Get inspired by thought-provoking healthcare tales that touch the heart and mind

INNOVATION

Genes influences smoking Industry Occasional smoking might eventually end in addiction. Currently, about 19% of adults around the world smoke tobacco. But, according to the WHO report, there is a global decline in tobacco use, especially among males. In India, according to the Global Adult Tobacco Survey (GATS) (2009-2010) and Global Adult Tobacco Survey (2016-2017) it has shown that there is a 3.3% decline in smoking rates (Fig 1). The global death rates have also declined from 146…

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Healthcare Spotlight Home Page Homehealthcare

What is the Future of Home Healthcare in India?

No one anticipated that the novel coronavirus, first reported in China in December 2019,would become a global pandemic and alter the way our world works, forever. In India, theoutbreak of SARS-CoV-2 blatantly exposed the vulnerabilities of our healthcare system, with the scarcity of hospital beds being a major concern during the first two waves of the viral infection. Niti Aayog reports that 65% of hospital beds in India cater to 50% of the population, while the other half is dependent on the remaining 35% of hospital beds. This is brought on by pronounced regional disparities in India’s healthcare system(1) There are stark differences in healthcare infrastructure development between urban and rural areas, as well as between different states. According to the Human Development Index 2020, India has merely 5 hospital beds and 8.6 physicians per 10,000 people. The country ranks only 155th on the Global Health Index (2) With a population of more than 1.38 billion, India’s healthcare infrastructure is woefully inadequate.Due to a severe shortage of hospital beds, as well as to ease overcrowding in hospitals, many patients were advised to use homecare services during the peak infection period of COVID-19. Thus, our country’s healthcare crisis opened up a number of previously untapped and unexplored avenues, which have since developed significantly. What is Home Healthcare? Home healthcare is an umbrella term referring to the medical services and assistanceoffered to healthcare seekers at their homes. This includes: ● Home healthcare services such as home medical and nursing assistance and lab services● Home healthcare devices that cover all health screening, monitoring, and self-diagnostic devices● Home healthcare solutions such as telemedicine and telehealth services COVID-19: The spark plug for growth of home healthcare in India Home healthcare services were previously available in India, but they truly expanded their reach during the height of the infection and lockdown and proved that they could close the enormous gap between demand and supply. During the lockdown, healthcare seekers had access to respiratory therapy, lab tests, health monitoring equipment, and teleconsultation services from the comfort of their homes. Around 21.5 million COVID patients received home-based care, and 93% of patients recovered from COVID-19 through home healthcare(3). The ‘contact-free’ nature of telemedicine services made them immensely popular during the pandemic period. According to a survey, telemedicine users nearly doubled during the lockdown, from only 21% of consumers in the pre-lockdown period to 44% at that time. Additionally, 73% of those who have never used telemedicine services before are indicating a readiness to do so now(4). The telemedicine market in India, valued at $830 million in 2019, is projected to grow at a CAGR of 31% and touch $5.5 billion by 2025(5). Similarly, home diagnostic testing also saw a significant increase in popularity during the lockdown, due to its prompt and practical results. In FY-2021, the Indian diagnostics lab market was estimated to be worth $12319.32 million. It is expected to grow at a CAGR of 12.25% by FY2027(6). There was also a significant increase in the at-home collection of samples for laboratory tests. A survey showed that almost 74% of respondents preferred sample collection at home rather than going to a hospital or lab. Patients also preferred receiving their postoperative care and therapy at home due to lower chances of infection, greater comfort, and lower costs(5). There was an impetus in the popularity of home diagnostic and health monitoring devices as well during the same period. Besides convenience and comfort, patients prefer home health care for its lower cost. By using home healthcare services, patients can reduce their overall medical treatment expenditures by up to 25%(9). Growth Catalysts Ageing Indian population WHO reports that by 2025, India’s elderly population is projected to increase to 158.7 million, thus making up 11.1% of the country’s overall population (7). According to ‘The National Commission on Population’, India’s elderly population will reach 193.8 million by 2031(8). The 75th NSS survey found that 21% of India’s elderly suffer from at least one chronic disease, with hypertension and diabetes accounting for 68% of them(7). This implies that in the future, there will be a significantly growing demand for home healthcare services such as telemedicine, medical assistance, at-home laboratory services, and personal monitoring devices. The increasing burden of chronic diseases By 2030, it is projected that lifestyle diseases will account for a staggering 74% of all fatalities (up from 56% in 2008) in India, with the bulk of cases being related to cardiovascular disease, cancer, and diabetes. As a result, home care facilities would experience a huge increase in demand.  Cost of treatment Besides convenience and comfort, patients prefer home health care for its lower cost. By using home healthcare services, patients can reduce their overall medical treatment expenditures by up to 25%(9). Changing family structure The 2011 Census reported that 52.1% of Indian households were nuclear families. With a greater shift to this type of family structure coupled with the increased participation of women in the workforce, people are hard-pressed to dedicate their time and attention to their aged parents, especially in urban India. This contributes to an increased dependency on home healthcare facilities to bridge the gap. Market value The global home healthcare market value was estimated to be $320.6 billion in 2021 and is expected to grow at a projected CAGR of 7.9% from 2022 to 2030(11). The Indian market in particular was valued at $7.4 billion and is anticipated to increase at a CAGR of 19.27% from 2022 to 2030(3). What can India learn from the successful home healthcare models of other countries? India’s home healthcare expenditure accounts for only about 3.6% of all healthcare expenditure, compared to 8.3% in developed nations. Countries such as the US, Japan, Canada, Denmark, Iceland, Sweden, and Norway have successful models of home healthcare. Country Home Healthcare Programm USA Triple Aim: By providing post-acute care at home, Medicare expenditure was reduced by 39% per patient Hospital at Home: Johns Hopkins’ initiative for the delivery of acute care at home resulted in a 32%

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3D Prinitng

Can We Print the Future of Healthcare?

Three-dimensional (3D) bioprinting is bringing about a paradigm shift in personalised medicine in the 21st century. According to a report by Mordor Intelligence (1), the global 3D bioprinting market was valued at USD 724.17 million in 2020 and is expected to reach USD 2398.27 million by 2026, growing at a CAGR of 21.91% over the forecast period (2021-2026). It has been predicted that the Asia-Pacific region has the highest scope for growth due to present demands (2). There’s presently an overwhelming demand for donated organs. However, it takes a long time to get an organ transplant through the donor list due to a shortage of adequate, compatible organ donors. There is also the matter of organ rejection and an extended course of immunosuppressants post transplantation (3). India has one of the lowest rates of organ donation in the world, at 0.86 per million (4).  Traditional methods of tissue engineering haven’t had much success in this aspect, both from a feasibility and economic point of view (5), bringing about a need for alternatives. Additionally, there are certain conditions, like spinal cord injuries, that currently have no known cure. There have also been increasing objections against the use of animals for drug testing, clinical trials, and cosmetics over the past few years. 3D bioprinting has been hailed as a method that can potentially overcome all these problems. This article aims to evaluate the current trends, applications, and challenges of 3D bioprinting.   How does 3D Bioprinting work? The aim of 3D bioprinting is to mimic the cell in an anatomically accurate way while maintaining its structure and function. It works similarly to 3D printing, except that a living cell suspension is utilised instead of a thermoplastic or a resin. According to Gu et al., the process of 3D bioprinting can be divided into 4 steps (6) : Data acquisition: 3D models are obtained by X-ray, CT, MRI, etc, and then divided into 2D horizontal slices by specific software. This data is further processed into particles or filaments according to different bioprinting approaches Bioink Preparation: Materials that include cells, growth factors, hydrogels, etc., collectively called ‘bioink’, are selected according to the requirements of printed structures and approaches Bioprinting: The bioink is deposited layer by layer Functionalization: After printing, the dispersed cells form connections and generate some functions of natural tissue or organ through physical and chemical stimulation While there are various types of 3D bioprinting, Extrusion-based bioprinting is currently the most widely used method (6). The Scope of 3D Bioprinting  While the long-term goal is to be able to use 3D bioprinting for organ regeneration and transplantation, it is quite arduous and currently not feasible. Instead, the current short-term goal is to use it to successfully replicate tissue for pharmaceutical drug trials, toxicology, and research. Innovating Healthcare 3D bioprinting provides the opportunity to test drugs at a lower cost, for a shorter duration, and in a more biologically relevant way compared to animal testing. Pharmaceutical companies like Aspect Biosystems have been developing bioprinted lung tissue for this purpose since 2015 (3). It has expanded to address the management of type 1 diabetes through the printing of human beta-like cells (2, 7). Organovo Inc. developed a bioprinting process in which human primary hepatocytes, hepatic stellate cells, and endothelial cells were used to bioprint liver-like tissue constructs and then utilised to monitor the hepatic tissue response to methotrexate and thioacetamide exposure (8).  In another study, Kupffer cells were added to examine their impact on the injury/ fibrogenic response following cytokine and drug stimuli (9). Heinrich et al. demonstrated the construction of mini brains consisting of glioblastoma cells and macrophages as tools for testing therapeutics that target the interaction between these two cell types (10). Several breakthroughs in 3D tissue bioprinting were demonstrated recently to create organ-level structures including bone, cornea, cartilage, heart, and skin. Zhou et al. constructed a patient-specific ear-shaped cartilage using expanded microtia chondrocytes and a biodegradable scaffold (8). In situ bioprinting, or the placement of de novo tissue directly onto the desirable part of the body, has also been explored. Albana et al., demonstrated precise delivery of autologous/allogeneic dermal fibroblasts and epidermal keratinocytes directly into an injured area in animals, replicating the layered skin structure (11).  Recent advances have been made in creating a living neural tissue scaffold. This has important implications in the management of spinal cord injuries, which are widely known for being untreatable (12). Tumour Models and Cancer Research Progress has also been made in cancer research. Tumours are characterised by a high degree of heterogeneity and complexity. The fabrication of suitable in vitro models of the microenvironment is difficult as two-dimensional (2D) models do not completely recapitulate the biochemical and biophysical signals of the tumour environment. Thus, three-dimensional (3D) tumour models, particularly 3D bioprinted models, are emerging as a vital tool since it has a competitive advantage due to the ability to precisely control and define the desired structure and position of multiple types of cells in a high-throughput manner (13). In 2019, Langer et al., made 3D bioprinted scaffold-free tumours using patient-derived cells to examine if the growth and development of pancreatic cells could be recapitulated in vitro. This model was able to mimic many features of pancreatic adenocarcinoma tumour cells, including response to extrinsic signals and in vivo morphology (14). Similar in-vitro 3D bioprinted tumour models have been developed for glioblastoma, breast cancer, and ovarian cancer as well (15).  Challenges of 3D Bioprinting The challenges of 3D bioprinting can be broadly categorised under three headings: Technical Regulatory Ethical Technical Concerns A major drawback is that suitable printing materials are not currently available, which can withstand high temperatures, organic solvents, and crosslinking agents in the printer (16). The cell source may either be animal derived, autologous, or allogeneic. Animal sources, while enabling greater mass production, pose the risk of xenosis. Autologous and allogeneic sources offer greater biocompatibility but involve tighter regulation, longer production times, and higher costs. Teratoma formation, recurrence, or potentiation of malignancy from stem cells

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Healthcare Spotlight Home Page Teleconsultation

Teleconsultation leads the way for a new Future!

The world as we know, has afterall changed exponentially since the first COVID-19 case erupted in late 2019. COVID-19 was declared a “Global Pandemic” by WHO in March 2020. Countries across the globe had imposed a stay at home order, affecting several industries, including the healthcare industry. Data from the National Health Profile- 2019 India, there are 7,13,986 government hospitals’ beds in total, which accounts for 0.55 beds per 1,000 population. The widespread cases of COVID-19 and the unpredictable transmission rates skyrocketing high, there is a big demand in the healthcare industry. Though, the doctors and hospitals, despite running around the clock services, are not able to fulfill the demands. Patients on other hand, have started to decline the opportunity to visit hospitals for consulting in the fear of transmission of COVID-19. However, owing to the pandemic  scenario, teleconsultation has become the beacon of hope for the patients and doctors, and in general the hospitals. Teleconsultation provides a platform for doctors/physicians to conduct virtual, secure consultations with patients in the comfort and safety of their own living rooms. For instance, advanced solutions like using Artificial Intelligence (AI) to deliver the required content to dynamic platforms, benefits both patients and physicians to connect while saving money and time.  Evolution of Teleconsultation When did teleconsultation begin? From urgent house calls to hospital visits, on-demand healthcare has always been a hot asset. A modern patient expects around the clock access to their doctor, and doctors today are able to do that via teleconsultation. However, though modern technologies like skype and facetime are in use, teleconsultation has been around much longer, since the first half of the 20th century. Back in the early 1900s, the invention of radio revolutionized communication. After that, it wasn’t long before experts were inspired by the sudden boom in radio and started speculating about how doctors could attend patients remotely. Radiology images were shared for the first time in 1940 between two towns via a telephone line. This was the world’s first recorded example of medical records being electronically transferred. In addition, building upon this technology in the 1950s, a Candian doctor constructed a teleradiology system that used motion pictures, also known as Video medicine. In 1959, University of Nebraska used two television setups for transferring information to medical students across campus. After that, five short years later the state hospital started performing video consultations.  It was in the 1960’s when both rural and urban regions were using telehealth technology. To be specific in 1967, Miami general hospital paired up with the fire-rescue department to transmit electrocardiographic rhythms over radion at the time of resume situations. After that, teleconsultation officially bloomed. Teleconsultation today resembles the earlier telemedicine equipment, but modern health tech has made it much smaller in size and more features, like the wearable fitness wristbands and heart rate monitors. Amidst the pandemic crisis, teleconsultation appears to be peoples’ go-to for any healthcare solutions. A rise in demand for Teleconsultation services Reports state that as much as 90% of primary care visits can be performed remotely, and the in-person part is only to make the patients feel better and confident. Furthermore, the tools for virtual doctor visits have been in place for a while and but trending now owing to the current COVID-19 pandemic, doctors are opting into this service. Furthermore, the futuristic assumption states that once the majority of doctors and patients are exposed to the benefits and efficiencies of telehealth, it will become a leading way to access health care. There are currently more than 3 million confirmed COVID-19 cases worldwide.In the current scenario, teleconsultation provides the cheapest and safest way for primary health care consultations. It also acts as a bridge to sort the gap between rural-urban health.  Given the situation that our medical staff are getting engulfed by COVID-19 cases outnumbering the resources, it would be disastrous if doctors and other medical staff are quarantined. A teleconsultation enabled virtual visit could be the solution, without exposing the staff to the virus in times of such outbreaks. Added to that, this could contain the infection and reduce the risks for both healthcare workers and patients. Government efforts to facilitate teleconsultation With the need to regulate the utility of teleconsultation, the Government of India recently launched certain teleconsultation guidelines. According to the guidelines the government is committed to providing quality healthcare to all and that teleconsultation is the profound solution to do it. The government believes that by facilitating teleconsultation, it is possible to minimize the barrier of access for medical assistance and services.   India’s new initiative encourages the use of digital tools for improving the outcome of the healthcare system. Moreover, it also focuses on the use of teleconsultation services, especially for primary health issues, wherein a mid-level healthcare provider can connect with the patients virtually ensuring a timely and best possible manner.  Currently, the government has collaborated with Apollo hospitals through which rural patients can consult doctors online and prescribe generic medicines, if needed. The Common Service Centres (CSCs) have been facilitating teleconsultation services with the support from Medanta and Apollo and now are currently being extended to 60,000 CSCs across the country.  Technical and Data privacy problems Just as everyone from governments to healthcare providers the focus is on  teleconsultation. There are certain teething problems that need to be addressed and fixed. Not every patient will have a positive response to teleconsultation. There would be barriers like adaptability to change of regular practices, language issues, and more which need to be addressed. From the hospital’s end, there were few concerns mostly on technical support like software and legal issues.  Secondly, patients are hesitant to pay for such modes of consultation and also don’t receive full satisfaction. There is also the probability of other challenges related to cancellations, incomplete consultations, and refunds. To address these issues, hospitals are allocating a certified body that monitors the quality standards. In the case of India, a country of multiple languages, it becomes difficult to resolve language issues.

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MENTAL HEALTH

Mind Over Matter:Mindfulness-based Cognitive Therapy Industry “Mind over Matter”, “We are the masters of our own universe”, “Our life is what our thoughts make it” These terms are not foreign to us. While the perception of the meaning behind it differs, when dwelled into the science of it, each of these terms holds a significant meaning. Mind over Matter- Our thoughts interact with the physical world, whether or not we know it, affecting change all the way down to the…

PATIENT CARE

pexels engin akyurt 4087417 1

Allergy: an overreaction of the body or overdiagnosis as a disease?

Allergy: An itch that goes around the world All over the world, allergies are counted as one of the most common chronic diseases that impact millions of people every day. What makes them so common is the fact that they are an umbrella term for a plethora of diseases with different subtypes and affecting different organs: allergic rhinitis or inhalant allergy (eyes, nose, and airways), allergic asthma (lungs and airways), food allergy (mouth, skin, and systematic symptoms), eosinophilic esophagitis (respiratory and digestive tract), anaphylaxis (systematic symptoms), atopic dermatitis (skin), insect allergy (skin and systematic symptoms), and drug allergy (systematic symptoms). Due to the overwhelming data for all those allergy-related diseases, we will focus on allergic rhinitis or inhalant allergy, food allergy, and drug allergy in this blog. Allergic rhinitis According to the American Academy of Allergy, Asthma & Immunology, allergic rhinitis affects 10% to 30% of the population worldwide. 1 In a recent cross-sectional and multicentred study, the prevalence of allergic rhinitis was 8% (children), 24% (adolescents), and 10% (adults) in India. 2 Savouré et al. (2022) shared detailed information about the prevalence of allergic rhinitis all over the world. (Fig. 1). 3 Food allergy A European multicentre study from eight Western countries concluded that 1%-4% of school children suffer from food allergies. 4 The prevalence rate of food-specific IgE sensitisation for at least one food allergen was 19.1% in Indian children, although true food allergy was only proven in 0.14% of them. 5 Furthermore, Warren et al. summarised the prevalence of food allergies around the globe (Tab. 1). 6 Continent Prevalence of food allergies Age groups North America 3.5–7.6% (Canada, Mexico, and USA) 0-17 years Europe 1.7–9.3% (Austria, Belgium, Croatia, Denmark, Finland, France, Germany, Greece, Greenland, Iceland, Italy, Malta, Netherlands, Norway, Poland, Portugal, Slovenia, Sweden, Switzerland, and the UK) 0-20 years Central and South America 0.6–5.5% (Brazil, Chile, and El Salvador) 4 months–15 years Middle East 0.8–8 % (Israel, Kuwait, Lebanon, Turkey, and the UAE) 0-30 years Africa 2–5% (Ghana and South Africa) 1–16 years Asia, and Oceania 1.1–7.7% (Australia, China, Hong Kong, Japan, Singapore, South Korea, Taiwan, Thailand) 0-18 years Drug allergy The World Allergy Organization (WAO) defines drug allergy as ‘an immunologically mediated drug hypersensitivity reaction, which can be either IgE or non-IgE mediated’.  It is generally very uncommon, representing less than 10% of all adverse drug reactions. However, approximately 3%-6% of all hospital admissions are related to adverse drug reactions, and 10%-15% of people admitted to the hospital suffer from them. 7 A recent Polish study gave insight into common culprit drugs for adverse reactions: NSAIDs (67.5%), followed by antibiotics (54.3%), local anaesthetics (7.4%), general anaesthetics (2%), and other drugs such as antihypertensive drugs (4.6%), dietary supplements (3.2%), antihistamines (2.8%), and contrast agents (2.4%). 8 For decades, doctors and healthcare workers have noticed an increase in the prevalence of allergies. Numerous scientists have tried to investigate the reasons for this persistent rise and come up with different explanations. The “hygiene hypothesis” is generally accepted and states that exposure to germs and infections during childhood helps to “educate” the immune system. Therefore, a very clean and sterile environment would be counterproductive, as there are no stimuli for the immune system. This is directly linked with the idea of the “biodiversity hypothesis”, which highlights the importance of a diverse microbiome as it seems to promote immune balance and protect from allergy and inflammatory disorders. 9,10 Furthermore, lifestyle changes, such as the increase of pollution in the environment (“pollution hypothesis”), were considered a reasonable explanation. Studies found a direct correlation between diesel exhaust and increased airway inflammation, allergies, and asthma exacerbations. 11,12 Along with that, psychosocial factors, such as increased stress and fast-paced lifestyles, were also found to be accountable for an increased allergy prevalence. For all those reasons, allergies have been called the “epidemic of the 21st century”. 13 What you should know about Allergy: Symptoms, Diagnosis, and Treatment Allergy is often referred to as an overreaction of the immune system since it attacks normally harmless substances. The mechanism behind allergies is well-understood, and scientists agree that IgE antibodies are the culprits that cause allergic reaction. 14 The symptoms can be diverse, according to the allergy-related disease: For allergic rhinitis, common symptoms are a running or blocked nose, sneezing, wheezing, and itchy and swollen eyes. For food allergies, itchiness in the mouth, rashes, diarrhea, vomiting, dizziness, and headaches are typical symptoms. However, some allergies, such as food and drug allergies, also lead to life-threatening anaphylaxis, where the body’s circulatory system and breathing drop abruptly due to the systemic allergic reaction. 14,15 There are different types of allergies according to the offensive allergen: plant and tree pollen, house dust mites, mold spores, and pet hair (dog, cat, etc.) are the most common inhalant allergens 16, whereas milk, eggs, fruits (peaches and apples), nuts, wheat, soy, sesame, and seafood (shrimps and fish) tend to be the most prevalent food allergens 17. The onset of these allergies depends on the exposure; a European study found that shrimp allergies were one of the most common food allergies in Spain and Iceland, which are countries with the highest seafood consumption. 17 Another influencing factor is age. Children usually suffer from milk allergies from an early age, but they can develop tolerance, which is why fewer individuals have a milk allergy in adulthood. 18 The most common method to diagnose allergies is skin prick testing, where allergen extracts are applied subcutaneously or intradermally, and the reaction is read after a short time. Redness and wheal formation are positive signs for the test. Additionally, in-vitro tests are available where only the patient’s blood is needed. The levels of allergen-specific IgE antibodies are quantified with different methods, and higher levels of allergen-specific IgE confirm allergy. 19 However, for food allergies, the double-blind, placebo-controlled, food challenge is the gold standard, where the assumed culprit food is given to the patient in a safe setting and the reaction is monitored. Newer and safer methods, such as basophil or mast

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A New Aura Of Relief: The Future of Migraine Treatment

The World Health Organisation rates migraine as the most common, debilitating, long-term neurological condition1. Globally, migraines affect more than 10% of people, primarily those between the ages of 20 and 50. Migraines are also three times more common in women than men. About one-third of migraineurs are able to anticipate when an episode is about to begin as it is preceded by an ‘aura’ or visual abnormalities like flashing lights, zigzag lines, or a temporary loss of vision2. A severe pulsing or throbbing pain in one area of the head is a common way to describe the discomfort of a migraine headache. The International Headache Society defines a migraine as pain with at least five attacks, lasting four to 72 hours if left untreated, as well as other symptoms including nausea, vomiting, or sensitivity to light and sound3. Depending on the number of days a month a person has headaches, a migraine can be classified as either episodic (EM) or chronic (CM). When a migraine sufferer has fewer than 15 headache days per month, they are said to have episodic migraine, according to the International Classification of Headache Disorders (ICHD-2) criteria. 15 or more headache days per month match the requirements for chronic migraine, according to general definitions. Some sufferers of chronic migraine endure daily headaches, while others constantly feel discomfort4. Is migraine a serious disease? Migraine headaches rarely cause death or brain damage. However, there may be an elevated risk of cardiovascular events and a stroke in those who experience migraine with aura5. According to the American Migraine Foundation, stroke can occur independently of a migraine headache and is more common in persons who currently have or have had migraine. Migraine sufferers are more likely to get hemorrhagic strokes than ischemic strokes. Compared to women without migraine, women with aura had a 2 to 3 times higher risk of having a stroke. Young individuals less than 45 years are more prone to develop stroke associated with migraine6.  A web-based survey revealed that people suffering from migraines had considerably greater rates of insomnia, depression, anxiety, gastric ulcers, gastrointestinal bleeding, angina, and epilepsy.7 Researchers have found a connection between migraine and heart disease from all over the world. Recent research from the Nurses’ Health Study, which enrolled participants between the ages of 25 and 42, demonstrated a 50% increased risk of stroke, coronary events, and related death in migraineurs. The likelihood of developing ischemic heart disease was also double in numerous study populations. Although the exact causes are unknown, they most likely involve coagulation, inflammation, and malfunction of the arteries of endothelial lining8. The negative impact of migraine Every element of a person’s life, including their relationships with friends, family, and partners, can be impacted by migraines. People with migraines frequently experience loneliness and isolation. When asked what the most discouraging aspect of having migraines was, 48% said that it was being misunderstood by others9.  According to a cross-sectional study carried out in several headache clinics in Austria, about 34% of respondents, the majority of whom had episodic (56.4%) or chronic (38.3%) headaches, said their headaches had a negative impact on their careers, and 21.5% said they had a negative impact on their earnings. Only approximately 50% of respondents thought that their coworkers understood their headaches, which highlights the stigma connected with headaches that migraine sufferers face.  According to this study, the negative effects on one’s job and the financial situation grew as headache frequency increased9. It is only because of a lack of education that migraine is viewed as a minor issue; in reality, it is a highly serious illness that can drastically reduce your quality of life. How was migraine treated traditionally? Initially, non-migraine-specific medications like antiemetics, analgesics, and opium were used to treat migraines. Analgesics were regarded as the first-line medication therapy for treating migraines, while antiemetics were used to lessen the vomiting and nausea brought on by migraine attacks10. In the 1990s, triptans—selective 5-HT1B/1D receptor agonists were authorised for the treatment of acute migraines and were the first migraine-specific drugs to be introduced. Acetaminophen, aspirin, and NSAIDs were suggested treatments for mild episodes. Tablets of diclofenac and effervescent aspirin start working more quickly than the powdered versions. Moderate to severe migraine were treated with triptans or dihydroergotamine DHE. Triptans typically outperform DHE because they are more tolerable, have a lower risk of side effects, and are more effective. For a subsequent attack, a different triptan should be attempted if the patient does not respond well to the first one. Nasal, injectable intranasal and intranasal works better for migraines that are most painful when they first start and for migraines that cause nausea and vomiting11.  Even though numerous migraine treatment options were available at that time, migraine sufferers still faced difficulties because attacks can come on suddenly and without warning. The biggest loss was that these drug formulations were never convenient for them to use while travelling or in an emergency because they always required assistance for administration. Introduction of novel therapy options Until the development of monoclonal antibodies in 2018, there had been no new migraine drug since triptans were developed. The CGRP monoclonal antibody treatment truly advanced the field of migraine because it was the first approved preventive medication treatment that targeted the CGRP molecule, the root cause of migraine12.  In 2019, a group of drugs called ditans was introduced. Lasmiditan was the first among them, making ditans the first novel class of acute migraine medications to be approved by the FDA in more than 20 years. They block the spread of nerve inflammation and stop pain signals from reaching the brain12.  This period also saw the development of CGRP ‘gepants’, a class of CGRP receptor antagonists that prevent the CGPR molecule from correctly attaching to receptor sites in the body. By doing this, they can prevent the series of reactions that leads to a migraine episode.  Gepants, in contrast to triptan medicines, do not cause blood vessels to constrict, making them safe for persons

Healthcare Spotlight Home Page Diabetes 1

The Indian Diabetes Story: Reflections on World Diabetes Day

‘Sugar is the new tobacco.” In India, unsurprisingly, people’s first thought when they hear the term sugar is diabetes. According to the International Diabetes Federation (IDF), around half a billion people in the world are living with diabetes. This means that roughly every tenth person on the planet has diabetes. The number is projected to grow to a whopping 643 million by 2030 and 783 million by 2045. The terror does not end here. Diabetes was responsible for 6.7 million deaths in 2021, which roughly translates to 1 death every 5 seconds. The report’s findings highlight the elephant in the room: that diabetes is one of the fastest-growing health emergencies of the 21st century. 1 In response to growing concerns over the health and economic impact of diabetes, the IDF established World Diabetes Day (WDD) in 1991 with the support of the WHO. It became an official UN day in 2006. It is observed each year on November 14, which happens to be Sir Frederick Banting’s birthday. He, along with Charles Best, is famously responsible for the discovery of insulin in 1922. WDD is the world’s largest diabetes awareness campaign. It puts diabetes firmly in the public and political spotlight while bringing attention to topics of cardinal concern to the diabetes community. 2 Diabetes awareness is represented by a blue circle, which is the logo of WDD. This logo represents the unity of the global diabetes community in response to diabetes. Each year, WDD focuses on a specific theme that sometimes lasts for more than a year. This blog will revisit and review the themes of the last decade and evaluate our progress in battling diabetes. 3,4 WDD 2013: Protect Our Future: Diabetes Education and Prevention WDD 2013 focused on the prevention of diabetes for the protection of one’s future. This was a call for countries to adopt and implement affordable and effective solutions to minimise diabetes-related health and financial burdens. Many countries, including India, have national-level programs for the prevention and detection of diabetes. The campaign was an invitation to the countries to optimise their efforts and yield the best results. WDD 2014: Go Blue for Breakfast The theme of WWD 2014 focused on the significance of healthy eating in the prevention of diabetes. The campaign promoted healthy lifestyle choices to avoid the development of the disease. This includes choosing a healthy, balanced meal over fatty and sweet junk food, exercising regularly, and cutting down on smoking and alcohol. 5 WDD 2015: Healthy Eating The theme for WDD 2015 was similar to the one in 2014. It focused on healthy eating in order to maintain a healthy weight and lower the risk of diabetes. Healthy food was treated as a human right, a necessity that needed to be prioritized to save lives, reduce the global burden of diabetes, and bring down healthcare costs by billions of dollars. In addition to highlighting the significance of healthy eating as a preventive strategy, it also emphasised its role as a cornerstone for successful diabetes management, along with comprehensive healthcare strategies and medicine such as insulin. 6 WDD 2016: Eyes on Diabetes The campaign of 2016 focused on two key messages: i) screening for type II diabetes is essential for managing the condition and reducing the risk of complications ii) screening for diabetes complications, including retinopathy and other eye diseases, is vital for managing all types of diabetes.7 Considering the high number of people living with undiagnosed diabetes, this call to ‘act today to change tomorrow’ was very significant and impactful. According to the IDF, diabetes remains undiagnosed in 50% of individuals around the world.1 By the time a person is actually diagnosed, complications may already be present. Thus, aggressive screening, early detection, and effective interventions in managing the condition are becoming more important than ever. 8 WDD 2017: Women and Diabetes – Our Right to a Healthy Future The idea behind the 2017 WDD was to promote the significance of affordable and equitable access to essential diabetes medications and technologies for all women at risk of or living with diabetes. It highlighted the importance of access to education and information on the self-management of diabetes for women. This helps in ensuring optimal diabetes outcomes and in preventing type 2 diabetes. A WHO press release highlighted that “Women and girls are key agents in the adoption of healthy lifestyles to improve their health and the health and well-being of future generations. They have important roles to play to avoid diabetes or alleviate its effects, including practising physical activity and proper healthy diets to improve their health outcomes.”9 The campaign recognised the fact that gender roles and power dynamics influence vulnerability to diabetes and impact access to care. It worked towards creating awareness about the additional risks that women experience, including cardiovascular diseases, gestational diabetes, and chances for miscarriage due to diabetes. 10 WDD 2018–2019: The Family and Diabetes: Diabetes Concerns Every Family IDF planned a biannual theme spanning 2018 and 2019 focusing on the role of family in the prevention, detection, and management of diabetes. Families are essential to support systems for patients with diabetes. The activities and materials of the campaign were aimed at creating awareness about the impact diabetes has on the family and patient support network and promoting the family’s role in diabetes management, treatment, prevention, and education.11 WDD 2020: The Nurse and Diabetes The theme for 2020 aimed to create awareness about the crucial role of nurses in supporting people living with diabetes. It highlighted the global shortage of nurses to cater to healthcare demand. In 2018, this shortage was 5.9 million. The campaign urged that the number of trained and employed nurses needed to grow by 8% a year until 2030 in order to overcome this alarming shortfall. It highlighted the need for further investment in the health workforce.12 WDD 2021–2023: Access to Diabetes Care The theme for 2021 runs until 2023. At the heart of the campaign is the compelling necessity to ensure access to diabetes