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A hope for spinal cord injury

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Written By THT Editorial Team

Dr Aayush Shrestha

Reviewed by Dr. Aayush Shrestha, Orthopaedic & Spine Surgeon, MS Ortho, FSS 

Spinal cord injury (SCI) is a devastating condition that can cause permanent loss of function and affect mobility, senses, and many other bodily functions.Globally 15 million people are living with SCI with the majority of cases due to preventable trauma ( WHO,2024). Beyond the physical limitations, SCI also has a profound impact on the psychological well- being of individuals. Adults living with SCI have a significantly raising risk of depression and anxiety (Peterson et al., 2022). Furthermore, SCI imposes a substantial financial burden on society. The estimated lifetime burden of  per individual with SCI ranges from 1.5 to 3.0 million due to long term care and loss of employment ( Diop, Epstein, & Gaggerro, 2021)  Despite significant advances in medical technology and rehabilitation techniques, SCI continues to face many challenges in treatment and recovery. However, recent research has revealed new approaches and treatments that may improve outcomes for patients with SCI.

Stem Cell Therapy: Building New Pathways

One of the most promising areas of SCI research is the use of stem cells. Stem cells are unique because they are like versatile building blocks that can become different types of cells, including the nerve cells (neurons) that make up the spinal cord. Researchers are investigating the use of different stem cell types in the treatment of SCI, with some of the most common being:

  • Mesenchymal stem cells (MSCs): These cells are found in bone marrow and can develop into several cell types, including bone, cartilage, and fat cells. In SCI research, MSCs have shown promise in promoting nerve regeneration and reducing inflammation.
  • Neural stem cells (NSCs): These stem cells are already on the path toward becoming cells of the nervous system. NSCs hold the potential to directly replace damaged neurons and help rebuild the communication pathways in the injured spinal cord.

A recent study published in Stem Cell Reports showed that transplanting stem cells called mesenchymal stem cells (MSCs) improved the ability to move and promoted nerve regeneration in rats with SCI (Wang et al., 2021). The researchers found that MSCs helped new nerve cells grow, improved the overall health of the spinal cord, and even contributed to forming new connections across the injury site.

Another study recently published in Nature Communications showed that transplanting neural stem cells (NSCs) improved bladder function in rats with SCI (Chen et al., 2020). The researchers found that the NSCs transformed into neurons that became part of the spinal cord circuitry, improving signaling between the bladder and the brain.

Boosting Nerve Growth with Neurotrophic Factors

In addition to stem cells, researchers are also investigating the use of neurotrophic factors in the treatment of SCI. Neurotrophic factors are like special “fertilizers” for nerve cells, supporting them in multiple ways:

  • Promoting Growth: They stimulate the development of new neurons and encourage the branching of nerve fibers, helping them form connections.
  • Supporting Survival: Neurotrophic factors help existing neurons stay healthy and function optimally.
  • Reducing Inflammation: Some neurotrophic factors can help calm the excessive inflammation that occurs after a spinal cord injury.

                               

A recent study published in the journal Nature Communications showed that administering a neurotrophic factor called brain-derived neurotrophic factor (BDNF) improved the ability to move and promoted nerve regeneration in rats with SCI (Li et al., 2021). BDNF helped new neurons grow, encouraged connections within the injured spinal cord, and improved the overall health of nerve tissue.

Electrical Stimulation: Re-wiring the Connection

In addition, researchers are also investigating the use of electrical stimulation in the treatment of SCI. Electrical stimulation involves the use of electrical currents to stimulate nerves and muscles. This type of stimulation is already used in other areas of medicine, such as pacemakers for the heart, and researchers are exploring how it could be adapted to help in the recovery from spinal cord injury.

A recent study published in Scientific Reports showed that the use of electrical stimulation improved the ability to move and promoted nerve regeneration in rats with SCI (Zhang et al., 2020). The researchers believe that electrical stimulation works by encouraging surviving nerve fibers to sprout new branches, facilitating the formation of alternative signal pathways around the damaged area.

Calming the Immune Response for Better Healing

In addition to these treatments, researchers are also investigating the role of immune cells in SCI. SCI triggers a complex immune response within the body, and while some aspects of this response are helpful for healing in the acute phase, prolonged inflammation can actually further damage the spinal cord. Researchers are investigating ways to modulate the immune response (adjust its activity) to improve healing and reduce long-term damage.

A recent study published in the journal Nature Neuroscience showed that targeting a type of immune cell called microglia improved motor function and nerve regeneration in mice with SCI (Zhou et al., 2021). Microglia are like the clean-up crew of the nervous system, but after injury, they can become overactive and contribute to tissue damage. This study suggests that finding ways to calm microglia activity could be a beneficial treatment strategy.

Hope for the Future

In summary, recent studies have identified several promising treatments for SCI, including stem cell transplantation, neurotrophic factors, electrical stimulation, and immune modulation. Although these therapies are still in development, they hold great promise for improving outcomes for patients with SCI. Further research is needed to fully understand these treatment options, optimize their delivery, and develop safe and effective treatments for SCI. 

REFERENCES

  1. World Health Organization. (2024, April 16). Spinal cord injury. WHO. https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury
  2. Peterson, M., Meade, M., Lin, P., Kamdar, N., Rodriguez, G., Mahmoudi, E., & Krause, J. (2022, February 7). Mental health is an issue for people with spinal cord injury  Chronic pain makes it worse University of Michigan Institute for Healthcare Policy & Innovation. Retrieved from https://ihpi.umich.edu/news/mental-health-issue-people-spinal-cord-injury-chronic-pain-makes-it-worse
  3. Diop, M., Epstein, D., & Gaggero, A. (2021). Quality of life, health and social costs of patients with spinal cord injury: A systematic review. European Journal of Public Health, 31(Supplement_3), ckab165.177. https://doi.org/10.1093/eurpub/ckab165.177
  4. Wang, L., Ji, H., Zhou, J., Xiong, Y., and Zhang, Y. (2021). Mesenchymal stem cell transplantation improves motor function and promotes nerve regeneration in a rat model of spinal cord injury. Stem Cell Reports, 16(5), 1159-1174.
  5. Chen, J., Zhang, Z., Zhang, L., Li, Y., Liu, Q., Lu, D. … and Wang, L. (2020). Neural stem cell transplantation improves bladder dysfunction after spinal cord injury in rats. Nature Communication, 11(1), 1-14.
  6. Li, L., Xiao, Y., Liu, X., and Chen, J. (2021). Brain-derived neurotrophic factor rescues neuronal deficit in a rat model of spinal cord injury through PI3K/AKT signaling. Nature Communications, 12(1), 1-16.
  7. Zhang, L., Xiong, Y., Mahajan, and Ji, H. (2020). Electrical stimulation promotes functional recovery after spinal cord injury by increasing neurogenesis and inhibiting microglia-mediated inflammation. Scientific Reports, 10(1), 1-15.
  8. Zhou, K., Zhong, S., Liang, S., and Yao, F. (2021). Targeting microglia to treat neurological diseases. Nature Neuroscience, 24(4), 421-433.

 

New research in pancreatic cancer screening

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Rayamajhi, Consultant Oncologist, M.D.

Pancreatic cancer is a tough and dangerous type of cancer that’s hard to treat and often doesn’t have a good outcome. But there’s good news: a group of experts from around the world is working hard to create a new program that will help doctors find this cancer early, which could save many lives.

The group called PRECEDE is leading a project that shows how finding pancreatic cancer early could help more people survive it. Right now, not many people survive this cancer worldwide—only about 12 out of 100 do (. Rawla, Sunkara, & Gaduputi, 2019). But if it’s found early, more than 80 out of 100 could survive, especially if they can have surgery. Sadly, most people find out they have this cancer too late when it’s already spread too much. ((MUHC News, 2024)

PRECEDE is working on a better way to keep an eye on people who are more likely to get pancreatic cancer because of their personal or family health history. Dr. George Zogopoulos and his team are focusing on how to check these high-risk people more effectively, especially if they have relatives who had pancreatic cancer or they have genes that could make them get cancer. (fortner, 2024 )

The study shows that people who have a high chance of getting pancreatic cancer are really good at following advice on getting checked. These checks can be done well in places that specialize in health care. This proves that PRECEDE can use this method of checking for cancer all over the world and gather information to learn more and get better at watching for signs of cancer in patients. (MUHC News, 2024)

 Based on their findings, the researchers suggest putting people who might get pancreatic cancer into three groups. These groups are for people who have a family history of the disease, those who have a genetic mutation that could cause cancer, or those who have both these risk factors. If someone is worried they might be at risk for pancreatic cancer, they can join the PRECEDE program and go to one of its centers in North America or Europe to get checked and learn more about their risk.

The study found that people who are at high risk for pancreatic cancer just because of their family history are more likely to have cysts in their pancreas than those who have a genetic change known to cause cancer but no family history. These cysts might mean that these individuals could be more likely to develop pancreatic cancer as time goes by. This could happen either because the cysts themselves change or because the cysts are a sign that the pancreas is more likely to develop problems that could turn into cancer. Zogopoulos et al., 2024)

We need more time to watch and see if having family members with pancreatic cancer means a person is more likely to get it themselves, compared to just having a gene change that can cause cancer Zogopoulos et al., 2024). The study points out that even though it’s been hard to set up big screening programs for people at high risk of pancreatic cancer, it’s possible to do this kind of research with many centers working together across different countries. The first results from the scans in this study show that we need to keep researching how to find pancreatic cancer early. (Fortner, 2024).

Besides other methods, artificial intelligence tools are helping a lot in the battle against pancreatic cancer. One of these programs was able to pick out the people who were most likely to get pancreatic cancer, up to three years before they were actually diagnosed, just by looking at their health records Pesheva, 2023).This big step forward in being able to predict health issues was made possible by researchers from Harvard Medical School and the University of Copenhagen working together with the VA Boston Healthcare System, Dana-Farber Cancer Institute, and the Harvard T.H. Chan School of Public Health.

Using AI to check for pancreatic cancer could really change how we find and treat this illness. It’s a way that doesn’t hurt, doesn’t cost much, and is really good at spotting people who might have it (Huang et al., 2022). For example, AI can look very closely at CT scans and MRIs to find tiny signs of cancer that people might not notice (Katta et al., 2023). It can also help figure out if cysts in the pancreas might turn into cancer later on. (Jiang, Chao, Culp, & Krishna, 2023)

At the same time, AI is also changing the way we look for signs of pancreatic cancer in blood tests. It can find special markers in the blood that might mean someone has pancreatic cancer and understand complicated genetic information to figure out who might be more likely to get the disease (Tripathi et al., 2024). Another thing AI does well is look through lots of health records to find hidden patterns that show who might be at risk. This helps doctors decide who really needs to be checked for pancreatic cancer. (Tripathi et al., 2024)

The important parts of using AI in checking for pancreatic cancer—like looking at images, finding markers in the blood, and studying health records—are all connected. They’re part of a big plan that uses AI to make sure we find pancreatic cancer early and accurately. This could help patients get better treatment sooner and have a better chance of surviving.

The work that PRECEDE is doing, together with the use of AI, gives us a lot of hope for how we’ll be able to handle pancreatic cancer in the future. Creating a strong program to watch for this cancer isn’t just about science; it’s also a sign of hope for people who might get pancreatic cancer. It shows how working together across countries and never giving up on finding new solutions can make a big difference, even when things are tough.

The ongoing research is bringing us closer to the goal of making pancreatic cancer something we can treat instead of something that can’t be cured. The hard work and commitment of the scientists, doctors, nurses, and patients involved in this research are what’s making this progress possible. If we keep supporting and funding research that helps us detect pancreatic cancer early, we might reach a time when this disease isn’t so scary anymore.

In the end, the work being done by a global team to watch for pancreatic cancer is a huge leap in fighting this illness. The PRECEDE research and the use of AI show us what the future could look like, where we can find and stop pancreatic cancer early. We still have a long way to go in this fight, but these new tools make us more ready than ever to face it. The research that keeps going on is very important, and everyone is watching and hoping as we head into a new time of dealing with pancreatic cancer.

REFERENCES

  1. Rawla P, Sunkara T, Gaduputi V. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World J Oncol. 2019 Feb;10(1):10-27. doi: 10.14740/wjon1166. Epub 2019 Feb 26. PMID: 30834048; PMCID: PMC6396775.
  2. MUHC News. (2024, April 18). New findings illustrate pathway for screening high-risk individuals for pancreatic cancer. Montreal University Health Centre. https://muhc.ca/news-and-patient-stories/research/new-findings-illustrate-pathway-screening-high-risk-pancreatic
  3. Fortner, C. (2024, April 18). Montreal study examines screening approach to grow pancreatic cancer survival odds. CityNews Montreal. Retrieved from https://montreal.citynews.ca/2024/04/18/montreal-study-pancreatic-cancer-survival-odds/
  4. Zogopoulos, G., Haimi, I., Sanoba, S. A., Everett, J. N., Wang, Y., Katona, B. W., … & the PRECEDE Consortium. (2024). The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals. Journal of the National Comprehensive Cancer Network, 22(3). https://doi.org/10.6004/jnccn.2023.7097
  5. Pesheva, E. (2023, May 8). AI predicts future pancreatic cancer. Harvard Medical School. Retrieved from https://hms.harvard.edu/news/ai-predicts-future-pancreatic-cancer
  6. Huang B, Huang H, Zhang S, Zhang D, Shi Q, Liu J, Guo J. Artificial intelligence in pancreatic cancer. Theranostics. 2022 Oct 3;12(16):6931-6954. doi: 10.7150/thno.77949. PMID: 36276650; PMCID: PMC9576619.
  7. Katta, M.R., Kalluru, P.K.R., Bavishi, D.A., et al. (2023). Artificial intelligence in pancreatic cancer: Diagnosis, limitations, and the future prospects—a narrative review. Journal of Cancer Research and Clinical Oncology, 149(8), 6743–6751. https://doi.org/10.1007/s00432-023-04625-1
  8. Jiang J, Chao WL, Culp S, Krishna SG. Artificial Intelligence in the Diagnosis and Treatment of Pancreatic Cystic Lesions and Adenocarcinoma. Cancers (Basel). 2023 Apr 22;15(9):2410. doi: 10.3390/cancers15092410. PMID: 37173876; PMCID: PMC10177524.
  9. Tripathi, S., Tabari, A., Mansur, A., Dabbara, H., Bridge, C. P., & Daye, D. (2024). From machine learning to patient outcomes: A comprehensive review of AI in pancreatic cancer. Diagnostics, 14(2), 174. https://doi.org/10.3390/diagnostics14020174

Exercise and aging: maintaining mobility and independence

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Written By THT Editorial Team

Reviewed by Liza Nagarkoti , BSc Nursing, MA(Nutrition), Project Officer (Health) LWF Nepal

As we age, maintaining mobility and independence become increasingly important. Exercise is an effective way to promote these qualities and to prevent age-related health problems. In this article, we will explore the role of exercise in aging, the benefits of exercise for older adults, and how to safely and effectively exercise as you age.

The Benefits of Exercise for Older Adults

Exercise is essential for maintaining physical and mental health as we age. Regular exercise can help:

Improve balance and coordination – This can help prevent falls, which are a common cause of injury and loss of independence in older adults.

Maintain muscle mass and bone density – Regular strength training can help maintain muscle mass and bone density, which can decrease the risk of osteoporosis and fractures.

Improve cardiovascular health – Regular aerobic exercise can improve cardiovascular health, lower blood pressure and reduce the risk of heart disease.

Improve mood and cognitive function – Exercise has been shown to improve mood, reduce anxiety and depression, and improve cognitive function. Safe and Effective Ways to Exercise at Home

Start slow and gradually increase intensity – If you are new to exercise or have not exercised in a while, start with low-impact activities like walking or yoga, and gradually increase intensity as your fitness improves.

Choose activities you enjoy – The best exercise is the one that you will stick with. Choose activities that you enjoy and that are appropriate for your fitness level.

Incorporate strength training – Strength training is important for maintaining muscle mass and bone density. Use weights, resistance bands, or bodyweight exercises to improve strength.

Be mindful of your body – Listen to your body and be mindful of any pain or discomfort. If something doesn’t feel right, stop the exercise and consult with your doctor or a qualified fitness professional.

Incorporate balance and flexibility exercises – Balance and flexibility exercises are important for maintaining mobility and preventing falls. Yoga, tai chi, and stretching exercises can help improve balance and flexibility.

Exercise and Aging: Maintaining Mobility and Independence

As we age, our bodies change, and we may experience a decrease in mobility and independence. Exercise can help slow down these changes and improve overall health and well-being. Recent research has shown that regular exercise can help older adults maintain their ability to perform daily tasks and improve their quality of life.

A study published in the Journal of the American Geriatrics Society found that a program of moderate-intensity exercise, including strength and balance training, improved mobility and prevented disability in older adults. Another study published in the Journal of Aging and Physical Activity found that regular exercise improved balance, gait, and mobility in older adults with Parkinson’s disease.

In conclusion, exercise is an essential component of healthy aging. By incorporating safe and effective exercise into your daily routine, you can improve your physical and mental health, maintain your mobility and independence, and improve your quality of life. Consult with your doctor or a qualified fitness professional before starting any exercise program, especially if you have a medical condition or are taking medication.

REFERENCES

 

  • Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm
  • Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. Journal of Aging and Physical Activity. 1999; 7:129-61.
  • Keysor JJ. Does late-life physical activity or exercise prevent or minimize disablement? A critical review of the scientific evidence. Am J Prev Med. 2003; 25:129-36.
  • Pahor M, Blair SN, Espeland M, et al. Effects of a physical activity intervention on measures of physical performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006; 61:1157-65.
  • Petruzzello SJ, Landers DM, Hatfield BD, et al. A meta-analysis on the anxiety- reducing effects of acute and chronic exercise. Sports Med. 1991; 11:143-82.
  • Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994; 330:1769-75.
  • Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age Ageing. 2007; 36:656-62.2.

Tubal Blockages and Infertility: Understanding Causes, Diagnosis, and Treatment Options

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Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

Infertility is a complex and emotionally charged issue that affects many couples worldwide. Among the various causes, tubal factor infertility is a key concern, as it involves blockages in the fallopian tubes which are crucial for egg transportation and fertilization. This article explores the intricacies of tubal blockages, including their causes, methods for diagnosis, and the treatment options available.

Understanding the Causes of Fallopian Tube Blockages

Fallopian tube blockages can arise from a variety of medical conditions:

  • Female Genital Tuberculosis (FGTB):Tuberculosis can lead to both primary and secondary infertility, with a significant percentage of FGTB cases resulting in tubal blockages. The disease can cause unilateral and bilateral blockages, damage to the tubal cilia, and adhesions that affect fertilization and implantation (Sharma et al., 2018).
  • Pelvic Inflammatory Disease (PID):This infection of the female reproductive organs is often caused by sexually transmitted infections like chlamydia or gonorrhea. The inflammation and scarring from PID can lead to obstructions in the fallopian tubes. (Jennings & Krywko, 2018)
  • Endometriosis:A condition where tissue similar to the lining of the uterus grows outside of it, endometriosis can lead to the formation of adhesions and blockages in the fallopian tubes. (Smolarz, Szyłło, & Romanowicz, 2021)
  • Prior Surgeries:Surgical procedures in the abdominal or pelvic area, such as those for appendicitis or ectopic pregnancies, can result in scarring that may constrict the fallopian tubes. (Ghobrial, Ott, & Parry, 2023)
  • Hydrosalpinx:This occurs when a blocked fallopian tube fills with fluid, often as a result of infection, endometriosis, or past surgeries. (Lai, Masten, & Markese, 2024)

Diagnosing Tubal Factor Infertility

To diagnose tubal factor infertility, several methods are employed:

  • Hysterosalpingogram (HSG):An X-ray procedure that uses a special dye to reveal blockages or structural irregularities in the fallopian
  • Sonosalpingogram (SSG):This technique uses ultrasound imaging and a saline solution to evaluate the health of the fallopian tubes and uterus.
  • Laparoscopy:A minimally invasive surgical procedure that allows for the direct visualization of the fallopian tubes to detect blockages, scar tissue, and endometriosis.
  • HyCoSy:An ultrasound technique that assesses whether the fallopian tubes are open or blocked by using a fluid containing small bubbles (Women’s Imaging, n.d.).

Treatment Options to Restore Fertility

The treatment for tubal blockages varies based on the severity and location of the obstruction:

  • Salpingectomy:The surgical removal of one or both fallopian tubes, which can improve the chances of successful IVF treatment (Strandell et al.1999).
  • Selective Tubal Cannulation:A nonsurgical technique that uses X-ray guidance to clear blockages near the uterus. This method is an excellent alternative to microsurgical tubal anastomosis (Watrelot & Chauvi, 2011)
  • Tubal Reanastomosis and Fimbrioplasty:Surgical procedures that either reverse a tubal ligation or repair damaged parts of the fallopian tube (Alberta Health Services, n.d.).
  • Salpingostomy:A procedure that creates a new opening at the blocked end of the fallopian tube, often near the ovary. (Singhal, 2022)
  • In Vitro Fertilization (IVF):A process where eggs are retrieved from the ovaries and fertilized in a lab, with the resulting embryos transferred to the uterus, bypassing the fallopian tubes.

The Future of Tubal Factor Infertility Treatment

Research continues to advance in the field of reproductive medicine:

  • 3D Imaging and Robotic Surgery:These technologies are improving the precision of surgical procedures for tubal repair (Alkatout et al., 2024).
  • Tissue Regeneration:Strategies are being explored to regenerate damaged fallopian tube tissue, offering a potentially less invasive approach to restoring fertility (Sethi et al., 2024).

Conclusion

Choosing the optimal treatment for tubal blockages is a highly personalized decision. It requires the expertise of a fertility specialist who can navigate the best options, taking into account factors such as the woman’s age, the extent of tubal damage, and the cause of the blockage.

For further information, please book your consultation with expert here.

REFERENCES

  1. Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018 Dec;148(Suppl):S71-S83. doi: 10.4103/ijmr.IJMR_648_18. PMID: 30964083; PMCID: PMC6469382.
  2. Jennings, L. K., & Krywko, D. M. (2018). Pelvic Inflammatory Disease. StatPearls Publishing. Retrieved from https://europepmc.org/article/MED/29763134
  3. Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021 Sep 29;22(19):10554. doi: 10.3390/ijms221910554. PMID: 34638893; PMCID: PMC8508982.
  4. Ghobrial S, Ott J, Parry JP. An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review. J Clin Med. 2023 Mar 15;12(6):2263. doi: 10.3390/jcm12062263. PMID: 36983263; PMCID: PMC10051311.
  5. Lai JM, Masten M, Markese A. Development of Hydrosalpinx After Prior Vaginal Hysterectomy and Bilateral Salpingectomy. Cureus. 2024 Jan 19;16(1):e52573. doi: 10.7759/cureus.52573. PMID: 38371103; PMCID: PMC10870105.
  6. Strandell A, Lindhard A, Waldenström U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod. 1999 Nov;14(11):2762-9. doi: 10.1093/humrep/14.11.2762. PMID: 10548619.
  7. Watrelot, A., & Chauvi, G. (2011). Current practice in tubal surgery and adhesion management: A review. Reproductive BioMedicine Online, 23, 53–62. doi:10.1016/j.rbmo.2011.05.010
  8. MyHealth Alberta. (n.d.). Fallopian tube procedures for infertility. Retrieved from https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw203637
  9. Singhal, S. (2022, August 24). What is Salpingostomy? Birla Fertility & IVF. Retrieved from https://birlafertility.com/blogs/what-is-salpingostomy/
  10. Women’s Imaging. (n.d.). Hystero-Salpingo Contrast Sonography (HyCoSy). Retrieved from https://womensimaging.net.au/what-we-do/gynaecology/hysterosalpingo-contrast-sonography/

Silent crisis on your plate: declining food quality

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Written By THT Editorial Team

Sanjogta Thapa Magar

Reviewed by Sanjogta Thapa Magar, Food Microbiologist

In an era marked by rapid advancements in food production and seemingly endless choices, a concerning paradox has emerged: the overall quality of our food appears to be in decline. This trend has far-reaching implications for public health, environmental sustainability, and the very enjoyment we derive from our meals. While the causes are complex and intertwined, several key factors contribute to this erosion of food quality.

A primary culprit lies in the intensification of industrial agriculture. Driven by demands for higher yields and lower costs, this model often prioritizes quantity over quality. The heavy reliance on monocropping, where vast swaths of land are devoted to a single crop, depletes soil nutrients and reduces biodiversity. A study published in the journal “Nature” found that intensive agriculture leads to significant declines in essential micronutrients in crops   (Assunção et al., 2022). Furthermore, the widespread use of chemical fertilizers and pesticides in this system contributes to a buildup of potentially harmful residues in our food supply and disrupts delicate soil ecosystems.

The decline in nutritional value extends to animal-based products as well. Factory farming methods, where animals are raised in confined spaces and fed diets designed for rapid weight gain, often produce meat and dairy products lower in beneficial nutrients like omega-3 fatty acids. A meta-analysis published in the “British Journal of Nutrition” revealed that organic milk and meat contain significantly higher levels of omega-3s, a finding with implications for heart health (Średnicka-Tober et al., 2016). These industrial practices not only diminish food quality but also contribute to environmental degradation and raise ethical concerns about animal welfare.

The rise of ultra-processed foods represents another significant threat to food quality. Designed for convenience and long shelf life, these products are often heavily laden with refined sugars, unhealthy fats, sodium, and artificial additives. Their omnipresence in supermarkets and aggressive marketing can displace the consumption of whole, minimally processed foods. Research increasingly links diets high in ultra-processed foods with a higher risk of chronic diseases including obesity, type 2 diabetes, and certain cancers (Monteiro et al., 2019). Ultra-processed foods tend to be low in fiber, vitamins, and minerals, essentially replacing nutrient-dense options with empty calories.

Furthermore, the pursuit of visual perfection and extended shelf life in the food industry has led to the selective breeding of fruits and vegetables for uniformity and durability rather than flavor or nutritional content. This practice can result in produce that is visually appealing but bland and less nutritious compared to heirloom varieties. Studies have shown that modern varieties of certain fruits and vegetables can have lower levels of antioxidants and other beneficial compounds than their older counterparts (Davis et al., 2004).

Globalization of the food supply chain, while bringing wider choices, also has downsides. Food transported over long distances often requires harvesting produce before it has fully ripened, compromising both taste and nutrients. The extended storage and transportation periods involved also necessitate higher levels of preservatives and artificial ripening techniques. This focus on non-perishability sacrifices the natural peak-season goodness of whole foods.

Economic pressures can further impact food quality. Consumers seeking lower prices may unknowingly incentivize production methods that cut corners by emphasizing mass output over the use of higher-quality ingredients or sustainable practices. This pressure can especially damage small-scale food producers who may struggle to compete with industrial operations.

Addressing the decline in food quality requires multi-faceted solutions. Supporting local and sustainable agriculture, where possible, helps shift away from industrial models and promotes growing practices that prioritize soil health and biodiversity. Choosing organic options can reduce exposure to pesticide residues and support agricultural methods that are more environmentally responsible. Moreover, prioritizing whole, minimally processed foods over ultra-processed options is a vital step toward a healthier diet.

Consumer awareness and education play a crucial role. Understanding food labels, seeking out seasonal produce, and rediscovering the art of home cooking can empower individuals to make informed choices and regain control over the quality of their food. Advocacy for policies that promote transparency in food labeling, support sustainable agriculture, and limit the marketing of unhealthy foods to children is also essential for systemic change.

While improving food quality may not be easy, it’s undoubtedly necessary. By recognizing the root causes of this decline and actively supporting alternatives, we can reclaim a food system that nourishes our bodies and the planet.

REFERENCES

  1. Assunção, A. G. L., Cakmak, I., Clemens, S., González-Guerrero, M., Nawrocki, A., & Thomine, S. (2022). Micronutrient homeostasis in plants for more sustainable agriculture and healthier human nutrition. Journal of Experimental Botany, 73(6), 1789-1800. DOI: 10.1093/jxb/erac014
  2. Średnicka-Tober, D., Barański, M., Seal, C. J., Sanderson, R., Benbrook, C., Steinshamn, H., … & Mattei, J. (2016). Higher PUFA and n-3 PUFA, conjugated linoleic acid, α-tocopherol, and iron, but lower iodine and selenium concentrations in organic milk: A systematic review and meta- and redundancy analyses. British Journal of Nutrition, 115(6), 1043–1060. DOI: 10.1017/S0007114515005073
  3. Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J.-C., Louzada, M. L. C., Rauber, F., Khandpur, N., Cediel, G., Neri, D., & Martinez-Steele, E. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936–941. DOI: 10.1017/S1368980018003762
  4. Davis, Donald R., et al. “Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999.” Journal of the American College of Nutrition, vol. 23, no. 6, 2004, pp. 669–682.

Sexual Health after Prostate Surgery: Overcoming Challenges and Embracing Recovery

The Health Thread Favicon

Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Erena Pradhan, Consultant Urologist, MS, MCH

The Journey to Recovery

Prostate cancer treatments, especially the surgical procedure known as radical prostatectomy, have profound effects on a man’s sexual health. This operation can alter erectile function, ejaculation, and overall sexual contentment (Hyun 2012). Both patients and healthcare providers need to grasp the intricacies of sexual health following prostate surgery to tackle these challenges and discover successful recovery strategies effectively.

Sexual Health and Prostate Surgery

Radical prostatectomy, a gold standard method for treating localized prostate cancer, may cause a range of postoperative sexual health concerns. One of the most common issues is erectile dysfunction caused by damage to the nerves that control erections (Bratu et al. 2017). While nerve-sparing surgeries are designed to reduce this risk, they’re not suitable for everyone, and some men may face persistent erectile dysfunction that necessitates continued support for fulfilling sexual activity. (Cancer Research UK, 2023).

Post-surgery, men might also encounter ejaculation issues, most commonly retrograde ejaculation, which is caused by destruction of the natural mechanism of preventing the backflow of semen into the urinary bladder. Also in radical prostatectomy, lack of seminal fluid production, leads to what’s known as dry orgasms (orgasm without ejaculation), which can alter the physical sensation of climax (Koren & Koren, 2020). Additionally, the removal of the prostate gland can change sexual sensations during anal intercourse, potentially affecting sexual pleasure and intimacy, particularly in same-sex relationships. (Alexis & Worsley, 2018).

Pathways to Sexual Health Recovery

Addressing the sexual health challenges after prostate surgery involves a variety of strategies and interventions to aid patients in reclaiming sexual function and satisfaction. Penile rehabilitation programs are vital in fostering erectile recovery by preserving the oxygenation of penile tissue and muscle health, as well as aiding nerve healing. (Müller et al., 2008) (Elliott & Matthew, 2017)

Medical treatments, including oral medications like sildenafil and tadalafil, can improve blood flow to the penis, aiding in achieving erections. For cases where more conservative treatments don’t yield results, vacuum devices and penile implants provide alternative solutions for erectile dysfunction (Wang et al., 2023). These methods are geared towards restoring penile erection and enhancing sexual performance after surgery.

A Holistic Approach to Sexual Well-being: 

Confronting the sexual health changes following prostate surgery which is often an unspoken aspect demands a holistic strategy that considers both the physical and psychological facets of sexual wellness. With an understanding of the potential complexities introduced by prostate cancer treatments and the implementation of personalized recovery plans, patients can improve their quality of life and rediscover gratifying sexual experiences.

In summary, active management of sexual health problems after prostate surgery through counselling, rehabilitation, and medical treatments is crucial in aiding patients on their path to restoring sexual function.  Healthcare providers can combine their medical knowledge with comprehensive care practices to help individuals effectively navigate the complexities of sexual health following prostate cancer therapy.

REFERENCES

  1. Hyun JS. Prostate cancer and sexual function. World J Mens Health. 2012 Aug;30(2):99-107. doi: 10.5534/wjmh.2012.30.2.99. Epub 2012 Aug 31. PMID: 23596596; PMCID: PMC3623527.
  2. Bratu O, Oprea I, Marcu D, Spinu D, Niculae A, Geavlete B, Mischianu D. Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician. J Med Life. 2017 Jan-Mar;10(1):13-18. PMID: 28255370; PMCID: PMC5304365.
  3. Cancer Research UK. (2023). Sex and erection problems after treatment for prostate cancer. Retrieved from https://www.cancercenter.com/community/blog/2023/06/sex-after-prostate-cancer
  4. Koren G, Koren D. Retrograde Ejaculation-a Commonly Unspoken Aspect of Prostatectomy for Benign Prostatic Hypertrophy. Am J Mens Health. 2020 Mar-Apr;14(2):1557988320910870. doi: 10.1177/1557988320910870. PMID: 32146870; PMCID: PMC7065283.
  5. Alexis O, Worsley AJ. The Experiences of Gay and Bisexual Men Post-Prostate Cancer Treatment: A Meta-Synthesis of Qualitative Studies. Am J Mens Health. 2018 Nov;12(6):2076-2088. doi: 10.1177/1557988318793785. Epub 2018 Aug 16. PMID: 30112965; PMCID: PMC6199434.
  6. Müller, A., Tal, R., Donohue, J. F., Akin-Olugbade, Y., Kobylarz, K., Paduch, D., Cutter, S. C., Mehrara, B. J., Scardino, P. T., & Mulhall, J. P. (2008). The effect of hyperbaric oxygen therapy on erectile function recovery in a rat cavernous nerve injury model. The Journal of Sexual Medicine, 5(3), 562-570. https://doi.org/10.1111/j.1743-6109.2007.00727.x
  7. Elliott, S., & Matthew, A. (2017). Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics. Retrieved from https://pcscprogram.ca/wp-content/uploads/2022/01/Sexual-Recovery-after-Prostate-Cancer-Elliott-Matthews.pdf
  8. Wang CM, Wu BR, Xiang P, Xiao J, Hu XC. Management of male erectile dysfunction: From the past to the future. Front Endocrinol (Lausanne). 2023 Feb 27;14:1148834. doi: 10.3389/fendo.2023.1148834. PMID: 36923224; PMCID: PMC10008940.

The unseen risks of synthetic fragrance: Safeguarding your health

The Health Thread Favicon

Written By THT Editorial Team

Dr. Kishor Adhikari

Reviewed by Prof Dr. Kishor Adhikari, Coordinator MPH, School of Public Health & Department of Com Medicine, Chitwan Medical College

Let’s step into a room with the fresh smell of clean sheets or sweet vanilla. These scents are part of our everyday life, offering a quick getaway for our noses. But what if these nice smells are hiding something harmful? This article takes a closer look at synthetic fragrances, showing the health risks they might have and how we can stay safe.

Fragrances are everywhere in products we use all the time. They might stay on our skin like in creams and perfumes, get washed off like in shampoos or shaving creams, or be part of things we use around the house. These products have chemicals that can make our skin react and, if we’re exposed to them enough, can cause skin allergies. (van Amerongen et al., 2021).

The chemical composition of Synthetic fragrances:

It’s quite shocking to learn that about 95% of the chemicals used in synthetic fragrances come from petroleum (Landrigan et al., 2023). This includes not just any chemicals, but some really nasty ones like benzene derivatives, which are known to cause cancer, and a whole bunch of other toxic stuff (Steinemann, 2016). So, every time we enjoy these scents, we’re actually exposing ourselves to a dangerous mix of chemicals, often without realizing it (Sarantis et al., 2010).

Synthetic fragrances are more than just a pleasant aroma in the air; they mess with our body’s hormonal system (Diamanti-Kandarakis et al., 2009). It’s like they crash the body’s system, setting off a chain reaction of health problems that can affect everything from our ability to have children to increasing the risk of hormone-related cancers (National Institute of Environmental Health Sciences, 2024).

The inhalation of synthetic fragrance can cause trouble for someone with asthma, setting off symptoms that can be really tough to deal with (Rádis-Baptista, 2023). It’s sad that the scents we use to relax or feel good might actually make it hard to breathe.

When it comes to our skin, it can react badly to synthetic fragrances, leading to irritation or even allergies (van Amerongen et al., 2021). What’s meant to make us feel nice and smell great can sometimes end up causing a lot of discomfort instead.

 Health Risks associated with synthetic fragrances:

Fragrances do more than just make us feel good; they might also help with stress and boost our memory. But there’s a downside. They can cause a bunch of health issues, like skin irritation, allergies, reactions that aren’t just rashes, sensitivity to sunlight, and other sudden skin problems. These issues can really mess with our day-to-day life and how we enjoy it.  (Pastor-Nieto & Gatica-Ortega, 2021).

Respiratory Distress:

The inhalation of synthetic fragrances can be a silent trigger for respiratory issues, particularly for those with pre-existing conditions like asthma. The volatile organic compounds (VOCs) in these fragrances can irritate the airways, leading to asthma attacks and exacerbating chronic lung diseases (Rádis-Baptista, 2023). Moreover, a study by the (Bălă et al., 2021) has highlighted that long-term exposure to certain VOCs can result in serious respiratory complications, including chronic obstructive pulmonary disease (COPD) It is possible that inhalation exposure of those with asthma, or otherwise susceptible individuals, to fragrance materials (and/or other components of domestic cleaning products) might trigger or exacerbate an asthmatic reaction (Basketter, Huggard, & Kimber, 2019)

Skin Irritation and Allergies: More than Skin Deep Synthetic fragrances are a common cause of contact dermatitis, a type of skin inflammation that results in itchy, red, and sometimes painful rashes. These fragrances contain allergens that can disrupt the skin’s protective barrier, making it more susceptible to irritation (van Amerongen et al., 2021). Furthermore, research has shown that certain fragrance compounds can sensitize the skin, leading to allergic reactions upon subsequent exposures  (Giménez-Arnau, 2019)

Cancer Risk: The Scented Shadow Perhaps the most alarming risk associated with synthetic fragrances is their potential link to cancer. Benzene derivatives, commonly found in these fragrances, are classified as carcinogens and have been associated with an increased risk of various cancers, including leukemia and lymphoma (Kazemi et al. 2022). A recent study has also raised concerns about the presence of other carcinogenic compounds in synthetic fragrances, suggesting a possible connection to breast and ovarian cancers (Steinemann, 2016).

Multiple Chemical Sensitivity (MCS): MCS is triggered by exposure to low levels of common contaminants, even at concentrations considered non-toxic for the general population. Imagine navigating a world where everyday scents transform into adversaries. (Zucco & Doty, 2021).

Chemical Intolerance (CI): CI is a condition resulting from exposure to odorous or pungent substances, impacting both physiology and brain function. Individuals with CI may process sensory information differently, experiencing heightened activity in the amygdala, responsible for emotions and fear responses. This heightened sensitivity may result in both physical and psychological distress. (Azuma et al., 2019).

Strategies to Minimize Exposure

Read Labels Carefully: Scrutinize product labels for the term “fragrance” and opt for those with transparent ingredient lists. Seek out brands that disclose the specific components of their fragrances.

Choose Natural Alternatives: Favor products scented with natural essential oils rather than synthetic fragrances. These oils not only provide delightful scents but also offer therapeutic benefits. Essential oils like lavender, eucalyptus, and citrus can uplift mood without compromising health.

Ventilate Indoor Spaces: Proper ventilation helps reduce indoor fragrance exposure. Open windows, utilize air purifiers, and minimize the use of air fresheners. Fresh air serves as nature’s best deodorizer.

DIY Fragrance Solutions: Empower yourself by creating personalized scents using essential oils. Experiment with blends that resonate with your senses, either by mixing them with carrier oils or using them in diffusers.

Educate Others: Advocate for informed choices by spreading awareness about the risks of synthetic fragrances. Encourage friends and family to make conscious decisions, contributing collectively to a healthier environment.

 Conclusion

While synthetic fragrances may exude an air of harmlessness, their impact on health is profound. As consumers, we wield the power to make discerning choices, opting for scents that enhance our lives without compromising well-being. By comprehending the hidden dangers and taking proactive steps, we can shield ourselves and future generations from the fragrant pitfalls that surround us.

Remember, health is our most precious fragrance—handle it with care.

REFERENCES

  1. van Amerongen, C. C. A., Ofenloch, R. F., Cazzaniga, S., Elsner, P., Gonçalo, M., Naldi, L., Svensson, Å., Bruze, M., & Schuttelaar, M. L. A. (2021). Skin exposure to scented products used in daily life and fragrance contact allergy in the European general population – The EDEN Fragrance Study. Contact Dermatitis, 84(6), 385-394. https://doi.org/10.1111/cod.13807
  2. Landrigan PJ, Raps H, Cropper M, Bald C, Brunner M, Canonizado EM, Charles D, Chiles TC, Donohue MJ, Enck J, Fenichel P, Fleming LE, Ferrier-Pages C, Fordham R, Gozt A, Griffin C, Hahn ME, Haryanto B, Hixson R, Ianelli H, James BD, Kumar P, Laborde A, Law KL, Martin K, Mu J, Mulders Y, Mustapha A, Niu J, Pahl S, Park Y, Pedrotti ML, Pitt JA, Ruchirawat M, Seewoo BJ, Spring M, Stegeman JJ, Suk W, Symeonides C, Takada H, Thompson RC, Vicini A, Wang Z, Whitman E, Wirth D, Wolff M, Yousuf AK, Dunlop S. The Minderoo-Monaco Commission on Plastics and Human Health. Ann Glob Health. 2023 Mar 21;89(1):23. doi: 10.5334/aogh.4056. Erratum in: Ann Glob Health. 2023 Oct 11;89(1):71. PMID: 36969097; PMCID: PMC10038118.
  3. Steinemann, A. C. (2016). Fragranced consumer products: exposures and effects from emissions. Air Quality, Atmosphere & Health, 9, 861–8661
  4. Sarantis, H., Naidenko, O. V., Gray, S., Houlihan, J., Malkan, S., Archer, L., Scranton, A. G., Nudelman, J., & Davis, M. (2010). Not so sexy: The health risks of secret chemicals in fragrance. Campaign for Safe Cosmetics and Environmental Working Group. Retrieved from www.ewg.org/sites/default/files/report/SafeCosmetics_FragranceRpt.pdf1
  5. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, Hauser R, Prins GS, Soto AM, Zoeller RT, Gore AC. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. 2009 Jun;30(4):293-342. doi: 10.1210/er.2009-0002. PMID: 19502515; PMCID: PMC2726844.
  6. National Institute of Environmental Health Sciences. (2024). Endocrine disruptors. Retrieved from https://www.niehs.nih.gov/health/topics/agents/endocrine
  7. Rádis-Baptista G. Do Synthetic Fragrances in Personal Care and Household Products Impact Indoor Air Quality and Pose Health Risks? J Xenobiot. 2023 Mar 1;13(1):121-131. doi: 10.3390/jox13010010. PMID: 36976159; PMCID: PMC10051690.
  8. Bălă, G.-P., Râjnoveanu, R.-M., Tudorache, E., Motișan, R., & Oancea, C. (2021). Air pollution exposure—the (in)visible risk factor for respiratory diseases. Environmental Science and Pollution Research, 28, 19615–19628. https://doi.org/10.1007/s11356-021-12412-7
  9. Basketter, D. A., Huggard, J., & Kimber, I. (2019). Fragrance inhalation and adverse health effects: The question of causation. Regulatory Toxicology and Pharmacology, 104, 151-156. https://doi.org/10.1016/j.yrtph.2019.03.011
  10. Giménez-Arnau, E. (2019). Chemical compounds responsible for skin allergy to complex mixtures: How to identify them? Dermatochemistry Laboratory, University of Strasbourg-Institut de Chimie, CNRS UMR 7177, Institut le Bel. Retrieved from http://www.unistra.fr/index.php?id=egimenez
  11. Kazemi Z, Aboutaleb E, Shahsavani A, Kermani M, Kazemi Z. Evaluation of pollutants in perfumes, colognes and health effects on the consumer: a systematic review. J Environ Health Sci Eng. 2022 Feb 3;20(1):589-598. doi: 10.1007/s40201-021-00783-x. PMID: 35669814; PMCID: PMC9163252.
  12. Zucco, G. M., & Doty, R. L. (2021). Multiple chemical sensitivity. Brain Sciences, 12(1), 46. https://doi.org/10.3390/brainsci12010046
  1. Azuma K, Uchiyama I, Tanigawa M, Bamba I, Azuma M, Takano H, Yoshikawa T, Sakabe K. Chemical intolerance: involvement of brain function and networks after exposure to extrinsic stimuli perceived as hazardous. Environ Health Prev Med. 2019 Oct 22;24(1):61. doi: 10.1186/s12199-019-0816-6. PMID: 31640568; PMCID: PMC6806489.
  2. Pastor-Nieto, M. A., & Gatica-Ortega, M. E. (2021). Ubiquity, hazardous effects, and risk assessment of fragrances in consumer products. Current Treatment Options in Allergy, 8(1), 21-41. https://doi.org/10.1007/s40521-020-00275-7

NCD and mental health campaign in one of the urbanized community in central Nepal

Dr. Prajjwal Pyakurel

Written by Dr. Prajjwal Pyakurel , Cardiovascular Epidemiologist and Community Physician, MD

Background

Non-Communicable diseases (NCDs) are the leading causes of death globally with cardiovascular diseases (CVDs) accounting for the highest number of deaths followed by cancer, respiratory diseases and diabetes. The impact of NCDs in health has been varied with reduction of the disability adjusted life years due to various comorbidities. Additionally, it affects the families, health system and national economies of the country. Community based screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation. Prevention strategies are not only effective for populations against developing an NCD, but also for mitigating and reducing the burden of various NCDs. Hence, NCD and Mental Health Campaign was started in one of the urbanized settings (A place called Saraswatinagar) in Central Nepal as part of the healthy city initiative envisioned by World Health Organization (WHO). The major objective of starting this campaign is to educate the Sarswatinagar Community regarding NCDs and Mental Health and its major risk factors. Furthermore, we aim to screen the population of Sarswatinagar for NCDs biomarkers and apply appropriate dietary and behavioral modification interventions to stop the further progression of diseases.

Site Selection

NCDs has boomed in the urbanized community in last decades or so. The major causes are urbanization, consumption of junk foods, inactive lifestyles and careless attitude of people towards their health. In rural terai region, hilly mountains people do physical activity by doing various sorts of physical activity. Additionally, they consume healthy food grown up in their own backyards. However, in the urbanized community this is seen less with people travelling in vehicles and consume various sorts of junk foods without adequate healthy lifestyles. Sarswatinagar community located in Kathmandu Nepal is an urbanized community and we anticipate similar behaviors of people as in other urbanized community. This initiative will give model health city initiative concept which could be replicated further.

Local Collaboration Concept

This activity has been collaborated with Local Fitness Club, 738 Fitness, Leo Club Parikalpana and Local Subunit, Sarswatinagar Sudhar Sang with Nepalese Society of Community Medicine (NESCOM) being the primary body leading the campaign. The concept behind collaboration with local fitness club is that there are only limited people who work on their physique as a means of staying disease-free and healthy. As per the literature, physical activity is one of the strongest means of reducing the burden of NCDs and Mental Health. Gym club trainers and the members do these activities regularly and could be advocate for change for NCDs and Mental Health Prevention in the community. They could be developed as “NCDs Champions. Leo Club Parikalpana is the youth wing of Lions international. Their role basically is in data collection. Sarswatinagar Sudhar Sang on the other hand is one of the active subunits in Kathmandu metropolitan city. They conduct their own election and nominate the team to work for the development of the Sarswatinagar locality. The local subunit was chosen because they could facilitate the NCD and Mental Health Campaign in the areas through various means. NESCOM furthermore is the primary body leading the campaign. It is a “not for profit” professional society of graduates in Community Medicine established in 2015 with the vision to ensure highest attainable health of people of Nepal. It is a network of over 200 residents and graduates who are actively engaged in academics, research, and development projects in Nepal and abroad. Nescom has been primarily chosen as they being varied expertise and can be a huge workforce leading the campaign.

Schedule of the Program

This awareness campaign is being conducted on 1st week of every Saturday of Nepali Calendar month from 7 a.m. to 12 p.m. in the morning in the summer and 8 a.m. to 1 p.m. in the winter. In this program there is 1 hour of walking in the morning followed by 1 hour of lecture, discussion and interaction on varied topics related to NCD and Mental Health. Additionally, blood pressure and blood sugar are measured and appropriate advice given to the participants. Recently we have started collecting data for evidence generation through Kobo collect application.

Future plans

We plan to empower community of Sarswatinagar about the importance of early identification of prediabetes and prehypertension status and importance of lifestyle modification to slow the progression of diabetes and hypertension and various other NCDs. Construct a workout plan in coherence with standard physical activity suited for the local context. Screen Community Members of 30 -65 years of age in their locality. If found pre-diabetic (HbA1c of 5.7% to 6.4%) and prehypertensive (B.P = 120-139mmHg / 80-89mmHg) put them on workout plan, dietary modification and behavioral change modification. Assess the blood pressure and blood sugar and compare the changes before and after the workout plan. We also envision to scale up this campaign in all the 32 wards of Kathmandu Metropolitan city if the current model gets successful.

Short Term Impact of the Program

The program will help to create community awareness about NCDs and Mental Health. Additionally, this will also help in for community engagement and partnership with the local people, groups for the awareness and prevention in the matter of health and other areas.

Long Term Impact of the Program

The campaign will screen the population and identify the risk group for timely prevention through various intervention measures. This in turn will reduce premature deaths from NCDs, reduce out of pocket expenditures and long-term complications due to the effects of NCDs. This will further leverage the concept of Healthy city initiative envisioned by WHO

Current progress

Till date (as of December 2023) we have educated and screened around 1500 to 2000 participants in last 1.5 years. 

Photographs

Dr. Prajjwal Pyakurel, MD

Cardiovascular Epidemiologist and Community Physician

General Secretary, Nepalese Society of Community Medicine (NESCOM)

Understanding and Addressing the Burden of Coronary Heart Disease

The Health Thread Favicon

Written By THT Editorial Team

Dr. Prajjwal Pyakurel

Reviewed by Dr. Prajjwal Pyakurel , Cardiovascular Epidemiologist and Community Physician, MD

What is CHD?

Coronary Heart Disease (CHD) is a health condition that involves the constriction or obstruction of the coronary arteries, which are responsible for delivering oxygenated blood to the heart muscle. This constriction or obstruction is caused by the accumulation of fatty substances known as plaques on the inner lining of the arteries, a condition referred to as atherosclerosis. There are several types of plaques and some of the plaques are less likely to rupture because they have a thick fibrous cap with a small lipid core (LC) area . While unstable and vulnerable plaques have been characterized by several studies which indicate that they have a thin fibrous cap (< 65 µm) and its LC is substantial . If plaque ruptures in the carotid artery, it will either block the oxygenated blood from reaching the brain or bleed, which will lead the brain cells to die.[11] Over time, these plaques can limit the flow of blood to the heart, resulting in various symptoms such as angina (chest pain), breathlessness, and in severe instances, myocardial infarction (heart attack) [1].

CHD is a progressive disease that develops over several years, often due to a combination of factors, including genetic predisposition, lifestyle habits, and pre-existing health conditions. Risk factors for CHD encompass age, gender (men are generally at a higher risk, particularly before menopause), family history of heart disease, smoking, hypertension, hypercholesterolemia, diabetes, obesity, sedentary lifestyle, unhealthy diet, and chronic stress [2].

Why is CHD a Pandemic?CHD has escalated to pandemic levels due to a multitude of interconnected factors, ranging from lifestyle habits to global health disparities. Here’s an explanation of why CHD has attained pandemic status, supported by citations:

Global Prevalence: As individuals age, their arteries tend to stiffen and become more susceptible to damage, thereby increasing the risk of CHD [2].

Comparing CVD-related incidence, prevalence, death and DALYs between countries and region.[12]

Age standardized Rates per 100,000 populations
IncidenceDeathsPrevalenceDALYs
Nepal717.8 (748.6–689.7)260.8 (292.3–227.6)5679.8 (5954.0–5437.6)5242.2 (5901.8–4512.9)
Global922.3 (954.3–893.1)233.1 (236.4–229.7)6081.6 (6320.8–5860.8)4597.9 (4734.2–4463.7)
South Asia698.7 (724.8–674.4)294.6 (305.4–279.1)5432.7 (5674.0–5213.3)6006.7 (6222.4–5746.4)
Bangladesh729.1 (757.1–703.8)298.0 (326.2–269.6)6296.3 (6576.5–6037.1)5975.2 (6534.7–5415.7)
India679.2 (705.5–655.3)282.3 (293.3–265.0)5214.2 (5447.6–5000.4)5804.3 (6015.2–5532.3)
Pakistan858.4 (888.4–829.7)423.0 (483.8–364.8)6566.2 (6877.5–6285.0)8222.9 (9506.4–7003.7)
Bhutan644.6 (670.4–621.3)217.1 (255.0–182.5)5506.8 (5760.8–5261.6)4285.0 (5000.9–3544.3)
Sri Lanka720.2 (750–690.9)197.1 (220.2–171.6)5600.3 (5904.0–5326.7)3717.4 (4204.1–3246.3)
Maldives689.4 (719.7–662.8)164.9 (175.6–154.3)5615.6 (5873.0–5366.5)3162.2 (3371.4–2924.0)
USA1588.2 (1637.0–1537.7)151.1 (153.9–148.1)7275.8 (7565.4–7012.2)3029.7 (3168.0–2900.9)

Increasing Burden in Developing Countries: Low- and middle-income countries (LMICs) shoulder a significant burden of CHD, with over three-quarters of cardiovascular disease (CVD) deaths occurring in these regions [2]. Rapid urbanization, the adoption of unhealthy western lifestyles, and limited healthcare access contribute to the rising prevalence of CHD in LMICs.

Common Risk Factors: Shared risk factors such as tobacco use, unhealthy diet, physical inactivity, obesity, hypertension, and diabetes contribute to the global spread of CHD [3]. These risk factors are common across various populations and contribute to the worldwide proliferation of CHD.

Distribution of CVD risk factors by age groups (n = 314).

 

Age group (years)40–49 (n = 94)50–59 (n = 83)60–69 (n = 93)70 and above (n = 44)Total (n = 314)p Value
n (%)n (%)n (%)n (%)n (%)
Gender
Male40 (42.5)42 (50.6)51 (54.8)27 (61.4)160 (51.0)0.16
Female54 (57.5)41 (49.4)42 (45.2)17 (38.6)154 (49.0)
Smoking tobacco16 (17.0)23 (27.7)16 (17.20)13 (29.50)68 (21.7)0.12
Alcohol use9 (9.6)23 (27.7)13 (13.9)9 (20.4)54 (17.2)0.01
Overweight12 (12.7)14 (16.8)21 (22.5)10 (22.7)57 (18.2)0.61
Obese61 (64.9)50 (60.2)46 (49.4)21 (47.7)178 (56.7)0.61
Hypertension43 (45.7)54 (65.1)59 (63.4)36 (81.8)192 (61.1)<0.01
Diabetes23 (24.4)37 (44.6)39 (41.9)13 (29.5)112 (35.7)0.02
      • Abbreviation: CVD, cardiovascular disease.

Figure 2 shows the gender-wise distribution of 10-year CVD risk. Moderate–high CVD risk is significantly higher (p < 0.01) among males compared to females. Cardiovascular risk according to the age group is shown in Table 3. Very high and high cardiovascular risk (>20%) was seen mostly among people aged 70 years and above. 49.4% of participants in the 60–69 years age group, and 63.6% of participants above 70 years had moderate cardiovascular risk (10%–20%).[13]

Economic and Healthcare Systems Impact: CHD imposes a substantial economic burden on societies, encompassing direct medical costs, lost productivity, and social welfare losses. The World Heart Federation estimates the annual cost of CHD to be in the billions of dollars, with projections indicating a further increase in costs over time [4].

Health Inequities: Disparities in access to healthcare and preventive services exacerbate the impact of CHD, particularly in underserved communities and marginalized populations. Limited access to affordable healthcare, preventive interventions, and treatment modalities perpetuates the cycle of CHD burden in vulnerable populations [5].

Environmental and Social Determinants: Environmental factors such as air pollution, noise pollution ,inadequate urban planning, and exposure to toxins contribute to the development of CHD. Social determinants of health, including poverty, education level, and social support networks, also play a significant role in shaping CHD risk [6].

Globalization of Unhealthy Lifestyles: Globalization has facilitated the spread of unhealthy lifestyles characterized by sedentary behavior, poor dietary choices, and increased stress levels. These lifestyle factors contribute to the rising incidence of CHD worldwide, transcending geographical boundaries [7].

Current Status of CHD in Nepal

Coronary Heart Disease (CHD) in Nepal currently poses a significant public health challenge, underscored by increasing prevalence rates and associated risk factors. As per data from the World Health Organization (WHO), CHD contributes to a considerable portion of Nepal’s disease burden, accounting for approximately 12.26% of total deaths, with an age-adjusted death rate of 102.19 per 100,000 population [1].

Emerging epidemiological data suggests a worrying trend of rising CHD prevalence in Nepal. A study conducted in urban Kathmandu revealed a prevalence of 5.9%, indicating a significant burden of cardiovascular diseases in urban areas [2]. Moreover, recent findings indicate that the prevalence of smoking, hypertension, diabetes, and dyslipidemia among the population aged 40 to 80 years in rural Nepal was 27.8%, 34.4%, 6.9%, and 38.5%, respectively, highlighting the multifactorial nature of CHD risk factors in the Nepalese population [3].

Furthermore, the shift towards sedentary lifestyles, urbanization, and dietary changes exacerbates the prevalence of CHD. These factors, compounded by limited access to healthcare services, especially in rural regions, pose significant challenges to effective CHD management [4].

Addressing the Burden of CHD in Nepal

Addressing the burden of Coronary Heart Disease (CHD) in Nepal necessitates a comprehensive approach, drawing insights from strategies employed in both developed and developing nations. Here are some potential strategies for improvement, incorporating insights from global initiatives and interventions tailored for Nepal:

Health Education and Awareness Campaigns: The implementation of public health campaigns to raise awareness about CHD risk factors and promote healthy lifestyle choices is crucial. This strategy has proven effective in various contexts, including developed countries like the United States and Europe [1]. In Nepal, community-based health education programs can target both rural and urban populations, emphasizing the importance of quitting smoking, adopting healthy dietary habits, engaging in regular physical activity, and managing hypertension [2].

Access to Healthcare Services:  Due to fragmented health care systems in many LMICs(Low and Middle Income Countries), many patients are unaware of the disease and disease symptoms resulting in the delay of the care-seeking behavior. People from remote areas and limited access to advanced technology are more prone to suffer. The limited ambulance services in these parts also play a major role in the delay.Apart from the delay in reaching the primary care centers or hospitals, the lack of specialists and inadequate medical facilities hinder the delivery of proper and timely care. [10]Enhancing access to healthcare services, especially in rural areas, is vital for effective CHD management. Telemedicine facilities and mobile clinics can help bridge the gap in healthcare access, as demonstrated in countries like India and Bangladesh [3]. In Nepal, initiatives to establish primary healthcare clinics in remote regions and promote telemedicine consultations can enhance CHD diagnosis, treatment, and follow-up care [4].

Risk Factor Modification:  Early identification of pre-diabetic and pre-hypertensive condition and applying appropriate dietary and behavioural measures will be crucial .Encouraging lifestyle modifications to reduce CHD risk factors is paramount. Developed countries have implemented policies to regulate the availability of unhealthy foods and promote smoke-free environments [5]. In Nepal, advocating for tobacco control measures, promoting healthy dietary patterns rich in fruits, vegetables, and whole grains, and facilitating access to affordable medications for hypertension and dyslipidemia can help mitigate CHD risk [6].

Policy Interventions: Implementing policies to regulate unhealthy behaviors and strengthen healthcare infrastructure is vital. Examples include taxation on tobacco products, legislation on trans-fat content in foods, and investments in healthcare workforce training and facility development [7]. In Nepal, aligning with the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases (2014–2020) and integrating CHD prevention strategies into primary healthcare systems can drive sustainable improvements [8].

Early Detection and Management: Enhancing screening programs for early detection of CHD risk factors and ensuring timely management of the condition are critical. Evidence-based treatment protocols and risk-based management approaches, as outlined in global initiatives like the HEARTS Technical Package, can guide healthcare providers in Nepal [9]. Strengthening data collection systems and integrating cardiovascular risk assessment tools into routine clinical practice are also essential steps.

By integrating these strategies into a comprehensive national CHD prevention and control program, Nepal can make significant strides in reducing the burden of CHD and improving cardiovascular health outcomes across diverse populations.

REFERENCES

  1. World Health Organization. (2018). Noncommunicable diseases country profiles 2018. World Health Organization. Retrieved from:  https://www.who.int/publications/i/item/9789241514620
  2. Khanal, M. K., Ahmed, M. S. A. M., Moniruzzaman, M., Banik, P. C., Dhungana, R. R., Bhandari, P., Devkota, S., & Shayami, A. (2018). Prevalence and clustering of cardiovascular disease risk factors in rural Nepalese population aged 40–80 years. BMC Public Health, 18(677). https://doi.org/10.1186/s12889-018-5584-3
  3. Government of Nepal. (2014). Multisectoral action plan for the prevention and control of non communicable diseases (2014-2020). Retrieved from https://www.who.int/docs/default-source/nepal-documents/multisectoral-action-plan-for-prevention-and-control-of-ncds-(2014-2020).pdf).
  4. World Health Organization. (n.d.). Cardiovascular diseases. Retrieved from WHO(Original work published 2021)
  5. World Heart Federation. (2011). World heart report 2011.
  6. Mendis, S., Lindholm, L. H., Mancia, G., Whitworth, J., Alderman, M., Lim, S., & Heagerty, T. (2007). World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: Assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries. Journal of Hypertension, 25(8), 1578-1582. https://doi.org/10.1097/hjh.0b013e3282861fd3
  7. World Health Organization. (2007). Prevention of cardiovascular disease: Guidelines for assessment and management of total cardiovascular risk. https://www.who.int/publications/i/item/9789241547178
  8. Rajan, S., Rathod, S. D., Luitel, N. P., Murphy, A., Roberts, T., & Jordans, M. J. D. (2020). Healthcare utilization and out-of-pocket expenditures associated with depression in adults: A cross-sectional analysis in Nepal. BMC Health Services Research, 20, Article 250. https://doi.org/10.1186/s12913-020-05094-9
  9. Aryal, A., Citrin, D., Halliday, S., Kumar, A., Nepal, P., Shrestha, A., Nugent, R., & Schwarz, D. (2020). Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal. Global Health Research and Policy, 5, Article 2. https://doi.org/10.1186/s41256-020-0130-2
  10. Prajapati D, Bhandari N, Gautam P, Dhital R, Shrestha A. Coronary Artery Disease in Nepal: Current Perspective, Challenges, Need for National Practice Guidelines, and Potential Solutions. Kathmandu Univ Med J. 2022;80(4):505-13.
  11. Abdulsalam, J Feng. Distinguish the Stable and Unstable Plaques Based on Arterial Waveform Analysis. Procedia Structural Integrity 15 (2019) 2–7
  12. Bhattarai S, Aryal A, Pyakurel M, Bajracharya S, Baral P, Citrin D, Cox H, Dhimal M, Fitzpatrick A, Jha AK, Jha N, Karmacharya BM, Koju R, Maharjan R, Oli N, Pyakurel P, Sapkota BP, Shrestha R, Shrestha S, Spiegelman D, Vaidya A, Shrestha A. Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017. Int J Cardiol Heart Vasc. 2020 Jul 31;30:100602. doi: 10.1016/j.ijcha.2020.100602. PMID: 32775605; PMCID: PMC7399110.
  13. Sitaula,D., Dhakal,A.,  Mandal,S.,  Bhattarai,N.,  Silwal,A., Adhikari,P., Gupta,S., Khatri,D., Lageju,N., Guragain,B.,(2023). Estimation of 10-year cardiovascular risk among adult population in western Nepal using nonlaboratory-based WHO/ISH chart, 2023: A cross-sectional study,VOL6,Issue (10). https://doi.org/10.1002/hsr2.1614
  14.  

Tuberculosis: Causes, Prevention and Management

The Health Thread Favicon

Written By THT Editorial Team

Sujata Shakya

Reviewed by Sujata Shakya, Public Health Practitioner, Assistant Professor, Public health (IOM)

Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also impact other parts of the body. Understanding the causes, prevention, and management of TB is essential for controlling its spread and reducing its impact on public health.

Causes of Tuberculosis:

Tuberculosis is caused by the transmission of Mycobacterium tuberculosis from an infected individual to a susceptible person. The bacteria can be spread through the air when an infected individual coughs, sneezes, or speaks, releasing respiratory droplets containing the bacteria (1). Factors such as overcrowded living conditions, poor ventilation, and compromised immune systems increase the risk of TB transmission (2).

Prevention of Tuberculosis:

Preventative measures play a crucial role in reducing the incidence of TB. Some examples of preventative measures include:

Vaccination: Bacille Calmette-Guérin (BCG) vaccine is used to prevent severe forms of TB in children. It provides partial protection against TB and reduces the risk of disseminated TB in infants and young children (3). However, the BCG vaccine’s effectiveness in preventing pulmonary TB, the most common form of the disease, varies and is generally less effective in adults.

Infection Control: Implementing effective infection control measures is crucial to prevent the spread of TB. This includes identifying and promptly isolating individuals with active TB, ensuring proper ventilation in healthcare facilities, and promoting cough etiquette (4).

Screening and Testing: Active case finding and early detection of TB cases are essential for preventing further transmission. Regular screening of high-risk populations, such as close contacts of TB patients, healthcare workers, and individuals living with HIV, is recommended. Diagnostic tests such as sputum smear microscopy, molecular tests, and chest X-rays are used to detect TB infection (5).

Treatment of Latent TB Infection: Individuals with latent TB infection, who have the TB bacteria in their bodies but do not have active disease, can progress to active TB if not treated. Treating latent TB infection with antibiotics, such as isoniazid or rifampin, can prevent the development of active TB disease (6).

Management of Tuberculosis:

TB management focuses on early diagnosis, appropriate treatment, and adherence to medication. Some key aspects of TB management include:

Directly Observed Therapy (DOT): DOT is a strategy in which healthcare providers or trained community health workers directly observe patients taking their TB medications. This approach ensures treatment adherence and helps prevent the development of drug-resistant TB (7).

Drug Therapy: TB is treated with a combination of antibiotics for a specific duration. The standard treatment regimen for drug-susceptible TB includes a combination of isoniazid, rifampin, ethambutol, and pyrazinamide. Drug-resistant TB requires more complex treatment regimens using second-line drugs (8).

Contact Investigation: Identifying and testing individuals who have had close contact with TB patients is crucial for early detection of TB cases and preventing further transmission. Contact investigation involves screening and testing close contacts to identify latent TB infection or active TB disease (9).

Adherence Support: Ensuring treatment adherence is vital for successful TB management and prevention of drug resistance. Providing patient education, counseling, and support services can improve medication adherence and treatment outcomes (10).

Conclusion:

Preventing and managing tuberculosis requires a comprehensive approach involving vaccination, infection control measures, screening and testing, treatment of latent infection, and effective management of active TB cases. By implementing evidence-based preventative measures and ensuring early diagnosis and appropriate treatment, communities can work towards reducing the burden of tuberculosis and protecting public health.

REFERENCES