2. Pencil Beam Technology for Cancer

India has a huge number of cancer patients, keeping them in mind Apollo Group has launched Asia’s first proton therapy centre known as Apollo Proton Cancer Centre (APCC) located in Taramani, Tamil Nadu, India. Proton therapy is one of the most advanced forms of radiation treatment which attacks tumours with more precision thereby causing minimal damage to the surrounding healthy tissues. This therapy is particularly effective for pediatric cancers; tumours affecting eye, brain, breast, colon, gastrointestinal region, prostate and pelvis; areas close to the spinal cord, brain stem and other vital organs; and re-radiation in relapsed cases. Proton therapy is particularly useful in curing paediatric cancers. The centre built at a cost of Rs 1300 crore will cater not only to Indian patients but also a destination for foreign patients promoting Medical Tourism for cancer treatment. With this step taken by the Apollo hospitals, India becomes one of the few nations which offers proton therapy for cancer treatment in addition to UK. The facility is 150 bedded dedicated to cancer care with three proton therapy rooms, advanced radiation oncology centre, medical oncology and immuno therapy facility and high end day-care chemo wards. The facility will also have five modular digital MRI integrated operation theatres, besides a high-end diagnostic imaging centre for genomic profiling of cancers including DNA sequencing and digital pathology services. SOURCE: www.healthtechnology.in

3. Bio Glue for Fast Wound Repairing

Any trauma or surgery can lead to uncontrolled bleeding which is a major cause of death many a times as it is difficult to seal these bleeding wounds without sutures. To tackle this problem, a team of researchers in China from Zhejiang University and East China University of Science and Technology have developed a ‘biological glue’ that could one day stop arteries and hearts from uncontrollable bleeding. The study is published online in the Journal Nature Communications. So far, the use of the gel has been demonstrated in animal experiments involving pigs and rabbits wherein the light activated adhesive gel can rapidly seal wounds to arteries and the heart and could be potentially used in surgeries in the future. The USP of the biological gel is that when it is placed on an open wound, it mimics the composition of the extracellular matrix and sets fast when exposed to ultraviolet light. The non-toxic hydrogel can be injected and has the potential to be used for surgical haemostasis and fast wound sealing in cases of open surgery and minimally invasive endoscopic surgery. The gel is also capable of withstanding both slippery surfaces and the pulsing of heart tissue. The adhesive gel still has not been used on human organs, but a prototype was used inside rabbits and pigs where it performed better than sutures or other currently available surgical glues. In preliminary animal experiments, a set of surgical procedures were carried out on pigs and the use of gel could seal the wounds of livers of pigs without the need for sutures. With the use of this gel, for the first time ever high-pressure bleeding of a beating heart with 6 mm diameter cardiac penetration holes, was stopped and the wounds were stably sealed within 20 seconds without sutures. In pig surgery, the gel closed a punctured carotid artery in less than a minute and repaired a hole in the cardiac wall. In rabbit surgery, the light activated hydrogel was able to stop a bleeding liver cut and a femoral artery in mere seconds. The three pigs not only survived the heart surgery but also showed natural signs of healing within 2 weeks with little inflammation and almost no necrosis. Despite the progress, additional studies are needed to confirm the safety of the gel for its use in further trials, including those involving humans. The gel has improved properties over other similar materials present in the market – it can withstand upto 290 mmHg blood pressure, which is much higher than what most doctors and nurses usually deal with, it’s structure is based on that of human connective tissue, the extracellular matrix of this gel is compatible with internal organs and arteries that facilitates it’s binding with arterial and cardiac walls. The team is hoping that the gel could be ready for human surgical use in the next 3 to 5 years.

SOURCE: www.sciencealert.com

4. Bluestar Diabetes

The International Diabetes Foundation has predicted that diabetes could affect nearly 123 million of the Indian population by 2040 and world over the treatment for diabetes complications costs more than $670 billion dollars a year. The disease claims the lives of five million people worldwide each year. To contribute to the efficient management of diabetes, IFC (a member of the World Bank Group), WellDoc (a US-based digital health start-up) and Max Healthcare (a leading healthcare provider in India) have come together and recently launched an innovative mobile application named ‘Bluestar Diabetes’ to improve diabetic care in India. The pilot project will include a selected group of patients in New Delhi whose smart phones, personal computers and tablets will transform into a personal health advisor once the app is downloaded on their devices. The app will be tailored for the Indian market to account for local diets and specific medications which will allow patients to enter details of their meals and receive immediate advice on optimal medication and dosage. The app by WellDoc is a mobile health monitoring tool that helps type 2 diabetes patients and their doctors drive behavioural and clinical change by analyzing the diabetes data including medications and blood glucose levels entered by the patient which is then shared with the patient’s healthcare team to improve decisions and better manage the disease. IFC is providing the funding and support through its TechEmerge program which works in the emerging markets to match innovative firms with local partners creating a win-win situation for businesses. This TechEmerge program is being implemented in partnership with the Finnish Ministry of Employment and Economy along with the Israeli Ministry of Economy and Industry, and supported by Indian Health 2.0. The focus of Max Healthcare is on changing the healthcare delivery to serve patients with chronic ailments of which one is diabetes in a better and more efficient way. Thus, the role of each partner comes from their own vision and areas of expertise. Hope to witness better management of diabetes care in India with this initiative of the parties.

SOURCE: www.healthtechnology.in

5. ‘SCGEN’ – AN AI Tool to Predict Cell Behaviour

Researchers have created an Artificial Intelligence powered tool named ‘scGen’ that promises to reshape the way we study diseases and their treatment at cellular level. The research is published in the Journal Nature Methods where it demonstrates that scGen will help to map and study cellular disease response and treatment beyond the information accessible from experiments. scGen is the first tool to predict out-of-sample cellular reaction which means it is prepared to create credible projections for a distinct system if trained on information capturing the impact of perturbations for a specified system. As per scientists, scGen is a generative deep learning model that takes ideas from pictures, sequence and language processing and then uses them to model a cell’s behaviour conducted on a computer or through computer simulation. scGen is a part of computational biology which has the objective to accurately model cellular response to perturbations like illness, genetic procedures. The team further needs to work to make it a fully data driven formulation so that its predictive power is enhanced, and it permits better and more accurate analysis of perturbation combinations. SOURCE: www.healthtechnology.in

6. Artificial Intelligence may soon help spot Autism early on

It is difficult to identify signs and symptoms of autism in kids, but a recent study released in the Journal Proceedings of the National Academy of Sciences indicates that easy quantifiable artificial intelligence measures could allow for much earlier diagnosis of Rett syndrome and potentially other autism-like illnesses. Rett syndrome is a genetic disorder that impairs sensory, motor, cognitive and autonomic function from 6 to 18 months of age. The research has revealed that a machine-learning algorithm can detect pupil dilation defects that can predict autism spectrum disorder (ASD) in mouse models. In the research, the algorithm has shown to detect correctly if a child has Rett syndrome and autism-like behavior. Researchers hope that this algorithm will be able to provide an early warning signal not only for Rett syndrome but also for ASD. The team thinks that this tool can further be used in the future to monitor the reactions of patients to medicines as currently, it is testing the drug ketamine for Rett syndrome and a gene therapy trial is also in works. SOURCE: www.healthtechnology.in

7. Care4u: An Artificial Intelligence App for Geriatric Care

Second year students of B.Tech, IIT Kharagpur recently created an interconnected android smartphone application ‘CARE4U’ to promote elderly care by helping caregivers reach the elderly on time. To connect both the parties, CARE4U is mounted both on the elderly’s devices and the caregiver’s smartphone. The neural network based drop detection algorithm in the app on the elderly’s phone can identify whether the elderly has fallen down. In case of a fall, it automatically calls the caregiver and emergency services along with the location of the elderly. A unique feature of the app is that it detects emotion of the person by taking his/her picture and calculating their index of mood. To make this feature more effective, the team has developed a cognitive intelligent chat bot for better engagement of the elderly. Other features of the app include operations like calling, booking a taxi, sending a message, medical history record, an SOS button, an allergy account, real-time location monitoring and medicine reminder which reminds both the elderly and the caregiver the time of taking the medicine. SOURCE: www.healthtechnology.in

8. Itc Lamp: Hemorrhage Control Device

Massive hemorrhage is the leading cause of death in traumatic injuries, immediate control of bleeding is of prime importance in such scenarios. With a vision to effectively contain such situations of traumatic injuries a firm, Innovative Trauma Care (ITC) came into action. ITC, a Canada based early-stage medical device firm, focuses on developing point of care solutions for trauma, first responders and military medicine applications. With this vision, they introduced iTClamp, a hemorrhage control device for use in the extremities, axilla, inguinal, scalp and neck. The device minimizes blood loss until the wound is surgically repaired by sealing the edges of the wound. Research studies have shown that the clamp is superior to wound packing in terms of patient survival, survival time and total blood loss. iTClamp hemorrhage control system is one of the most unique devices and ideal for emergency medical personnel as it is simple to use, does an immediate fluid-tight and airtight wound closure within seconds. The clamping device works by sealing the skin closed to create a temporary pool of blood under pressure, which forms a stable clot until surgical repair of the wound is done. The device has been in the market for a while now and is a hit amongst the emergency first responders. The company is trying to address the unmet needs in the emergency medicine field by developing, manufacturing and commercialising point of injury solutions to control the common causes of preventable death in traumatic injury situations. SOURCE: www.innovativecare.com

Healthcare Newscope

Compiled by  Dr. Avantika Batish, working as the Director Strategy and Healthcare at International Health Emergency Learning and Preparedness. She is also a guest faculty for MBA (HR) and MBA Healthcare Management at various B-Schools and is a soft skills trainer.

Water, as we all know, is the utmost need of our survival. Human body comprises around 60% water and the fact that less consumption of water leads to various diseases in the future. Apart from facts and figure, one simple question we often forget to inquire is where this water is coming from? Surface water i.e. lakes, rivers and ponds or groundwater i.e. tube wells, bore well, well as these are the two sources that give us a glass of water.

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Our health concern and the credulous brainwash of our mind by the various available water filter present scenario and save our planet from the harmful effect of self-made destruction.Effective treatment and management of wastewater from the pharmaceutical industry will help in overcoming antimicrobial resistance. Advanced treatment methods such as reverse osmosis, nano filtration, and membrane bioreactors have shown to be promising processes for cleaning micro pollutants with nano gram per litre (ng/L) concentration levels.The nation where the trial/testing of most of the antibiotic occurs, there are rarely any constraints implemented on the disposal of pharmaceutical wastewater to the surface water. The current scenario of environmental issue foresees that in the near future there will be scarcity of drinking water and our hope was restored when global challenge was taken to in the market often diverts us from our prime concern of keeping our planet safe from water pollution. The pollution of water bodies has been initiated by us and still we are invariably helping it grow with every passing day. As discussed earlier, the various point sources from domestic to industrial pave the way for antibiotic to contaminate the water bodies. According to the latest report of UNICEF, 2.1 billion people lack the access to clean and safe drinking water.

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How do we remove the problem? What do we do to save ourselves from the harmful effects?

The encouraging words of Normal Vincent Peale, American author ‘Every problem has in it the seeds of its own solution. If you don’t have any problems, you don’t get any seeds’ gives us the hope that we will successfully overcome the present scenario and save our planet from the harmful effect of self-made destruction.Effective treatment and management of wastewater from the pharmaceutical industry will help in overcoming antimicrobial resistance. Advanced treatment methods such as reverse osmosis, nano filtration, and membrane bioreactors have shown to be promising processes for cleaning micro pollutants with nano gram per litre (ng/L) concentration levels.The nation where the trial/testing of most of the antibiotic occurs, there are rarely any constraints implemented on the disposal of pharmaceutical wastewater to the surface water. The current scenario of environmental issue foresees that in the near future there will be scarcity of drinking water and our hope was restored when global challenge was taken to curb the antimicrobial resistance from environment. Remedial measures taken towards eradication are further discussed.

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Political commitments: International efforts: World Health Organization Jaipur declaration on antimicrobial resistance 2011 recognized AMR as a serious public health threat. With the 2014 WHO Report, the extraordinary rates of AMR prevalent in India came into focus. After this report, joint efforts were made by India and WHO. While WHO labelled AMR as the Flagship Priority area for South East Asia Regional Office (SEARO), the Indian Medical Association launched an awareness programme to train the physicians and sensitize the general public. In 2015, the 68th World Health Assembly decided to incorporate the concept of One Health in the fight against AMR and a Global Action Plan was initiated. All member countries, including India, agreed to frame their own National Action Plans (NAPs) for AMR by 2017.

Also Read: Specific health situation of Indian states

National efforts: The Government of India formulated a Core Working Group on AMR that drafted a NAP for the country. Six strategic priorities were listed in NAP, all of which incorporated considerations for AMR in the environment, directly or indirectly. Further, each strategic priority has defined interventions, activities and outputs, the fulfillment of which is delineated by a timeline projected for the next five years. The NAP, although promising, has not yet come into full action in any of the Indian states so far. To curtail the prevalent malpractice of over-the-counter (OTC) sale of drugs, the Central Drugs Standard Control Organization implemented Schedule H1 in India in 2014. It, however, encompasses only a few selected antimicrobial groups. In June 2017, the Food Safety and Standards Authority of India (FSSAI) published the list of maximum residue levels for antimicrobials in foods prepared from animal, poultry and fish.

Health Organization in India: To know the near-exact extent of AMR, AMR surveillance networks were initiated by the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC) in 2013 and 2014, respectively. In 2015, these two organizations along with the support from Centers for Disease Control and Prevention (CDC) USA, started a systematic assessment of the prevailing IPC practices in India with the aim of formulating new guidelines for preventing hospital-acquired infections.

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These activities, however, cater basically to the emerging AMR in the healthcare settings and do not include special provisions for AMR in the environment. Similarly, the National Health Mission’s National Health Systems Resource Centre and the National Accreditation Board deal with IPC practices and strengthening of laboratories/hospitals and not with the AMR in the environment per se. The importance of AMR in the environment has been realized recently by the national health authorities and The National Health Policy 2017 calls for a rapid standardization of guidelines regarding antibiotic use, limiting the use of antibiotics as OTC medications, banning or restricting the use of antibiotics as growth promoters in animal livestock, and pharma co-vigilance including prescription audits inclusive of antibiotic usage – in the hospital and community.

Innovative ideas: The National Health Mission of India started the Swachh Bharat Abhiyan or the Swachh India Mission to improve the basic hygiene and sanitation in all spheres of life. As a part of this massive programme, education was imparted through mass media on the health hazards of open defecation. UNICEF data shows that out of one billion openly defecating people in the world, 60 percent reside in India. It is further argued that it is a behavioural problem with the Indians as other poverty struck nations of Africa and South East Asia did not have the problem of open defecation to this an extent. To deal with such socio-cultural issues, innovative ideas along with mass media are needed in India.

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So far in India, antimicrobial resistance in the environment has been a topic of least priority. With an ever-increasing threat of AMR in the environment, immediate action is required to halt its progress and spread. A combined effort of multidisciplinary and multi-sectoral approach will be able to eradicate the problem in the near future.

About the author

Dr. Debleena Bhattacharya is an independent researcher. She is presently working as an Assistant Professor in the Department of Environmental Science and Engineering at MEFGI, India. She holds a doctoral degree in Environmental Science from IIT (Indian School of Mines) Dhanbad (India). Her specialisation is in the field of wastewater treatment and biotechnology.

About the author

Mahan Shome is a young medico studying medicine abroad. In his leisure time, Mahan likes to read innovative scientific health articles. His dream is to be part of healthcare research that brings about advancement in medicine. He hails from Howrah, West Bengal.

Tools and Tactics

Some of these machine-based data analysis tools such as Cell Profiler have now evolved from individualistic feature-based characterisation to analysing multiple features like DNA staining, organelle texture and quality of empty cases-based cell sorting. In a similar way, Deep Variant has evolved from genomic information processing to image-based analysis. Google’s TensorFlow (open platform for deep learning algorithms); Atom wise (visualise molecules into 3D pixels referred to as voxels, provides atom- based interactions); answer ALS (a consortium-based approach to combine genomics, transcriptomics, epigenomics, proteomics, imaging and pluripotent stem cell population to target neuro degenerative diseases) and Contour (clustering of cellular imaging on the basis of trends rather than mortality factor alone) etc., are some remarkable newly evolving Deep Algorithm tools.

The over fitting of the model to its training data, which in turn is huge in size, poses a challenge to find ways to classify data to train it more efficiently. Computers have learned to find the needle (required information) in a haystack (huge database)which we as humans fail to identify and process.

During data analysis earlier, we were keeping experimental variations constant, but now with input tools like adding environment design, multiple controls etc., the perspective of data processing has changed completely. Present elaborate databases are analogous to our DNA in which most part looks repetitive and to know exactly why it is there, critical data screening and processing is required by new tools which further get improved through the acquired information and are better prepared for next generation of data.

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Human intelligence is a complex simulation outcome of twelve characteristic features that include perception, resolving problems, learn, reason, abstract, plan,decide, understand, feel, act, create, and finally communicate. The human brain can be compared to a processor which processes these features using eight mental mechanisms which include imagery, concepts, rules, analogy, emotions, actions based on intentions, language, and consciousness. These twenty features (twelve characteristic features and eight mechanisms), taken together present the evaluating benchmarks for current AI. The major flaw in our current AI system compared to human intelligence is its limited ability in terms of abstracting and understanding with no feelings. However, AI is expanding its knowledge and processing in an exponential manner. Human-made AI now understands more than its earlier versions. AI is forecasted to pass through phases of knowledge engineering, machine-learning, and contextual marginalisation. It is like acting by rules, making new rules, learning to act again, to evolve new rules.

A simple AI tool such as a calculator can enable a person to use arithmetic for him/her. AI is now providing solutions in natural language processing, complex data sets for agriculture variables, etc.

However, unlike a calculator, it is yet to be accessible both in terms of tools, data set and skill for the public. Networking of multiple disciplines and protected commercial data with limited accessibility are major hurdles in the process. India is getting digitized in a fast manner. Adding Aadhar *unique identification number* was the major step followed by demonetization. As per CIS (India) of 2018, AI will add 957 billion USD by 2035. Health IT is booming with new start-ups every day, but the challenge is integration under streamlined vision. It is important to understand that any solution is sustainable with a participatory approach as exhibited by the evolution of telecommunication globally. Our basic education system is extremely diverse across the country with varied types of public and private players. The variation in state wise curriculum especially other than language is questionable. We can still choose Biology or Mathematics as separate options at our higher secondary education. This itself kicks out the possibility of emerging computational biologists in the future. It took almost ten years to build the world’s largest neuromorphic (neuron-like) computer Dubbed Spiking Neural Network Architecture (SpiNNaker) at the University of Manchester. This machine rethinks the way a conventional computer works. Its major objective is to support existing partial brain models of the cortex, basal ganglia, etc. It can manage 200 quadrillion tasks simultaneously. Still, we have reached only 1 percent of human brain capability that too with many simplified assumptions in the process. SpiNNaker is more comparable to mouse brain which is 1000x times smaller than the human brain. Although we need to explore more to understand the human brain and how it functions but once it is decoded any universal Turing machine can be turned to mimic human cortex actions. Intelligent and super-intelligent machines are our future and will make our life more convenient. Still, there are numerous challenges and ethical issues during these developments. We are moving towards a stage where time will become the ultimate currency governing all the aspects of human life.

About the author

Dr. Sarita Jaiswal, an ex-research officer at University of Saskatchewan, Canada, is an accomplished Plat Scientist having 15+ years of R&D experience with specialization in cereal and pulse crop biochemistry and genomics. She has been awarded twice for the category of Young Scientist (Indian Society of Plant Physiology and amp; KK Nanda Foundation for Advancement of Plant Sciences).

This is because of the singular and unique ability of the TB bacterium to hide inside the human body in a dormant state without causing the disease or revealing any outward symptoms. Such cases are classified as latent TB infections and can be revealed by diagnostic tests in healthy seemingly uninfected individuals. Studies indicate that close to 40% of the Indian population is positive for latent TB and without treatment 5%-10% of these will develop active TB at some point in their lives. Unfortunately, due to the high burden of TB in India, the detection and treatment of latent TB are not prioritized, resulting in a huge reservoir of dormant and potentially infectious bacteria primed to emerge under favorable conditions.

In 2017, 10 million people were infected with TB and 1.6 million died worldwide, surpassing AIDS as the world’s leading cause of death due to an infectious disease. WHO has designated March 24t has the World TB Day to raise public awareness about TB and its deleterious effects on health, society and the economy. In 2015, it began to implement the ‘End TB Strategy’ which envisions a world free of TB with zero TB related deaths and zero incidences of the disease. In order to do this, WHO aims to support and promote a patient-centric approach to care and prevention, encourage proactive policies and support systems by involving the government and private sector healthcare and finally intensify research and innovation in the field of TB treatment, prevention, and diagnosis. The Government of India has instituted a similar strategy, the Revised National Tuberculosis Control Program (RNTCP). RNTCP involves adopting WHO guidelines of Direct Observation Therapy (DOT) to the Indian scenario and includes direct monitoring and administration of anti-TB drugs to the patient, rapid TB diagnosis and treatment, and increased partnership between public and private healthcare systems. RNTCP’s objective is to eliminate TB by 2025. The plan outlines four directives – Detect, Treat, Prevent and Build and includes a system for free and sensitive diagnostic tests for TB, screening of the high-risk population, free TB drugs for all patients, implementation of a uniform treatment regimen, increased social support and monitoring and treatment of latent TB. Finally, the plan will work towards translation of political commitment to action through strengthening support structures for surveillance, research, and innovation.

Several technological innovations have facilitated easier and improved patient monitoring, such as 99DOTS which is a low-cost solution for improving patient compliance during TB treatment. Patients using 99DOTS receive medication in specially packaged blister packs. Dispensation of a dose reveals a hidden and unique phone number that the patients can call for free and confirm that the medication has been taken. In this way, remote monitoring of patient compliance has been made possible. Several digital adherence technologies have also been developed as an electronic way to monitor medication and provide reminders. These include digital pill boxes (evriMED, Wisepill, etc.) that are given to patients with their medication inside. The digital boxes provide visual cues such as colored LED lights which turn on and remind the patient of the dose and the medicine that is due. These boxes can also record medication events in real time by logging the opening of the box for each dose, allowing for real-time monitoring of patient compliance. Pilot studies are also underway in the US for ingestible sensors that are embedded inside each pill, which transmits information that the pill was consumed upon activation inside the patient’s stomach. However, the cost of such technology is yet to be estimated and given WHO and Govt. of India goals to reduce the economic burden of TB, cost-effective ingestible sensors may remain only a distant possibility.

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Risk Factors for TB

Being primarily a respiratory disease, TB is disseminated by airborne infection as the bacteria is exhaled from an infected individual and inhaled by another. This often happens in poorly ventilated and over-crowded settings typically seen in cramped housing where the disease can spread like wildfire. Indeed, earlier TB was thought to be hereditary as it used to wipe out entire households. Weakening of the body’s immune system due to age, substance abuse, air pollution, diabetes, HIV infection, and malnutrition, among others, play a major role in increasing susceptibility to TB. Its spread is seen across the socio-economic strata. As Dr. Zarir Udwadia, one of the world’s leading pulmonologists puts it, “TB does not distinguish between the chauffeur driving the Mercedes and the CEO sitting at the back!”

Detection and Diagnosis of TB

One of the main challenges in the fight against TB is the very first step of diagnosis. Millions of TB cases go undetected and unrecorded all over the world due to the shortcomings of technology. Conventional TB diagnosis is performed by sputum smear microscopy, wherein the sputum of the patient is examined under a microscope for TB bacilli. However, this approach is only 36-43% sensitive which means that many cases of TB infection are missed by this method.

Sputum smear microscopy also suffers from false positives, as some non-TB bacilli may also pick up the TB specific stain. Therefore, a positive sputum smear needs to be confirmed by culturing the bacilli obtained from the sputum in the lab, which can then be tested to confirm TB. Unfortunately, growing patient strains and analyzing them requires resources and technical expertise that are not available in most of the high prevalence countries. In addition, growth-based confirmation of TB positivity takes a minimum of 21 days since the growth rate of the bacilli is extremely slow.

A third technique, which involves the detection of TB DNA using polymerase chain reaction (PCR) and named Xpert MTB/RIF promises results of sample positivity within 2 hours and is currently the gold standard in PCR based TB diagnosis. However, this system suffers from high costs per assay and the requirement for infrastructure and constant electricity, which are not available in many cases.

Treatment for TB

Active TB infections are treated with a standard 6-9 months treatment regimen involving four antibiotics: rifampin, isoniazid, ethambutol, and pyrazinamide for varying durations. This treatment duration is one of the longest for bacterial infectious disease, second only to the treatment of leprosy. Side effects like itching, rashes, fever, nausea, diarrhea and reddish/orange discoloration of body fluids including urine, tears, and saliva is another cause of worry which takes a physical, emotional and mental toll on the patient.

Since most infected individuals begin to feel better after a few weeks of treatment and the length and side-effects of the drug treatment are arduous, many patients stop the treatment prematurely or skip doses. Rampant patient non-compliance when it comes to the completion of anti-TB therapy is one of the main factors for the emergence of a more severe form of the disease, one which is resistant to common drugs! This is a big reason for TB reactivation and the continued prevalence of this disease even though it is completely curable in most cases.

Drug resistance in TB has been known since the first antibiotics to treat this disease were put into place. An increasingly larger repertoire of drug-resistant strains necessitated and increasingly larger arsenal of drugs to treat the disease. As of today, TB strains resistant to one of the first line of four antibiotics are called resistant strains. Strains resistant to two first-line antibiotics are called multi-drug resistant strains of TB or MDR-TB. These are treated with a second line of antibiotics, consisting of fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin) or injectable drugs such as amikacin, kanamycin, and streptomycin. More recently, the third category of strains labeled Extensively drug-resistant- or XDR-TB has been described with resistance to a fluoroquinolone and at least one of three injectable drugs. A total of 12 drugs are approved today, each of which individually and in combination is used to treat these three categories of TB, MDR-TB, and XDR-TB. However, a little characterized fourth type of strain dubbed totally drug-resistant- or TDR-TB has been reported in India, Italy, Iran, and South Africa. These strains are completely resistant to all known anti-TB medication and given the airborne and infectious nature of the disease, are ticking time bombs of catastrophe.

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Newer Strategies in TB Healthcare

The emergence of drug resistance, the persistently high rate of TB incidence and TB mortality and the challenges associated with patient non-compliance demand improved methods to detect TB with high accuracy, newer drugs to treat resistant forms of TB and increased awareness of the disease.

Bedaquiline and delamanid are two new drugs for TB that have shown promising results in clinical trials after nearly 40 years of failed attempts. These two drugs have received approval for use in the treatment of MDR- and XDR-TB. Additionally, a new drug combination involving bedaquiline, pretomanid and linezolid is reported to have successfully treated XDR-TB in six months with a lower mortality rate than current treatments. However, these new treatment regimens are yet to enter mainstream clinical practice, with further and larger clinical trials needed to make an accurate cost-benefit analysis of these strategies.

Looking to the Future

Although the current situation of TB in India and worldwide looks bleak, the global TB incidence is falling at a rate of 2% per year. According to WHO, this rate needs to increase to 5% to achieve the WHO Global Plan to End TB milestones of reaching 90% of all people with TB through national TB programmes, reaching at least 90% of vulnerable high-risk population through affordable treatment and achieve at least 90% success in the treatment of all people diagnosed with TB. Achieving both WHO and RNTCP milestones will require a concerted effort by policymakers, healthcare providers, TB researchers, patients, and the general public. What we need today is increased public spending on healthcare to make TB therapy affordable and accessible, improvement of research funding and infrastructure and stronger public awareness campaigns to disseminate the reality and requirements of ending TB.

Over just the past two centuries, TB is estimated to have killed 1 billion people, which is more than the number of people killed due to AIDS, cholera, influenza, plague, and smallpox combined! It is time we take the initiative and responsibility to help the millions that are suffering from this deadly disease.

About the Author

Vignesh Narayan is a scientist and science writer at the Indian Institute of Science who currently studies the molecular biology of the TB pathogen Mycobacterium tuberculosis in an attempt to understand how the bacterium senses and responds to its environment and develop new drugs and drug targets to combat the disease.

In an effort to give a fillip to the ecosystem, the second edition of The Economic Times Hospital Strategic Management Summit 2019 held at The Hyatt Regency brought together government officials, healthcare industry leaders, analysts & service providers under one roof to focus on delivering innovative and world-class hospital planning. While healthcare systems and hospitals are faced with increasing pressure to find operating efficiencies in a time where traditional cost-cutting methodologies are producing diminishing returns, it is imperative to create a sustainable healthcare funding mechanism.

In a panel discussion focusing on Ensuring Profitability Through Optimum Patient Care, Dr. K. Ravindranath, Founder & Chairman, Global Hospitals opined that “Our doctors, staff and everybody needs to be educated in such a way that they become involved partners in patient care. From the beginning, our organization has always focused on delivering patient-centric doctor driven care”.

Dr. Tarang Gianchandani, CEO, Sir HN Reliance Foundation Hospital added, “Clinical outcomes are the key and it’s the future, so not only will it improve patient satisfaction, but it will also help the hospital to ensure that costs are taken care of. We always say; what we don’t measure, you can’t improve. In the same way, if you don’t measure your clinical outcomes how will you improve, and if you don’t improve your clinical outcomes, what satisfaction will you give to the patient?”.

Dr. B.K Rao, Chairman, National Accreditation Board for Hospitals and Healthcare Providers (NABH) made a succinct point when he explained, “Accreditation is a holistic kind of thing, it’s a process, it’s not an event and if you really look at what we are talking about, we are talking of quality and safety of the patient and we agree whatever you may do in the hospital or in the healthcare industry, quality and safety is an integral part of every activity”.

Addressing the topic of Futuristic Models in Home Health Care, Meena Ganesh, Co-Founder, MD & CEO, Portea Medical proclaimed, “The movement towards setting up of quality standards is a very important move that’s happening in the whole hospital care space”.
Ram Natesan, Group COO, SRM Institute of Medical Health Sciences & Research also aired his views, stating that, “Blockchain is going to impact the healthcare sector in a very big way, starting from patient data management, patient medical records, the insurance claim process management and publishing of research papers. Blockchain is going to impact healthcare in every stream of clinical excellence, because this is one technology which can not be erased or duplicated, and this will help long way for maintaining the patient data medical records”.

About Times Strategic Solutions Limited
Times Strategic Solutions Ltd., functional under the brand name ET Edge, is an Economic Times initiative founded to empower multiple industries and segments by sharing critical business knowledge through strategic conferences and summits. Encompassing the Indian business vista, ET Edge strives to bring together visionaries and key leaders on its knowledge platforms to create social and business ecology conducive to the positive changes required by the industry. The main aim of this initiative is to channel global business intelligence through summits and conferences in overarching lectures, hands-on workshops, panels, roundtables, and case studies.