect on the body, making it far more suitable for those undergoing powerful medication and radiation therapy. In the fight against cancer every tool in our arsenal is a blessing, and that is precisely what yoga is. It has absolutely no negative side effects and contributes immensely to the patient’s quality of life; furthermore, it can be highly customised to accommodate each patient’s unique personal requirements. When coupled with light exercise such as brisk walking, yoga is without a doubt an excellent, effective, and quite possibly the ultimate form of therapeutic healing. As a non-medicinal therapy, Yoga offers various benefits to lung cancer patients; it improves the mental, physical and spiritual well-being of the patients going through a tough battle against lung cancer.   Gulshan Kapadia, Yoga Therapist, Saifee Hospital ]]> https://biospectrumindia.com/features/21/12056/dealing-with-blocked-ears-when-flying-high.html https://biospectrumindia.com/features/21/12056/dealing-with-blocked-ears-when-flying-high.html Mon, 19 Nov 2018 12:45:00 +0530 Dreading your next trip because you are one of the hundreds of fliers who suffer from pain in the ears the minute your flight takes off? Ear problems are surprisingly common among travellers on airplanes. While sometimes, they can be mildly annoying, at other times, there can be more serious effects, including acute pain in the ears, ear discharge and even temporary loss of hearing. However, fear not. Understanding why it happens as well as taking a few precautions can ensure that your journey is pleasant from take-off to landing! Understanding blocked ears- The Eustachian tube is a membrane-lined tube, about the thickness of a pencil lead, which connects the back of the nose to the ears. On one side (the ear), we have a space surrounded by bone and closed off from the outside world by the ear drum, and on the other side, a space that is open to the outside through the nose and mouth. The closed space in the ear is lined by a membrane which constantly absorbs air and this air is replaced from the Eustachian tube. Thus air pressure outside the ear drum and inside the space remains equal. When there is a difference in pressures, the ear feels blocked. This is because if the air in the middle ear is absorbed but not replaced, a vacuum forms which pulls the eardrum inwards, causing a block as it cannot vibrate. It is the stretching of the ear drum that causes pain. This vacuum also pulls fluid into the space from the membrane, filling the middle ear with fluid. This can be dangerous as when the fluid builds up, it punctures the ear drum leading to discharge from the ear. Common causes of Eustachian block- Common cold, nasal allergies and infection in the tonsils or throat. How does flying cause ear block- When your flight takes off or lands, there is a rapid change in the air pressure. This causes swelling of the membranes, which does not allow the air pressure inside the ear to equalise rapidly, which in turn results in blocked Eustachian tubes and other ear problems. How to unblock the tubes- Swallowing unblocks the Eustachian tubes by activating muscles that open them. Chewing gum or sucking on hard candies helps this process. Yawning works better. If yawning and swallowing both don’t work, pinch your nose shut, close the mouth and make sure you blow air into the nose from the mouth very gently. If the pain and block persists, see a doctor immediately to get decongestant nasal drops and sprays to open the Eustachian tubes before fluid builds up in the ears. In rare cases, if the build-up of fluid in the ear is too much, the doctor may make a tiny puncture in the ear drum to release it. If the problem is recurrent, tiny plastic or metal tubes are inserted into the ear drum to equalise the pressure. These are called grommets—they fall out when the Eustachian tube function recovers. For babies- Sucking on a pacifier or feeding bottle during take-off or landing of the flight works. It is a good idea to feed the baby during the flight. Make sure you don’t allow the child to sleep during take-off and landing. For people with chronic problems- Nasal decongestant drops and sprays can be used to open the Eustachian tubes. Tips for air travellers- If you have had ear surgery or are seeking treatment for any problem in your ears, ask your doctor if it’s okay for you to take a flight. If you are currently suffering from a severe cold, sinus infection, or an allergy attack, consider postponing your trip. Keep a decongestant pill or nose spray handy. Use it approximately an hour before descent to help the ears pop. Make sure you stay awake during take-off and descent. Carry chewing gum or a couple of hard candies that you can pop into your mouth during your flight.   Dr Dillon Dsouza , Consultant ENT and Head and Neck surgeon, Jaslok Hospital, Breach Candy Hospital and Desas Hospital ]]> https://biospectrumindia.com/features/21/12054/intelligent-ambulance-placement-for-maximum-efficiency-.html https://biospectrumindia.com/features/21/12054/intelligent-ambulance-placement-for-maximum-efficiency-.html Mon, 19 Nov 2018 12:35:00 +0530 In a developing nation like India, where human assets are a huge support, and despite the fact that the country is home to a population of 132 crores, we have earned a dubious distinction for the number of road accidents that take place. In fact, with over 130,000 deaths annually, India has overtaken China, and now has the world’s worst road traffic accident rate. With one accident being reported every minute and 16 deaths every hour, our roads are now more unsafe than ever. Rush hour, in particular, is said to be the most dangerous time to be on the roads. Statistics put out by the Indian Government show that nearly 35 per cent of all road accidents occur between 3-9pm. As visibility drops post 6pm, and people are rushing to get home, perhaps, this could be among the reasons for accidents during the rush hour. And it is during this period, that transportation of a patient to the nearest hospital is truly troublesome, amid peak traffic. As a solution, emergency medical service providers have developed various strategies for ambulance placement to reduce the response time, thus making optimum use of the Golden Hour.  The time after an accident can be optimally used to make a difference between a life saved and life lost, if recovery actions are able to take place in time. However, routing problems and traffic congestion is one of the major factors hampering speedy assistance. By identifying sites where the possibility of accidents are higher and the closest spot for ambulance placement, the response time can be greatly reduced. In order to operate efficiently as well as effectively, ambulances should be deployed in areas where there is maximum demand and the vehicle is able to reach the victim within a drive time of five minutes.  In a sector which is tightly time bound, rationing resources for maximum efficiency is a dire need of the hour. Unfortunately Ambulance providers are caught having to constantly defend their decisions to shift the vehicles from the government allotted spaces. But in order to fully understand the advantages of strategic ambulance placement, there is a lot we can learn from countries like New Zealand who have implemented such systems and seen success in their response rates over a period. The same can also be felt in cases of large scale events such as sports matches, where there is a risk of having a medical emergency due to stampede or man made disasters. By having an ambulance on site or in close proximity to the sports venue, the response time can be significantly reduced and thereby save precious lives. At present the average response time of a medical emergency vehicle is 9 minutes. By strategically and intelligently placing them, we can further reduce this time, and increase the number of lives saved.    Manish Sacheti, CFO, Ziqitza Healthcare ]]> https://biospectrumindia.com/views/21/11994/modern-health-and-fitness-industry-in-india.html https://biospectrumindia.com/views/21/11994/modern-health-and-fitness-industry-in-india.html Sat, 10 Nov 2018 13:10:00 +0530 One industry in India which is largely unorganised and lacks a definite structure but where input and output can be directly proportional and measured instantly is our fitness industry. The more you work on your body, the more you look and feel fit. From the past decade Indian Fitness industry has changed enormously.  It is fascinating to see how the demand for fitness products and services has grown by leaps and bounds over the last decade.  McKinsey report pegs wellness as the next trillion dollar industry. What is even more encouraging to see is developing markets like India ride the wellness wave with as much gumption and fervor as developed markets. Though, we certainly cannot avoid the fact that the Indian market is still largely ‘out of shape’ compared to many mature markets, such as US & Europe. According to a Deloitte Report, India’s wellness market in 2015 was estimated at approximately $13 billion and it is expected to grow at a CAGR of nearly 12% for the next 5 years.  There are several areas that fit-tech startups in India have already helped address over the last few years, fuelling the growth within this space. Some of these include: Deeper connect: Earlier people were keen to work in a collaborative fashion for better health, however, one-stop fit-tech solutions covering better lifestyle choices, curated workouts, health coaches monitoring your food intake and nutrition choices easily come together in everyday life. Devices: Fitness gadgets are commonly used by the fitness conscious urban dweller. They enable the user to focus on their health and measure the input to ensure a healthier lifestyle. Community driven fitness solution: Evolved community of India is back on the rise and more people want to come together to accomplish the goals of fitness through unified thoughts and actions. To keep their customers engaged, gym owners in India have introduced several unconventional workouts which copies actions of animals. Gamification: This is a human-centric app which help people keep a track of their fitness- Steps walked, calories burnt etc. Hyper-Targeted solutions: Bioprint, which keeps the record of a customers’ detail like BMI is the best example of gyms and fitness centers becoming more targeted in their approach and adopting the updated technologies. The inclination of people towards health and wellness is growing around the world coupled with increased consumer’s awareness. If planned according to customers’ needs in coordination with our government, there is plethora of opportunities available in this industry to grow like a giant.   Vikas Jain, MD, Anytime Fitness ]]> https://biospectrumindia.com/features/21/11929/collaboration-translates-into-improved-healthcare-delivery-.html https://biospectrumindia.com/features/21/11929/collaboration-translates-into-improved-healthcare-delivery-.html Mon, 29 Oct 2018 16:20:00 +0530 Modern organisations are increasingly becoming complex entities where cross-disciplinary teams are being employed to innovate and improve work quality and efficiency. Multifunctional teams bring together a range of functional expertise to the task at hand, when teams incorporate a diversity of knowledge, skills, and training. In the healthcare sector too, multifunctional teams are assuming importance as they improve intermediary predictors of quality such as transfer of knowledge, sharing of information and enhanced decision-making. The general consensus that seems to be emerging among health care experts from a variety of professions and perspectives is that a collaboratively practicing workforce is more responsive, efficient, and considerate of patient care. In my many years of experience in plastic and cosmetic surgery, in India and abroad, I can say without a doubt that such symbiotic relationships have an indispensable and irreplaceable role to play in a wide range of aesthetic and reconstructive challenges. Plastic surgery in this day and age, is much beyond a surgery; it involves a diverse set of unique skillsets which need to be sensitively employed to boost patients’ confidence as well as maintain the balance of aesthetic and functional features. The surgery has become an amalgamation of a wide spectrum of surgical sub-specialties. Collaboration in plastic surgery is the norm now and rightly so as it is helping in creating many new approaches through exposure to other types of expertise. Plastic surgery today involves treatment of many varied conditions such as cranio-maxillofacial surgery; facial cancers; microvascular surgery to re-create the face post cancers; surgeries for congenital malformations like cleft lip, cleft palate; genital surgery like for hypospadias; reconstructive surgery for burns; facial cosmetic surgery like blepharoplasty, rhinoplasty, facelifting and hair transplantation; body cosmetic surgery like breast augmentation, liposuction and body contouring, oculoplastic surgery to treat lacrimal disorders, orbital diseases and peri-ocular surgeries; non surgical facial tightening, injectables like botox and filler injections; and non surgical body contouring. This is a very wide repertoire of surgeries, by no means exhaustive and it is inconceivable that any one surgeon can be good at all of the surgeries. To make matters worse, traditional plastic surgery training courses do not train surgeons in a majority of these areas which means unless there is collaboration and cooperation, plastic surgery would at best be half baked and poorly brewed. The super-specialisation required for proficiency in all these procedures and increased patient expectation in the new millennium has made sub-specialisation the byword to watch out for. In the USA, surgeons performing the varied surgeries listed above, now come from multiple Boards /fields of training - The General Plastic Surgeons (coming in post a General Surgery residency), The Facial Plastic Surgeons (Coming in from an Ophthalmology or an ENT residency), The Facial Cosmetic Surgeons (Coming in from an Oro-Maxillo-Facial Surgery or an Ophthalmology residency), The Cosmetic Surgeons (coming in from a General Plastic Surgery, Ophthalmology, ENT or a Dermatology Residency) etc. Given the advantages that each group brings in from their basic residency, this has led to far improved surgical outcomes and patient satisfaction. The face is a crossover zone that specifically requires collaboration among various specialities such as reconstructive surgeons for micro-vascular flaps, facial plastic surgeons, facial cosmetic surgeons, oculoplastic surgeons, dermatologists for skin conditions, maxillofacial surgeons and ENT specialists. For exceptional results to be obtained, collaboration and learning from other sub-specialties are the buzzwords. A collaborative, inter-professional team supports high quality and safe care, patient and staff satisfaction and engagement and organisational efficiency and innovation. To illustrate a case in point, a successful plastic surgery for a 25 year old who suffers severe facial disfigurement due to an accident will require coordinating a large number of activities by several different individuals of different specialties, often with each one having interrelated tasks and a different focus on each. A cranio-maxillofacial surgeon would be needed to fix the broken bones, a micro-vascular surgeon may be required for flaps to treat the wounds, a cosmetic surgeon for aesthetically improving looks as well as a dermatologist for laser therapy to enhance the texture of the damaged skin. So many specialists coming together to provide cutting edge care speaks volumes of the kind of healthcare needs of patients in the current scenario. Rather than a single procedure, multi-specialty care is needed for the right expertise and skills to get the person back to his original self. The impact of collaboration on patient safety is immense and several researchers have identified reductions in rates of medical error when inter-professional collaboration is strong and teams are trained to work safely, cooperatively and in a coordinated manner to avoid gaps in quality assurance measures. However, to implement this successfully and to promote collaborative practice, physical and structural opportunities, a psychologically supportive environment, and appropriate education and training are indispensable. The role of the patient and patient-clinician interactions is also important, if not central, to the inter-professional team. These interactions are necessarily two-way and involve establishing shared values, goals and expectations as well as information. Furthermore, collaborative patient-clinician interactions generate trust and rapport which in turn lead to greater levels of openness, negotiation, successful adherence to medical care strategies and reduced anxiety. The time has truly come for all surgeons to proclaim that while we do not know everything about everything to provide exceptional results to our patients, we must super-specialise in one thing and become really good at it. For all other things, we must work in a team where individual surgeons are better than us at those aspects. This collaboration will assist our patients in getting exceptional results in all spheres, in this era of super-specialisation. Ultimately, we are here because of and for our patients. No one surgeon may know everything, but together we may all know more than we have ever known in the history of mankind! After all, we are here for our patients and not for our own ego and leveraging and fostering collaboration exponentially will improve outcomes in patient care.   Dr. Debraj Shome, Facial Plastic Surgeon and Director of The Esthetic Clinics ]]> https://biospectrumindia.com/features/21/11871/postpartum-haemorrhage-a-serious-concern-.html https://biospectrumindia.com/features/21/11871/postpartum-haemorrhage-a-serious-concern-.html Wed, 17 Oct 2018 14:25:00 +0530 Postpartum Haemorrhage (PPH) is the excessive bleeding after childbirth. While bleeding is common after childbirth, the concern arises when the placenta gets expelled out and the loss of blood is more than 500cc after normal delivery and 1000 cc after caesarean. In these circumstances PPH is said to have occurred. If the bleeding occurs within the first 24 hours of delivery it is called Primary PPH; whereas any excessive bleeding that occurs between 24 hours and 6 weeks after delivery is termed as Secondary PPH. In developing countries about 1.2 per cent deliveries are associated with PPH and when it occurrs, about 3 per cent of women die. PPH accounts to about 30 per cent of maternal deaths in India. PPH can be caused due to Uterine atony which is the impaired uterine contraction after birth, that occurs in majority cases. The other causes include High Blood Pressure during pregnancy, Anaemia, Twin Pregnancy, Prolonged Labor, Hydramnios (a condition in which excess amniotic fluid accumulates during pregnancy), Retained Placenta or Clots or if any previous history of PPH. Due to continuous bleeding the pulse rate of the patient increases and the blood pressure falls. The patient sometimes goes into shock and it might lead to death too. In the initial stages there might be a feeling of giddiness, tiredness, increased heart rate, and breathing rate. Treatment: Treatment of PPH is actively managing placental expulsion with drugs available like oxytocin or misoprostol which helps in better contraction of the uterus. In cases of PPH initial treatment includes fluid replacement with intravenous fluids. Blood investigation is done while monitoring pulse rate, blood pressure and urine output. Blood Transfusion is also needed during this stage. If none of the medical management works then surgical management is needed. Treatment of PPH is crucial in the first hour which is termed as “The Golden Hour” – where resuscitation begins to arrest the bleeding. A woman can bleed to death in 2 hours or less. If she bleeds continuously she may go into shock which may be irreversible even resulting in the death of the patient. Replacement of blood and blood products plays an important role. For every 1 blood transfused, 1 platelet concentrate and 1 fresh frozen plasma is transfused in massive haemorrhage. Today, certain low-cost treatment methods have been introduced to serve this problem. The Government is taking keen interest in addressing this problem. Some of these treatment methods are: - The Non-pneumatic Anti-shock Garment (NASG) is used as a first-aid device that can be placed around the lower body of a woman when she goes into shock. This garment decreases blood loss, and helps the woman to recover from the shock and will keep her alive while shifting her to a healthcare unit. After the patient is made to wear NASG the patient’s vital signs often get quickly restored. The NASG is a low-cost technology device which is of lot of help in developing countries. If the above measures fail, then an alternative is to try Balloon tamponade using Bakri balloon or Condom Tamponade. Bakri Balloon is an intra-uterine device to reduce or control blood loss. The device consists of a silicon balloon connected to a catheter of the same material. The collapsed balloon is inserted into the uterine cavity, and when it is inflated with liquid it conforms to the shape of the cavity and stops the bleeding. Whereas in a Condom tamponade the condom is used as a tamponade for intrauterine pressure to stop massive postpartum haemorrhage. This method controls PPH quickly and effectively and is inexpensive and safe. Postpartum haemorrhage today is a very serious concern and needs extreme attention so that the maternal death rate is controlled.   Dr Sheela Mane, Gynecologist and Obstetrician, Founder of Anugraha Nursing Home ]]> https://biospectrumindia.com/features/21/11790/inpatient-rehabilitation-can-help-in-stroke-recovery.html https://biospectrumindia.com/features/21/11790/inpatient-rehabilitation-can-help-in-stroke-recovery.html Wed, 03 Oct 2018 16:50:00 +0530 An incidence of a stroke isn’t one that doesn’t leave traces behind. There are often many complications associated with strokes in the form of after-effects that follow the stroke. This post explores the reason why Rehabilitation is of high importance to those who have suffered from this and how it can help them recover and live a life as close to normal as possible. What is a Stroke? It is a medical condition where due to any reason, there is lack of blood supply- thereby lack of oxygen to parts of the brain (known as Ischemia) which ultimately leads to the death of the brain tissue. This leads to impaired functions of the areas that were under the control of the affected part of the brain. Strokes can be essentially of two types: Ischemic strokes caused by lack of blood supply to the brain. Hemorrhagic strokes that are caused due to bleeding in the brain which affects the functioning of the affected areas of the brain. Depending on the duration of the stroke, if the symptoms have been present for less than a couple of hours the stroke may be referred to as a transient ischemic attack. What are the effects of a Stroke? The brain remains swollen following the incident of a stroke which is evident through proper imaging. Infections can occur especially in the chest region causing a condition known as pneumonia. This occurs because a stroke, depending on the side of the brain affected puts the patient in a half paralysis state (usually) where one side of the body cannot be moved by the patient. Pneumonia occurs as a result of long-term hospital admission as well and can be controlled using antibiotics. Similarly, since the patients are catheterized many lose bladder control following a stroke and develop urinary tract infections that are also manageable. More severe incidents of stroke result in seizures that result in the severe discomfort of the patient but are medically manageable under the supervision and continued medication.   How does inpatient rehabilitation help? Medical supervision: Continuous medical supervision is provided in good rehabilitation centres that help the patients with conditions that require follow up scanning and diagnostic help, as well as an introduction of necessary medications to the patients in order to deal with each arising complication. This includes prescribing the right antibiotics, anticonvulsants, etc.   Counselling and proper medical advice: The patient’s families receive counselling and proper medical advice on how to control hypertension in the patients whose stroke has resulted from long-standing hypertension that has not been controlled. This counselling is provided by experts who have years of knowledge and collected experience dealing with stroke recovery cases. The importance of such lifestyle changes and continued support to the patient is emphasized to the families who are also educated on how best to manage the patients.   Physical Exercises/Treatment Regimens: Physical exercises as a part of physiotherapy play a major role in the stroke recovery. Under the guidance of a proper physiotherapist and working along with them, the patients slowly recover from the after-effects of the stroke that have resulted in the muscles being shortened and unable to move due to long-standing lack of movement exercises. They are provided with a wide range of exercises that help them improve their basic motion function and thus relieving any clot formation or blood circulation problems to the affected limbs.   These exercises are also important to avoid the formation of bed sores in the patient who are made to move from side to side and lie on different sides to prevent the occurrence of these bed sores. Speech and Swallow Therapy: Strokes result in the patients being unable to speak or swallow according to the extent of damage caused to the affected areas. Well facilitated rehabilitation centres, experienced in helping patients undergoing stroke recovery are trained to provide speech and swallow therapy that is tailored for such patients and work on their basic skills to let them lead a life as comfortable as possible.   Occupational Therapy: As best possible by the current ability of the patients to move and function, occupational therapy helps them to practice and learn basic life that allow them to carry on a relatively independent and normal life ahead where they can take care of themselves should the need arise. This involves teaching them to wash- by helping them to do so at first and then making them do it on their own, similarly other skills as well.   Emotional And Psychological Support: Patients who have undergone an incident as traumatising as a stroke are highly vulnerable to developing clinical depression and associated withdrawal and other behavioural changes that need to be rectified for the sake of the patients well being. Therapy helps the patients slowly come to terms with their condition and regain the will to lead a normal life again by working towards it through physiotherapy and other aspects of stroke recovery. Through rigorous group therapies, counselling sessions and medications- should the need arise; the patients are helped out of their depressive stages. Thus, by improving all the areas of the patient’s health including the physical and mental aspects, an inpatient rehabilitation plays a major role in stroke recovery.   Dr. Vijay Janagama, Director, New Initiatives, SuVitas Holistic Healthcare ]]> https://biospectrumindia.com/features/21/11769/impact-of-ultrasound-in-cardiology-applications.html https://biospectrumindia.com/features/21/11769/impact-of-ultrasound-in-cardiology-applications.html Sat, 29 Sep 2018 09:40:00 +0530 Cardiovascular diseases (CVDs) have become one of the leading causes of mortality in India. Nearly 10 percent of urban adult population and 5 percent of rural adult population suffer from some form of heart diseases. Around 20-30 percent of them require specialized investigation and treatment to prevent deaths due to heart ailments and coronary vascular diseases (CVD). According to a recent study published by Elsevier in the Journal of the American College of Cardiology, the death rate due to cardiovascular diseases (CVD) declined by a significant 41 per cent in the US between 1990 and 2016 whereas in India it rose by around 34 per cent from 155.7 to 209.1 deaths per one lakh population in the same period. With an increase in cases of heart disease, there is a huge demand for proper medical imaging system which will help in achieving accurate diagnosis and treatment in early stages. The evolution of ultrasound has transformed the medical imaging and diagnostic market. The diagnostic capabilities of ultrasound have grown beyond imagination, providing a plethora of medical specialties such as obstetrics and gynecology, orthopedics, and cardiology, among others. An ultrasound scan is a medical test that uses sound waves to capture live images from inside your body. The unique feature of ultrasound makes procedures painless and patients aren't exposed to ionizing radiation. There are no known harmful effects when used as directed by the health care provider. In recent years, ultrasound has proliferated beyond the confines of radiology and is being increasingly used by non-radiologists for diagnostic purposes in a variety of clinical settings. The speed, safety and cost-effectiveness of ultrasound are some of the key features that give this technology an edge over the other imaging modalities. Cardiac ultrasound has also helped in evaluating the structure and function of the heart and associated vessels. The evaluation is one of the fastest, easy and painless that uses ultrasound waves to produce images of the heart and helps doctor to understand patient’s heart health. Color Doppler feature in ultrasound enables measuring of the velocity & direction of blood flow inside the various heart vessels and its chambers. The movement of cardiac muscles and valves can be measured with tissue Doppler. New and advanced ultrasound technology is available now which can measure E/Em, which is the ratio of blood velocity of mitral valve to the blood velocity of mitral annulus in a single Doppler slice, which saves time and help to measure both the velocities in same section. Measuring regurgitations of tricuspid, mitral and aortic valves is easier with new generation modified color flow and continuous wave Doppler. The use of focused cardiac ultrasound has also grown tremendously over recent years, and is increasingly being performed and interpreted by intensivists, anesthesiologists and emergency medicine physicians. These imaging techniques are useful in establishing etiologies of cardiac dysfunction and compliment the physical examination and standard hemodynamic monitoring. Since its inception, cardiac ultrasound has made enormous progression with respect to image quality and quantity, various Doppler techniques, the transfer of data and offline calculations. Trans-thoracic & Trans-Esophageal ultrasound has also become an indispensable in cardiac applications.   M Brahadeesh, President – Imaging, Trivitron Healthcare ]]> https://biospectrumindia.com/features/21/11721/building-the-crux-of-the-modern-day-healthcare-relationship.html https://biospectrumindia.com/features/21/11721/building-the-crux-of-the-modern-day-healthcare-relationship.html Fri, 21 Sep 2018 11:35:00 +0530 The sacrosanct relationship between the doctor and the patient perhaps is at a tipping point. The paternalistic medicine has ceased to exist. Doctors playing the role of a medical advisor and guiding on what must be done, is slowly becoming a thing of past. Trust in doctors may not be completely eroding but is certainly grinding down. Patients are now immensely educated through the internet, however its use (misuse) via Social Media platforms is dangerous and often the reason for trust deficit; patients and doctors must evolve to this fact. Often poor communication and unrealistic expectations form the basis of deteriorating trust and thus it is time to redefine the doctor patient relationship in India.  You wouldn’t want someone you don’t trust handling small, everyday matters for you, much less diagnosing a health condition or performing a complex surgery. Trust is the foundation of any relationship, and a doctor-patient relationship is no exception. With this background let’s look at some key aspects to build trust in the 21st century.   Open Two-Way Communication The single most important aspect is open communication. A doctor is expected to listen to patient’s problems, symptoms and ask relevant questions in order to arrive at a diagnosis. Gentle manners, undivided attention and compassionate communication form the hallmark of good doctor communication. Similarly, patients are expected to convey all information, symptoms and events leading to the problem. However embarrassing or subtle the point may be, the information must be shared with the doctor for him to arrive at a correct diagnosis.  Patients and their families must remember that doctors are trained professionals and only humans, rude or aggressive behavior towards doctor or other healthcare professionals is not only distracting and stressful for these caregivers, and it can also lead to error of judgement. Patients must understand that NO doctor ever wishes any harm to the patient. While it is expected for patients to ask for queries and questions regarding their problems and disease, an irrational interrogation of medical decisions or doubting the ethics will only add to delayed diagnosis and inadequate care. A doctor should offer a patient and their family with options, and decisions should be mutually shared. Yes, we can tell them what we think is the best option; however, ultimately, the patient and their family are making the decision. Doctors must also act like educators, point patients towards right resources on the internet for reference and protect them from wrong information which is available there. This will help in confidence building. Often an open communication on other opinions helps build a lot of trust.   Cost of healthcare delivery In a country where majority of healthcare is privately driven, the cost of healthcare is rising daily. Though insurance and some government policies have bridged the gap, it still remains out of reach for a large section of the population. While most doctors and healthcare facilities are sensitive to this issue and do their bit, it remains a challenge. In India we provide quality healthcare at a very economical rate compared to the world and healthcare professional’s remuneration is only a small part of the total cost. But to deliver quality care, one needs infrastructure, equipment, quality checks and standardization, this is where the cost escalates. Our patients need quality healthcare and therefore the cost will have to be shared. Government, insurance, tax exemptions on equipment and infrastructure etc. are some of the key elements to reduce cost burden to patient. While healthcare is now being considered an industry, it is rather unfortunate that some see it as a client and provider relationship. While it is important to bring accountability in healthcare, it cannot be at the cost of disintegration of trust. As I often feel that patients and doctors are one team in caregiving, with a single goal of making patients better. There should not be any ambiguity in understanding this. Practicing medicine is becoming more difficult than ever before. There is an evolvement of technology and innovation from all corners. Data has become more quantified and we are regulated to follow new guidelines. Our time is being constricted, while more and more is expected from healthcare providers. On these lines, patients have time constrains as well, because they are going through a similar turmoil at their work place, financial burdens and emotional stress. But there are only so many hours in a day and both sides need to balance and redefine how they will interact with each other to optimize care.   Dr Rahul Pandit, Director-Intensive Care, Fortis Hospital, Mulund, Mumbai ]]> https://biospectrumindia.com/features/21/11707/laser-management-for-enlarged-prostate-and-stone-disease.html https://biospectrumindia.com/features/21/11707/laser-management-for-enlarged-prostate-and-stone-disease.html Wed, 19 Sep 2018 11:55:00 +0530 Urology has seen dramatic changes over the last few years with certain conditions becoming very common with age. The advent of laser in Urology has revolutionized the way in which we treat such disorders of the urinary tract.  Technological advancements are occurring on a day-to-day basis with the management of urinary stones undergoing a transformation where instruments are getting smaller and smaller and the procedures getting almost completely painless. A lot of these procedures can now be done as day-care, simply because holmium laser fibres which are smaller than a millimetre in size, allow us to access stones in the any part of the kidney.  Earlier stone breaking technology resulted in stones moving away from the surgeon. The 100 Watt holmium laser typically minimizes retropulsion. Holmium laser energy is absorbed by water. Sudden evaporation of water in the lattice structure of stones creates micro-explosions which cause fragmentation. Miniaturization also resulted in improvements in the surgery of PCNL (percutaneous nephrolithotomy).  Here a small puncture is made directly from the skin into the kidney without disturbing any other organs and the stones are fragmented and removed.  Earlier operation consisted of making an opening about 1 cm, now this has become much smaller.  It is not just a question of a smaller size, it also means that pain is much less and recovery is much faster. Holmium laser allows the surgeon precise control over the size of the fragments that are removed.  Additional engineering marvels in fluid dynamics have allowed us to actually wash out stones without having to hold any fragments.  This has resulted in much more efficient stone clearance as well as improved operation time. Another application in Urology for lasers has been enucleation of the prostate (HOLEP).  In the traditional TUR-P surgery, prostate is removed piecemeal in small bits resulting in large amounts of bleeding. Holmium laser allows us to enucleate or completely remove the prostate by going into the correct plane between the capsule and the prostatic tissue.  With less blood loss and improved vision, the outcomes of removal of large prostates have been very successful. Earlier, surgeons had the option between an endoscopic surgery for smaller glands and depending on the surgeon’s comfort levels, they would offer open surgery for larger glands.  However, HoLEP has been shown to be a size independent procedure and these procedures can be done for all prostate sizes.  Because of changes in the type of fluid used, other complications like TUR syndrome are no longer seen with HoLEP.   Dr. Prasanna Venkatesh,  MBBS, MS - General Surgery, DNB - General Surgery, Fellowship in Pediatric Urology, DNB - Urology/Genito - Urinary Surgery, NU Hospitals, Bengaluru   Dr. Maneesh Sinha, MBBS, MS - General Surgery, DNB - Urology/Genito - Urinary Surgery, MCh - Urology, Urologist, Laparoscopic Surgeon, NU Hospitals, Bengaluru   ]]> https://biospectrumindia.com/features/21/11698/is-good-cholesterol-really-healthy-for-your-heart.html https://biospectrumindia.com/features/21/11698/is-good-cholesterol-really-healthy-for-your-heart.html Tue, 18 Sep 2018 13:45:00 +0530 Cholesterol! Though a fairly commonly used term, people often see it as an illness. ‘He can’t eat mutton /Butter as he has cholesterol, is a classic example. Other spectrum is news on circulating virtual media that Cholesterol is blindly removed from naughty list and egg, butter, dairy products, nuts, coconut oil and meat are safe. So what is true? Latest article published on NEJM 2017 that according to a study in Denmark where they analysed that parents who had stopped taking statins because of news on virtual media had increased incidence of heart attacks and brain stokes and there for increased mortality. That had put all speculations of Cholesterol being all healthy to rest. However cholesterol isn’t all bad; there is good cholesterol (HDL) and bad cholesterol (Total/ LDL). Cholesterol is a fatty material that is present in all of our cells and has few positive roles like helping to make your cells and their biochemical reactions. Low-density lipoproteins (LDL). These lipoproteins carry cholesterol throughout the body, delivering it to different organs and tissues. But if the body has more LDL cholesterol than it requires, the excess keeps circulating in the blood. Over time, this type of cholesterol can enter the blood vessel walls and start to build up under the vessel lining. Deposits of these cholesterol particles within the vessel walls are called plaques, and blood vessels become narrow and can block blood flow causing coronary artery disease (Atherosclerosis). This is the reason that LDL cholesterol is often referred to as “bad” cholesterol. High-density lipoproteins (HDL). This type is referred to as HDL, or “good, “cholesterol. They act as cholesterol scavengers, picking up excess cholesterol in the blood and taking it back to the liver where it’s broken down. This helps prevent the fat from oxidizing and building up on the walls of the blood vessels. The higher your HDL level, the more protected are the organs. Blood test which measures these fats or lipids is known as lipid profile. Recent guidelines according to American society endocrinology and cardiology 2017 have stated that level of LDL should be less than 50 on patients with previous heart attacks or stents or prior history of  by-pass. Both genetics and the lifestyle plays an important role in your cholesterol levels. Indians peculiarly have low HDL levels. Some people may be naturally predisposed to low HDL and they may also have a harder time increasing a low number, by diet and exercise alone. And doctors may prescribe medication such as Fibrates or Niacin. There are certain lifestyle habits like Smoking, taking steroids, eating foods with trans fats, being obese and inactive push a low number further down.   Tips to improve HDL values Lose excess body fat: Appropriate body mass index (ratio of weight and height) can help control high cholesterol, especially LDLs. But weight loss from dieting alone can cause HDLs to drop along with the LDLs. Exercise: Exercise has a powerful, albeit short-lived effect. Each workout may result in a subtle HDL boost, so that’s why it needs to be done on a consistent basis. Regular exercisers tend to have higher HDLs. Research shows that HDL may be elevated by as much as 20% from regular aerobic exercise that expends at least 800 to 1,200 calories per week. Walking at 5km/hour, for example, will use around 300 calories. So a person needs to walk around 12 to 15km in a week, or do some equivalent aerobic activity for at least 30 minutes on five per week. Inactive people may need to do slightly more, burning from 1,500 to 2,200 calories per week through aerobic workouts like walking, swimming, cycling or aerobics. (Beginners should always start slow and gradually work up to higher intensity and longer workouts.) Avoid trans fats: High intakes of trans fats which is found in processed foods made with hydrogenated oils, bakery products, reboiled oils have been found to lower HDLs. So, cutting out fast foods and processed foods that contain these fats is wise.  Go for good fats and plenty of plant foods.   Dr. Amit Bhushan Sharma, Associate Director & Unit Head, Interventional cardiology, Paras Hospitals, Gurugram ]]> https://biospectrumindia.com/features/21/11648/medical-insurance-for-infertility-treatment-the-first-step-towards-empathy-.html https://biospectrumindia.com/features/21/11648/medical-insurance-for-infertility-treatment-the-first-step-towards-empathy-.html Mon, 10 Sep 2018 15:20:00 +0530 Infertility is fast becoming a huge concern in India. With 30 million infertile couples currently, it is estimated that in the year 2020, 2,50,000 IVF cycles will be performed in the country. Needless to say, the cost of infertility treatments too continues to rise, making it unaffordable to a large number of couples. There is a huge need for not just insurance companies to cover infertility, but the government too to chip in and make necessary provisions in the Union Budget 2017-18 to bring infertility treatment under insurance cover. This is why, during my presidential year (2017-2018) at the Indian Society for Assisted Reproduction (ISAR), I had made it my mission to push for insurance companies and the government to make necessary provisions to bring infertility treatment under insurance cover in India. And I am delighted to note that the change has been brought about by the efforts of the Govt of india especially the division heading the Ayushman Bharat program and the Insurance Regulatory Authority of India ! In August 2018, the Insurance and Regulatory Authority of India (IRDAI), asked for the removal of around 10 items, including procedures such as dental, stem cell, infertility and psychiatric treatment, from the list of “optional cover” for health insurance. This would mean that these procedures could be made part of standard insurance policies. Some of them could even be made mandatory ! It is heartening to note that infertility has been included in this list—the fact that the Indian insurance sector will now provide insurance cover for infertility treatment will definitely make it more affordable to the millions of couples who need it. As the President of ISAR, I dedicated the year 2017- 2018 as "ISAR's year of Empowerment: through "Education, Ethics and Empathy”. The empathy here implied empathy for infertile couples. As a part of my mission, I met with insurance companies, the Ministry of Health and campaigned to make infertility treatment easier for couples seeking treatment for infertility, by having it covered under their health insurance plan. And now, with the Ministry of Health considering this proposal, I am happy to see my efforts bearing fruit.  I must compliment the Ministry of Health for having responded so quickly and positively. Research has shown that one in every five to six couples have a problem conceiving on their own, which is a clear indication of the large number of people who need assistance to overcome their need to have children. Very often simple advice or a little help from the Gynecologist helps them in their pursuit of having their own biological child . But occasionally they require advanced procedures like ivf, icsi, egg donation, etc. Simpler treatments are mangable and affordable with every Gynecologist , but advanced procedures need to be undertaken at Centers which offer assisted reproduction. However, the fact is that the cost of IVF, ranges upwards of Rs1.5 lakh to 2 lakh per cycle of treatment, mainly because the consumables used for ivf and the cost of maintaining a high quality embryology lab are high. Hence a huge number of couples desist from seeking treatment or resort to poor quality care. Infertility treatment not only involves expenditure but it also involves a huge amount of investment from the couple seeking treatment, this includes daily injections, the time spent on treatment, giving up on their careers due to frequent visits to the clinic, the financial loss, the mental agony, and many a times, disappointment when the pregnancy test is negative after such a long ordeal! Their journey while seeking infertility treatment will definitely be easier now, thanks to IRDAI’s change in policy. And I am sure we will soon begin to see the effect of this change in the number of patients seeking affordable medical treatment for infertility. On another note, if we start creating our own consumables under the “made in india” program, instead of importing all of them which increases the cost of treatment, we will be able to make ivf much more affordable than it is today!!   Dr Duru Shah, Director, Gynaecworld, Centre for Assisted Reproduction & Women’s health; Panel Consultant – Breach Candy Hospital & Jaslok Hospital ]]> https://biospectrumindia.com/news/21/11514/how-late-is-too-late-to-be-a-mother-.html https://biospectrumindia.com/news/21/11514/how-late-is-too-late-to-be-a-mother-.html Mon, 20 Aug 2018 14:20:00 +0530 As issues like gender equality take a centre stage and we have more women leading businesses or important roles within an organization, starting a family takes a back seat. Women are often faced with a question how late is “too late” to be a mom? Everyone wants to give their child the best. Working women are more at pressure to juggle between their careers and personal life. Society at large believes that ‘women is complete when she rejoices motherhood’. But without denying the social norms they also want to achieve their career aspirations and life goals. So, it is okay to be little late in being a mom?  Motherhood is every woman's dream. While they fight the social pressures and focus on their careers but at the back of their mind they know that their biological clock is ticking faster. As they grow older and smarter, their eggs also grow older and their quality decreases..  As per the American Society for Reproductive Medicine, a woman's fertility starts to decline beginning in her 30's, with a more significant decline after the age of 35. Every month, there's only a 20 percent chance of pregnancy for a woman in her 30’s. Studies also suggest that women conceiving at later age may be at risk of having a child with chromosomal abnormality such as Down Syndrome. Shall they lose heart and all hope? No. With evolving IVF techniques, it is probably not even late till your 60's. Recently in a rare case in Punjab, India, a 70 year old woman had given birth through IVF. While this is one of the rare case, it tells us the extent of how evolved is medical science today but not one of the ideal one. So with advancements in fertility treatments, there is an option for professional women not yet ready for motherhood, to continue to build their careers without being in an emotional dilemma of choosing between a baby and their career.  Women now have  choices! These range from egg freezing, IVF treatment, surrogacy, adoption among others. We know of many celebrities who have gone through either the above options to experience their joy of parenthood much later in their lives.  Option one: Egg Freezing for a Future Pregnancy  Egg freezing is considered as a safe, sound and competent method for women who wish to delay parenthood. This could be a career choice or a recommended way forward for those diagnosed with medical conditions which have a direct impact on the embryo quality and quantity.  As per Zsolt Peter Nagy, PhD, an Atlanta embryologist, accurate data on the number of babies born from frozen eggs are hard to obtain, but it is approximately 5,000 births worldwide. Though a small number now, the number of women opting to freeze their eggs in their late 20's or early 30's is on a rise. Big companies like Apple, JP Morgan chase, Citigroup, Facebook and many more are bearing the cost of voluntary egg freezing for women who decide to delay child-bearing.  Option two; The rise of “Surrogacy “ Surrogacyis a popular and a successful method for women who are unable to carry their own babies. This is a choice for those who decided to have a baby much later in their lives and couldn’t conceive due to infertility or other medical or personal reasons. This method entails IVF with the eggs of either the intended mother or a donor’s egg as the case may be. In this case the surrogate mother is not genetically linked to the child.  Option three: IVF is the way forward  Besides being opted by infertile couples to conceive a baby, both egg freezing or surrogacy also utilize an IVF treatment.  While the success of IVF depends on a lot of factors such as the age of the woman, the quality of the embryo, status of the uterus etc. But the two principal factors for maximizing the chances of implantation during an IVF treatment are a chromosomally normal embryo and a receptive endometrium. With the recent advancements, genetic techniques such as Preimplantation genetic screening (PGS) and Endometrium Receptivity Analysis (ERA) are being used to advance the chances of IVF success and pregnancy. Option four: Adoption There are still many who believe in the noble cause. Adoption helps completing your family balance and the desire to be a parent. - Dr. Rajni Khajuria, PHD, Laboratory Manager, IGENOMIX India   ]]> https://biospectrumindia.com/features/21/11470/illuminations-the-shadowy-world-of-radiology.html https://biospectrumindia.com/features/21/11470/illuminations-the-shadowy-world-of-radiology.html Mon, 13 Aug 2018 13:00:00 +0530 It was seemingly a routine day for me in my Radiology department with several scans piled up for reporting. But my flow was being regularly interrupted with a stream of clinical colleagues who wanted to see the scans of their patients. Each one wanting to know the various possible diagnoses that we had to offer for the patients. It was in the midst of this, that my surgeon colleague barged in and wondered if one of his young patients in the Emergency Room with a history of minor injury by a bicycle accident, would need a CT scan. He said that based on relatively innocuous preliminary findings, they were considering to discharge the patient, but for the fact that there was a niggling abdomen pain, he is going to order a CT scan. He also added for a good measure that chances of finding something on the scan are low. At 6 pm, it was my phone call which interrupted the surgeon as he was driving back home. With an urgency in my tone, I told him that the CT scan of his young patient shows a complete pancreatic tear with bleeding and would warrant an urgent surgery. “Are you sure” was his immediate incredulous reaction. It is after some years of practice and managing many emergencies successfully, that surgeons start believing in the advice of their colleagues from Radiology. We were steadfast in our finding, hence the patient was promptly wheeled to the OR. Soon enough the findings were confirmed and the bleeding Pancreas were repaired. Danger averted, the patient went home healthy in a few days leaving everybody with a satisfied smile. This is the success story that a Radiologist remembers and craves for, because not only did he diagnose an emergency condition when nobody was suspecting it, he also helped in the treatment plan which finally led to saving a life. This also exemplifies why modern diagnostics have become so important in todays’ clinical care. Imaging Technology often comes to the aid of clinicians in confirming their suspicion and also occasionally throwing up completely unsuspected diagnoses. It is not an overstatement to say that ‘innovations in imaging medicine is one of the most important advancement that has revolutionized modern medicine, and enabled more effective and efficient care that has saved countless lives’. Radiology scans allow doctors to peep inside people bodies virtually, and diagnose tumors and diseases as small as few millimeters. This early diagnoses of diseases like Cancers leads to less invasive treatment procedures and markedly improves the treatment outcomes. From the point of more efficient and cost effective medicine, scans have virtually eliminated exploratory surgeries, reduced unnecessary hospital admissions and often shortened hospital stays. The various tools of imaging available to Radiologists include the humble X-rays, Sonography, CT Scans, MRI Scans, Catheter Angiographies and PET Scans. While X-rays continue to be the cost effective, and widely available imaging tool to look at Lungs, Bones etc., Sonography occupies a stellar position in imaging the foetuses. With Sonograms one can assess the development of the foetus and also diagnose developmental anomalies. Sonography also is the first imaging tool to look inside the abdomen and other soft body parts. The advantage being, it’s non-ionizing nature and also wide availability. The cross sectional modalities like CT, MRI and PET have revolutionized the diagnostic care enabling high resolution and precise imaging to diagnose smallest of tumors. Multi-slice CT scanners have become so fast that the entire body can be covered in a matter of 10 seconds. The most modern CT scanners even allow imaging of beating heart with exquisite anatomy of the Coronary Arteries and pick up small plaques that may cause a Heart Attack in the future. MRI places the patient in a magnetic field and small radio frequency pulses are sent to patients, body and the resulting changes in the hydrogen protons of the body are read and the images are generated. MRI is also non-ionizing and safe for all ages. The modern scanners have evolved into a stronger 3 Tesla strength with wider bore sizes and less noise for patient comfort. PET scanners are molecular imaging tools which take help of tumor metabolism to diagnose cancers.   A radiologist not only reports the scans but discusses the findings with the clinicians, often guides the surgeon on the pathological anatomy, enabling them to take decisions on the approach to surgery. Through interaction with the Radiologist, the surgeon prepares himself on what difficulties he is going to encounter even before opening up the patient. In the modern medicine oblivious to the patients, the treatment plan for the patient is often made in the Radiologists room. The Radiologist thus plays a role of consultant to the other consultants of the hospital. Radiologists these days are not just content with diagnosing diseases, a modern Intervention Radiologist is using catheters and tubes for treating emergencies like a bleeding Aneurysm or blocking blood supply of tumors. They often open up arteries by placing stents and obtain tissue pieces from deep inside for Biopsies. Radiology has been around for over a century since Wilhelm Rontgen first discovered the strange new phenomenon he called “X-rays,” It has been evolving ever since and changing the way medicine is practiced.   Dr. Rajat Bhargava, HOD-Radiology, Fortis Hospital ]]> https://biospectrumindia.com/features/21/11418/breastfeeding-the-myths-facts.html https://biospectrumindia.com/features/21/11418/breastfeeding-the-myths-facts.html Thu, 02 Aug 2018 18:05:00 +0530 With the theme of Breast feeding week 2018 – “Foundation of life”, everyone knows that breast feeding is a precious God's gift to mother but its always a big challenge for first time mother to understand how to feed ?, how much to feed ?, when to feed ?, to give best to her baby.  Newer generation mothers always face difficulties in balancing between old myths and modern lifestyle. So breast feeding week is the best way to discuss about this. Breast milk is the natural, unequalled high balance of carbohydrate, proteins, fats, vitamins and minerals that is easier to digest and absorb by your baby. Colostrum, breast milk produced after delivery is the perfect first food for your baby as it is similar to receiving first vaccination because colostrum is filled with antibodies and immunoglobulin A (IgA). Colostrum is also rich in protective white cells called leukocytes which defend against microbes. Thus breast milk boost immunity. The chances of infection like diarrhoea, cholera are higher in bottle feed babies as compared to breastfeed ones. Breast milk also ensures lesser chances of diabetes in children by as much as 35%, reduces risk of childhood cancers and heart disease later in life.  Breastfeeding also contributes to the health of well being of mother. It helps space children, reduce the risk of ovarian cancer, breast cancer by as much as 25%. Breastfeeding women recovers faster and easier from childbirth as hormone such as Oxytocin help the uterus to return to normalcy quicker and reduces Postpartum bleeding. The benefits also extends to effortlessly losing the weight gain during pregnancy. While breastfeeding is a natural act but it is also a learned behavior. Motivation and right way of feeding baby so as to give support to mother for establishing and sustaining best breast feeding practices is important.    Myth- You need to nurse every 2 hours around the clock to make sure your baby gets enough. Truth- Just like adults, babies too have their own individual eating patterns. Most babies fall into the routine of feeding once every 2 hours. "Watch the baby and not the clock". Feed your baby on demand. One way to look whether your baby is feeding enough is to observe their output ie; 6 wet diapers and 2 - 3 stools per day is an indicator of healthy baby.  Also better your child is latched on to your nipple, longer and adequately he or she will feed. Breast milk is also ideal for preterm babies.   Myth- Start formula feed as baby not sleeping in night with breast milk. Truth- Sleep depends on personality and sleeping patterns of your baby. As long as your baby is getting enough to eat, she or he will sleep for as long as meant to sleep.   Myth- If baby is feeding more or sleeping less that means milk secretion is not adequate. Truth- This is a common misconception. In reality only 1% of women can not physically produce enough breast milk. The truth is that, the breast milk is easy to digest and absorb as compared to formula feed, so frequent feedings are required. This is absolutely normal for your baby to feed frequently in the beginning because their stomach are so small at birth.    Myth- Mother must eat only bland foods while breastfeeding.  Truth- By the time the foods you eat have been digested and used to make breast milk, the potentially upsetting elements have been broken down and should not affect your baby at all. i.e. if you eat cabbage or broccoli, it is unlikely that it will make your baby gassy. Do not change your feeding habits. Keep yourself well hydrated.   Myth- Your breast will forever sag after breast feed. Truth- The breast often doubles in weight during pregnancy. Whether or not you breast fed, increase in breast during pregnancy put extra stress on the ligaments that support the breast and more stress equals extra sagging. Your age, BMI, pre pregnancy bra size, all affects how likely your breasts will drop.   Myth- Breastfeeding causes pain and sore nipples. Truth- The fact is that such discomfort is usually a result of an improper latch and so entirely preventable. Learn to latch correctly with your pediatrician and gynecologist.   Myth- Should not nurse if you have blocked ducts. Truth- Best way to treat blocked duct is to nurse as often as you can to prevent infections. Besides frequent nursing, apply hot fomentation before nursing. If you develop infection, consult your gynecologist.   Myth- Breastfeeding is a reliable form of birth control. Truth- Even if you exclusively breastfeed, ovulation and chance of becoming pregnant start after 3 months of delivery. So consult before that for contraception. Mothers who breastfeed burn around 300 to 500 extra calories per day as compared to those who give formula feed and researchs have shown that they do tend to slim down faster.   To conclude important points to be considered by our mothers are initiation of breastfeeding within the first hour of life; exclusive breastfeeding for 6 month i.e. infant only receives breast milk without any additional food or drink or even water; breastfeeding on demand i.e. as often as the child wants and no use of bottles, teats or pacifiers to have a healthy mother with healthy baby for whole life.   Dr. Mayur Dass, Consultant Obstetrics & Gynaecology, Max Super Speciality Hospital ]]> https://biospectrumindia.com/features/21/11237/deep-venous-thrombosis-a-devil-in-the-dark.html https://biospectrumindia.com/features/21/11237/deep-venous-thrombosis-a-devil-in-the-dark.html Tue, 03 Jul 2018 16:35:00 +0530 Human body has two types of blood channels. Arteries are the blood channels which take oxygenated blood from heart to different body parts and Veins take the used, deoxygenated blood back from different parts of body to heart.  The flow of blood in the arterial system is facilitated by Heart pump with pressure; the same is not there for venous blood flow.  However there are ingenious mechanisms by which the Venous returns back to heart through venous channels.  The Limb Muscle pumps and Valves in the Veins play a pivotal role in this process.  Humans’ being bipedal animal’s gravity plays a negative role in venous blood flow. One of the recently discovered atorvastatin side effects and those of statins in general is the prevention of blood clots in the veins Clotting of blood in the Venous channels can lead to blockage of the flow. If this happens in deeper veins of the body parts it is called Deep Venous thrombosis (can happen in Upper limbs and Lower limbs). The effect of Deep Venous thrombosis (DVT) is venous return is blocked and the limb will swell with venous blood. The same clots can slowly travel to right side chambers of Heart and from there to Lungs and this condition is called Pulmonary Embolism (PE). If a very big clot goes and fills the main pulmonary artery it is called Massive PE and can be very fatal and one of the very common cause of sudden death. In Indian scenario the causes for DVT in majority cases are very simple like  Fever, Accidents with fractures in Limbs and needing Immobilization,  Paralysis, Episodes of Loose motions and vomiting, Excessive work in Hot environment, continuous long journeys and Pregnancy- the common factor in all the above cases are dehydration and immobility and to some extent pressure on Veins.  In minority of cases People do have tendency to form more clots both by genetical composition and environmental influences like smoking.  Very rarely DVT can be a presentation of Cancers. The common symptoms of limb DVT is swelling with discomfort, redness and low grade fever. Sometimes the leg swelling can be very tight and intensely painful.  Shortness of Breath, Palpitations and sweating could hint some of the clots might have travelled to Heart and lungs. Unfortunately some patients come with Massive Pulmonary Embolism which can be fatal. Once the clots form in venous channels this can slowly increase in size as the stasis in venous blood flow promotes further thrombosis and as mentioned above can travel towards heart. The longer the clot stays in venous channels it damages the valves inside veins leading to both structural and functional failure of venous blood return.  This particular scenario can leave a patient with a permanent irreversible swollen limb with hardened discolored skin and Ulcers, in particular around ankle and lower legs. This condition is called post DVT syndrome (Post thrombosis Syndrome PTS). PTS can be crippling and functionally impair many people and unfortunately with discolored and ulcerated leg will be a social problem to many people. When a patient presents with DVT the immediate goal of the doctor is to reduce the risk of Massive Pulmonary embolism, attend to immediate lower limb symptoms and aim to prevent long term complications like PTS and evaluate patient to identify any factors which causes re occurrence of the problem. This particular problem can happen in many diverse varieties of patients and  almost all specialties across medical field will have to recognize that there  are preventive strategies for onset of DVT and immediate and long term implications and try as much as to reduce these dreadful problems.    Dr Bheem Sangars from Gleneagles Global Hospitals ]]> https://biospectrumindia.com/features/21/11177/blood-quality-safety-concern.html https://biospectrumindia.com/features/21/11177/blood-quality-safety-concern.html Mon, 25 Jun 2018 15:40:00 +0530 Around the world, patients are in need of blood and blood components, which may be used for life saving measures as in trauma, complications of pregnancy or for transfusion support for treatments like chemotherapy, management of hematological malignancies, and disorders like thalassemia and hemophilia. Pattern of usage may be different, depending upon the availability of diagnostic facility and treatment options given to any patient. Certainly, transfusion is the only option for saving many patients life. Whenever a transfusion is prescribed, a common fear that patients and doctors have, is how safe is the blood or component that is going to be transfused. Would there be an immediate adverse reaction? Can some problem arise after a couple of days or months after transfusion? The access to safe and clinically effective blood is a challenge across the globe. Challenges may differ but the fear is common. The very first step, to meet this challenge is to have a constant pool of blood donors who are fit as per the standards prescribed for being eligible to donate blood. Second, is to collect, process and then test the blood for Transfusion Transmissible Infections. In addition to this is the storage as per the guidelines required for blood and its components. Third, is to have a correct prescription based on clinical judgment and transfusion guidelines for appropriate use and doing the required “compatibility testing”. Lastly, transportation of the blood or component to the patient’s bed side and transfusing the correct patient within the required time frame is important. Transmission of blood borne diseases is the most common fear, backed by numerous reports from across the globe. In our country, all units collected are tested for hepatitis B and C viruses, Human Immunodeficiency Virus (HIV), Malarial parasite and Syphilis. Depending on the national guidelines and strategies applied at various levels, the following testing methodologies are applied most commonly in our country.  For Hepatitis B virus (HBV) Hepatitis B surface antigen (HBsAg),  for Hepatitis C Virus  (HCV), Hepatitis C virus antibody (anti-HCV) and  for Human Immunodeficiency virus (HIV) Types 1 and 2 detection, HIV-1 and HIV-2 antibody (anti-HIV-1 and anti-HIV-2) detection is done by Enzyme-Linked Immunosorbent Assay (ELISA). Chemiluminescence is also being used for testing at many centers, which has added to the safety level. Over the decade, many centers have started using the Nucleic Acid Amplification Testing (NAT) in either Individual Donor (ID), that is, Single Donor Testing – NAT format or Minipool NAT format, where pool of 6 samples is tested as one sample. Certain studies from various parts of the world have shown that ID-NAT has better detection rates as compared to Minipool NAT. Prevalence rate of viral markers in general and donor population, implementation of immunization program and testing methodology presently in use, can be a major guiding factor for selection between ID or Minipool NAT. Cost can be a major challenge for its implementation. The quality and safety of blood provided to patients, depends not only on the presence of a National quality system for Blood Transfusion Services, but also on knowledge, skills and commitment of the people working in the blood transfusion department of every hospital. Regular, voluntary non-remunerated blood donors from low-risk populations are the foundation of safe blood supply in a country.   Dr. Ashish Tewari- Consultant & Head, Department of Transfusion Medicine at Sahara Hospital, Lucknow ]]> https://biospectrumindia.com/features/21/11172/polycystic-ovarian-syndrome-an-emerging-disease.html https://biospectrumindia.com/features/21/11172/polycystic-ovarian-syndrome-an-emerging-disease.html Mon, 25 Jun 2018 10:55:00 +0530 PCOS is a gynecological hormonal disorder, which affects 8-10% of women in their reproductive age.  It affects women of all ages, from puberty to menopause. The presenting complaints may differ from cosmetic issues like facial hair and acne, irregular periods and inability to conceive, and chronic diseases like diabetes mellitus, high blood pressure, high cholesterol, and uterine cancer. 80% of girls or women are obese and quite a few have excessive pigmentation in the nape of their necks, underarms, groins etc. PCOS is one of the prominent causes of infertility, in which ovulation does not occur or occurs irregularly.  It is possible to assist infertile patients with various forms of medications which help ovulation and various other infertility treatments. As a matter of fact at our Center, we see a maximum of infertile women with PCOS. As of today, the cause for PCOS to occur is not known, but a lot of research is ongoing and hopefully we should have an answer in the near future. But we do know that PCOS is a hormonal disorder which is genetically determined, with insulin resistance (relative lack of insulin hormone leading to diabetes) as the root cause. It occurs due to an interaction of genetic and environmental factors such as obesity. It is a life-long condition which cannot be completely cured but can definitely be kept under check. PCOS is also accompanied by raised androgen levels ie. excessive male hormone leading to acne, facial hair and loss of scalp hair. How do we diagnose PCOS? This is done by a detailed history including that of periods, weight gain, hair growth, acne, hairloss on the scalp, and pigmentation, a detailed examination, blood investigations and ultrasound. The treatment is tailored based on the lady’s symptoms, test results and the desire to get pregnant, or not. Lifestlye modification is the first line treatment for PCOS. A low calorie diet and regular exercise is the key to weight loss. Weight loss can improve fertility, regularize periods, reduce the insulin resistance and lower androgen levels. A weight control program with regular aerobic exercises, preferably under a nutritionist’s guidance, is highly recommended. Birth Control Pills: These can be used in women not keen to get pregnant. The pills  regulate the periods and correct excessive hair growth and acne by reducing the male hormone. By ensuring a regular period, they also decrease the chances of a womb cancer. These can be used long term if done under medical supervision. Newer birth control pills, are extremely effective and are low dose, hence less likely to have side effects. Needless to say, they are not an option for women wanting to get pregnant. Insulin Sensitizing Drugs: Drugs that improve insulin resistance and lower insulin levels include metformin. Metformin promotes fertility and regularizes periods, promotes weight loss with exercise, and improves insulin sensitivity. This can be also given to women desirous of childbearing. There are studies which conclude its safety during pregnancy. Metformin, if used during pregnancy, prevents miscarriages, gestational diabetes and high blood pressure during pregnancy in such women. Metformin is also indicated if the lady’s blood sugar and insulin are high, or if she is pre- diabetic or already a diabetic. Ovulation inducing drugs: These are the medications that help infertile women ovulate. These include tablets like Clomiphene and Letrozole, and hormonal injections like FSH & LH. These medicines are given from the 2nd/3rd day the period. After taking these medicines, ovulation is usually monitored by serial ultrasound to assess the follicular growth and to avoid problems like too many eggs getting mature (Hyperstimulation).  Some patients may require assisted reproduction such as IVF or ICSI if they do not get pregnant with simple ovulation induction and intrauterine insemination. Anti-male hormones drugs/ Antiandrogens: These are used when the androgen levels are high. They include oral medicines like Spironolactone & Flutamide or creams like Elfornithine. Effective contraception is required when using any of these drugs as they can affect the male fetus if a woman gets pregnant whilst on these treatments. These drugs are not used long term.  As already said, PCOS is a lifelong condition, which can have serious cardiovascular and other consequences, if not kept under check. It is therefore important, that the PCOS patient should see her doctor at least once in 6 months, so that her treatment can be optimized and any necessary referrals made. The management may be multidisciplinary, involving the gynaecologist, endocrinologist, physician, dermatologist, nutritionist, fitness expert etc. Nevertheless, a PCOS lady can help herself by maintaining a healthy life style. Regular exercises and healthy eating is the part that she can play and will work wonders in keeping her PCOS under control. The PCOS Society was recently launched in India as a multi specialty professional Organization which consists of gynecologists, dermatologists, endocrinologists and all other specialties involved in the care of PCOS women. As the Society grows, its agenda is to create a PCOS Support Group for women with PCOS.   Dr. Duru Shah - Director, Gynaecworld , Center for Assisted Reproduction & Women’s health; Panel Consultant – Breach Candy Hospital & Jaslok Hospital ]]> https://biospectrumindia.com/news/21/11157/strengthen-your-aging-bones.html https://biospectrumindia.com/news/21/11157/strengthen-your-aging-bones.html Thu, 21 Jun 2018 13:55:00 +0530 According to a new study by researchers in the University of Missouri-Columbia, certain types of exercises significantly contributed to improve bone-density in middle-aged men with a low bone mass. As men enter late 40s-mid 50s, their bone density and strength reduces. This results in weak joints, pain while walking and also puts them at risk for developing osteoporosis. Exercises such as weight-lifting and jumping, while known to enhance muscle strength, also have a positive impact on bone growth and strengthening, a feature which is little talked about. Mentioned below are a few exercises that can help middle-aged men battle weak bones and remain strong during a period otherwise associated with debilitating ailments- Weightlifting-Weightlifting exercises continued over a span of 6 months have been observed to significantly enhance bone mass. However, not all kinds of weight lifting will serve the purpose. As only the bone experiencing the mechanical load gets stronger, middle-aged men should focus on doing squats, deadlifts, lunges and the overhead press to load the lumbar spine and the hip region. Increasing the intensity and the weight is also important to build bone strength over time. Walking or jogging-Cardiovascular workouts bearing weight are better for bone strengthening compared to exercises such as swimming or cycling. Increasing the intensity of your walks and going up and down inclined terrains helps to put more force on the bones, thereby strengthening them. In fact, middle-aged men should practice stomping their feet to increase bone density in the hips. At least four stomps on each foot twice a day using enough pressure to crush a can will strengthen bone mass in the pelvic region. Resistance training-It is important to incorporate some sort of resistance training in your exercise schedule every week. As you put more tension on your muscles, it puts higher pressure on your bones, which then respond simultaneously by creating fresh, new bone. While it is not a very popular exercise with middle-aged men, resistance training offers significant bone health benefits. ‘Daily living’ exercises-A quick plank while waiting for the microwave’s timer to reach zero or some curls with the bucket while watering the plants, exercise should be an integral part of daily lives of individuals. Such practices help to keep fit while not devoting extra time specifically for exercises. While it is recommended to devote 30-45 mins every day to exercise, making daily chores into smart exercise options also help middle-aged men to keep fit. Ample rest-It is necessary to rest well and space out exercises with recuperation time. Over-stressing muscles or carrying out high-intensity exercises without proper rest leads to burnout and eventual weakening. Regular exercise helps individuals to sleep well and have healthy cardiovascular rhythms, which is very important to stay fit and active, especially during middle-age. Other important tips: Having a diet rich in calcium and other essential nutrients will go a long way in strengthening bone mass and density. It is important to get adequate sunlight as a source of Vitamin D3 which helps in strengthening bones. Lifestyle changes like giving up smoking is essential for healthy bones. It is recommended that men over the age of 40 undergo an annual check up as it will help detect chronic diseases like diabetes, inflammatory bowel disease, coeliac disease, etc that are linked to bone health.   Dr. Gowri Kulkarni, Heads of Operations, DocsApp ]]> https://biospectrumindia.com/features/21/11064/the-science-behind-the-practice.html https://biospectrumindia.com/features/21/11064/the-science-behind-the-practice.html Mon, 04 Jun 2018 17:45:00 +0530 Across the world, interesting discussions have taken place in the last five years that concern what one would categorize as part of our lifestyle. Moreover, the discussion has been driven not only by the sheer range of topics but also by a diversity of commentators as experts and non-experts alike have collectively weighed in. Our diets, how much sleep we get, what is the best posture to sit in at work, are a few of the topics that were grist to the mill. One area where these discussions have raged is around fasting. For years, the mere mention of the word fasting elicited deep skepticism from the larger public owing to its association with various religious practices. This state of affairs was in sharp contrast to the views from many health and wellness experts, who have, over the years, always extolled the virtues of fasting. This is where fasting can play a crucial role. The key idea here is not to fast indiscriminately but to fast intermittently. What does intermittent fasting mean? Intermittent fasting is a pattern of eating and fasting where you keep tabs on both what and when you eat. When reading this, the first question that is bound to come up is the impact intermittent fasting has on the human body. When someone fasts, the human body has an inbuilt coping mechanism which adjusts for the dwindling energy reserves stored in your liver. In order to do this, the body draws energy from our fat reserves as fat cells are processed in the liver where they are burned and energy is derived. Moreover, within the body, the appetite ‘regulatory’ procedure has two important participants, one is a hormone in the gut called ghrelin and the other is leptin, a hormone found in fat cells. The former induces hunger whilst the latter indicates to the brain when you are ‘full’. For individuals who have kept up intermittent fasting for a longer period of time, research has shown that ghrelin increased appreciably but this wasn’t accompanied by an insatiable appetite. When individuals – both diabetic and non-diabetic – were seen fasting for a relatively long duration, their bodies showed positive effects. For example, when non-diabetic individuals underwent fasting, they experienced an average weight loss of around 1.5 to 3 kg, the loss more pronounced in overweight patients. It was also noticed in studies on non-diabetics that fasting reduced body-fat percentage, waist circumference, cholesterol/HDL, and LDL/HDL ratio, but all the while there was no reduction in daily energy intake. For years, doctors have combatted the debilitating effects of Diabetes by recommending medicines but diabetes is a metabolic disease and thus, the diet plays an all-the-more critical part. This is where fasting can be part of the solution but the caveat here is that there is plenty scope for more research but should a breakthrough arrive, the benefits could be humongous for humanity. Among the many approaches to intermittent fasting, few are 16:8 where you eat between 8 hours of the day and fast the rest 16 hours, may be done daily or alternate days. Another method is the 5:2 diet where you follow your normal diet for five days of the week but for the two remaining days – the fasting days – your diet is controlled where the calorie count is pegged to around 600 calories. Whilst the jury is out owing to an absence of clinical proof from a large number of patients, what has been seen is that people following this diet have developed a healthier diet and over time, this has reflected positively on their health. For healthcare experts – especially doctors, one interesting development in the last few years has been the role that fasting can play as a means to control or treat diseases. Here, research is currently being undertaken to see the impact of fasting vis-à-vis various diseases like Type-2 Diabetes, Alzheimers, Huntington’s disease (as well as other autoimmune diseases) and even some strains of cancer. Focusing on one such disease, when it comes to fasting, perhaps no disease will have as great an associative in the minds of the people as diabetes. With evolving lifestyles and science and technology taking big strides, research on fasting – especially when conducted on large trial groups – will also come up leaps and bounds. However, on current evidence, a case can’t be made that states without a shred of doubt that fasting is bad for health but on the other side of the argument, evidence has been piling up wherein individuals who have fasted intermittently have felt positive changes. This gives both healthcare experts and the large populace hope that science will be able to reveal more secrets behind the effects of fasting.   Dr Altamash Shaikh - Consulting Endocrinologist, Saifee Hospital ]]> https://biospectrumindia.com/features/21/10944/safe-blood-transfusion-for-thalassemics.html https://biospectrumindia.com/features/21/10944/safe-blood-transfusion-for-thalassemics.html Tue, 15 May 2018 14:45:00 +0530 Thalassemia is a hereditary haemolytic anaemia characterized by the deficient synthesis of one or more globin chains in the haemoglobin. Beta thalassemia major, also called Cooley's anaemia, is a severe form. The conventional treatment for this category of patients is regular blood transfusion and chelation therapy. Repeated blood transfusion exposes these patients to a variety of risks such as transmission of infectious diseases, iron over load and alloimmunization. It becomes the prime responsibility of the treating medical facility to offer the safest possible blood for transfusion that is free from various transfusion transmissible infections (TTI's). Although measures such as adoption of strict donor selection criteria, encouragement of voluntary non-remunerative blood donors and permanent deferral of those with high-risk behaviour as judged by the use of questionnaires are a routine practice globally, the final decision on whether or not to use a blood or blood component, entirely rests on the results of infectious marker testing reports. The Drug and Cosmetics Act governs transfusion services in India and mandates testing for Human Immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), Syphilis and Malaria on all donor units. Different centres use different screening modalities and kits that differ in their sensitivities and specificities. In spite of extensive screening protocols, none of the transfusion services across the globe can ensure 100% blood safety from any of these infectious diseases. Although thalassemia management has drastically improved in recent years, unfortunately the services are not uniform in all the centres. Different blood banks use different screening modalities and kits that differ in their sensitivities and specificities .  The advent of Individual Donor Nucleic acid Amplification Testing (ID-NAT) has narrowed down the window period of these infections considerably and we are a step closer in provision of safest possible blood. ID-NAT is a method of testing blood that is more sensitive than conventional serology tests (ELISA) that require the presence of antibodies to trigger a positive test result. In ID-NAT, Viral RNA and DNA is targeted and amplified billions of times before being detected. It significantly reduces the 'window period' or the time between donor exposure to the virus and the appearance of antibodies. ID-NAT or Individual Donor Nucleic Acid Test assay, which was introduced in India by Hemogenomics, is based on Transcription Mediated Amplification. This technique has decreased the window period of HCV to 2.2 days, HIV to 4.7 days and HBV to 14.9 days. It can even detect viral mutants which may escape the detection otherwise. Yet, there is a long way to go before the Government of India mandates the introduction of NAT in testing algorithms used in blood banks. In a multicentric study, done among Thalassemics, it was shown that  thirteen cases (2.8%) were positive for HBsAg by ELISA, 107 (23.1%) were reactive for anti HCV and 11 (2.38%) for anti HIV antibodies. Further screening and discriminatory assays by ID-NAT confirmed the presence of HBV DNA in 11 cases, HIV RNA in 7 cases and HCV RNA in 48 cases.It was also shown that the overall alloimmunization rate in India was 4.1% and ‘Anti-Kell’ was the most common antibody identified among the 462 thalassemics tested. In spite of economic constraints, the continuous work and efforts of the Transfusion Medicine fraternity, who are switching over to ID-NAT testing to provide the safest possible blood at their respective centres, is commendable. Patient awareness and public outcry can help drive the way further towards universal ID-NAT across all the centres in the country.   -Dr. Mohit Chowdhry, HOD- Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi ]]> https://biospectrumindia.com/features/21/10821/a-serious-condition-called-snoring.html https://biospectrumindia.com/features/21/10821/a-serious-condition-called-snoring.html Tue, 24 Apr 2018 14:25:00 +0530 Snoring is a condition where something in the nose, mouth, throat or lungs blocks breathing while sleeping producing a soft or loud and unpleasant sound. It is a sign or first alarm of OSA (obstructive sleep apnoea). Sleep Apnoea is where there are one or more pauses in breathing while you sleep. Pauses may last a few seconds to minutes, and as many as 30 times an hour. Breathing usually restarts with a loud snort or choking sound. Sleep apnoea may be obstructive, central or a combination called complex sleep apnoea. Causes- Snoring and Obstructive sleep apnoea- In the nose a crooked nose bone or polyps are common causes, in the throat, throat muscle weakness, loose or tight jaw, fat in the neck, thick tongue, loose low roof of mouth, or tongue falling back while sleeping on the back. Relaxants like alcohol or some medicines also cause this. Effects- Medical- Increased risk of high blood pressure, heart attack, stroke, obesity, diabetes, heart failure, irregular heartbeats, and driving or work related accidents. Psychosocial- irritability, poor concentration. Social- Usually bed partner is also tired, irritable and suffers sleep deprivation due to the loud snoring . At one time sleep apnoea and snoring was a major cause for divorces or separations around the world . Signs and symptoms- In adults include loud chronic snoring almost every night , choking snorting or gasping during sleep, pauses in breathing, waking up often feeling out of breath, daytime sleepiness and tiredness, waking up with a dry mouth, going to bathroom often at night, forgetfulness and decreased concentration, morning headaches, impotence in men. In children loud snoring, sleeping in strange positions, bedwetting , heavy sweating at night, or night termors are frequent symptoms. Risk factors- overweight, male, over 50, smoker, high blood pressure, alcoholic, or thick neck collar size over 40 cm. Crooked nose bones, large tonsils, flat chin, allergies and nasal polyps. Treatment- Medical- all treatments for snoring and sleep apnoea try to fix the blockage or bypass it. These include special pillows, devices to keep the jaw aligned or the nose open, machines that continuously blow air into the nose and throat to keep them open (CPAP). These are all for mild to moderate cases. Surgical- Uvulopalatopharyngoplasty (removal of tissues in back of throat), surgery to correct crooked nose bones and remove extra tissues from the nose, removal of tonsils , reducing the size of the tongue, and insertion of stiff materials into the top of the mouth . Hyoid advancement where the bone in the neck to which tongue is attached is pulled up and forward, tongue advancement by moving the tip of the jaw outward, lower jaw advancement, where the entire upper and lower jaw is moved forward by 1.2 cm, and making a hole in the neck called a permanent tracheostomy (for extreme cases). Self help tips- Loose weight, exercise or brisk walking, lifestyle changes, mouthpieces and use of breathing devices. Also, identification of other conditions causing obstruction like allergies and avoiding anything that causes allergies and blocked nose. Quitting drinking, smoking and avoid taking sleeping pills or sedatives of any kind. Avoid caffeine and heavy meals two hours before sleeping. Yoga to strengthen the muscles of the throat. Maintain regular sleeping hours. Sleeping on the side (or ask bed partner to roll you over if you snore), wedge a pillow stuffed with tennis back behind the back to prevent rolling onto the back, elevate the head of the bed by 4 to 6 inches. If the cause of sleep apnoea is heart or nerve problems or any kind of brain damage or diabetes, get it treated by a specialist. Get a sleep apnoea test called a polysomnography done. Learning to play blowing instruments and singing can also strengthen throat muscles and reduce sleep apnoea. Home exercise for sleep apnoea include- Press the tongue down and brush top and sides of tongue with toothbrush. Press the tongue up against the roof of mouth and hold it there for 3 minutes a day. Purse the lips as if going to kiss and move them up and to the right, then up and to the left 10 times. Repeat again 3 times. Blow a balloon by breathing in through nose and out through mouth 5 times . Gargle with water five minutes, twice a day. Lightly hold the tongue in teeth and swallow five times. Repeat this 5 to 10 times a day.   - Dr Dillon Dsouza , Mumbai based Consultant ENT and Head and Neck surgeon, Snoring and Sleep Apnoea, attached to Jaslok Hospital and Desa Hospital ]]> https://biospectrumindia.com/features/21/10797/challenges-opportunities-of-blood-screening.html https://biospectrumindia.com/features/21/10797/challenges-opportunities-of-blood-screening.html Wed, 18 Apr 2018 11:55:00 +0530 A 10-year-old girl suffering from blood cancer, who had tested positive for HIV allegedly after getting a transfusion of infected blood in Kerala, died recently. Patients such as thalassemic children, accident victims, those undergoing surgery and cancer patients require frequent blood transfusion. A myriad of agents can potentially be transmitted through blood transfusions, including pathogens and viruses. Given the high prevalence of HIV and Hepatitis in India, the National Blood Policy states that every unit of donated blood should be tested for safety against transfusion transmissible infections. The current method of screening which is used across most blood banks is serology (including ELISA/ Chemiluminescence) that relies upon the presence of antibodies in the donated blood for detecting the infection. However there is a time gap between a person being infected and sufficient antibodies (which can be detected) being produced against that infection and that time gap is called ‘Window Period’. Therefore, blood donors who are recently infected may pass on their infection through their donated blood, since their blood does not have enough antibodies. This may cause the infection to be ‘missed’ (undetected by serology-based tests,) leading to an innocent patient receiving infected blood. The Hepatitis B virus genotype D is the most predominantly found genotype in India and is characterized by low viral load. Such type of infections, if in the early stage, may get missed by serology. Another situation where even a highly sensitive serology test may fail to work, is Occult Hepatitis B infection, which is identified by the absence of detectable Hepatitis B surface Antigen and low levels of viral replication. One of the most advanced screening techniques introduced in the field of Transfusion Medicine is Nucleic Acid Testing (NAT). Unlike serology, NAT does not depend on antibodies. Instead, it directly targets the viral genetic material (RNA/DNA), amplifies it and detects it. This considerably reduces the risk of transmission of window period infections. A noteworthy example is that of Hepatitis C virus, where the window period is reduced from over  3 months in case of conventional serology to as low as 2 days in case of NAT testing !  According to a study conducted by AIIMS (New Delhi)  to analyse the data of 5 years of NAT testing, a total of 684 cases of infected blood units  were detected  by NAT, thereby preventing the transmission of infection to 1200 to 1800 innocent patients. Currently in India, NAT is used in two formats: Individual Donor (ID-NAT) and Mini-Pool NAT (MP-NAT). ID-NAT tests each donor sample individually, thus decreasing the chances of missing out infections in cases of low viremia and makes it a highly sensitive technique.  On the other hand, MP-NAT mixes together 6 or more donor samples in small quantities and then tests it. Pooling compromises the accuracy of results in cases of low viremia. Unlike countries like USA, Canada, most of Europe, Japan, Korea, Singapore, Sri Lanka, UAE, South Africa, Thailand, China, etc. where compulsory NAT has ensured the safest blood supply possible, NAT is still not mandatory in India. Currently, almost 100 blood banks including AIIMS, PGI Chandigarh, CMC Vellore, Medanta-The Medicity and Narayana Hrudayalaya are using NAT in ID-NAT format, whereas around 40 blood banks are using pooling technique. High prevalence of HIV and Hepatitis, lack of regular repeat blood donations and usage of low sensitivity screening result in a high number of transfusion transmitted infections in India. Even though we have started moving towards the direction of ‘safe blood for all’, more stringent measures are needed to ensure blood safety.   - Sumit Bagaria, Managing Director & CEO, Hemgenomics Pvt. Ltd., Bengaluru ]]> https://biospectrumindia.com/features/21/10766/the-trending-critical-care.html https://biospectrumindia.com/features/21/10766/the-trending-critical-care.html Thu, 12 Apr 2018 18:25:00 +0530 Intensive care medicine, also referred as 'critical care medicine' is a speciality concerned with management of critically ill patients who are at-risk, or have developed potentially life threatening failure of any of the body organ systems. It is a speciality involving holistic care of all aspects of critically ill patients. This includes diagnosis, monitoring, treatment and organ support for acute illness, patient safety, end of life care, ethics and the support of families. While other specialities have a predefined role of managing a single organ, in intensive care medicine, the entire spectrum of medical and surgical pathologies are managed. It is a lifesaving and dynamic branch with the responsibility of managing the sickest of patients in hospital. An intensivist is able to provide advanced organ support during critical illness and co-ordinates with other specialities for the care of ICU patient. Till about two decades ago, there was a scarcity of a structured training program in ICU management. But there are now formal recognised courses in our country in the field of intensive care medicine like FNB (Critical care Medicine) by National board of examinations, IDCCM and IFCCM courses run by the Indian society of critical care medicine (ISCCM). MCI has recognised critical care medicine as a superspeciality. Of late awareness about critical care and intensive care facilities has come into focus. There is increased understanding among general public about the difference in care between an ICU and ward patient. Recently several TV channels had shown several ICUs in big cities with no MBBS doctors. Now the authorities have made it mandatory to have qualified and ICU trained doctors to work in ICU. This should be ensured at all times. A well-equipped ICU is able to provide facilities i.e. respiratory support, renal replacement therapy (kidney support), radiologic bedside investigations, echocardiography, ECMO therapy, IABP (for support to the heart) to name a few. Also, in-house microbiological (infection) and several radiological investigations facilities are a must. Because of the very nature of high tech, high intensity work involved, the care in ICU thus comes at a substantial cost. To be able to deliver optimal care lot of equipments, and manpower like intensivists, nurses, technicians, physiotherapists, dieticians, occupational therapists are required. There are scant data on the organisational aspects, case mix and practice patterns in India. A closed ICU is defined as one in which final orders for the patient were written by the ICU team; an open ICU defined as one in which care of the patient was directed by non-ICU doctor teams, and orders could be written by non-ICU team doctors. The most common ICU is however an open ICU with mandatory critical care consultation, with shared responsibility of ICU and non- ICU teams. As Comparative data with the west is lacking about critical care facilities no conclusion can be drawn, but it is understood that with rising number of private sector hospitals and upgrading govt hospitals the focus has been on providing better critical care services. This is both in terms of number of beds, ICU armamentarium and services. Upgrading ambulance services – both road and air ambulance has further pushed the need of ICU beds in super specialty centres. Upto 15-20% of the beds are being dedicated to Intensive care in recent times. The need for ICU care is being emphasized for advanced monitoring as it contributes to – pre emotive / timely diagnosis and management that provides medicolegal safety.  In the Indian context the major challenge is providing adequately trained nursing staff and paramedics. As the nursing turnover is high due to several reasons, going abroad being foremost – a fresh look at developing a staff retention policy is needed.  Technicians (dialysis/radiology) physiotherapists dieticians, occupational therapists are not readily available at all centres. Telemedicine is an important modality in these times. Several satellite ICUs can be linked and expert opinion can be sought in real time. There are no head to head trials demonstrating a direct benefit of eICUs but it is presumed that remote expert opinion and supervision would translate into benefit of the critically ill in these ICUs but cannot be compared with closed ICUs. A hospital information system with electronic record keeping is not available universally but hospitals are realizing the importance of digital records / data and imaging. This enables bed side viewing of results, prescriptions, safety alerts apart from faster data transfer and safe record keeping. In future the advances in the field of genomics and metabolomics will give us better understanding of the disease process and hopefully a treatment modality that will be individually tailored to the patient. Conclusion Critical care medicine is an important part of healthcare system in the developed world and is one of the fastest growing medical fields especially in terms of patient numbers.  It is now slowly being felt and recognized in developing countries where a major challenge is to ensure adequate infrastructure, training, equipments and funding for these newer members of the critical care arena.   - Dr. Yatin Mehta, Chairman Institute of Critical Care and Anaesthesiology, Medanta – The Medicity ]]> https://biospectrumindia.com/features/21/10746/the-agony-of-endometriosis.html https://biospectrumindia.com/features/21/10746/the-agony-of-endometriosis.html Tue, 10 Apr 2018 11:05:00 +0530 The most severe painful periods in women occur due to a condition called “Endometriosis”. Though it is a benign condition, it can behave like a cancer! It spreads its tentacles from the ovaries to the pelvis and can go further to invade the bowel, the bladder, the uterus, scars in the abdomen wall and sometimes travels even beyond the pelvis and the abdomen into the chest! What is endometriosis? It is simply the invasion of the endometrium (inner lining of the uterus) into spaces where endometrium is normally not found. It responds to the hormones in the body in a similar way as the endometrium responds. Every month, the endometrium within the uterus grows thicker in response to the rising hormones in the blood of a menstruating woman, and prepares itself to receive an embryo. If a woman has been sexually active and has conceived, then this thick lining helps in nourishing the growing embryo. But if a woman is not pregnant the endometrium is shed off through the vagina during a menstrual period and the cycle starts all over again in the next month. Just as the endometrium within the uterus responds, so also does the endometrium outside the uterus responds to the circulating reproductive hormones.  It grows thicker and sheds every month, and when it sheds, the blood which accompanies it, has no outlet. This collection of blood into spaces which have no outlet causes the extreme pain which accompanies this condition. The pain in the early stages maybe mild, but as the disease progresses, the pain gets excruciating and unbearable, leaving a woman in agony which is difficult to be control with routine pain killers. Unfortunately, endometriosis is the disease of young women in their reproductive age, when estrogen, the youth hormone is in circulation. Hence it can occur in any girl after she starts menstruating but is not seen after menopause. It is important to keep this in mind, as there are many girls who have such severe pain during periods that they actually miss school or college during their periods. Some of them vomit and even faint, and they are told that this is normal, that it also happened to their own mothers, bear the pain, it will go after marriage etc. etc. If only an ultrasound is done, we would be able to treat these young girls and make their lives more comfortable, besides preventing the disease from getting more severe. The only self limiting event is menopause. Once a woman attains menopause either naturally or due to surgical removal of the ovaries which produce the reproductive hormones causing the endometrium to grow and shed, the disease comes to a halt and regresses gradually. But even after menopause, it can get stimulated once again if the affected woman consumes therapies containing estrogenic compounds such as isoflavones (herbal) or estrogen itself. Endometriosis is more commonly seen in career women or those who have “Type A” personalities and in women who delay childbirth. Approximately 40% of infertile women have endometriosis which may be mild, moderate or severe. In infertile women, the disease may be so mild that it may not show on sonography. But if we suspect that it may be present, then to prove the diagnosis we have to proceed with a laparoscopy ie. check the interior of the abdomen with a telescope. Besides the pain which it causes in the lower abdomen and back, endometriosis can also be the cause of extreme pain during sexual intercourse which is termed as dyspareunia. There is unfortunately no cure for this disease as of today, only because we still do not know the cause of this disease. Fortunately we do have potent drugs which can help to keep it under control, but these drugs do have side effects thus limiting their use. Surgery is the preferred choice of treatment for relief of pain especially if excessive. The surgery can be performed laparoscopically or as open surgery, depending on the severity of the condition. The ideal option for infertility management in a woman having moderate or severe endometriosis is Assisted Reproduction (IVF) after removing as much of the disease as possible surgically.  Endometriosis is truly a condition which may make a woman dread the approach of her period and also her sexual partner. -Dr Duru Shah , Director, Gynaecworld Center for Assisted Reproduction & Women’s health; Panel Consultant – Breach Candy Hospital & Jaslok Hospital ]]> https://biospectrumindia.com/features/21/10735/world-health-day-2018-universal-health-care-for-all.html https://biospectrumindia.com/features/21/10735/world-health-day-2018-universal-health-care-for-all.html Fri, 06 Apr 2018 15:40:00 +0530 Universal Health Care has become a fundamental principle guiding much of Public Policy and Healthcare Services in countries around the world. The basic premise of this construct is to alleviate the financial costs associated with healthcare while increasing individual access to these services. The World Health Organisation has designated the theme for 2018’s World Health Day to be ‘Everyone, Everywhere’, an indication that nations around the world are aspiring to provide higher accessibility of healthcare to their citizens. Time is therefore right for stakeholders in the public and private healthcare delivery systems and the medical education ecosystem to collaborate and drive the agenda of universal healthcare coverage for India. The Government seems to have given the principle a tacit approval, as demonstrated by the impetus placed on Public Healthcare in the 2018 Budget. Upon implementation, India is set to have the world’s largest public health care programme that would cater to half a billion of its citizens. Modicare has lofty goals to fulfill as it aims to ensure that nearly 10 crore vulnerable families would be entitled to coverage of up to Rs 5 Lakhs a year. India is amongst the group of countries with the lowest proportions allocated to healthcare globally. This policy would help ensure a minimum standard of coverage offered to citizens, improving accessibility and health outcomes for the masses. Apart from this, there are indications of a New Pharmaceutical Policy that is likely to be introduced that would run in tandem to help ensure the effective implementation of the Modicare plan. While a change in public policy and discourse is one end of the spectrum that governs Universal Healthcare, it’s effective implementation is governed by stakeholders in the Healthcare Industry. For a country where public healthcare spending has traditionally been less than 1% of its GDP, private healthcare delivery has taken monumental strides to improve accessibility and delivery of healthcare services in the country. The start up ecosystem in healthcare which has contributed to the rise in use of digital technologies in various facets of healthcare has also played an important role in the market. Right from the use of health applications by consumers, data mining and analytics for personalized service offerings, digitization of health information and records, or even leveraging Artificial Intelligence (AI) for a varied array of functions specific to the industry, the trends in healthcare seem to move towards improving access, delivery and personalisation. The diagnostics industry is similarly transforming disease detection with innovative technologies. Another important trend seen is a rise in the adoption of Home Health Services, where access to quality healthcare is not limited to institutions like hospitals; instead, it can be delivered to the patients' doorstep. This would make it easy for individuals to access Clinical and Non- Clinical Care despite time, distance, monetary and other restrictions.  All these changes happening in the industry will collectively contribute to the idea of Universal healthcare in India. When these trends are analyzed cohesively, they leave us with the impression that the consumer with various new technologies at their disposal will define the movement of Universal Healthcare. This is a promising sign for the future and hopefully will lead towards a healthier country. -Vishal Bali, Co-founder and Chairman, Medwell Ventures ]]> https://biospectrumindia.com/features/21/10692/good-oral-hygiene-can-prevent-life-threatening-diseases.html https://biospectrumindia.com/features/21/10692/good-oral-hygiene-can-prevent-life-threatening-diseases.html Fri, 30 Mar 2018 09:15:00 +0530 The most neglected part of our health is usually our teeth. Most of us are unlikely to visit a dentist until the problem is really serious. A nagging toothache that will not go away is the only time we reluctantly decide to visit the dentist. What many of us do not know is that a simple toothache or a decayed tooth can have severe implications on our overall health and well-being. Even the slightest tingling discomfort in our gums can be a telltale sign of bad oral health, which needs immediate attention.   A good oral hygiene can prevent Stroke A recent study has discovered a link between a particular type of oral bacteria that increases our chances of having a stroke. Although the connection seems far-fetched, research has shown that these bacteria are found in among one third of all stroke victims who have simultaneously been diagnosed with severe oral health problems.  A strain of bacteria, popularly known as Streptococcus Mutans, causes bleeding from the gums; transmitting the bacteria through the bloodstream into the brain. The bacteria then attaches itself to the fragile veins of the brain and triggers cerebral hemorrhages or strokes. Consequently, tongue movements are lost, and lips become droopy while the infection enters the blood stream and attacks the lining in the heart. This bacterium also has a protein layer on its surface, which makes the platelets in the blood to clump around it, thereby creating a protective cover. This shield protects the bacteria from the body’s natural immune system and antibiotics. Unfortunately, the platelets gathering together in this way creates blood clots, which can ultimately lead to strokes.   Poor Oral Hygiene can lead to rheumatoid heart diseases Keeping our teeth healthy goes a long way in keeping our hearts healthy! Without regular cleaning, plaque builds up on the teeth and hardens into tartar. Tartar can cause inflammation in our gums and makes it very difficult to clean our teeth. Decayed teeth is like a fertile breeding ground for bacteria. One theory that researchers have put forward is that oral bacteria can cause the liver to produce high levels of certain proteins, which inflame the blood vessels, leading to a heart attack or stroke. The simplest way to identify periodontal disease is persistent bad breath and swollen or tender gums that are prone to regular bleeding while brushing. In such cases, the patient might also feel that their gums are being pulled away from the teeth or experience loose and shaky teeth. Such symptoms require immediate attention.   Dental hygiene and respiratory disorders For years, scientists have suggested that there is a connection between respiratory disorders and poor oral hygiene. Pneumonia is an infection of the lungs caused by a wide variety of infectious agents, including bacteria, fungi, parasites, and viruses. Bacterial chest infections are usually caused by inhaling bacteria from the throat and mouth into the lungs. However, food particles that tend to degenerate in the mouth also cause bad bacteria, which can be transmitted into our lungs. When the bacteria is transmitted to the lungs and is not eliminated on time, they can multiply and cause serious respiratory infections and Pneumonia, which can be a serious threat to life especially to our elderly.   Expert Speak: Non-Negotiables Fortunately, maintaining a good oral hygiene is not a very difficult task. It is important to follow a regular regimen that prevents decay and gum disease. Here are a couple of ‘dos’ that ensure optimum oral health for one and for all. Adolescents with hectic traveling and erratic lifestyles must brush daily before going to bed and in the morning before eating anything. Regular rinsing of the mouth after eating food and drinking sweet drinks is non-negotiable! It is never too late to learn the right techniques of brushing your teeth. Practice brushing in small circular motions in order to clear the mouth from residual food particles Flossing is completely neglected in our country due to low awareness. Regular flossing keeps the gaps between the teeth clean from food particles, which can otherwise accumulate debris and cause plaque. It is also advisable to use an antibacterial mouth rinse, which can kill any germs in the mouth. Those with poor eating patterns should focus on consuming vitamin rich food such as Vitamin D and calcium regularly to maintain strong and healthy teeth One must be aware that certain medications like those for high blood pressure and depression cause dry mouth and therefore are at a risk for contracting oral infections A half-yearly visit to the dentist to get your teeth checked and cleaned is also a part of good dental regimen. People in the age group of 30-45 years must visit the dentist once in 6-8 months as cavity which is normally 0.1 mm wide may expand to 0.4 mm in the 40s causing irreparable treatment For people aged above 45 years, visiting the dentist once every 6 months and professional teeth cleaning is advisable   - Dr. Nivedan Kumbi, Lead Dentist, Nightingales Home Health Services ]]> https://biospectrumindia.com/features/21/10660/the-common-disorder-called-nafld.html https://biospectrumindia.com/features/21/10660/the-common-disorder-called-nafld.html Tue, 27 Mar 2018 10:10:00 +0530 Liver is an organ that processes food we eat, stores energy and provides the body with a healthy immune system.  Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non serious condition called fatty liver.  In fatty liver, fat accumulates in the liver cells. Although having fat in the liver is not normal, by itself it probably does not damage the liver. Some people with NAFLD may have a more serious condition named non-alcoholic steatohepatitis (NASH). In NASH, fat accumulation is associated with liver cell inflammation and different degrees of scarring. NASH is a potentially serious condition that may lead to severe liver scarring and cirrhosis. Cirrhosis occurs when the liver sustains substantial damage, and the liver cells are gradually replaced by scar tissue, which results in the inability of the liver to work properly. Some patients who develop cirrhosis may eventually require a liver transplant (surgery to remove the damaged liver and replace it with a “new” liver). Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include: Enlarged liver, Fatigue, discomfort in the upper right abdomen. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following: Overweight or obesity (Lean people may also suffer from NASH) Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin High blood sugar (hyperglycemia) High levels of fats, particularly triglycerides, in the blood These combined health problems appear to promote the deposition of fat in the liver. For some people, this excess fat acts as a toxin to liver          cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver.  Some patients with excessive fibrosis progress to cirrhosis.   - Dr Prasanna S Shah, MD, DNB Consultant Interventional Gastroenterologist, Jaslok Hospital and Research Centre ]]> https://biospectrumindia.com/features/21/10614/tonsils-and-adenoids-do-not-always-follow-the-rules.html https://biospectrumindia.com/features/21/10614/tonsils-and-adenoids-do-not-always-follow-the-rules.html Sat, 17 Mar 2018 13:30:00 +0530 The Adenoids are two small lumpy balloon like tissues behind the back of the nose and throat. They are part of the lymphatic system which is lots of piping and tubing around the body with little storage tanks and pumps to move it around. The lymphatic system produces white blood cells and proteins and fats in a liquid form. The lymph system is a major part of the bodies immune system that fights infections , cleans up dead cells and even destroys cancer cells naturally. Lymph nodes are soft, small, round- or bean-shaped structures like rajmah beans . They are found in the neck, armpit, groin, inside the center of the chest and abdomen. They make immune cells or soldier cells that help the body fight infection. They also filter the lymph fluid and remove foreign material such as bacteria and cancer cells. When bacteria are recognized in the lymph fluid, the lymph nodes make more infection-fighting white blood cells, which cause the nodes to swell. The swollen nodes are sometimes felt in the neck, under the arms, and groin, this is what your doctor looks for by poking and pressing you in uncomfortable places to find them. Lymphatic Tissue is like a bath sponge, soaked with large numbers of white cells, and is found in the spleen near the stomach, the thymus a butterfly like organ behind the chest in front of the heart, and the tonsils (little balls of lymphoid tissue  arranged in a ring including the adenoids, two tubat tonsils near opening of ear into throat, two palatine in the soft part of the top of the mouth, and lingual tonsils inside the tongue), as well as visceral nodes(around stomach liver and other organs), peyer's patches (all along the intestines) and lacteals which are all associated with mucous membranes of the gastro-intestinal tract. The adenoid, also known as a pharyngeal tonsil or nasopharyngeal tonsil, is a bunch of grapelike  tissue situated behind the nose,  where the nose joins  the throat. They usually disappear around four to five years of age. After birth, enlargement begins and continues until aged 5 to 7 years. Symptomatic enlargement between 18 to 24 months of age is not uncommon, meaning that snoring, nasal airway obstruction and obstructed breathing may occur during sleep. However, this may be reasonably expected to decline when children reach school age, and progressive shrinkage may be expected thereafter. What do they do? These immunocompetent tissues are the immune system's first line of defense against ingested or inhaled foreign bacteria, viruses. Tonsils have on their surface specialized antigen capture cells called M (like the police crime detection cell) cells that allow them to recognise bacteria and viruses . These M cells then alert the underlying B cells and T cells (active police force) in the tonsil that a pathogen is present and an immune response (attack against the invader) is stimulated.  B cells are activated and proliferate (multiply) in areas called germinal centres in the tonsil. B memory cells are produced which can remember the bacteria or virus for future reference (rogues gallery). Recent studies have provided evidence that the tonsils produce T lymphocytes, (Traffic controllers which control the body’s immune fighting response) also known as T-cells. Thus they are part of the police force of the human body. Effect of large adenoids An enlarged adenoid, or adenoid hypertrophy, can become nearly the size of a ping pong ball and completely block airflow through the nasal passages. Even if the enlarged adenoid is not substantial enough to physically block the back of the nose, it can obstruct airflow enough so that breathing through the nose requires an uncomfortable amount of work, and inhalation occurs instead through an open mouth. The enlarged adenoid can also obstruct the nasal airway enough to affect the voice without actually stopping nasal airflow altogether. Adenoid faces Enlargement of the adenoid, especially in children, causes an atypical appearance of the face, often referred to as adenoid faces.  Features of adenoid faces include mouth breathing an elongated face, prominent incisors (front teeth poking out) hypoplastic maxilla (flat face) short upper lip raised nostrils, and a high arched palate (top of the mouth becomes high like a dome. Can they be treated? Yes when problem causing adenoids are first detected and the amount of block confirmed by xrays or ct scans, antibiotics , anti-inflammatories and medicines to stop allergies are used to treat them. Most of the cases respond well to medication. When do I need to remove my adenoids? If in spite of good medication and avoiding allergy causing foods , there is severe difficulty breathing in a child or adenoid facies starts developing or the child keeps developing ear infections and discharge , removal of adenoids and tonsils is indicated. How are they removed? Surgical removal of the adenoid is a procedure called adenoidectomy. Adenoid infection may cause symptoms such as excessive mucus production, which can be treated by its removal. Studies have shown that adenoid regrowth occurs in as many as 20% of the cases after removal. Carried out through the mouth under a general anaesthetic (or less commonly a topical), adenoidectomy involves the adenoid being scooped out like scoopin g icecream , or cauterised (burnt by electric current ), or vaporised by lasers or melted by a machine called a coblator. Is there any risk involved in the procedure? Apart from the usual risks associated with anaesthesia and any surgery , there are no additional risks associated with adenoidectomy done properly.   - Dr Dillon Dsouza , Consultant ENT and Head and Neck surgeon , attached to Jaslok hospital , Breach Candy Hospital and Desa's Hospital ]]> https://biospectrumindia.com/features/21/10539/the-complex-nature-of-stds.html https://biospectrumindia.com/features/21/10539/the-complex-nature-of-stds.html Mon, 05 Mar 2018 17:35:00 +0530 Casual Sex, sometimes with a partner one hardly knows, has become a common feature in modern society, especially amongst those who are addicted to drugs and alcohol. Having a different sexual partner every few weeks or months is considered “cool” and an achievement to be bragged about! But how many women realize the kind of risks they are exposing themselves to when they live such a life? Many women find it difficult to ask their partners to use condoms, fearing that their partners, whom they think they are in love with, may get offended at such a suggestion. There are others who proceed with unprotected sex, because they would not like to displease their partners as many men find condoms sexually unsatisfying. Unprotected sex has 2 major risks for women, the first being an unwanted pregnancy and the other which is the more risky one, is that of getting infected with a sexually transmitted infection. Young girls feel that an unwanted pregnancy can be easily managed by popping in an “I pill” immediately after sexual intercourse. Little do they realize that it has a 10-15% failure rate and they would get pregnant even after they have taken the pill! On the other hand there are women who would not even take that precaution and would act only after they got pregnant. Termination of pregnancy is so easily available at such a low cost, that subjecting themselves to a procedure whether medical or surgical, does not really bother them. It is unfortunate that with every termination of pregnancy there is always a possibility of an incomplete abortion, whereby some of the pregnancy tissue does not get expelled and gets retained within the uterus, leading to an infection which may be so severe that it could even lead to death! If less severe, it could damage the fallopian tubes, leading to infertility, when later in life pregnancy is desired. Hence it is so necessary to have the procedure taken care of at centers which are hygienic, though prevention of pregnancy would be definitely the more advisable choice. The second risk which women face with unprotected sex is that of picking up a sexually transmitted infection (STI) from an infected sexual partner. There are various STI’s which exist and they lead to various symptoms such as excessive foul smelling vaginal discharge, severe vaginal burning and itching, frequent and painful urination. These distressing symptoms, force a victim to seek urgent medical help and treatment of the infection. But there are certain infections such as Chlymadia, which silently invades the female reproductive system and causes havoc by damaging the fallopian tubes leading to infertility or ectopic pregnancies. On the other hand is the HPV infection which is the cause of 80% cases of cancer cervix! Besides such infections may create ugly growths around the genital area, which can become extremely embarrassing and repulsive! There are some infections like the Herpes infection which can stay within the system for years  and get passed on to the developing baby within the uterus, leading to problems in the healthy development of the baby’s brain and various other organs. Bacterial STI’s can be easily treated with antibiotics though Viral infections can be only suppressed. It is extremely important that treatment should be taken by both the sexual partners, so as to nip it in the bud before it reaches humungous proportions. The infection can have a domino effect by an infected partner passing it on to all his or her unsuspecting partners, when both the partners don’t take the treatment simultaneously, which happens very often. The male partners usually do not have any symptoms hence are reluctant to take the treatment. In such a situation the infection can become chronic and resistant to any treatment. So, the simple advice to all sexually active women, especially those who have multiple partners, is to insist that all their partners use condoms, which will offer them dual protection from pregnancy and STI’s.  And the advice to the women who have only  single sexual partners, please insist on the condom, because for you, he may be the first and only sexual partner, but you may not be his first and “only” sexual partner in his life! On the other hand, when men are sexually active without protection, they are equally at risk of picking up infection from their female partners. Sexually transmitted infections like HIV, Hepatitis B, Hepatities C and HPV are silent infections, without any symptoms but lead to life long disability and cancer. Sexually transmitted infections may cause actually painful symptoms such as gonorrhoea, which makes the person rush to the doctor immediately. So the acute ones get treated quickly, whilst the silent ones remain inside for years and are detected only when the disease has caused its harm. Yes, men don’t have to worry about getting pregnant, but they should realize that they can pass on their diseases picked up through unprotected casual sex, sometimes with commercial sex workers, to their future wives and through them, to their future children ! Hence being young and having fun is ok, but not when it is irresponsible, not when such fun is the cause of dreaded diseases in one’s loved ones !   - Dr Duru Shah, Director, Gynaecworld, Center for Assisted Reproduction & Women’s health; Panel Consultant – Breach Candy Hospital, Jaslok Hospital, Global Hospital and Hinduja Healthcare ]]> https://biospectrumindia.com/features/21/10494/the-biological-therapy-of-cancer.html https://biospectrumindia.com/features/21/10494/the-biological-therapy-of-cancer.html Tue, 27 Feb 2018 12:35:00 +0530 Cancer, the big C, is a dreaded word for patients and medical professionals alike. In simple words, cancer refers to abnormal, uncontrolled growth of cells. Many cancers are not detected or do not cause symptoms until advanced stages, making it challenging to treat the condition. India is showing significant increase in incidence rates of oral, prostate and renal cancer among male population while the female population is showing increased rates of uterine, cervical, breast and thyroid cancers. Chemotherapy, radiation therapy and surgery comprise mainstream treatment modality for various cancers. However, despite advances in these therapies, cure from cancer remains an elusive goal. Immune surveillance by multiple cell types is responsible for recognizing and eliminating damaged/abnormal cells from the body thereby protecting the host. Nonetheless, there are limits to which the body can respond to illnesses. Cancer is one such condition where the immune system is challenged to keep the uncontrolled proliferation of cells in check. As a result, otherwise healthy individuals are also known to develop cancer. Additionally, cancer cells are capable of ‘hiding’ from the immune system and evade being removed from the body. In other instances, despite recognition of the abnormality, rapid proliferation and substances released by cancer cells may hinder immune surveillance. Recent advances in cancer therapy therefore aim to harness the power of immune cells and train them to specifically attack cancerous cells. Immunotherapy aims to utilize certain parts of a person’s immune system and stimulate them to fight diseases such as cancer. Immune effectors are capable of identifying and destroying cancerous cells that are inaccessible to conventional treatment modalities. Specificity and generation of long term immune surveillance against cancer cells is the chief goal of immunotherapy. Several types of immune system cells such as: T cells, Dendritic cells (DC), Natural Killer cells (NK) etc. are candidates being researched in cancer immunotherapy. As universally known, antigen presenting cells (APC) are a group of cells that mediate immune response by processing and presenting antigens to lymphocytes such as T cells. Dendritic cells (DC) are professional APCs that act as a bridge between the innate and adaptive immune systems. These cells function to eliminate extrinsic antigens and are strategically placed at niches/interfaces between internal and external environments. DCs are responsible for the initiation and regulation of adaptive immune responses to viruses, bacteria and tumors. In context of cancer, discovery of DCs and development of the capacity to generate large numbers of these cells through ex vivo culture, has fundamentally changed the approaches to active cancer immunotherapy. Efficient loading of DCs with tumor-derived antigens is at the forefront of most immunization strategies. Proper activation of antigen-loaded DCs can initiate potent anti-tumor immune responses. Immunization strategies may be accomplished either by directing tumor antigens to host DCs in situ or by ex vivo expansion and loading of DCs with tumor antigens and the return of these antigen-pulsed DCs to patients with cancer. Dendritic cells also interact with host regulatory T cells and are capable of inducing activation and expansion of these potently immunosuppressive populations. Clinical studies using DC vaccines for various cancers have demonstrated the biological activity, feasibility, safety and efficacy of these vaccines. Although these studies are preliminary, results are encouraging in that these strategies may prolong survival in cancer patients. Similar to dendritic cells, natural killer cells (NK cells) are components of the innate immune system that play a major role in host-rejection of tumors and virally infected cells. Cells of the innate immunity mediate immediate, short-lived responses against tumor cells. These cells when released in close proximity to cells that are marked for killing, form pores in the cell membrane of the target cell through enzymatic activity and induce programmed cell death. However, cancer cells, as previously explained are capable of escaping NK cell attack and inducing NK cell paralysis/defective NK cells. Nonetheless, NK cells can kill target cells without prior immunization or Major Histocompatibility Complex (MHC) restriction. Therefore, immunotherapy strategies aim to utilize adoptive transfer of expanded NK cells to inactivate cancer cells. As an example of cancer immunotherapy, in context of brain tumors, it was earlier assumed that the CNS is immunologically privileged which hindered the development of immunotherapy strategies. However, it is now known that even though dendritic cells are absent in the CNS, microglia act as resident antigen presenting cells. Also, studies have shown that naïve T cells can access antigens originating from the CNS at the cervical lymph nodes and nasal mucosa through cerebrospinal fluid drainage via perivascular spaces. Activated T cells with CNS tropism then cross the blood–brain barrier where they function as either cytotoxic or helper T cells. Additionally, low levels of antibody accumulation in the CNS following peripheral immunization have been described. Overall, therefore, we may describe the immune status of the brain as ‘immunologically quiescent’ and that techniques to activate the immune system should be devised to mount an effective response against cancerous cells in cases of brain tumors. Immunotherapy may be of different types namely: passive, active and adoptive. Passive immunotherapy targets tumor cell-specific antigens by administration of molecules in the absence of a host anti-tumor response. Active immunotherapy constitutes initiating an effective immune response in vivo, upon immunization against the cancer cells. Adoptive immunotherapy involves the ex vivo expansion and activation of a patient’s lymphocyte before returning these effector cells to the tumor-bearing host to fight cancer cells. Amongst the types of cells used in immunotherapy, studies are also focusing on chimeric antigen receptors (CAR) to generate non-HLA-restricted tumor-reactive T cells. CARs are recombinant receptors that typically target surface molecules. The reason that CARs are gathering attention is because, similar to APCs, they can circumvent mechanisms by which cancer cells avoid recognition by the immune system cells. T cells obtained from a patient can be modified with CARs such that they express receptors specific to the particular type of cancer. CAR T cell therapy has shown tremendous anti-tumor efficacy in ovarian cancer, lymphoma, breast cancer and brain cancer. Co-stimulatory molecules and cytokines can also be incorporated into engineered T-cells which can further enhance their anti-tumorigenic activity. Recently, ‘armored CAR T-cells’, which are capable of cytokine secretion are being engineered. One such future generation of CARs being researched is T cells Redirected for Universal Cytokine Killing (TRUCK). Vectors encoding the CAR construct in TRUCKs possess a cytokine expressing cassette which can target specific tumors and their environments. Also, various ligand modified CAR T-cells are being researched that can reprogram the immunosuppressive tumor microenvironment. Studies have shown that host immune system cells also mediate killing of cancer cells through activation of other types of cells and cytokines. This had led to research on development of combination strategies that can capitalize on the synergistic effects of various immune cells. One such example would be combination of immunotherapy and chemotherapy, radiation or monoclonal antibody therapy. Despite ongoing research on cancer immunotherapy, we are just at the tip of the iceberg. The need of the hour is development of techniques that would exclusively target cancer cells and spare normal cells and tissues. This is imperative to minimize the side effects of current therapies and achieve tangible results from therapy. Future areas for development in vaccines using immune cells for cancer therapy should include applicability to individual tumor types, optimization of cell biology including migratory and costimulatory properties, and the manipulation of the host and tumor microenvironments to alleviate immunosuppressive mechanisms.   Dr. Pradeep Mahajan, Regenerative medicine Researcher, StemRx Bioscience Solutions Pvt. Ltd ]]> https://biospectrumindia.com/features/21/10469/the-rising-concern-of-hepatitis-b.html https://biospectrumindia.com/features/21/10469/the-rising-concern-of-hepatitis-b.html Fri, 23 Feb 2018 19:30:00 +0530 Hepatitis B virus {HBV} infection recognized nearly 40 years ago with the identification of the Australia antigen, remains a global health problem. It is estimated that 2 million people worldwide have been infected with HBV. 350 million are chronically infected and 50 million new cases are diagnosed annually. HBV remains the leading cause of cirrhosis {destruction of the liver} and Hepatocellular carcinoma {HCC}. Of those chronically infected, 15% to 25% will die of sequale related to HBV infection. If routine infant HBV vaccination with 3 doses is given to the population then 68% of HBV related deaths could be prevented. The virus is transmitted via various routes. HBV is ubiquitous in body fluids including blood saliva, sweat, breast milk, tears, vaginal secretions, semen and menstrual blood. Viral transmission can be mother to child {vertical or perinatal transmission}and by percutaneous of mucosa exposure to infectious bodily fluids. After any person who is infected by any one of the following mentioned above routes of transmission, the incubation period of the virus ranges from 45-160days {mean 120 days}. There are various tests available to check if ones infected or not. They are basically blood tests which shall be mentioned later.In areas of low prevalence of HBV infection the transmission is more commonly via unprotected sexual intercourse, IV drug abusers or occupational exposure to blood or blood products like our paramedical workers. It is important to safeguard ourselves in the form of having simple hand gloves are a good way to protect ourselves in times of calamity. But in underdeveloped countries reuse of medical instruments, contamination of multiple dosing vials and reuse of disposable needles remains a risk of infection. Now in most hospitals in Mumbai follow a very strict guidelines. Disposable needles are only used and they are disposed off also according to infection control guidelines. Contamination of dialysis equipment is also a source of transmission if isolation of infected patients and strict adherence to infection control measures are not practiced. Percutaneous routes of exposure include transmission of blood or blood products, contaminated health related paraphenelia or needle sticks and IV drug users. Less commonly tatooing which has now become a fashion statement and accupuncture have also been implicated in HBV transmission. We commonly see barbers on the road side shaving and cutting hair. It is a very important source in our economic background. The low socioeconomic people are affected by this and the virus is transmitted through contaminated blades and scissors. Hence a check has to be done or then one must insist on changing the blade in front of your own eyes. In areas of high endemicity of HBV, vertical transmission remains to be the predominant mode of transmission. Pregnant woman in the third trimester or in the post partum period will more likely lead to infection of the infant. Once infected it can lead to acute hepatitis b or then progress to chronic Hepatitis B. Chronic Hepatitis B is the more dangerous one and that can lead to Cirrhosis [destruction of liver] and then to cancer of the liver. Once infected the body clears the virus by average 6 months on its own. If the virus still persists then one can say that the individual is a chronic Hepatitis B infected person. In acute Hepatitis B one can develop symptoms like yellow discoloration of eyes [jaundice], generalized weakness, loss of appetite / weight , nausea, vomiting, pain in abdomen and fever. If severe then bleeding disorders can be seen .If very severe then the person can become comatosed but this is not very common. In chronic hepatitis B infected people, they can have liver related complications like vomiting of blood [haematemesis], black tarry stools [malena] ,loss of conciousness {hepatic encephalopathy}, fever[because of low immunity] ,distension of abdomen {ascites}, swelling of the legs [pedal edema]. If the individual consumes alcohol then the liver damage is accelerated with concurrent Hepatitis B virus infection. If the person has co-infection of HIV then the clearance of the virus is delayed. The treatment for acute Hepatitis B infection is mainly supportive cause acute Hepatitis B resolves without chronic sequale. There are routine blood tests available and can be done in any reputed laboratory. There are specialized test also available and have to be done if the person is chronic infected. There is treatment for Hepatitis B chronic infection . There are various drugs available. They are Lamuvidine, adefovir, telbuvidine and entecavir which are available in India..These are tablets and have to be taken according to the dosing schedules. There are injections also available, Inj. Interferon [ALPHA 2A] & [ALPHA 2B], Plain Interferon and pegylated interferon{40kDa and 12kDa}therapy. Interferon therapy treatment remains the benchmark of antiviral treatment with durable ,sustained response to a 12 month course in about 15-25 % of patients. Now liver transplant is also an option for people with cirrhosis of liver and have liver related complications. Liver transplant is being done in Mumbai. If there is accidental exposure to the virus then injection immunoglobulin is recommended. There are vaccines which are available and it is adviced to all so that one is protected. Hepatitis B virus infection is a potent killer, right information and right steps towards prevention can put this deadly virus in our grips. (Dr. Prasanna S Shah, Gastroenterologist, Jaslok Hospital) ]]> https://biospectrumindia.com/features/21/10447/the-burden-of-organ-demand.html https://biospectrumindia.com/features/21/10447/the-burden-of-organ-demand.html Wed, 21 Feb 2018 14:00:00 +0530 Organ transplantation for end stage kidney, liver, heart and lung disease is one of the biggest success stories of 20th Century medicine. The year 2017 marked the 50th anniversary of the world’s first heart transplant and also marks the same milestone for the world longest surviving liver transplant recipient. Kidney transplantation was already being delivered over a decade earlier. This period of 50 years has seen cadaver organ transplantation being delivered as a routine procedure worldwide, and approximately 140,000 transplant procedures are performed worldwide every year. In India, awareness about cadaver transplantation has been slow to develop, even though the legal basis for this, the Human Organ Transplant Act, was passed by Parliament in 1994. The last 5 years has seen several Indian states develop and grow their cadaver organ donation programmes, led by Tamil Nadu, Maharashtra, Andhra Pradesh and Kerala with around 700 cadaver organ donations expected in 2017, a figure almost 5 times higher than what was achieved 5 years ago. Despite this growth, we still are only just beginning to address the burden of organ demand, and of the 10,000 transplants performed annually in India, almost 80 % of organs come from living donors, who donate either a single kidney or part of their liver. The figure is reversed in the West, with over 80% of transplanted organs donated from brain dead cadavers. Consequently we are able to offer transplantation to only a small proportion of patients needing this treatment, treating around 3% of the annual total of 300,000 Indians who could benefit from a life-saving transplant, and a vast majority of these Indians will die within a year of being diagnosed with end stage organ failure. Why then has this been slow to develop? Health is a state matter, and this has resulted in individual states having different approaches to cadaver organ donation and transplantation. The National, Regional and State Organ Transplant and Tissue Organisations (NOTTO, ROTTO and SOTTO) announced by the Ministry of Health in the last 2 years, has yet to have any influence in the delivery of cadaver organ transplantation. There is no structured network of transplant centres, organ donation centres and transplant co-ordinators. The latter are essential to help in identifying and approaching potential donors in the intensive care setting. Currently, apart from Tamil Nadu, all co-ordinators are individuals appointed at their institutions usually to oversee living donor transplantation. In several states where cadaver organ donation has been growing, this growth has been led by initiatives particular to the region, supported by well-meaning NGOs such as the Chennai based multi organ harvesting of organs network (MOHAN) and Maharashtra’s zonal transplant co-ordination committees (ZTCC). In many parts of the country, especially in eastern, central and northern India, there is almost no cadaver organ donation activity.   Organ transplantation is still considered as an expensive and complex treatment in India, and is largely delivered in private institutions. Unlike the rest of the world, very little organ transplant activity is undertaken at teaching or University hospitals. Offering transplantation services has been shown to improve levels of care in teaching institutions. This is especially true for the more complex liver, heart and lung transplant procedures, and pancreas and intestinal transplantation are almost non- existent in India. Consequently, little emphasis is given to this field in medical education, so both teachers and students alike have little insight into this treatment option, and as a consequence there is little or no incentive for these institutions to address the need for organ donation. All these factors contribute to India having amongst the lowest organ donation rates in the world, currently at about 1% of what is being achieved by the best performing countries, even though India has very high trauma rates and a limited delivery of emergency neurosurgery. Most potential donors are admitted in public hospitals and almost never have the opportunity to donate, with most cadaver organ donations taking place in private hospitals, where the awareness for organ donation and transplantation is on the increase. Involvement of the public and the teaching hospitals as well as other stakeholders, such as the police authorities for medicolegal cases, in organ donation will be crucial if India is to try to bridge the gap between demand and supply of donor organs. There is also a huge dearth of data on outcomes after transplantation. Units performing transplants are not required to submit outcomes or be open to audit. The earning potential in transplantation for private hospitals remains large and this financial factor also prevents sharing of outcome data between institutions. This aspect leads individual transplant units to compete with each other, instead of encouraging collaborative practice, so essential for the successful delivery of transplantation. The only outcomes data available is unaudited presentations made by individual units, usually from corporate hospitals, largely performed to help attract new patients to undergo transplantation. This data collection of outcomes is routine worldwide, and is something that could and should be introduced as a matter of priority by the newly designated regulatory authorities, especially for teams currently utilising the few cadaver organs being made available. The cost burden of transplantation has so far been borne by the patient, limiting this treatment option to a privileged few. The costs of delivering transplantation in India are amongst the lowest in the world, and as activity increases and these treatments become more available, these costs are likely to decrease further. Drug costs in India are amongst the lowest in the world, and some post-transplant medicine regimes cost less than the drugs needed by patients prior to transplantation. Recently, additional funding options are being made available. Recognised governmental and NGO led charities have helped fund patients, innovative web based crowd-funding platforms have helped raise entire transplant and post-transplant costs for some patients, and some state governments and employers are supporting part of the costs for transplants. There also remains the potential to tap into corporate social responsibility (CSR) funds to help bridge the gap between affordability and cost of transplantation. For transplantation to be widely accepted as a routine treatment, it is essential that this treatment is made available to most members of society, not just the privileged few. Other practices potentially detrimental to development of good transplant outcomes include delayed referral of patients by managing physicians to transplant centres, by which time the ability to wait for a suitable donor and survive the transplant procedure is compromised, and also further escalates the costs of managing these sicker patients pre and post transplantation. Patients and their families are also habituated to a practice of seeking multiple opinions, a sort of “window shopping”, contributing further to the indecision and delay in accepting transplantation. In summary, organ transplantation in India is growing, especially from cadaver donors. Adoption of successful practices in realising cadaveric donation by the few groups in some states should be encouraged. Greater involvement by public sector hospitals will make transplantation more accessible to the wider society. Reduction in costs and use of innovative funding will help widen the practice of transplantation. There is an urgent need for the newly designated regulatory authorities to be empowered to regulate delivery of transplantation, and to develop donor co-ordination systems. A uniform organ allocation infrastructure needs to be realised in both the public and private sectors, along with the need for more transparency in availability of outcomes after transplantation.      (Dr Darius F Mirza; Professor of HPB and Transplant Surgery; University Hospital Birmingham and Birmingham Children’s Hospital, Birmingham, UK; Lead Consultant Transplant and HPB Surgeon, Apollo Navi Mumbai Hospital, Mumbai, India; Co-Founder, Transplants – Help the Poor Foundation)                    ]]> https://biospectrumindia.com/features/21/10317/women-and-tobacco.html https://biospectrumindia.com/features/21/10317/women-and-tobacco.html Sat, 03 Feb 2018 15:30:00 +0530 Women are catching up with men in every field and even surpassing them in some. Today women have outperformed men in many fields and one of them is tobacco consumption. According to studies, India now has 12.1 million women smokers and lags behind only to the United States in this segment. While an average male smokes 6.1 cigarettes a day, a woman smokes an average of 7 cigarettes per day! And this is only the tip of the iceberg. Rural women consume tobacco in various forms – dental paste, bidis, hookah and masheri powder which they rub on their teeth and inside of the mouth, to energize them to work in the fields, manage their children and their husbands. Second-Hand Smoking- Second-hand smoke is a mixture of sidestream and mainstream smoke. The smoke which comes from the burning end of a cigarette is termed as sidestream smoke and the smoke that is exhaled by the smoker is mainstream smoke. Being exposed to second-hand smoke affects an adult’s heart and blood vessels directly. Adult nonsmokers who live with smokers are at about 25% more risk of developing heart disease. Sidestream smoke makes up about 85% of second-hand smoke which consists of different chemicals than exhaled mainstream smoke. It burns at a lower temperature, and the burn is not as clean or complete. Hence, this may result to the possibility of lung cancer even in the non-smokers. Smoking and exposure to second-hand smoke during pregnancy increases the risk of health and behavioral problems in the newborns, which includes: abnormal blood pressure in infants and children, cleft palate and lip, leukemia, infantile colic, childhood wheezing, respiratory disorders, eye problems, mental retardation, attention deficit disorder, behavioral problems and other learning and developmental problems in the affected children. Smoking affects not only the health of smokers, but also the health of those around them who are exposed to second-hand smoke, such as their children, spouses and other relatives at home and the co-workers in the workplace. Exposure to second-hand tobacco smoke can cause serious and fatal diseases in adults and children. Research studies have found that smoking and exposure to second-hand smoke among pregnant women is a significant cause of miscarriages and Sudden Infant Death Syndrome (SIDS) after birth. Infants of mothers who smoke during and after pregnancy are 3 to 4 times more likely to die from sudden infant death syndrome (SIDS) than babies of non-smoking mothers. This indicates that there is a direct impact of tobacco on the infant mortality rate. Research has revealed that smoking causes infertility as it harms the eggs in women and sperms in men. Consumption of smokeless tobacco during pregnancy leads to premature deliveries and also prevents the babies from growing optimally whilst in the mothers’ wombs.   Third-Hand smoking- When tobacco is burns, it releases nicotine in the form of a vapour. This vapour attaches to surfaces like walls, floors, carpets, drapes, and furniture. Children are more sensitive to being exposed to third-hand smoke because they breathe, crawl on, play on, touch, and even taste (because they often put their hands in their mouths) surfaces contaminated with tobacco residue. Hence, Second hand smoke and Third hand smoke are equally dangerous as they contain more than 7000 chemicals, of which hundreds are harmful and about 70 can cause cancer. This shows that there is an urgency to control the consumption of tobacco and the target population must include: adolescent girls, pregnant women and older women. According to Global Adult Tobacco Survey (GATS), India has an alarmingly high rate of tobacco consumption. Almost 275 million Indian adults, ie. nearly 35% of the population, consume some form of tobacco. GATS findings related to tobacco use among women are: 3 % of adult women use tobacco products Over 90% women tobacco users consume smokeless tobacco (a large number of these users are in the reproductive age group) The average age at initiation of tobacco use was 17.8 years with 25.8% of females starting tobacco use before the age of 15   Apart from cigarette, Smokeless Tobacco can also be dangerous for human life. India has a long history of using smokeless tobacco products as it is the most dominant format in India. It is a form tobacco which is consumed without burning, it is consumed by chewing. Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up. There are several types of tobacco available in India; the most prominent ones are gutkha, zarda, khaini, masheri and mawa. Maternal health effects of smoking Impaired lactation Miscarriage Premature birth Ectopic pregnancy Placental abnormalities Bleeding Premature rupture of membranes Smoking also adversely affects the fetus which can be dangerous, as it may lead to: Fetalgrowth retardation Small for gestational age Increased fetal heart rate Chronic fetalhypoxia Perinatal death Preterm delivery Low birth weight Fetal artery constriction Lessened amounts of oxygen and nutrients in the foetus ]]> https://biospectrumindia.com/features/21/10017/pcos-is-a-lifestyle-disorder.html https://biospectrumindia.com/features/21/10017/pcos-is-a-lifestyle-disorder.html Tue, 12 Dec 2017 12:40:00 +0530 Among the many lifestyle disorders that are prevalent today, PCOS is one of the reasons for a lot of stress among the youngsters. Renowned aesthetic dermatologist Dr. Sadhana Deshmukh talks about her concern on how PCOS has become so common in her routine practice- Today,  every woman is leading a stressful and competitive lifestyle. 6 out of10 women show PCOS symptoms when they walk in to skin clinic for various skin issues. The causes of skin related symptoms are often due to an imbalance in androgen hormones, male sex hormones testosterone, along with an underlying Insulin resistance. It is a lifestyle disorder where lack of exercise and disciplined food habits are major contributing factors for PCOS. Top 5 clinical skin clues to recognize PCOS and treatment of these may improve patient's quality of life and psychologic well-being : 1) Hirsutism : Women, with male pattern of excessive hair growth on face, chest, stomach & inner thighs can be extremely distressing and disturbing. We can offer soprano Hair-free pain-free 810-nm diode laser hair reduction with a patented DualChill treatment tip & unique, IN-Motion technology ensuring that the surface of your skin stays cool and comfortable. The sessions are done once in 30-60 days. And it takes 12 to 15 turns to convert the thick terminal hair in to soft baby hair or permanent reduction. 2) Acne vulgaris:  Nodules like scarring pimples can be treated with some oral medicines and applications. Salicylic-Glycolic combination peels, retinol peels, Laser resurfacing  can be of great help for these patients. 3) Androgenetic alopecia hair loss and baldness: PRP Platelet rich plasma treatment helps a lot in this regard. 4) Acanthosis nigricans : dark velvety skin patches on neck underarms, face (undereyes, forehead,around lips) inner thighs. Helios Q switch Ndyag laser will be very helpful in its treatment. 5)The effects of androgen on sweat gland units can cause oily follicular patchy uneven skin with pigmentation around the mouth and under eye skin. Silent PCOS : These women typically do not have any symptoms. Their periods are regular, they are not obese and blood levels of hormones and ultrasound are normal, but only one of the skin manifestations are present. The main mantra to deal with PCOS is lifestyle change and leading a disciplined and healthy lifestyle every single day. Only a strict diet regime, daily exercise and some skincare treatments can make a difference. ]]> https://biospectrumindia.com/features/21/9940/revolutionising-stone-disease-management.html https://biospectrumindia.com/features/21/9940/revolutionising-stone-disease-management.html Fri, 01 Dec 2017 14:30:00 +0530   Stone disease has been known to affect the human race ever since its existence. The incidence and the prevalence have increased of late with wide regional variations, roughly 4 – 20 % in India. The reasons for increasing prevalence of stone disease are related to increasing westernization and changes in diet, decreased water intake and climatic variations. Genetic and familial afflictions are well known, due to either hereditary or dietary factors. Once stones are formed in the kidney, they either stay there or descend down into the ureter. Spontaneous stone passage is well known and depends on the size and shape of the stone and the location in the kidney. Stone treatment is mandated by the same factors as mentioned above as well as the clinical scenario of the patient. Two most commonly used endoscopic modalities are Percutaneous Nephrolithotomy (PCNL) and Flexible Ureteroscopy (FURS). The advancements in laser have revolutionized the stone management, especially increasing miniaturization, lower morbidity and better stone clearance for a given patient. I strongly believe in the quote by Toto – “The only permanent thing in the world is change”. One such revolutionary change is the introduction of Moses technology. The Holmium laser is used for stone management as it can fragment all stone compositions and pulverizes the stone into either stone dust or small fragments of size 1 – 2 mm, which can be retrieved with dedicated tools or pass down the urinary tract with urine. It is the current gold standard for intra-corporeal stone management and is very well established. As a further advancement of the current technology it has come out with Lumenis Pulse 120H laser system including the Moses technology. When standard holmium energy is fired via the fiber, there is a fluid filled gap between the tip of the laser fiber and the target stone. This results in loss of energy as the holmium laser energy is absorbed by water invested in inflating a vapor bubble. Moses technology creates a pulse modulation that optimizes energy delivery through the water to the stone. In other words, the Moses technology modulates the vapor bubbles which form between the laser fiber tip and the stone separating the water and then delivers the remaining energy to the stone. This modulation results in more energy being transferred to the stone and less absorbed in the surrounding water. It is dependent on the proprietary Moses laser fiber and the modes available in the Lumenis Pulse 120H system. optimized for two different fiber ‘tip to target’ distances, namely Contact mode and Distance mode. In comparison to the available lasers, there is more efficient and better energy transmission to the stone. There is also less dependence on the distance between the fiber tip and the stone. Because of its inbuilt dual settings, the laser fiber can work at two modes and consequently can work in varied clinical scenarios. In the Contact mode, the fiber is effective at a distance of 1 mm which is useful when the stones are easily approachable through the flexible ureteroscope. In the Distance mode, the Regular Holmium mode may not be as effective as they are unable to reach the stone and more energy is absorbed by the water between the stone and the fiber tip. It is here where the Moses Technology is most effective as we can still treat the stone even when the fiber is at some distance away. The pulse delivery technology results in an improved energy transmission to the stone. This translates into significantly higher stone ablation volume ( up to 160 % higher) than the regular laser technology. Both the in vitro and clinical studies have clearly documented lesser retropulsion than the regular fiber. For same energy settings, the Moses fiber causes 50 times lesser stone displacement upon activation then the regular fiber. This means that your stone stays close to the fiber tip and does not migrate to some other part of the kidney during the surgery. Moses fibers are available in all three standard sizes: 200, 365 and 550 D/F/L. When working in the lower pole during FURS, the regular fiber may not reach the stone due to difficult patient anatomy and loss of deflection of the ureteroscope (12 – 20 degrees). With the Moses fiber, this deflection loss is only 4 – 6 degrees. Hence, more commonly than not, your stone will be treated. The ball shaped tip allows an initial smooth fiber insertion through the ureteroscope and potentially minimizes the ureteroscope damage and improved longevity of the ureteroscope. Thus, the patient benefits include more efficient stone ablation during surgery, lesser retropulsion thereby decreasing the potential need for a second procedure, shorter operative time, safe laser lithotripsy and possibly lesser retreatment for left behind small fragments. The surgeon benefits include lesser damage to the ureteroscope, shorter operative time and hassle free laser fiber usage. All these also potentially result in reduced cost implications on the patient. Despite the advancements in the field of stone treatment, preventive medicine and avoidance of stone formation is always the goal. High water intake to maintain a minimum daily urine output of 3 liters, citrus fruit juices, reduced animal protein intake, low salt diet, better control of diabetes and regular exercise and weight reduction are some of the key requirements to reduce the risk of stone formation.   ]]> https://biospectrumindia.com/features/21/9897/the-endless-applications-of-digital-pathology.html https://biospectrumindia.com/features/21/9897/the-endless-applications-of-digital-pathology.html Mon, 27 Nov 2017 16:45:00 +0530 What exactly is Digital Pathology and does India need it? Yes. Why? What purpose will it solve and what value will it add to patient management? From simply remotely viewing patient slides, to consulting specialists real time within India and other parts of the world – the applications of digital pathology are endless. Until the advent of this technology, histological slides and photographs the primary ways images seen under a microscope lens could be shared with others. Digital Pathology eliminates some of the issues associated with sharing slides such as the degradation of samples and inability to share samples. In addition to preserving quality, specimen images can be transferred to colleagues in a timely fashion. It has immense role in Diagnostics – a hospital or laboratory can share images anywhere in the world, possibly decreasing the time it takes to properly diagnose and treat. In addition, using networking tools, multiple pathologists can assure that he/she is discussing the same aspect of the sample. It breaks the geographical barriers and brings experts together in the virtual world even though they are oceans apart and need strong expensive logistics to bridge that distance. For rural areas this will open a new window as they will get access to experts sitting anywhere in the world. In surgical pathology, biopsied tissue is dissected, fixated, embedded and cut into very thin slices, which are then stained and permanently mounted on glass slides. The slides are then examined by a pathologist under a light microscope to arrive at a diagnosis. WSI, on the other hand, refers to the digitization of the stained tissue mounted on glass slides. When utilizing WSI, the tissue is prepared as it normally is for light microscopy. However, the slide is then converted into a digital whole slide image that the pathologist views on a computer monitor instead of through microscope oculars. Digital slides can be reproduced an unlimited number of times which has been a major limitation so far. This is very useful for chronic and recurring diseases e.g. cancer. In essence, Digital Pathology extends the limits of microscopy, enabling students, educators, researchers, and clinicians to share tissue samples. Images sent or shared over the Internet or through specific analysis software open the path to a new and exciting microscopy tool ensuring optimal patient treatment. It lends algorithmic objectivity to numerous tests that were otherwise subjective by nature and through image analysis software quantification is possible which can be monitored before and after treatment. Pathology in the near future will provide digitally-enabled services as the norm to provide primary diagnosis of disease, facilitate personalized medicine where therapies are tailored to the individual, extract and analyse data to understand the links between tests and treatments, and to maximize outcomes. It will help pathologist’s access prior data and data from a spectrum of different data sites quickly. It will also empower people to manage their own health through access to electronic health records. In a major breakthrough, it has received regulatory clearance from the FDA (via De Novo classification), marking a significant leap forward for the pathology services industry in the U.S.  De novo classification is the regulatory pathway for marketing clearance for novel, low- to moderate-risk medical devices that are the first of their kind. This news has implications not only for improving laboratory workflow and efficiencies, but also for improving the quality and accuracy of cancer diagnostics through computational pathology—an approach to rendering disease diagnoses that incorporates multiple sources of data and uses mathematical models to generate clinically actionable inferences. Just as picture archiving and communication systems (PACS) turned radiology on its head, this may be about to do the same for pathology. Digitized slides can reduce turnaround times, improve communication between physicians, and are well-suited to computer-aided detection, similar to the technology widely used in mammography. Pathology occupies a similar role as radiology in hospital workflows, as a referral-based service. As many as 95 percent of clinical pathways pass through the pathology department, according to a 2013 NHS study, so increasing efficiency in pathology can improve the hospital as a whole. Digital pathology systems have been used for primary diagnosis in Europe for several years. Now that some digital pathology systems have received FDA approval for narrow applications, it has opened up new avenues. To conclude, Digital pathology is a dynamic, image-based environment that enables the acquisition, management and interpretation of pathology information generated from a digitized glass slide. Healthcare applications include primary diagnosis, diagnostic consultation, intraoperative diagnosis, medical student and resident training, manual and semi-quantitative review of immunohistochemistry (IHC), clinical research, diagnostic decision support, peer review, and tumor boards. ]]> https://biospectrumindia.com/features/21/9869/lack-of-sleep-stress-a-vicious-cycle.html https://biospectrumindia.com/features/21/9869/lack-of-sleep-stress-a-vicious-cycle.html Thu, 23 Nov 2017 11:00:00 +0530 I believe stress is ubiquitous and in this jungle of modern living we have forgotten to pause and wonder how it affects the very body that we all strive to maintain. The onset of diseases is much earlier and has become more difficult to treat. You are often asked the question as to what is the cause for this early onset of disorders and you simply accord it to lifestyle and stress but stress is so difficult to define because it is so relative but any condition which changes the condition of homeostasis would be perceived as stress. One of the manifestations of stress are altered living patterns which are taking a big toll on the endocrine health of the female population which is manifesting in varied disorders like obesity with PCOD starting in adolescence, hyperprolactinemia, primary and secondary infertility and premature menopause. We need to understand that endocrine health is a finely tuned orchestra where a wrong note jars the entire system. Stress leads to chronic activation of the neuroendocrine system and contributes to one of the biggest banes of society today i.e obesity. Weight gain can be due to many reasons but one of the contributory factors of modern living is sleep deprivation and eating disorders like night eating syndrome. Reduction in sleeping time to less than 7 hours results in a decrease in serum leptin an increase in serum ghrelin and increased hunger and appetite (in particular for calorie-dense foods with high carbohydrate content). There is diminished activity in higher-order cortical evaluation regions combined with excess subcortical limbic responsivity. Furthermore it also affects glucose and insulin levels. Sleep deprivation consequently results in chronic fatigue with reduced cognitive function, reduced ability to make healthy food choices and reduced desire to exercise. Hence sleep contributes in a very big way to your health and it does not mean only catching up on 40 winks a day but a proper restful sleep for at least 7 hours would go a long way in contributing to your overall metabolic health. ]]> https://biospectrumindia.com/news/21/11416/how-technology-revolutionized-the-sports-betting-industry.html https://biospectrumindia.com/news/21/11416/how-technology-revolutionized-the-sports-betting-industry.html Wed, 01 Nov 2017 00:00:00 +0530 There are technological changes in how things work every day, and at the center of this, we see how things like VR and AI play a partial role. Both new and already established brands look for the most exciting emerging markets, so the companies must be ready to keep up, or risk falling behind. This applies not least also to the sports betting industry.  Availability and convenience Availability and convenience are the key features of a successful sports betting industry today. This is not least seen in big, established names like Betflorida.com who offer the opportunity to find the best, licensed betting companies available in Florida. The users are provided with information about bonuses and betting tips, to stay up to date with the latest betting trend.  Betflorida.com ranks the betting companies. These rankings are primarily based on how the different bookmakers are perceived on the basis of “availability and convenience”. That is, how user-friendly the platform is and whether there is a mobile site available. But also, how they integrate other technological advancements that improve the industry and the betting experience. For example, are there realistic elements such as live dealers or the opportunity to play with friends? Faster betting opportunities with 5G 5G has begun to enter many markets. Many have high expectations, and the transition has been described as a new revolution. Gambling has become more of a digital activity and the new 5G technology can also have a big impact on the industry, nonetheless, be revolutionary to the future of mobile gaming. Today, we expect everything we do online to go fast and be done efficiently. There is no time to waste. With 5G, we can place bets within seconds. In addition to a faster and smoother gambling experience, mobile sports betting will be able to raise the visual standard. With 5G, the conditions for high graphics will be able to lead to players having an even more captivating experience, and a more authentic environment that is similar to a physical sports game. In other words, mobile gaming providers have the potential to offer higher quality sport betting opportunities.  The future of online sports betting It is only natural that sports betting will continue to revolutionize the world as technology advances at a rapid pace. More and more people seem to understand the pleasure of betting on their favorite sports, while the opportunities to do so increase. New bookmakers are constantly appearing on the market and the technology is getting better.  The greater the range available and the easier it is to play online; the more people will continue to do so. With that said, the future is bright for the online sports betting sector, and we have many things to look forward to! ]]> https://biospectrumindia.com/views/21/9723/using-logistics-to-bring-down-health-care-costs-and-improve-services.html https://biospectrumindia.com/views/21/9723/using-logistics-to-bring-down-health-care-costs-and-improve-services.html Thu, 26 Oct 2017 12:20:00 +0530 Owing to various reasons, including lifestyle, there has been a surge in health related issues and medical cases among the general population. This has consequently led to an increase in the demand for health care products and services, which have also seen their costs rise, making them unaffordable to the common man. In India, the healthcare industry is expected to touch USD 160 billion by the end of the year and USD 280 billion by 2020.   As a solution to allowing access to healthcare reach the masses, I feel the right approach would be to lower the costs involved in procurement and transportation, which will reduce the overall price of products. In the process of procurement of healthcare goods, besides production, logistic costs play a major role in determining their prices, and are particularly higher in cases of international imports. In a report published by McKinsey, it was reported that for pharma companies, logistics makes up 25 per cent of their operating costs. Logistics, as a service, is process driven and besides the time taken for shipment, involves various steps, which add to the length of the process. In cases of air shipments, transit time takes a maximum of five days, as compared to ocean, which can range from a week to 45 days. Additionally, there are the processes of warehousing, quality checks, custom clearance and the involvement of stake holders like the manufacturer, transporter of goods, freight forwarder (agent who coordinates between the former two), customs housing agents etc. As health care products are largely temperature sensitive and fall in the perishable category, most pharma companies use air services as their preferred mode of transport. Despite the obvious advantages of air transport, minor mishaps in coordination can lead to the consignment missing the scheduled flight which will result in the need to book an immediate flight, obviously at a much higher cost. Through the Internet of Things and Artificial Intelligence, logistic analysis platforms help in avoiding such scenarios as all the steps involved in shipment are automatically monitored and scope of error is reduced to a minimum. When using ships as a mode of transport, a reefer is employed to ensure product quality is maintained till the time the product reaches the destination. Reefers are special temperature controlled containers, which ensure cold chain movement takes place, to avoid product wastage. For the pharma industry, cold chain management is expected to cost them USD 17 billion by 2020. If this materialises, companies stand at a risk of lesser profits and lack of business. To minimise this, there are various systems which help show you real time temperature reports. As seen, the most common problems faced in movement of sensitive cargo are in coordination and maintenance of temperature. Healthcare providers, manufacturers and distributors also struggle with problems of procurement processes. Another challenge faced by the healthcare sector, is that of disparate proprietary data among medical devices and location information. The processes of continuously translating this data can also cause several errors and prevent healthcare companies from achieving efficiency. The healthcare sector still largely functions using manual processes, which not only allows more room for error and a significant amount of rework, but can also have larger implications. Cases of expired inventory, clinics receiving the wrong product, order errors etc. are common place and there an urgent need to find a solution. While other sectors have already implemented e-ordering, product scanning and order accuracy controls as key processes in improving their supply chains, the healthcare industry has a long way to go to catch up with them. By taking advantage of technology and newer intelligent systems, we an address both issues with ease, to ultimately lower the costs incurred in both international and domestic logistics. Today, a lot of companies have understood the need for technology in logistics and have already begun adopting it to solve various problems and increase efficiency. Early adopters of this technology have already begun to see the long term advantages and are reaping the benefits. Besides being confident that other players will gradually follow suit, we see technology as the ideal solution for reducing healthcare costs through logistics.   ]]> https://biospectrumindia.com/views/21/9574/take-corrective-steps-on-an-urgent-basis.html https://biospectrumindia.com/views/21/9574/take-corrective-steps-on-an-urgent-basis.html Fri, 22 Sep 2017 12:25:00 +0530 Some recent reports and news about healthcare sector are alarming as they bring into focus two important angles – growing disease burden on one hand and sharply contrasted inadequate healthcare facilities, particularly at the grass root level on the other. World Health Organisation (WHO) in its recent report highlighted that 61% of deaths in India are attributed to non-communicable diseases (NCDs). Almost 23% are at risk of premature death due to such diseases. NCDs caused over six million deaths in India in 2016 as per the Global Burden of Disease (GBD) study published in Lancet last year. India is at the 127th position among 188 countries in achieving UN’s health related sustainable development goals (SDGs). India’s poor performance on healthcare front gets exposed by frequent news about deaths of patients due to inadequate facilities in hospitals. It is also due to the failure of the authorities to reach the healthcare facilities to the sick people in remote areas. A recent report pointed out that while the government is setting up new All India Institutes of Medical Sciences (AIIMS) at different places, five major projects in a campus of AIIMS in Delhi, which started in 2014, are delayed due to lack of funds. First the beginning of the work on implementation of these projects delayed by a decade after they were proposed and even after the work began it got further delayed.   The failures of authorities on various such counts are no more restricted only to the publication of news, but the Comptroller and Auditor General (CAG) has now officially nailed them in its recent performance audit report, leaving no scope for any counter argument. The most interesting part of this report is that paucity of financial resources is generally cited as the cause for inadequate infrastructure in the government sector but that is not the case here. A massive Rs 9,509 crore remain unspent in the National Rural Health Mission in 2015-16. It is not a case of a single year. This amount has steadily increased from Rs 7,375 crore in 2011-12. While the funds on such a large scale remain unutilised, healthcare infrastructure in various forms, including sub-centres, primary and community health centres remain inadequate. The shortfall ranged between 24% and 38% and in case of five states the facilities are only half of the requirement. In over 1200 cases the constructions have been done but the facilities are not operational. Same is the situation of equipment, drugs, and human resources. Equipment is in short supply at some places and where equipment exit they lie unutilised due to non-availability of the required human resources. Average shortfall of five types of specialists ranged from 77% to 87%. Shortage of nurses in 236 Contributory Health Services Scheme (CHSs) is over 1000. Drugs are not only in short supply, but where they are available they are given to patients without conducting quality checks and without observing expiry dates. The performance report points out to the inadequacies in the rural healthcare in detail.  The CAG has shown the total neglect of the existing facilities and infrastructure in the healthcare. As a result of this the ministry curtailed the cost estimates of National Health Mission 2020 following the criticism of the inadequacies by NITI Aayog and finance ministry. The estimates are curtailed when the rural areas require much more healthcare facilities with more spending.    The report is certainly an eye opener for all. But more than that, it can be also looked at by the union and state governments as an opportunity to take corrective steps on an urgent basis for speedy improvement. Otherwise, it will continue to remain as one more report like many previous ones, gathering dust. ]]> https://biospectrumindia.com/views/21/9426/politics-of-peoples-health.html https://biospectrumindia.com/views/21/9426/politics-of-peoples-health.html Tue, 22 Aug 2017 14:50:00 +0530 The US Senate’s rejection of ‘skinny repeal’ of Affordable Care Act (ACA), popularly known as ‘Obamacare” is not merely a political issue. The defeat is very narrow. Still, it is embarrassing for the Trump administration as the President Donald Trump had made the repeal of Obamacare and its replacement with a new system a prestige issue. No wonder, he tweets on defeat, ‘3 Republicans and 48 Democrats let the American people down.’ The fact that the three Republican senators voting against and defeating the Republican legislation, which sought to repeal only some part of Obamacare, in which Republican President is interested is surely a political issue, no doubt. But there is much more into the defeat that goesbeyond the politics. This is a serious social issue too. The repeal of the former President Obama’s healthcare reform law would have left 22 million poorer citizens without health insurance. They were covered by the insurance due to a provision in ACA compelling the businesses with more than 50 employees to provide health insurance and offered subsidies to make coverage more affordable. Obamacare had showed positive results as census bureau figures showed that from 2014 to 2015 the percentage of Americans without insurance fell from 14.2% to 9.1%, the drop of 5.1% was largest. Still, it was sought to be repealed. Interestingly, the bill for repealing was defeated on the backdrop of news reports that health insurance premiums would increase by 20%. The Congressional Budget Office has estimated that this would result in 15 million more Americans becoming uninsured next year alone. Republicans were opposed to the ACA right since it was introduced in 2010 by the then President Obama, who had made this as one of his major election plank. They had intention to repeal it and voted several times to repeal the law even when Obama was still the President. Butthey could win the vote then and they could not do it even after the change of administration. Earlier, just four months back President and House speaker Paul Rayan had to cancel the voting in the house on the American Healthcare Act, repealing and replacing the ACA, as they realised that they lacked adequate number of votes to pass the bill. That time also there was opposition from two groups of Republicans.    The defeated bill, called the Healthcare Freedom Act, would have ended the requirement that most people have health coverage, providing the mandate to individuals. It would have also freed large employers from providing coverage to their employees. One good point was it would have increased government grants to community health centres.Though the ACA is considered to be the biggest overhaul of the healthcare system in US, it is also true that all is not well with the ACA. It required some changes with the changing times. The government could increase subsidies given for insurance purchase to bring down the cost or increase the minimum income limit to receive subsidies since affordability is an important issue. Some more policy changes could also be considered than to repeal the law.Instead of finding out what changes are needed in the ACA and working for them, attempts were made to strike it down as per the poll promise, obviously for political reasons. Thus, though the issues involved in the subject are much beyond politics, politics is surely involved in it. Butinstead of politics in people’s health, the defeat of the repeal in Senate should be considered as an opportunity for the Republicans and the administration to make changes in the ACA to make it more effective than repealing it.   ]]> https://biospectrumindia.com/views/21/9171/gst-and-pharma-industry-ficci-views.html https://biospectrumindia.com/views/21/9171/gst-and-pharma-industry-ficci-views.html Fri, 30 Jun 2017 10:55:00 +0530 On behalf of the Pharmaceutical Industry, FICCI would like to state that providing quality healthcare at affordable prices is the stated policy of the Government of India.  Industry members fully support this and remain committed to partner with the Government on this agenda. The GST rate structure for Pharma products No Drug GST rate 1 Pharma products 12% 2 Specified life-saving drugs 5% 3 GST on majority of Industrial inputs & Chemicals (API) 18%   Industry members of FICCI Lifesciences are completely prepared for implementing the new tax rates. FICCI has facilitated an interaction of its industry members with Department of Pharmaceuticals, NPPA, and the GST Sectoral Council for Drugs & Pharmaceuticals to get their implementation related queries resolved. Further, FICCI also conducted a workshop for its industry members in collaboration with external tax consultants to help them get clarity on billing, invoicing and tax rebates related matter. These initiatives helped our members to get clarity on all aspects of pricing and taxation under GST so that they can align themselves to the new structure and ensure availability of quality medicines GST is believed to be the most transformative change in the way business have been run in India thus far and to that end the coming times are going to be exciting. For Life Science Industry, it is expected to be relatively less disruptive and demand will likely pick up strongly in Q2 if the implementation post July 01 is smooth. The impact of GST on pharma sector will evolve. Overall it is a great step for boosting investment climate in the country. The requirement of tax compliance to various tax authorities will get reduced and is expected to bring efficiencies in supply chain by removing state barriers. However, with the existing tax rate of 12% for pharmaceuticals, the net effective tax rate is slated to increase by 2.3% as compared to the earlier indirect taxes regime. It is pertinent to note that the prices of drugs in India has been under stringent price control for decades with the primary objective to ensure availability of quality drugs at affordable prices. The higher rates on drugs would therefore be contrary to India’s drug policy as it would eventually lead to higher cost of medicines. We have therefore made representations to the Government to keep the GST rate for Medicines at 5% tax slab. This will not only help avoid any inflationary pressure in this essential segment but also in many cases will help reduce the medicines prices and act as a booster to the Government’s priority of access and affordability. Glenn Saldanha, Chair, FICCI Pharma Committee & CMD Glenmark Pharmaceuticals Ltd. ]]> https://biospectrumindia.com/views/21/8951/mapping-human-health.html https://biospectrumindia.com/views/21/8951/mapping-human-health.html Tue, 30 May 2017 14:30:00 +0530 What exactly is good health? People mostly realise what good health is when they fall sick.  Defining good health is thus essential, as being planned to do by Verily, Google’s former life sciences arm and now owned by Alphabet. In partnership with Duke University School of Medicine and Stanford Medicine in US, it has launched Project baseline, a systematic and broad effort designed to develop a well-defined reference or baseline for good health. The study is being done in two sites each in two US cities and will collect health data of 10,000 people for four years. Some of them will be in a good health while some others will be those who are at high risk of chronic diseases like diabetes, CVDs etc. Their health parameters will be tracked using sophisticated devices and sequencing their genomes. It will collect large broad phenotypic health data in number of forms like clinical, imaging, self-reported, behavioral, from sensors and biospecimen samples. It will be used to develop baseline map of human health and to get insight into transition from health to disease. Such a type of study is very significant since generally physicians peep into someone’s body, through various medical devices, only when the sickness has struck. They treat illness looking at the symptoms as and when they develop. Very rarely they get to examine a healthy body and the process of how it catches the disease. As a result, physicians treat disease without a well-defined reference of healthy biochemistry.  Through the collected data, researchers hope to find out early warning signs for disease. If that happens then it will be an important development in treating a disease. This may completely revolutionise the medical interventions and will highly improve the success rate.  Despite generating large data, selection of only two sites each in two cities in one country may lead to getting some restricted results as various factors like environment & weather, food, genetics, habits and other surroundings play a very crucial role in human health. That diversity may not represent in the data collected from only two cities in one country despite the claim by the researchers that by focusing on the health of a broad population they can have a meaningful impact on the well-being of patients around the world. Such studies face constraint of having more sites as it is difficult to have several sites together. Still, to gather much wider data more sites from different regions are needed. The researchers have said that the sites may increase. But, while selecting more sites they need to consider other factors like geographical regions, weather, environment, types of people, different diets etc. as they all affect the health.   The study, which is expected by some to transform the medical landscape, is not free from questions, doubts and concerns. Some experts feel that the database may oversimplify human biology, which is actually very complex and unpredictable. The experts have raised some questions over the utility of the study and feel that trivial or false trends will be seen in the data. The researchers can also look at the traditional knowledge of medicines like Ayurveda or Chinese traditional medicines. Ayurveda has dealt with the concept of health in detail and its one aim is to maintain the health of healthy individual. Thus, it naturally has defined what perfect health is. Even Chinese traditional medicine may also have developed understanding of good health. This traditional wisdom may have its own limitations, but it surely can provide some direction to the modern efforts of understanding health. ]]> https://biospectrumindia.com/news/21/102/a-new-3d-fingerprint-identification-system-developed.html https://biospectrumindia.com/news/21/102/a-new-3d-fingerprint-identification-system-developed.html Wed, 19 Apr 2017 11:50:00 +0530 A team of researchers at the Hong Kong Polytechnic University (PolyU) has developed a new system for three-dimensional (3D) fingerprinting identification for providing more accuracy during crime investigation, immigration control, security of access and forensic applications. Law enforcement agencies commonly use automated contact based 2D fingerprinting identification system for identifying people. The major drawback of this system is that contact-based acquisition of biometric scans by rolling or pressing fingers against a hard surface such as glass, silicon or polymer often results in partial or degraded images due to skin deformations, slippages or smearing. Non- contact fingerprint systems reduce these inaccuracies by avoiding direct contact between the imaging sensor and the elastic surface of the skin. The new identification system developed by Dr. Ajay Kumar's team, at the Department of Computing, overcomes all the limitations imposed by contact-based 2D biometric scans. This system involves the use of a single, low cost digital camera coupled with a few LED light sources controlled by a camera. This allows researchers to efficiently acquire high-frequency information in 3D fingerprints using advanced proprietary 3D fingerprint template generation algorithms to recover 3D minutiae features. The minutiae features from the fingerprint ridges - such as ridge ending and bifurcation are universally considered to be the most reliable of fingerprint details, ensuring that each fingerprint is unique. About 40-45 minutiae points can be recovered from a fingerprint on an average. The more minutiae points are matched, higher is the confidence and reliability in the matching. Although many contactless 3D systems have been emerging, they tend to be very expensive and bulky due to their use of multiple cameras or structured lighting systems. This new system offers compact size, high accuracy of around 97%, reduced cost of up to $780, the faster processing time of approximately 2 seconds, and reduced amount of equipment needed. This new practical system is all set for commercialization with several US patents granted on its ground breaking technologies. ]]>