Artificial intelligence can improve treatment of heart failure patient

MediBulletin Bureau
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Artificial intelligence can improve treatment of heart failure patient

The tool that was developed using anonymised patient data from heart failure clinical trials has been made available free of cost

Researchers from the University of Virginia have developed a machine learning tool to analyse patient outcomes in people who have suffered heart failure. The tool is available free to clinicians. 

Anonymised data from patients enrolled in heart failure clinical trials that were funded by the National Institutes of Health’s National Heart, Lung and Blood Institute. “This model presents a breakthrough because it ingests complex sets of data and can make decisions even among missing and conflicting factors. It is really exciting because the model intelligently presents and summarizes risk factors reducing decision burden so clinicians can quickly make treatment decisions,” said researcher Josephine Lamp, of the University of Virginia School of Engineering’s Department of Computer Science. 

Heart failure is a condition when for reasons that can vary widely, the heart is not capable of pumping all the blood that is required for all functions of the body to be carried out effectively. It can lead to symptoms such as accumulation of fluids in vital organs. It is a condition that often required lifelong management and dramatic lifestyle changes, making immaculate and well informed medical decisions key to the care of such patients.

“The collaborative research environment at the University of Virginia made this work possible by bringing together experts in heart failure, computer science, data science and statistics. Multidisciplinary biomedical research that integrates talented computer scientists like Josephine Lamp with experts in clinical medicine will be critical to helping our patients benefit from AI in the coming years and decades,” said researcher Kenneth Bilchick, MD, a cardiologist at UVA Health. “

Cancer kills 9 lakh Indians every year; to not screen is not an option

Dr O P Choudhury
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Cancer kills 9 lakh Indians every year; to not screen is not an option

A recent news report that exposed “huge gaps” in screening is not something the government did not know about 

Cancer kills over 9 lakh Indians every year yet India has not made any meaningful interventions towards lessening that burden; in fact 13 years after the government of India rolled out a programme to screen for breast, cervical and oral cancer, it is still a non-starter.

A recent The Indian Express report has exposed how even a new flagship programme – Ayushman Bharat – and its freshly rechristened primary healthcare centres, the Ayushman Arogya Mandirs have failed equally to achieve this basic public health requirement as had been the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)  launched in 2010 during the UPA era. The newspaper reported that a stocktaking done by the NITI Aayog has flagged “huge gaps” in cancer screening. The report has been in existence for some time now but the ministry of health and family welfare has chosen to sit on it rather than action remedies that can address the situation.

Teams from NITI visited  93 HWCs across 37 districts in 12 states and one Union Territory over a period of four months and came to the conclusion that: “Screening for breast cancer is being administered by educating beneficiaries to undertake self-examination. Provision for screening of cervical cancer is yet to be operationalized. Screening for oral cancer is performed on a case by case basis, depending on tobacco consumption habits or any other visible symptoms. Presently, suboptimal cancer screening activities are a huge gap.”

That the gaps exist is evident also from the National Family Health Survey 5 (2019-2021) data too. This document, which is the most comprehensive assessment of health parameters at the population level in India shows that 1.9% women have ever undergone screening for cervical cancer, 0.9% women have ever undergone screening for breast or oral cancer and only 1.2% men have ever undergone screening for oral cancer. It is also a very telling statistic that screening for cancer – or in this case the lack of it – affects women much more than men as two of three cancers occur almost exclusively in women and are in fact the two top killers in the cancer spectrum. Breast and cervical cancer have been the top two in India for perhaps as long as the population based cancer registries have existed in the country. Screening can help detect these cancers earlier and in many cases that changes the prognosis of the disease significantly. On a related but different note, the plan to roll out HPV vaccinations too needs to be actioned now instead of being left to the choice of states as was done in the interim budget earlier this year.

When detected with cancer there are currently huge gaps also in the accessibility and affordability of cancer care too that largely remain unaddressed. Many poor people even after the advent of AIIMS-like institutes and the Pradhan Mantri Jan Arogya Yojana that gives a family health cover of Rs 5 lakh per annum to eligible families continue to reach tertiery care centres when there is little or no hope of recovery losing their life’s savings and livelihoods in the process. 

While national level estimates of the cost of cancer care are hard to come by, a localised study in Kerala estimated that economic burden of cancer in this Vypin Block Panchayat was found to be Rs. 218,256,977/-.”Direct cost for cancer care contributed 75% toward the cost of illness and the remaining was found to be indirect cost. Loss of income (44%) contributed to the largest chunk of indirect cost. The average direct cost for cancer care was found to be Rs. 25,606 and the average indirect cost was Rs. 8772. The average total cost of cancer care was calculated to be Rs. 34,378. Significant statistical variation was found between the cost of cancer care in private and government hospitals,” says the 2020 study.

Healthcare industry among fastest in adopting artificial intelligence, show new data

MediBulletin Bureau
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Healthcare industry among fastest in adopting artificial intelligence, show new data

India lags global standards of AI adoption because of shortage of trained manpower

Among all sectors the pharmaceuticals and healthcare industry is among the fastest to adopt artificial intelligence (AI), show newly released data.

According to an analysis done by staffing firm Teamlease Digital, the AI adoption rate for this industry stood at 52%. A close second is the FMCG and retail sector whose AI adoption rate stands at 43%, followed by 28% for manufacturing, 20-22% for infrastructure and transport and 10-12% for media and entertainment. The leaders however are Banking
and Financial Services (BFSI) at 68%, followed by the
technology sector at 60-65%.

According to a 2023 article in BMC Medical Education, the uses of AI in healthcare can be manifold. “AI can be used to diagnose diseases, develop personalized treatment plans, and assist clinicians with decision-making. Rather than simply automating tasks, AI is about developing technologies that can enhance patient care across healthcare settings. However, challenges related to data privacy, bias, and the need for human expertise must be addressed for the responsible and effective implementation of AI in healthcare,” the article said.

Indian companies are using AI both to develop machine learning models that can step in as a first step screening tool in remote areas where trained medical manpower is hard to come by and also, at the other end of the spectrum, to deliver cutting edge personalised healthcare through advanced models that can predict and alleviate disease risks. It is also being widely used for drug development.

The AI market size in India was pegged at $6 billion in 2023 and projected to touch $20 billion over the next five years. However India’s adoption of AI still lags global standards, the primary reason for which is the lack of trained manpower, say industry experts.

Smokeless tobacco use is costing India  US$19 billion, claims study

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Smokeless tobacco use is costing India  US$19 billion, claims study

India’s primary anti tobacco law COTPA 2003 is considered to be effective but implementation is poor, particularly in the remote parts of the country

 

A recent study that looked at lifetime health and economic burden of smokeless tobacco in India, Pakistan and Bangladesh had estimated that unless India revises its current policy and decides to eliminate smokeless tobacco it could be staring at an expense of US$19 billion which is roughly Rs 1.6 lakh crore.

 

The study published in the journal Nicotine and Tobacco Research was carried out by researchers in the United Kingdom and in India. “The model predicted that the lifetime healthcare costs of ST use in Bangladesh, India, and Pakistan would be over US$1.5 billion, US$19 billion, and US$3.3 billion respectively…For all countries, the attributable costs are higher for younger cohorts with costs declining with increasing age for those over 50. The greatest costs for men in India were in the 35 to 39-year-old cohort with total lifetime discounted costs of US$1.803 billion. The greatest costs for men in Bangladesh were for the cohorts ranging from 30 to 44 years of age with costs ranging from US$83 million to US$85 million over the lifetime of each of the 5-year cohorts. The attributable costs for men in Pakistan peaked in the 20 to 24-year-old cohort and the 30 to 34-year-old cohort with costs of US$294 million and US$278 million, respectively,” they summed up. South and Southeast Asia is home to a large majority (>85%) of the 356 million users of smokeless tobacco (ST) globally.

 

Incidentally India is considered among the global leaders in tobacco control policies with the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA) considered to be an effective law. However implementation is poor, particularly in the backward and remote areas of the country where the easy availability of cheap smokeless tobacco has given rise to very high levels of tobacco use. In Maharashtra’s Gadchiroli – an aspirational district – for example studies show that about 50% of the population is addicted to tobacco. 

 

“The overall (absolute) burden is greatest for India due to the size of its ST users, with the highest burden borne by those in middle age, although per individual (relative) burden is comparable across the three countries. The burden is almost double for men compared with women in India and Pakistan; however, in Bangladesh, the burden is generally slightly greater for women compared with men,” says the study.

 

Battling obesity? Your health risks could be higher if you were also obese as a child

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Battling obesity? Your health risks could be higher if you were also obese as a child

A study presented at the European Congress on Obesity suggests that asking adults whether they were thinner, fatter than normal as a child could hold the key to finding mortality risks

 

It is not standard practice for doctors when they are treating obese, adult patients to delve into their body images as ten-year-olds. But doing so, suggests a study presented at the European Congress on Obesity could help doctors work out the actual health risks of their patients better.

The study is by Dr William Johnson, an epidemiology expert based at Loughborough University, UK, and colleagues.

Obesity both in adults and children is a major public health concern but the study aimed to build a connection between the two and to evaluate whether the associations of adulthood overweight and obesity with mortality and incident disease differ according to self-reported child body weight.

The sample comprised 191,181 men and 242,806 women aged 40-69 years at baseline in the UK Biobank prospective cohort study between 2006-10. The outcomes were all-cause mortality and incident cardiovascular disease (CVD), obesity-related cancer, and breast cancer. The authors measured BMI at baseline (categorised as normal weight, overweight, or living with obesity) and self-reported perceived body weight at age 10 years (about average, thinner, plumper). 

Obese adults were asked: “When you were 10 years old, compared to average, would you describe yourself as: thinner, about average, or plumper?” Across the recruited cohort during follow-up 8% died, 35% developed CVD, and 2% of the whole cohort (men and women) developed obesity related cancer – including cancers of the colon, uterus, oesophagus, gallbladder, stomach, kidney, pancreas, rectum, thyroid, brain lining (meningioma) and also multiple myeloma. And 5% of women developed breast cancer. Adult men who were thinner as children had the least mortality risk, the study found. Interestingly, adult women who were plumper as kids had the least mortality risk.

“For adult men who reported having a normal weight at 10 years old, living with obesity was associated with a 28% (1.28 times) increased risk of all-cause mortality compared to adult men with normal weight. For men reporting being thinner at age 10, living with obesity as an adult was associated with a 63% (1.63 times) increased risk of all-cause mortality compared to men with normal weight. And for men reporting being ‘plumper’ at age 10, there was a 45% (1.45 times) increased risk of all-cause mortality for those living with obesity as adults compared to those living with normal weight,” the researchers reported.

The correlations were marginally different for women. “For adult women who reported having a normal weight at 10 years old, living with obesity was associated with a 38% (1.38 times) increased risk of all-cause mortality compared to adult women living with normal weight. For women reporting being thinner at age 10, living with obesity was associated with a 60% (1.6 times) increased risk of all-cause mortality compared with women of normal weight. And for women reporting being plumper at age 10, there was a 32% (1.32 times) increased risk of all-cause mortality for those living with obesity as adults compared to those living with normal weight,” the researchers reported.

One in 10 Indian women over 45 has undergone hysterectomy; more likely in southern, western India

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One in 10 Indian women over 45 has undergone hysterectomy; more likely in southern, western India

Hysterectomy is one of the ‘moral hazard’ procedures in insurance parlance which means that likelihood of a patient undergoing it goes up when she can afford it

 

Women of 45 years and above are more likely to have undergone a hysterectomy if they are residents of southern or western India, a study has found. These also happen to be regions where quality and accessibility of healthcare services is relatively better.

“Heavy menstrual bleeding/pain (32.1%), fibroids/cysts (24.2%) and uterine prolapse (16.3%) are the most cited reasons for surgeries. Overall, 11.5% is the countrywide hysterectomy prevalence rate while the southern (18.2%) and western (12.7%) Indian regions reported the highest prevalence. A significant proportion of these may be attributed to unnecessary rampant surgeries prescribed by doctors in certain parts of India, summoning strict regulation by the government,” says the study which was published in the journal Women’s Reproductive Health. It was conducted by researchers from the International Institute for Population Sciences (IIPS), Indian Institute of Public Health, Gandhinagar and the National Institute of Health and Family Welfare found. 

Unnecessary hysterectomies have been flagged as a issue of public health concern by health experts over the years. It is also one of the procedures that in insurance parlance are known as “moral hazard” which is a term used for procedures that are pushed by doctors even in patients where it is not essential.

Despite the health benefits, hysterectomy also has several long-term ramifications on women’s health, longevity, and quality of life. Some of the adverse health concerns that arise after a hysterectomy even when medically necessary, include early menopause, increased risk of cardiovascular disease, increased risk of stroke, urinary incontinence, obesity, endocrine and metabolic complications, and loss of sexual desire. This is the first analysis of hysterectomies using nationally representative data.

The survey data covered different regions in India and classified them into the fol- lowing regions: North (Chandigarh, Delhi, Haryana, Himachal Pradesh, Jammu and Kashmir, Punjab, Rajasthan, Uttarakhand); Central (Chhattisgarh, Madhya Pradesh, and Uttar Pradesh); East (Bihar, Jharkhand, Odisha, West Bengal); Northeast (Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Tripura); West (Dadra and Nagar Haveli, Daman and Diu, Goa, Gujarat, Maharashtra); South (Andaman and Nicobar Islands, Andhra Pradesh, Karnataka, Kerala, Lakshadweep, Puducherry, Tamil Nadu, Telangana). 

“Our data revealed a disparity in hysterectomy prevalence between urban and rural residents. Women living in urban areas were more likely to report having had a hys- terectomy as compared to women from rural areas. This was also documented by a study conducted in China among rural women (Liu et al., 2017). It may be because of the flour- ishing private health-care facilities in the cities and towns and relatively higher income and greater affordability among the urban women than their rural counterparts (Shekhar et al., 2019), increasing the risk of hysterectomy for the latter group. It was also observed that highly educated women were less likely to report undergoing hysterectomy. A plaus- ible explanation may lie in the fact that educated and urban women have better access to health-care services owing to higher disposable income, enabling them to avail themselves of medical assistance at the initial stages of health concerns,” researchers wrote.

 

  

 

Ready to eat foods can affect longevity; meat or seafood based products more harmful

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Ready to eat foods can affect longevity; meat or seafood based products more harmful

A 30-year study that looked at all cause mortality in subjects consuming ultraprocessed foods finds higher mortality links and not just related to cancer and cardiovascular diseases

 

Ultraprocessed foods such as (but not limited to) sweetened breakfast ‘cereals’ and fruit yoghurt and ‘energy’ drinks; pre-prepared meat, cheese, pasta and pizza can shorten your life. This is the upshot of a new study published in The BMJ that has found that these food items are associated with a slightly higher all cause mortality, driven by causes other than cancer and cardiovascular diseases.

 

The study looked at people consuming ultraprocessed foods over a period of 30 years and came to this conclusion. During a median of 34 years of follow-up, the study documented 48 193 deaths (30 188 deaths of women and 18 005 deaths of men), including 13 557 deaths due to cancer, 11 416 deaths due to cardiovascular diseases, 3926 deaths due to respiratory diseases, and 6343 deaths due to neurodegenerative diseases. At the start the study had 74 563 women and 39 501 men with no history of cancer, cardiovascular diseases, or diabetes.

 

This is how the Food and Agricultural Organisation of the United Nations defines ultra processed foods: “Ultra-processed foods are formulations of ingredients, mostly of exclusive industrial use, typically created by series of industrial techniques and processes (hence ‘ultra-processed’). Some common ultra-processed products are carbonated soft drinks; sweet, fatty or salty packaged snacks; candies (confectionery); mass produced packaged breads and buns, cookies (biscuits), pastries, cakes and cake mixes; margarine and other spreads; sweetened breakfast ‘cereals’ and fruit yoghurt and ‘energy’ drinks; pre-prepared meat, cheese, pasta and pizza dishes; poultry and fish ‘nuggets’ and ‘sticks’; sausages, burgers, hot dogs and other reconstituted meat products; powdered and packaged ‘instant’ soups, noodles and desserts; baby formula; and many other types of product.”

 

The authors led by researchers from Harvard T H Chan School of Public Health recommended limited consumption of ultraprocessed foods and emphasised the fact that the positive association with mortality was driven mainly by ​​meat/poultry/seafood based ready-to-eat products, sugar and artificially sweetened beverages, dairy based desserts, and ultra-processed breakfast foods.

 

Covishield mainstay of India’s COVID19 vaccination yet ICMR last year said no sudden death link

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Covishield mainstay of India’s COVID19 vaccination yet ICMR last year said no sudden death link

1,74,94,17,978 Covishield doses, 1.22 lakh all vaccine adverse events: Astra Zeneca confession raises many questions for India

Abantika Ghosh

When AstraZeneca told a UK court earlier this week that

India Mask
COVID19 tested the resilience of the global science and health infrastructure

its COVID19 vaccines can cause thrombosis with thrombocytopenia syndrome – blood clots and low blood platelets – it created global ripples. Some of those are being felt in India which as late as December last year saw the government declaring COVID19 vaccines safe and with no link to sudden cardiac deaths based on a study by the Indian Council of Medical Research. 

Propensity for blood clots are one of the known reasons for sudden cardiac death and AZ’s submission admits that the vaccine causes it. How then did ICMR study reach a conclusion that defies the assessment of even the vaccine’s manufacturer? What also of the six other vaccines against the SARS-CoV2 virus that India has used since 2021, some of them from even before complete data on their safety and efficacy were available and even after they had fallen afoul of multiple foreign regulators. 

AstraZeneca’s vaccine, sold in India under the brand name Covishield and manufactured by the Serum Institute of India (SII) was the mainstay of India’s COVID19 vaccination programme. According to the Cowin portal, 1,74,94,17,978 Covishield doses have been administered in India with just about 1.2 lakh (0.007%) AEFIs (adverse events following immunisation) being reported. 

AZ’s submission in court raises questions both about how Indian scientists analysed AEFIs to exonerate COVID19 vaccines and why India has reported such a low rate of AEFI despite widely using a vaccine that its manufacturer says can have potentially serious or even fatal side effects. The AEFI committee has in the past faulted states on their AEFI reporting but it is also a fact that the noise created in associating vaccines with nationalism may have aso discouraged many people who faced vaccine side effects from reporting. It may also have been a function of the high level of resilience that Indians in general have in living with adverse reactions, in medicine and beyond.

In December last year, the government of India told the Lok Sabha that a study conducted by ICMR has observed that COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. 

Health minister Mansukh Mandaviya told the Lower House while replying to a question from Trinamool Congress MP Sajda Ahmed: “A total of 729 cases and 2916 controls were included in the analysis. It was observed that receipt of at least one dose of COVID-19 vaccine lowered the odds for unexplained sudden death, whereas past COVID-19 hospitalization, family history of sudden death, binge drinking 48 hours before death/interview, use of recreational drug/substance and performing vigorous-intensity physical activity 48 hours before death/interview were positively associated. Two doses lowered the odds of unexplained sudden death, whereas single dose did not. Hence, the study observed that COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.” 

Basically ICMR, blamed everything from lifestyle to addiction to family history for rising incidences of unexplained sudden death except the one thing that now stands indicted in AZ’s response to the class action suit where it conceded that the vaccine predisposes some recipients to blood clots. Documented data on sudden cardiac deaths says one of the reasons for sudden cardiac death may be coronary thrombosis or a blood clot in the coronary artery. “Approximately 60% of sudden coronary death is caused by coronary thrombosis,” says a 2001 analysis in the journal Cardiovascular Pathology that looked at sudden cardiac deaths.

As the country’s premier medical research organisation, this is a question ICMR can no longer skirt. As the most respected medical research organisation in the country, it can either start a process of introspection about how it conducts research, or commission a fresh one on why Indians tolerated Covishield better than  even what its makers expected. Science needs explanations and currently there isn’t one that explains the relationship between India and Covishield.

Related to this also are questions about the safety of the other vaccines used in India, including Covaxin that has been hailed as a feat of Indian science and which ICMR has jointly helmed with Bharat Biotech.That the much flaunted “Made in India” vaccine has run afoul of the World Health Organisation that suspended procurement and supply in April 2022 and multiple foreign regulatory agencies, is common knowledge. It had taken some strong arm diplomacy by India and a quid pro quo threat to get it approved for travel to the UK. Then there was the “world’s first DNA vaccine”  that was procured by the government but never used raising questions not of medical ethics but public morality; why waste public money on a vaccine that does not inspire enough confidence?

Much transpired in India during the COVID19 pandemic that defies science. In the interest of science and in the interest of better preparedness of future pandemic, honest stocktaking is the most basic step.

(Abantika Ghosh is a journalist and public policy professional. She is also author of Billion Under Lockdown: The Inside Story of India’s Fight Against COVID-19)

Too much to exercise daily? Just take the stairs for better heart health

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Too much to exercise daily? Just take the stairs for better heart health

Stair climbing is associated with a reduced risk of cardiovascular and all-cause mortality, researchers said while presenting a paper at the European Society of Cardiology conference

If pumping weights or doing a daily run are not your cups of tea, then take heart. Just shunning the lift and taking the stairs every day can have a similarly healthy effect on your heart.

This was the conclusion researchers reached after a review of over 700 published articles on the issue. They presented their conclusion at the ongoing conference of the European Society of Cardiology. “Physical activity in the form of stair climbing is associated with a reduced risk of cardiovascular and all-cause mortality. These findings highlight the importance of promoting everyday activities, even within the workplace and home, to foster healthier lifestyles and mitigate the risks associated with cardiovascular diseases,” they told the conference, making it clear that they were not expecting these results when they embarked on the project.

Physical inactivity causes a significant burden from cardiovascular disease worldwide. As sedentary behaviours and associated health risks become increasingly prevalent, there is a growing imperative to explore accessible and practical strategies to mitigate cardiovascular risk. This systematic review and meta-analysis aims to evaluate the association between physical activity in the form of stair climbing and cardiovascular risk.

India has a high burden of heart and cardiovascular diseases (CVD) with largescale food and lifestyle changes in both its urban and rural populations. According to a 2023 article in The Lancet Regional Health (southeast Asia), in 2017, CVD was responsible for 26.6%  of total deaths and 13.6% of total DALYs in India, compared with 15.2% and 6.9% respectively, in 1990.

Not many may be able to afford a gym or a trainer or have the time and discipline to do regular exercise. These findings mean staying active for the sake of one’s heart can come at no cost.

 

Henna is a hair dye, not for skin application, says USFDA

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Henna is a hair dye, not for skin application, says USFDA

Have received reports of adverse reactions to some henna and black henna tattoos, says the regulator, issues detailed clarification 

 

The USFDA has clarified that henna is a hair dye and not to be used on the skin. This clarification came after it received several complaints about allergic reactions to what it calls “henna” and “black henna” tattoos.

 

“Henna, a coloring made from a plant, is approved only for use as a hair dye. It is not approved for direct application to the skin, as in the body-decorating process known as mehndi. This unapproved use of a color additive makes these products adulterated. It is unlawful, for example, to introduce an adulterated cosmetic into interstate commerce.

Because henna typically produces a brown, orange-brown, or reddish-brown tint, other ingredients must be added to produce other colors, such as those marketed as “black henna” and “blue henna.” Even brown shades of products marketed as henna may contain other ingredients intended to make them darker or make the stain last longer on the skin,” the regulator has said. 

 

The allergic reaction to black henna in particular, is because of an extra ingredient used to blacken henna which is a coal-tar hair dye containing p-phenylenediamine (PPD), the statement added. It is because of additives such as these that hair dyes often come with a warning to conduct a patch test before use.

Mehendi
USFDA has received complaints about allergic reactions to Mehendi tattoos

FDA has issued warnings against temporary tattoos in the past too. 

 

Henna or mehendi are commonly used in India in various social functions across communities. The system of regulation and reporting of adverse reactions to cosmetics is far more lax in India.

 

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