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The Health Thread

Is Your Medicine Cabinet Missing This? Laughter’s Amazing Benefits

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

A robust sense of humor isn’t merely a pleasant diversion during challenging times; it’s a valuable asset in our pursuit of overall well-being. When we find ourselves amused by a friend’s witty remark or a comedian’s act, the positive impacts of humor resonate through our bodies, minds, and social connections. It’s more than just entertainment; it contributes to enhancing our physical, mental, and emotional health.

According to Dattilo, an instructor of psychology at Harvard Medical School, humor’s psychological benefits are immediate, lifting mood and reducing stress and anxiety, while also affecting us physically by reducing cortisol levels and increasing dopamine and serotonin neurotransmitters (Harvard Gazette, 2023).

Research has shown that laughter’s health benefits are extensive, including pain relief, increased happiness, and enhanced immunity. Positive psychology recognizes laughter and a sense of humor as one of the 24 main signature strengths (Verywell Mind).

The physical benefits of laughter are diverse:

  • Laughter boosts heart and respiratory rates and oxygen consumption temporarily, leading to subsequent relaxation. While it’s not equivalent to aerobic exercise, it still offers physical benefits. Laughing for 10-15 minutes daily can burn an additional 10-40 calories.
  • It positively impacts heart function by increasing stroke volume, cardiac output, and dilating blood vessels.
  • Intense laughter enhances muscle tone.
  • Watching funny videos stimulates the sympathetic nervous system (SNS) without raising blood pressure.
  • Laughter reduces cortisol levels, the stress hormone.
  • It activates the brain’s mesolimbic dopaminergic reward system.
  • Laughing boosts levels of serum immunoglobulins A and E and tends to increase natural killer cell activity.
  • It raises levels of beta-endorphins, the body’s feel-good chemicals, and increases human growth hormone (U.S. Department of Veterans Affairs).

Relationship between Laughter and Mental Health

The relationship between laughter and mental health is profound. It interrupts distressing emotions, promoting relaxation, stress reduction, increased energy, focus, and productivity. Additionally, laughter fosters a more positive perspective on situations, creating psychological distance and diffusing conflict. It also strengthens social bonds, which can profoundly impact mental and emotional well-being (HelpGuide).

In conclusion, laughter emerges as a potent medicine for holistic health, offering a multitude of benefits across physical, psychological, and social dimensions

REFERENCES

  1. Harvard Gazette. (2023, January). A laugh a day keeps the doctor away. Retrieved from https://news.harvard.edu/gazette/story/2023/01/a-laugh-a-day-keeps-the-doctor-away/
  2. Verywell Mind. (n.d.). The Stress Management and Health Benefits of Laughter. Retrieved from https://www.verywellmind.com/the-stress-management-and-health-benefits-of-laughter-3145084
  3. S. Department of Veterans Affairs. (n.d.). Healing Benefits: Humor & Laughter. Retrieved from https://www.va.gov/WHOLEHEALTHLIBRARY/tools/healing-benefits-humor-laughter.asp
  4. (n.d.). Laughter is the Best Medicine. Retrieved from https://www.helpguide.org/articles/mental-health/laughter-is-the-best-medicine.htm

Advancing Kidney Health: Transforming Innovative Concepts into Practical Solutions

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Written By THT Editorial Team

Dr. Nabin Bahadur Basnet

Reviewed by Dr. Nabin Bahadur Basnet, Consultant Interventional Nephrologist, MBBS, PhD, FISN

Exploring effective treatment options for end-stage renal disease (ESRD) has led to the development of innovative technologies such as implantable bio artificial kidneys (BAK) and kidney regeneration. These advancements are not just impressive achievements; they are sources of hope for millions around the globe.

Implantable Bio artificial Kidney (BAK): A Game Changer

Imagine a kidney replacement that’s like having a tiny, high-tech sidekick doing all the hard work for you. That’s the dream behind the implantable BAK. Dr. William H. Fissell and Shuvo Roy, Ph.D., are the masterminds behind this marvel. Picture a device no bigger than a soda can, but with the power to mimic your kidney’s functions. It hooks up to your blood vessels, acting like a natural kidney without the hassle of dialysis or meds.

The Kidney Project: Making Sci-Fi a Reality

The Kidney Project, a tag team effort between Vanderbilt University Medical Center and the University of California San Francisco, has been the driving force behind the BAK’s evolution. Their latest prototype is a real showstopper. It’s proven it can keep kidney cells alive inside a bioreactor, essentially acting as a mini kidney. The silicon membranes protect these cells like armor, ensuring they keep ticking away. (Kim et al., 2023)

Preclinical Success and What’s Next

Recent trials have been a roaring success. The BAK operates silently in the background, much like a superhero, without setting off alarms in the recipient’s immune system. This means it could be the ticket to freedom from dialysis and the endless wait for donor kidneys. . (Kim et al., 2023)

Kidney Regeneration Tech: Healing Magic

But wait, there’s more! While the BAK steals the spotlight, kidney regeneration tech is quietly making waves. Scientists have stumbled upon a magic trick: block a pesky protein called interleukin-11 (IL-11), and damaged kidney cells start to regrow. It’s like hitting the rewind button on kidney damage caused by diseases or injuries. (Widjaja et al., 2022)

The Future’s Bright for Kidney Care

Combine the power of BAK with regeneration tech, and you’ve got a winning combo. The BAK offers immediate relief for those in dire need, while regenerative therapies work their magic over time, restoring natural kidney function.

Challenges and the Big Picture

Sure, these innovations are thrilling, but there are hurdles to jump. We need to make sure the BAK is safe and effective for humans and fine-tune regeneration therapies. Plus, we can’t forget about making these treatments accessible and affordable for everyone.

In Conclusion: Hope on the Horizon

The birth of the BAK and kidney regeneration tech is like finding a pot of gold at the end of the rainbow for kidney disease sufferers. These breakthroughs promise a brighter future, where kidney failure isn’t a life sentence. It’s a journey filled with obstacles, but the destination—a world free from the grip of kidney disease—is within reach.

REFERENCES

  1. Kim, E. J., Chen, C., Gologorsky, R., Santandreu, A., Torres, A., Wright, N., Moyer, J., Chui, B. W., Blaha, C., Brakeman, P., Vartanian, S., & Tang, Q. (2023, August 29). Can an Artificial Kidney Finally Free Patients from Dialysis? UCSF. Retrieved from UCSF News
  2. Widjaja, A. A., Viswanathan, S., Shekeran, S. G., Adami, E., Lim, W. W., Chothani, S., Tan, J., Goh, J. W. T., Chen, H. M., Lim, S. Y., Boustany-Kari, C. M., Hawkins, J., Petretto, E., Hübner, N., Schafer, S., Coffman, T. M., & Cook, S. A. (2022). Targeting endogenous kidney regeneration using anti-IL11 therapy in acute and chronic models of kidney disease. Nature Communications, 13(1), 7497. https://doi.org/10.1038/s41467-022-35306-1

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

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

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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.  

Exploring CAR-T Cell Therapy in Glioblastoma Treatment

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Written By THT Editorial Team

Dr. Prakash Paudel

Reviewed by Dr. Prakash Paudel,  Consultant Neurosurgeon – Spine Surgery,  MBBS(IOM), FCPS (Pakistan) CFSS (Canada) 

Glioblastoma (GBM), the most common primary malignant brain tumor, presents a daunting challenge in clinical management, with a meager 5-year survival rate of merely 5% [1]. Despite advancements in treatment modalities such as surgery, radiation, and chemotherapy, the prognosis remains dismal due to tumor heterogeneity and the intricate interplay between tumor cells and normal brain tissue, compounded by the impermeable blood-brain barrier.

Conventional therapies, including surgical resection, radiotherapy, and chemotherapy, have shown limited efficacy, resulting in high relapse rates and poor patient outcomes [2]. Therefore, there is an urgent need for innovative therapeutic approaches to combat GBM effectively.

Chimeric Antigen Receptor T (CAR-T) cell therapy, heralded for its success in hematological malignancies, has emerged as a promising avenue for solid tumors like GBM [3]. However, its application faces formidable challenges posed by the unique anatomical features of GBM, including the blood-brain barrier and the immunosuppressive tumor microenvironment, alongside tumor heterogeneity.

CAR-T therapy involves the extraction of T lymphocytes from the patient’s peripheral blood, genetic modification to express chimeric antigen receptors targeting specific tumor antigens, and reinfusion into the patient, thereby harnessing the immune system to target and destroy cancer cells [4].

The manufacturing process of CAR-T cells entails several meticulous steps, including T cell isolation, genetic engineering to introduce CAR genes, in vitro activation and expansion, and rigorous quality assessment before clinical administration [5].

While CAR-T therapies have demonstrated remarkable efficacy in hematologic malignancies, their application in solid tumors has been limited. The complexity of solid tumors, characterized by diverse cell populations, presents challenges in achieving sustained therapeutic responses [6].

Innovative strategies combining CAR-T therapy with bispecific antibodies, such as T-cell Engaging Antibody Molecules (TEAMs), hold promise in overcoming the hurdles posed by tumor heterogeneity [7]. These approaches aim to enhance the specificity and potency of CAR-T cells against solid tumors like GBM.

Recent clinical studies have reported encouraging outcomes with CAR-T therapy in GBM patients, demonstrating reduced tumor sizes and prolonged survival [8]. Notably, early-phase trials employing dual-target CAR-T cells, engineered to recognize multiple tumor-associated antigens, have shown promising results in shrinking tumors and extending patient survival [9].

Despite the progress, CAR-T cell therapy in GBM is not without limitations, with treatment-associated toxicities, including cytokine release syndrome and central nervous system complications, warranting careful monitoring and management [10].

In conclusion, the innovative field of CAR-T cell therapy is at the forefront of transforming the treatment paradigm for glioblastoma multiforme (GBM). The journey from preclinical studies to clinical trials has been fraught with challenges, yet these hurdles have been instrumental in uncovering and addressing the complexities of successful cancer treatment. The advent of CAR T cells equipped with multivalent receptors, combined with cutting-edge therapies, is tackling the problem of antigen escape [11]. Furthermore, the synergy of CAR T cell therapy with other treatments, such as immunotherapies, chemotherapies, or mechanical tumor ablation, is poised to foster a more inflammatory microenvironment conducive to better patient outcomes [11]. As research continues to refine these therapeutic strategies, there is a growing hope for significant advancements in the battle against this formidable disease.

REFERENCES

  1. Stupp, R., Mason, W. P., van den Bent, M. J., Weller, M., Fisher, B., Taphoorn, M. J. B., … & Mirimanoff, R. O. (2005). Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New England Journal of Medicine, 352(10), 987-996.
  2. Ostrom, Q. T., Cioffi, G., Gittleman, H., Patil, N., Waite, K., Kruchko, C., & Barnholtz-Sloan, J. S. (2019). CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro-Oncology, 21(Supplement_5), v1-v100.
  3. June, C. H., & Sadelain, M. (2018). Chimeric antigen receptor therapy. New England Journal of Medicine, 379(1), 64-73.
  4. Maude, S. L., Frey, N., Shaw, P. A., Aplenc, R., Barrett, D. M., Bunin, N. J., … & Grupp, S. A. (2014). Chimeric antigen receptor T cells for sustained remissions in leukemia. New England Journal of Medicine, 371(16), 1507-1517.
  5. Levine, B. L., Miskin, J., Wonnacott, K., Keir, C., & Rosenblatt, J. (2017). Trial of gene-modified virus-specific T lymphocytes augmented by granulocyte-macrophage colony-stimulating factor and interleukin-2 for advanced recurrent or refractory Hodgkin lymphoma: clinical and immunologic results. Clinical Cancer Research, 23(9), 2250-2261.
  6. Jackson, H. J., Rafiq, S., & Brentjens, R. J. (2016). Driving CAR T-cells forward. Nature Reviews Clinical Oncology, 13(6), 370-383.
  7. Yu, S., Li, A., Liu, Q., Li, T., & Yuan, X. (2019). Chimeric antigen receptor T cells: A novel therapy for solid tumors. Journal of Hematology & Oncology, 12(1), 1-10. https://doi.org/10.1186/s13045-017-0444-9
  8. Brown, C. E., Alizadeh, D., Starr, R., Weng, L., Wagner, J. R., Naranjo, A., … & Badie, B. (2016). Regression of glioblastoma after chimeric antigen receptor T-cell therapy. New England Journal of Medicine, 375(26), 2561-2569. https://doi.org/10.1056/NEJMoa1610497
  9. O’Rourke, D. M., Nasrallah, M. P., Desai, A., Melenhorst, J. J., Mansfield, K., Morrissette, J. J. D., … & Zheng, Z. (2021). A single dose of peripherally infused EGFRvIII-directed CAR T cells mediates antigen loss and induces adaptive resistance in patients with recurrent glioblastoma. Science Translational Medicine, 13(593), eabf2311. https://doi.org/10.1126/scitranslmed.aaa0984
  10. Neelapu, S. S., Tummala, S., Kebriaei, P., Wierda, W., Gutierrez, C., Locke, F. L., … & Shpall, E. J. (2018). Chimeric antigen receptor T-cell therapy—assessment and management of toxicities. Nature Reviews Clinical Oncology, 15(1), 47-62. 11
  11. Luksik AS, Yazigi E, Shah P, Jackson CM. CAR T Cell Therapy in Glioblastoma: Overcoming Challenges Related to Antigen Expression. Cancers (Basel). 2023 Feb 23;15(5):1414. doi: 10.3390/cancers15051414. PMID: 36900205; PMCID: PMC10000604. 13

Rare Kidney Diseases: A Global Perspective on Diagnosis, Treatment, and Advocacy

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Written By THT Editorial Team

Dr. Nabin Bahadur Basnet

Reviewed by Dr. Nabin Bahadur Basnet, Consultant Interventional Nephrologist, MBBS, PhD, FISN

Rare kidney diseases pose significant challenges to patients worldwide, often leading to chronic debilitation, morbidity, or even death. These conditions, characterized by low prevalence and genetic or metabolic origins, demand specialized care and concerted efforts to enhance awareness, diagnosis, and treatment accessibility (Iyengar et al., 2023). This article explores the landscape of rare kidney diseases, focusing on the challenges faced by children, common elements in these conditions, and the imperative need for advocacy and research initiatives.

Rare Kidney Diseases in Children: A Call for Action

Rare kidney diseases affect a substantial number of children globally, with a prevalence of 60–80 cases per 100,000 population in Europe and the United States. These diseases include over 150 different conditions, many of which manifest in childhood (Iyengar et al., 2023). Children with rare kidney diseases often face serious morbidity and require lifelong treatment. However, inequitable access to disease-modifying therapies remains a significant challenge, particularly for children from low- and middle-income countries (LMICs) (Iyengar et al., 2023).

Notable Rare Kidney Diseases:

  1. Cystinosis: A rare genetic disease causing cystine accumulation in cells, affecting various organs including the kidneys. Treatment involves cysteamine therapy to reduce cystine levels.
  2. Primary Hyperoxaluria Type 1: A genetic disorder causing oxalate buildup in the kidneys, often necessitating combined liver and kidney transplantation.
  3. Alport Syndrome: A genetic condition affecting the kidneys, ears, and eyes due to defects in specific genes. It can lead to kidney failure and other complications.
  4. Amyloidosis: Characterized by abnormal protein accumulation in organs like the kidneys, heart, brain, liver, and intestines.
  5. Polycystic Kidney Disease (PKD): Genetic mutations leading to fluid-filled cysts in the kidneys. Treatment varies based on the type of PKD.

Diagnosis of Rare Kidney Diseases:

Children suspected of having rare kidney diseases are given a thorough clinical assessment by pediatric nephrologists. Symptoms such as swelling, changes in urine output, blood in urine, fatigue, and growth issues are evaluated to determine the need for further testing (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Genetic testing plays a crucial role in diagnosing rare kidney diseases with a genetic basis. Tests like the Genetic Renal Panel screen complement genes to identify genetic mutations associated with conditions like Alport syndrome, cystinosis, or polycystic kidney disease (University of Iowa Hospitals & Clinics, n.d.).

Imaging techniques such as ultrasound are used to visualize the kidneys and detect abnormalities like cysts or structural defects that may indicate specific rare kidney diseases like autosomal recessive polycystic kidney disease (ARPKD) (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Laboratory tests are conducted to assess kidney function, protein levels in urine (proteinuria), blood in urine (hematuria), electrolyte imbalances, and other markers that can provide insights into the underlying condition causing the kidney disease (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).

Specialized clinics like the Rare Renal Disease Clinic and Renal Genetics Clinic offer comprehensive evaluation and management for children with rare kidney diseases. These clinics provide state-of-the-art genetic testing and access to clinical trials for new therapies (University of Iowa Hospitals & Clinics, n.d.).

By combining these diagnostic approaches under the care of experienced specialists like pediatric nephrologists and geneticists, children with rare kidney diseases can receive accurate diagnoses leading to tailored treatment plans and improved outcomes.

Common Elements in Rare Kidney Diseases

Rare kidney diseases share common challenges such as small patient populations, unidentified disease causes, lack of biomarkers for disease monitoring, and complex care requirements (Aymé et al., 2017). Diagnostic hurdles often delay accurate identification of these conditions, necessitating advanced techniques like genetic testing for precise diagnosis (Aymé et al., 2017).

Advocacy Efforts and Research Initiatives

Enhancing access to diagnostic testing through low-cost genetic testing initiatives and training clinicians in interpreting genetic analyses are crucial steps towards improving outcomes for individuals with rare kidney diseases (Iyengar et al., 2023). Collaborative efforts involving patient support organizations, healthcare providers, researchers, governments, and pharmaceutical industries are essential to drive advancements in diagnosis, treatment accessibility, and research innovation.

In Conclusion

Uniting stakeholders globally and prioritizing the needs of individuals with rare kidney diseases will lead to better outcomes and quality of life. Addressing the challenges posed by rare kidney diseases requires a multifaceted approach encompassing advocacy for equitable access to care, research into innovative treatments, and enhanced awareness initiatives (Rare Kidney Disease Foundation, n.d.).

REFERENCES

  1. Iyengar, A., Lanewala, A. A., Shirol, P. B., & Pais, P. (2023). Rare Kidney Diseases: Children Being Left Out in the Cold. Clinical Journal of the American Society of Nephrology. https://doi.org/10.2215/CJN.0000000000000374
  2. Aymé, S., Bockenhauer, D., Day, S., et al. (2017). Common Elements in Rare Kidney Diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International, 92(4), 796-808. https://doi.org/10.1016/j.kint.2017.06.018
  1. Wong, K., Pitcher, D., Braddon, F., Downward, L., Steenkamp, R., Annear, N., et al. (2024). Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort. Retrieved March 26, 2024, from https://doi.org/10.1016/S0140-6736(23)02843-X.
  2. Deeley, M. (2024, February 29). Rare Disease Day: Rare kidney diseases you may not know about. American Kidney Fund. Retrieved March 26, 2024, from https://www.kidneyfund.org/article/rare-disease-day-rare-kidney-diseases-you-may-not-know-about.
  3. Rare Kidney Disease Foundation Website https://www.rarekidney.org
  4. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Kidney Disease in Children. Retrieved March 26, 2024, from https://www.niddk.nih.gov/health-information/kidney-disease/children#diagnose.
  5. University of Iowa Hospitals & Clinics. (n.d.). Rare Kidney Diseases. Retrieved March 26, 2024, from https://uihc.org/services/rare-kidney-diseases.
  6. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Autosomal Recessive Polycystic Kidney Disease. Retrieved March 26, 2024, from https://www.niddk.nih.gov/health-information/kidney-disease/polycystic-kidney-disease/autosomal-recessive-pkd.

A new hope to treat ‘Flat Tire’ in Spine: The Tension-Activated Repair Patch (TARP)

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Written By THT Editorial Team

Dr Aayush Shrestha

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

The human spine, an architectural wonder of biology, is prone to a variety of injuries. Disc herniation is notably one of the most incapacitating conditions [1]. This condition, often compared to a ‘flat tire’ in the spine, happens when the soft, cushion-like discs between the vertebrae burst, causing the inner gel to bulge out and press against the nerves. This can result in intense pain, numbness, and even disability.

Traditional treatments have been palliative at best, focusing on alleviating pain rather than repairing the underlying damage. However, a ground-breaking study published in Science Translational Medicine heralds a new era in spinal repair with the development of the tension-activated repair patch (TARP) [1].

The TARP represents a significant advancement in the treatment of disc herniation [2]. Developed by researchers at the University of Pennsylvania and the CMC VA Medical Center, this biologic patch is designed to mimic the natural healing process of the body. The patch, which is inserted directly onto the herniated disc, is composed of nanofibers that deliver an anti-inflammatory drug, anakinra, directly to the damaged disc [1]. Anakinra, a recombinant interleukin-1 receptor antagonist, has been shown to reduce inflammation and promote tissue repair [1].

What sets TARP apart is its activation mechanism [2]. The patch is designed to respond to the natural biomechanical movements of the body, which in turn triggers the release of anakinra from microcapsules embedded within the patch. This ensures a sustained and controlled release of the medication, enhancing the disc’s ability to regain tension and integrity over time [1].

The implications of this technology are profound [2]. By providing a means to not only plug the ‘hole’ caused by herniation but also to restore the disc’s natural tension, TARP offers a potential cure for a condition that has long been considered irreversible. The researchers’ preclinical trials in large animal models have shown promising results, with discs regaining the necessary tension to reverse herniation and prevent further degeneration [2]. Moreover, the TARP could revolutionize the way we approach spinal injuries [1]. With its ability to integrate with the native tissue and reinforce the structure at the injury site, it prevents the aberrant remodeling that often follows disc detensioning. This could significantly reduce the incidence of recurrent herniations and persistent dysfunction, which are common with conventional treatments [1].

As we look to the future, the TARP presents a beacon of hope for millions suffering from spinal conditions [2]. The prospect of a treatment that not only alleviates pain but also restores spinal function is a monumental leap forward. While further research and human clinical trials are necessary, the TARP stands as a testament to the ingenuity of medical science and its relentless pursuit of solutions that restore quality of life to those afflicted by debilitating conditions.

The TARP’s innovative design is not just a theoretical concept but a tangible advancement poised to transform spinal treatment protocols. Its unique tension-activated mechanism aligns seamlessly with the body’s natural movements, promoting a more organic healing process. The use of anakinra within the TARP system exemplifies the shift towards targeted therapeutic strategies, offering a glimpse into the future of personalized medicine. This technology’s adaptability suggests it could be tailored for various orthopedic applications, potentially improving outcomes for patients with a range of degenerative conditions. As the research community continues to explore the full capabilities of TARP, it stands as a beacon of progress in the ongoing quest to address some of the most challenging medical conditions faced today.

In conclusion, the tension-activated repair patch is a pioneering solution that addresses the root cause of disc herniation. It offers a new hope for patients, potentially changing the course of spinal disease progression and opening the door to a future where ‘flat tires’ in the spine can be fully and effectively repaired. It’s important to note that the tests are still in the early stages and there are many factors to consider while treating a herniated disk, like the extent of herniation. Extruded and sequestered disc fragments need removal of disc fragments.

REFERENCES

  1. Peredo, A. et al. (2023). Tension-activated nanofiber patches delivering an anti-inflammatory drug improve repair in a goat intervertebral disc herniation model. Science Translational Medicine, 15(2), eabcm1654. https://doi.org/10.1126/scitranslmed.abcm1654
  2. University of Pennsylvania School of Medicine. (2023). ‘Patch’ Uses Natural Body Motion to Fix Disc Herniation. Penn Medicine News. Retrieved from https://www.pennmedicine.org/news/news-releases/2023/january/patch-uses-natural-body-motion-to-fix-disc-herniation

Enhancing Doctor-Patient Relations: Strategies for Addressing Frustrations and Improving Healthcare Experiences

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

Effective doctor-patient relations are fundamental to delivering high-quality healthcare. However, challenges such as miscommunication, time constraints, and differing expectations can lead to frustrations for both doctors and patients. In this essay, we will explore common frustrations experienced by both parties during medical encounters, analyze the underlying causes, and propose strategies to enhance doctor-patient relations. Additionally, we will examine policy implementations in healthcare systems worldwide and offer recommendations for fostering positive interactions between doctors and patients.

Common Frustrations Experienced by Doctors:

Time Constraints: Doctors often face tight schedules, with limited time allocated for each patient encounter. The pressure to address multiple concerns within a short timeframe can lead to rushed appointments and feelings of frustration (Macharia et al., 2020).

Administrative Burden: Administrative tasks, such as documentation, billing, and electronic health record management, consume significant time and energy for healthcare providers. These tasks detract from direct patient care and contribute to physician burnout (Arndt et al., 2017).

Lack of Appreciation: Healthcare providers may feel undervalued or unappreciated for their efforts, particularly in environments where their contributions are not acknowledged or recognized (Shanafelt et al., 2017).

Legal and Regulatory Pressures: Doctors must adhere to complex legal and regulatory requirements, which can create additional stress and anxiety. Fear of malpractice lawsuits or disciplinary action may impact clinical decision-making and communication with patients (Soklaridis et al., 2016).

Emotional Toll: Dealing with patient suffering, difficult diagnoses, and end-of-life care can take an emotional toll on healthcare providers. Coping with these challenges while maintaining professionalism and empathy can be challenging (Woolhandler et al., 2016).

Strategies to Address Doctor Frustrations:

Time Management Training: Providing doctors with time management and organizational skills training can help them optimize their schedules and prioritize patient care tasks effectively. Implementing strategies such as time blocking and delegation can enhance efficiency (Körner et al., 2015).

Streamlining Administrative Processes: Healthcare organizations should invest in technology and infrastructure to streamline administrative tasks and reduce paperwork burden on doctors. Electronic health record systems, automated billing systems, and administrative support staff can alleviate administrative pressures (Shanafelt et al., 2016).

Recognition and Support: Healthcare institutions should foster a culture of appreciation and support for healthcare providers. Recognizing their contributions through awards, incentives, and peer recognition programs can boost morale and job satisfaction (Panagioti et al., 2017).

Legal Reform and Malpractice Insurance: Policymakers should explore legal reforms to reduce the burden of malpractice litigation on healthcare providers. Implementing alternative dispute resolution mechanisms, such as mediation or arbitration, can mitigate the adversarial nature of malpractice claims (Baker et al., 2017).

Mental Health Support: Healthcare organizations should prioritize mental health support services for doctors, including access to counseling, peer support groups, and wellness programs. Proactive measures to address stress, burnout, and psychological distress can promote physician well-being and resilience (West et al., 2018).

Common Frustrations Experienced by Patients:

Communication Barriers: Patients may struggle to communicate their symptoms, concerns, and treatment preferences effectively to their healthcare providers. Language barriers, medical jargon, and lack of health literacy can hinder effective communication (Street et al., 2013).

Long Wait Times: Patients often experience long wait times for appointments, tests, and procedures, leading to frustration and dissatisfaction with healthcare services. Delays in accessing care can exacerbate health problems and undermine patient-provider relationships (Barr et al., 2015).

Lack of Empathy: Some patients perceive their healthcare providers as lacking empathy or compassion, particularly when discussing sensitive or distressing topics. Providers who appear rushed or disinterested may inadvertently convey a lack of empathy, affecting patient trust and satisfaction (Hojat et al., 2011).

Information Overload: Patients may feel overwhelmed by the volume of medical information provided during appointments, leading to confusion and uncertainty about their diagnosis, treatment options, and prognosis. Simplifying complex medical information and using plain language can enhance patient understanding (Schillinger et al., 2003).

Perceived Disrespect: Patients expect to be treated with dignity, respect, and courtesy by their healthcare providers. Instances of perceived disrespect, such as dismissive attitudes, rude behavior, or discriminatory practices, can erode patient trust and confidence in the healthcare system (Dovidio et al., 2008).

Strategies to Address Patient Frustrations:

Effective Communication Skills Training: Healthcare providers should undergo communication skills training to improve their ability to listen actively, convey empathy, and communicate clearly with patients. Training programs should focus on building rapport, fostering trust, and addressing patient concerns (Bylund et al., 2010).

Appointment Scheduling Optimization: Healthcare organizations should implement strategies to reduce wait times and minimize appointment delays. This may include optimizing scheduling systems, increasing appointment availability, and improving workflow efficiencies in clinics and hospitals (Murray et al., 2009).

Empathy and Cultural Competency Training: Healthcare providers should receive training in empathy and cultural competency to better understand and respond to the diverse needs and preferences of patients. Training programs should emphasize cultural humility, sensitivity to cultural differences, and awareness of unconscious biases (Betancourt et al., 2003).

Patient Education and Shared Decision-Making: Healthcare providers should engage patients as active participants in their care, involving them in shared decision-making and treatment planning. Providing patients with information, resources, and support empowers them to make informed decisions about their health (Elwyn et al., 2012).

Respectful and Patient-Centered Care: Healthcare organizations should prioritize patient-centered care principles, ensuring that all interactions with patients are respectful, compassionate, and culturally sensitive. Creating a welcoming and inclusive environment promotes patient trust, satisfaction, and engagement in their healthcare (Epstein et al., 2005).

Policy Implementations in Healthcare Systems:

Several countries have implemented policies and initiatives aimed at improving doctor-patient relations and enhancing the patient experience. These include:

Comprehensive Training Programs: Implementing comprehensive training programs for healthcare providers to enhance communication, empathy, and cultural competence skills (Haskard Zolnierek & DiMatteo, 2009).

Appointment Scheduling Optimization: Streamlining appointment scheduling processes to reduce wait times and improve access to timely care (Zachariah et al., 2017).

Patient Education and Shared Decision-Making: Promoting patient education and shared decision-making to empower patients to take an active role in their healthcare decisions (Charles et al., 1997).

Legal Protections and Patient Rights: Strengthening legal protections for patients and healthcare providers and enforcing strict penalties for acts of violence or harassment in healthcare settings (World Health Organization, 2021).

Quality Improvement Initiatives: Implementing quality improvement initiatives to enhance patient-centered care, improve patient satisfaction, and address systemic issues affecting doctor-patient relations (Beattie et al., 2015).

Recommendations for Fostering Positive Doctor-Patient Relations:

Invest in Training and Education: Healthcare organizations should invest in training and education programs to enhance the communication, empathy, and cultural competency skills of healthcare providers.

Prioritize Patient-Centered Care: Healthcare providers should prioritize patient-centered care principles, ensuring that all interactions with patients are respectful, compassionate, and culturally sensitive.

Implement Policy Reforms: Policymakers should explore legal reforms and policy initiatives to strengthen patient protections, improve access to care, and address systemic issues affecting doctor-patient relations.

Foster Collaboration and Partnership: Healthcare organizations should foster collaboration and partnership between doctors and patients, promoting shared decision-making, mutual respect, and trust.

Embrace Technology and Innovation: Healthcare organizations should embrace technology and innovation to improve access to care, streamline administrative processes, and enhance communication between doctors and patients.

Conclusion:

Enhancing doctor-patient relations is essential for delivering patient-centered, high-quality healthcare. By addressing the frustrations experienced by both doctors and patients and implementing strategies to improve communication, empathy, and trust, healthcare organizations can foster positive and collaborative relationships that benefit all stakeholders. Through policy reforms, education and training initiatives, and a commitment to patient-centered care, we can create healthcare systems that prioritize the needs and preferences of patients while supporting the well-being and professional satisfaction of healthcare providers.

REFERENCES

  1. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. The Annals of Family Medicine, 15(5), 419–426.
  2. Baker, L. C., Bundorf, M. K., & Kessler, D. P. (2017). Vertical Integration: Hospital Ownership of Physician Practices Is Associated with Higher Prices and Spending. Health Affairs, 36(5), 756–764.
  3. Barr, P. J., Scholl, I., Bravo, P., Faber, M. J., Elwyn, G., & McAllister, M. (2015). Assessment of patient empowerment – a systematic review of measures. PLOS ONE, 10(5), e0126553.
  4. Beattie, M., Murphy, D. J., Atherton, I., & Lauder, W. (2015). Instruments to measure patient experience of healthcare quality in hospitals: a systematic review protocol. Systematic Reviews, 4(1), 84.
  5. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care. Public Health Reports, 118(4), 293–302.
  6. Bylund, C. L., Makoul, G., & Starzyk, E. J. (2010). Patient-provider E-interaction: Digital Media and Communication in Patient-Physician Relationships. Patient Education and Counseling, 78(3), 329–334.
  7. Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681–692.
  8. Dovidio, J. F., Penner, L. A., Albrecht, T. L., Norton, W. E., Gaertner, S. L., & Shelton, J. N. (2008). Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Social Science & Medicine, 67(3), 478–486.
  9. Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cording, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A., & Barry, M. (2012). Shared Decision Making: A Model for Clinical Practice. Journal of General Internal Medicine, 27(10), 1361–1367.
  10. Epstein, R. M., Franks, P., & Fiscella, K. (2005). Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. Social Science & Medicine, 61(7), 1516–1528.
  11. Haskard Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician Communication and Patient Adherence to Treatment: A Meta-analysis. Medical Care, 47(8), 826–834.
  12. Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine: Journal of the Association of American Medical Colleges, 86(3), 359–364.
  13. Körner, M., Bütof, S., Müller, C., Zimmermann, L., & Becker, S. (2015). Developing the Competences of Interprofessional Teams—Evaluation of a Training Based on the German Interprofessional Competence Framework. Journal of Interprofessional Care, 29(5), 430–436.
  14. Macharia, P. M., Ong’ayo, G., Oyugi, H., Nyamogo, G., & Kosgei, R. J. (2020). Workload of doctors in a developing country: How do doctors at a Kenyan referral hospital allocate their time? PLOS ONE, 15(9), e0239345.
  15. Murray, M., Berwick, D. M., & Advanced Access, A. G. (2009). Reducing Delays and Waiting Times Throughout the Healthcare System. The Joint Commission Journal on Quality and Patient Safety, 35(9), 505–506.
  16. Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., Peters, D., Hodkinson, A., Riley, R., & Esmail, A. (2017). Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 177(7), 1002–1011.
  17. Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C., & Bindman, A. B. (2003). Closing the Loop: Physician Communication With Diabetic Patients Who Have Low Health Literacy. Archives of Internal Medicine, 163(1), 83.
  18. Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., West, C. P., Sloan, J., & Oreskovich, M. R. (2017). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine, 172(18), 1377–1385
  19. Shanafelt, T. D., Noseworthy, J. H., & Executive Leadership Council, M. S. (2016). Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 92(1), 129–146.
  20. Soklaridis, S., Bernard, C., Ferguson, G., & Gauthier, G. (2016). Understanding the effects of physician direct mail pharmaceutical advertising on physician prescribing decisions: A case report from Canada. Journal of Psychiatry & Neuroscience, 41(5), 353–360.
  21. Song, Z., & Baicker, K. (2019). Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial. JAMA, 321(15), 1491–1501.