The Obesity Pandemic: What can we do about it?

Obesity today is a global crisis; the number of cases is on a continuous rise. As per the WHO,  “during the years 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four-fold from 4% to 18% globally”. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these, over 650 million were obese. 

Overweight or obesity is a chronic health condition that leads to abnormal or excessive fat accumulation in adipose tissue. The excess fat around the waist and trunk (abdominal, central, or android obesity) or peripherally around the body (gynoid obesity) can have severe complications. The disease is significantly increasing and surpassing traditional conditions such as undernutrition, infectious diseases, and many others. A particular trend related to obesity is that the number of people with the disease is slowly increasing even in the low- and middle-income countries, particularly in the urban areas, which earlier was mainly confined to the higher income countries. 

How is Obesity Measured? 

Obesity is divided into three classes. Among the various methods, the most basic and standard procedure is the body mass index (BMI). BMI considers a person’s weight and height to calculate the level of adiposity. Accordingly, the three classes of obesity are Overweight (not obese), Class 1 (low-risk) obesity, Class 2 (moderate-risk) obesity, and Class 3 (high-risk), obesity. 

Some other methods such as Bioelectric Impedance (BIA), Waist Circumference, Air-Displacement Plethysmography, Waist-to-Hip Ratio, Skinfold Thickness, and others also used to measure Obesity. 

Why is obesity a problem?

According to the global burden of disease (2017), over the years, Obesity has grown to epidemic proportions, with around 4 million people dying each year due to being overweight or obese. Overweight and obesity are considered big health problems as they can lead to many potentially life-threatening conditions or diseases if ignored for an extended period. Obesity is a risk factor for many health complications such as pulmonary embolism, joint osteoarthritis (OA), cardiovascular disease, and certain types of cancer

Besides these, it is linked to other health problems, including strokes, sleep apnea, fatty liver disease, kidney disease, pregnancy problems, etc. Obesity can hamper day-to-day physical activity, impact cognitive abilities, and lead to psychological issues such as depression, stress, and many others.

What causes obesity?

An Individual’s metabolic activity, genetics, environmental factors, behavior, and hormones can supposedly cause overweight and obesity. Primarily, the intake of more calories than the body requires is considered the leading cause of obesity. Over time if calories are not burned, the body stores the extra calories as body fat. Physical inactivity and a sedentary lifestyle increase the risk of obesity many times.

Obesity Pandemic

What are the risk factors for obesity?

Apart from calorie and physical activity, some of the genetic and social factors also influence the prevalence of obesity. Among various factors, some of the most common risk factors include:

Genes – The genes are supposed to have a small role in obesity. The gene, along with unhealthy diets and lifestyles, enhances the risk of obesity. The appetite pattern, calories burning time, and eating habits impact the risks of obesity.

Medical conditions– Certain medical conditions such as Cohen syndrome, Prader-Willi syndrome, Cushing syndrome, and other disorders are directly associated with the weight increase.

Age – As per the CDC, in the united states, in 2017–2018, “the prevalence of obesity was 40.0% among young adults aged 20 to 39 years, 44.8% among middle-aged adults aged 40 to 59 years and 42.8% among adults aged 60 and older”. With age, specific hormonal changes, and an inactive lifestyle increase risk of obesity.

Socio-economic conditions – The socioeconomic conditions such as education level, income, and ethnicity directly relate to obesity. As per the CDC, in the US, men and women with college degrees had lower obesity prevalence than those with less education. Also, among women, a higher prevalence was observed in the middle and low-income groups than in the higher income group.

Sex – A person’s sex can have an impact on obesity. For example, in the united states, black or Hispanic women are more obese than black or Hispanic men.

Some of the other factors, such as stress, depression, ceasing smoking, low sleep pattern, and pregnancy, also increase the risk of obesity.

Obesity Treatment Market 

Depending upon the cause and severity, the treatment option for obesity includes a lifestyle intervention, pharmacotherapy, and weight-loss procedures (including bariatric surgery). Significant progress has occurred in all three modalities in recent years, which has improved people’s lives with obesity. 

The lifestyle intervention focuses on a weight reduction program that includes healthy eating programs, physical activity, and healthy sleep patterns. Pharmacological treatments are recommended to reduce the intake or absorption of nutrients. These medications act on specific body parts. The aim of the interventions is to block the absorption of fat from foods or in some cases to regulate the urge to eat and to decrease the appetite. Pharmacological treatment is recommended with lifestyle changes. These interventions are followed only after recommended by doctors and can have some side effects also. During the last decades, many weight-loss interventions have entered clinical trials. Still, the majority have been withdrawn or ceased, not all because of lack of efficacy, but due to safety issues. 

Today, at the global level, some of the key companies such as Rhythm Pharmaceuticals, Gelesis, Novo Nordisk, Saniona, Medix, MedImmune, AstraZeneca, Boehringer Ingelheim, Gubra Pharma, and others are involved in developing therapies for obesity. The launch of the treatments in the coming years will significantly improve people’s lives affected by obesity. 

Similarly, surgical intervention is recommended to extremely obese patients if the lifestyle changes and medicines fail to produce a desirable outcome. The surgical intervention includes gastrectomy, gastric bypass surgery, and others. However, these surgeries are quite risky options as these can also cause infection, bleeding, and in some cases, even death.

What lies ahead

As discussed earlier, the prevalence of obesity has increased significantly over the decades. It has a particular impact on national productivity, economy, healthcare infrastructure, even though it is preventable. Obesity and its related illnesses take a large chunk of an individual’s income (for medical care and prescription needs), apart from time and productivity. Similarly, it causes unnecessary burdens such as higher insurance premiums, lower wages in certain fields, social bias and discrimination, limited opportunities (particularly in the areas requiring physical activity such as armed services), and many others. 

The WHO’s World Health Assembly in 2004 and again in 2011, through its political declaration on the non-communicable disease (NCDs), has described the need for actions to support healthy diets and regular physical activity patterns at the population level. Similarly, the governments, NGOs, health groups, are also promoting healthy lifestyle habits and environments at their level to reduce the burden of obesity and its related diseases. People are also getting self-conscious and taking these diseases seriously. Among all, the younger generation is actively adopting a healthy lifestyle that includes regular exercise, yoga, and a healthy diet. Although the number is quite low, in the coming year with regular promotion the number is likely to increase.

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Medical Tourism: Road to Affordable and Quality Medical Care

In recent decades, apart from the movement of goods and services from one corner of the world to another, globalization has brought many new aspects in its folds. Medical tourism is one of the growing phenomena of the globalized world. In recent years, significant growth has been observed in the medical tourism sector. As a result of the high healthcare cost, people from developed countries move from their home country to another to receive treatment. There is no defined definition of medical tourism, as governments worldwide follow different criteria to count the number of treatments and services offered. 

What is Medical Tourism?

Traveling from one country to another to receive medical care is referred to as Medical tourism, and the patients receiving medical treatment are often referred to as medical tourists or medical travelers. The cost and quality of medical services offered are the two main factors that drive the medical tourism industry.  Apart from these, factors such as limited insurance coverage, medical interventions not supported by home country, commercial organ transplants are other factors that make medical tourism thriving.  

Why is medical tourism important? Which are the top medical tourism countries?

Medical tourism offers a wide range of potential opportunities to the host countries. It improves their reputation in the healthcare sector and creates employment in healthcare and related industries. The most important aspect is the increase in medical revenue and economic growth. 

In the past, most people from developing countries used to travel to developed countries for healthcare services due to the availability of advanced technology and healthcare specialists. However, during the past few decades, the trend has reversed. The developing countries have made massive progress in their healthcare system, and many people seek healthcare services in developing countries. Among the Asian medical tourism industry, India, Thailand, Philippines, Japan, Malaysia, and Singapore are common medical treatment destinations. 

Similarly, in the American continent, Costa Rica, Panama, Brazil, and Mexico are preferred medical treatment destinations. In the last two decades, the middle-eastern countries like UAE, Oman, Bahrain, and Egypt have invested and revamped their existing healthcare infrastructure with many modern technologies. In the coming years, the gulf counties are expected to attract many medical tourists from European and African countries due to their strategic location.

What are the types of medical tourism?

Patients worldwide are adopting the route of medical tourism to seek a wide range of medical, surgical, and dental services. The most prominent healthcare services opted to include cosmetic surgery, dentistry, orthopedic surgery, cardiac surgery, and organ transplantation. Simultaneously, the demand for assisted reproductive technology like in vitro fertilization and surrogacy is also increasing at a rapid pace. Apart from these, Asian countries are significantly adding a wide range of traditional and alternative treatments in the existing armamentarium such as Ayurveda, Homeopathy, and many others. The demand for these therapies is immensely growing in western countries. 

What are the risks and challenges associated with Medical Tourism?

Certain challenges in the medical tourism sector affect its growth. Some of the leading challenges include:

  • Communication barrier – Communication is one of the significant barriers to medical tourism. The interaction between patient and doctor can hamper the medical service. However, the issue can be addressed with the help of an interpreter.
  • Quality of medication – Countries follow a different procedure for medication testing and approval. In some cases, medication quality in developing countries can affect health. 
  • Post-operative care –  In some cases, there may arise issues related to post-operative care. The health insurance plans in the home country may not support the post-operative complication and symptoms. 

Post-procedural care accountability, expected and actual health outcomes after treatment, traveling risk, cultural differences, issues related to privacy, and patient information confidentiality are some other issues associated with Medical Tourism.

What are the main factors that drive the medical tourism sector?

A wide range of factors influences people to receive healthcare from overseas countries. However, some of the most critical factors include – 

  • Soaring cost of healthcare services in the developed countries – Attractively lower cost of services attracts the people from developed countries to developing countries for medical care. Similarly, no healthcare insurance and coverage of limited services related to cosmetic surgery, fertility treatment, gender reassignment procedures, and dental reconstruction under the healthcare scheme also influence the decision.
  • Quality care – The quality of medical services offered is another primary driver for medical tourism. Several hospitals in developing countries are accredited by the Joint Commission International (JCI) to another country’s hospitals and healthcare centers. Similarly, healthcare professionals also have internationally respected credentials and are trained in foreign countries like the USA, UK, Canada, and many others. The services provided are at par with the developed countries.
  • Long waiting lists – In some developed countries, the long waiting list prompts patients to seek healthcare services from another country. The patients can bypass the waiting list, such as that for Hip replacement surgeries without any delay in time. 
  • Technological advancement – Earlier, patients not well versed with the medical facilities in another country, coordinate with the hospital or healthcare provider via travel agents to make an informed decision. However, the Information and communications technology (ICT) today can connect healthcare providers directly to patients. In the coming years also, the trend is likely going to move forward. Similarly, transferring the electronic medical records and related diagnostic has simplified the procedure to contact and consult healthcare professionals. 

Other factors, such as follow-up care, inexpensive flights, a wide range of accommodations options, easy medical visa policy, provision for the attendant, are some of the other factors that influence the medical tourism sector.  

What is the future of medical tourism? 

Today the competition is fierce in the healthcare industry. Every country is making an effort to develop its healthcare sector to cater to the needs of the local population and attract foreign patients. Although, amid the travel restrictions due to the Covid-19 lockdown, the past year has observed a significant drop in medical tourists. The lockdown measure has disrupted the revenue and the momentum of the healthcare industry in many countries. However, in the coming month, with the expected launch of the vaccine, the sector is expected to recover. Many countries have launched a dedicated medical tourism portal for healthcare procedures, immigration, and visa-related information. Some are offering an extended stay policy and the option to allow medical attendant visas for blood relatives. Similarly, the host countries are making changes in legislation governing the privacy and confidentiality of patient information. After the vaccine launch and improvement in the current situation due to the Coronavirus, the healthcare tourism industry is expected to grow leaps and bounds.

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Alcohol Use Disorder (AUD): When Drinking Becomes A Headache

Alcohol use is a serious health problem worldwide, leading to many physical, mental, and behavioral health problems. Besides physical health, it also leads to a significant number of mortality every year. As per the WHO, worldwide, harmful use of alcohol results in 3 million deaths every year which is about 5.3 % of all the deaths. Alcohol abuse or alcoholism is often referred to as AUD by the general population. As per the NIAAA, Alcohol Use Disorder (AUD) is “a chronic relapsing brain disorder characterized by an impaired ability to stop or control use despite adverse social, occupational, or health hazards.” AUD affects a person’s overall behavior and thinking process. 

According to Delveinsight, the total prevalent population of Alcohol Use Disorder (AUD) in the 7MM (the United States, the UK, Spain, Germany, Italy, France, and Japan) was found to be 25,774,817 in 2017. According to the 2019 National Survey on Drug Use and Health (NSDUH), in the United States, 14.1 million adults ages 18 and older (i.e. 5.6 percent of this age group) had AUD which includes 8.9 million men (7.3 percent of men in this age group) and 5.2 million women (4.0 percent of women in this age group). Similarly, in the age group of 12 to 17 years, an estimated 414,000 adolescents had AUD.

Among the EU5 countries, Germany had the highest prevalent population of Alcohol Use Disorder (AUD) with 2,105,809 cases, followed by France, which had the prevalence of 1,749,920 cases in 2017. On the other hand, Spain had the lowest prevalent population of 274,084 cases.

What are the risk factors for Alcohol Use Disorder (AUD)?

The exact causes of AUD are unknown; however, some external and internal factors are supposed to increase the risk of AUD. Environmental and social factors such as economic status, religion, culture in society, and family status are the common factors that influence initial alcohol use. Similarly, at the individual level, factors including age, education, personality, genetics, preference (personal choice), gender, psychological behavior also contribute to alcohol consumption. 

What are the signs and symptoms of Alcohol Use Disorder (AUD)? And How is it diagnosed?

Depending upon the number of symptoms the person experiences, the AUD can be divided into three categories, namely mild AUD, moderate AUD, and severe AUD. AUD is identified on the basis of the American Psychological Association’s criteria, commonly called as Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The severity criteria for AUD is assessed upon factors such as –

  • Experiencing strong and uncontrollable cravings to drink.
  • Getting sick from drinking and it is causing trouble in occupation, at home, and at school or at other places.
  • Ended up drinking more or longer than intended.
  • Devoted a lot of time to drink and to get over its aftereffects.
  • Tried more than once to cut down or stopped drinking but couldn’t.
  • Continuous drinking, even it is affecting relationships with friends and family.
  • Lack of interest in activities that once were important and interested the person.
  • Experiencing withdrawal symptoms such as anxiety, depression, restlessness, nausea, sweating, sleeping, shakiness, or irritability when staying away from alcohol.
  • Getting into situations while or after drinking that have increased the chances of getting hurt.
  • Continuous drinking even though it makes him depressed or anxious.
  • Had to drink more than the usual number to get that desired effect in the body.

What are the major health complications that arise due to Alcohol Use Disorder?

Alcohol consumption leads to many chronic and acute health complications. As per the WHO, alcohol’s harmful use leads to more than 200 disease and injury conditions. Around 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). Some of the leading health complications that arise due to heavy drinking include liver disease, Immune system dysfunction, pancreatitis, ulcer, gastrointestinal disease, cardiovascular disease, damage to the brain, and many others. The change in physical characteristics such as judgment, memory, weakness, mood, numbness, and dehydration are also quite evident. 

What is the treatment option for Alcohol Use Disorder (AUD)?

Even for the person with mild symptoms, the AUD can be dangerous; thus, treatment plays an important role. The first thing for proper treatment involves recognizing the need for help to overcome the issue. Different people may respond differently to a treatment. Initially, it is quite difficult for the person to stop alcohol abruptly. However, without a doubt, early intervention can help to produce favorable outcomes. The treatment pattern follows a systematic program, starting with detox or other options depending upon the person. Long-term alcohol consumption leads the body to chemical dependency; the sudden discontinuation leads to many physical discomforts; it may even lead to death. 

Different treatment options are available for AUD, including medications, mutual-support groups, behavioral therapies, and many others. The US FDA has approved medication-assisted treatment for AUD, including acamprosate calcium, disulfiram, oral naltrexone, and extended-release injectable naltrexone. Off-label antidepressants are also prescribed in AUD.

However, it is common for the patients receiving treatment for Alcohol Use Disorder (AUD) to undergo or experience “withdrawal symptoms” when he doesn’t take alcohol for days or weeks. The Withdrawal symptoms impact the brain and cause intense anxiety, hallucinations, depression, and restlessness. The physical symptoms such as occasional seizures, nausea, problems in sleeping, vomiting, rapid heartbeat, agitation, sweating are also quite common. 

For this, Behavioral treatments that consist of group counseling sessions, motivational enhancement therapy, cognitive–behavioral therapy, and marital & family counseling may help.  Apart from the above-marketed therapies, some of the key companies such as Adial Pharmaceuticals, Opiant Pharmaceuticals, Neurelis, Tonix Pharmaceuticals, and Mapreg are diligently working towards developing new therapies for Alcohol Use Disorder (AUD)

Many emerging therapies are in different developmental and early phases of a clinical trial for AUD. In the coming years, the launch of emerging therapies and the rise in the number of healthcare spending across the world is expected to improve the quality of life for people with AUD and their families. Regular monitoring of patients’ alcohol consumption by family members and caregivers, raising awareness about alcohol use, providing professional help to mild AUDs patients, avoiding delay in treatment to patients with severe AUD can significantly improve the health of society.  Similarly, taking steps at a personal level such as a change in the lifestyle and habits, expressing concerns with family members and friends, seeking professional help at early stages, recognizing and avoiding the pressure to drink can reduce alcohol use.

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8 Of The Most Common Foods Allergies – Do You Have One?

As per the  Food Allergy Research & Education, in the US, each year, around 200,000 people require emergency medical care for allergic reactions to food. Food allergy is a specific immune response to certain food items that it considers harmful. 

Upon exposure to the food allergen, the IgE antibodies alert cells to release powerful substances, such as histamine, that in turn give rise to different symptoms in the body. The symptoms of food allergy vary from person to person and can also differ over time. They can occur anywhere in the body but most commonly affects the skin, cardiovascular system, the gastrointestinal and respiratory tract and sometimes lead to anaphylaxis, a life-threatening reaction that results in rash, low pulse, and shock. Developed within a few hours of consumption, the most common symptoms include nausea, vomiting, itching in the mouth, wheezing, cough, diarrhea, and abdominal pain, etc. 

Food allergy often affects the quality of life and can also lead to an adverse health effect. For people allergic to particular food items, even the intake of a minimal quantity of food can lead to severe reactions. Food allergy is usually diagnosed during childhood; however, the allergy can also appear in the later phase of life. While children generally outgrow allergies, it is difficult for adults to outgrow these allergic reactions.  

What are the most common food allergies?

As per the  FARE, in the USA, around 32 million people are living with potentially life-threatening food allergies. More than 170 food items are supposed to cause allergic reactions; however, eight major allergens account for about 90% of food allergy reactions, which includes- 

Egg Allergy

Egg allergies are the most common food allergy in children. As per the ACAAI, around 2 percent of children are allergic to eggs, and about 70 percent of children with an egg allergy will outgrow the condition by age 16. 

The most common symptoms of egg allergy include Vomiting, Stomach Cramps, Indigestion, Nasal Congestion, Coughing, and Wheezing. The age and the family history of the person are the primary risk factors for egg allergy.

Milk Allergy 

Occurring most commonly in infants and young children, the milk allergy is an abnormal response by the body’s immune system to the milk products. Young children require vitamins and minerals like calcium for the growth and development  The milk allergy can lead to mild to severe symptoms in the affected person. The typical sign of the milk allergy includes Hives, Coughing, Stomach upset, Itching, Vomiting, Bloody stools, and many others. In some cases, it can also cause Anaphylaxis.  Avoiding milk products is the best way to avoid allergic reactions. 

Peanut Allergy 

Over the past few decades, peanut allergy prevalence has increased steadily, mostly in Western countries. Peanuts allergy can lead to Vomiting, Stomach Cramps, Indigestion, Diarrhea, Wheezing, and many other symptoms. Age, past allergy to peanuts, and family members with allergies are a risk factor for the peanut allergy. 

In Jan 2020, US FDA had approved Palforzia {AR101 (Aimmune Therapeutics)}, for the treatment of peanut allergy. Palforzia is the first approved treatment for patients with peanut allergy. 

Tree Nuts Allergy

Tree Nuts consist of almonds, cashew, lychee nuts, pecans, walnut, pine nut, and many others. Peanuts are often confused with tree nuts. While peanuts are legumes (enclosed in pods), on the other hand, tree nuts are produced on trees. The allergy to tree nuts starts in childhood and can also remain lifelong. 

As per the American Academy of Allergy, Asthma & Immunology, tree nut allergy is one of the eight most common food allergies, affecting roughly 0.5 to 1% of the U.S. population. Similarly, around 25–40% of people with peanut allergies are also allergic to at least one tree nut. Family history and the allergy to one type of nut increases the risk for other nuts allergies. 

Fish Allergy 

Fish allergy is usually a lifelong allergy that mostly develops in adulthood. Around 40% of people experience a fish allergy as an adult. Fish allergy can cause symptoms such as Nausea, Stomach cramps, Indigestion, Vomiting, Diarrhea, Headaches, and many others. Avoiding fish and fish products such as fish gelatin, fish oil, and sticks are the best options to prevent fish allergy. 

Shellfish Allergy

Upon exposure to protein in certain marine animals, the body’s immune system develops allergic reactions. Shellfish allergies are caused by two groups of marine animals known as Crustaceans and Mollusk. The allergic reactions from Crustaceans are more common than Mollusk. 

The allergic reactions can create mild symptoms such as Itching, Hives, Eczema, and sometimes can also lead to a  potentially life-threatening condition such as Anaphylaxis. The shellfish allergy can occur at any age; however, it is most common in adults as compared to children.  

Wheat Allergy 

As the name suggests, wheat allergy is usually triggered by the consumption of wheat products such as bread, pasta, noodles, dumplings, and many others. Family history and age are the two major risk factors that increase the risk of developing a wheat allergy. Babies and toddlers are observed to develop wheat allergy more commonly as compared to adults. As per Cianferoni A. et al., children have a higher prevalence of wheat allergies compared to adults and are more likely to develop an allergy if wheat is introduced after 6 months of life. As per the ACAAI, “wheat allergy is typically outgrown by adulthood, around 65 per cent of children with a wheat allergy will outgrow it by the time they are 12”.

Soy Allergy

Soy allergy is common in infants and young children. Usually, with age, most children outgrow the soy allergy; however, in some people, it remains lifelong. Like other food allergies, soy allergy can cause Itching, Hives, Eczema, Dizziness, Fainting, and many other reactions in the body. Family history, existing allergy to other food, and age are the risk factors for soy allergy. Avoiding soy and soy products is the first step to prevent soy allergy. 

Food allergy is a serious public health concern, especially for children. Apart from the quality of life, it also creates an imbalance in the nutritional diet balance of the person. What symptoms or reaction, a food allergy can cause is quite uncertain, which creates a psychological burden on the affected person. The risk of accidental exposure further restricts certain dietary activities and the social life of the person.

There is no cure for food allergies. However, medications such as Antihistamines and Adrenaline are used to relieve the symptoms of an allergic reaction. Antihistamines are recommended for mild to moderate allergic reactions while the adrenaline for severe allergic reactions. For peanut allergies, the FDA has approved the first treatment for children and teenagers between the ages of 4 and 17 years. Avoidance is the best way to protect oneself from an allergic reaction. The allergy passes from parent to children, for such cases, parents should routinely monitor the children’s health for any possible reactions. Reading labels, taking care while cooking or dining out, and carrying medications can reduce the chances of major allergic reactions. Today, many therapies are in research phases for different allergens. In the coming years, the launch of the expected therapies and the R&D in the cellular immune responses are expected to improve the quality of life of allergic patients and their caregivers.

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A Globally Rising Burden of Sexually Transmitted Diseases (STDs)

Caused by bacteria, viruses, and parasites, Sexually transmitted diseases (STDs) are a global health burden and it seems they are likely to maintain their status of being so in coming years also, primarily due to the lack of knowledge, and awareness. Further, diagnostics and screening, poverty, the stigma associated with the STDs, younger patient pool, illicit drug & alcohol use and negligence are some of the other key factors attributing to the increasing burden of STDs. 

STDs often called sexually transmitted infections (STIs) or venereal diseases are infections transmitted from an infected person to an uninfected person through sexual contact. The STDs include a number of diseases such as gonorrhoea, genital herpes, human papillomavirus infection, HIV/AIDS, chlamydia, syphilis and many others. Some of the diseases such as Zika and Ebola, can also spread through ways other than sex. 

According to WHO, more than 1 million STIs are acquired every day. As per estimates presented in 2016, 376 million new infections with 1 of 4 STIs: chlamydia (127 million), gonorrhoea (87 million), syphilis (6.3 million) and trichomoniasis (156 million) were reported. Moreover, more than 500 million people are living with genital HSV (herpes) infection and an estimated 300 million women have an HPV infection; and an estimated 240 million people are living with chronic hepatitis B worldwide. Although STDs are a global problem, they have quite a high prevalence in the low- and middle-income countries

However, despite several awareness programmes and campaigns by health organisations, government and NGOs, the prevalence of these diseases are on a continuous rise. 

Why is STD Prevention Important?

The STDs cause severe social, financial, psychological and health burdens on the affected person and their families. If remains untreated the STDs may cause many health complications and even death. Some of the major health problems that may arise due to STDs include infertility, chronic abdominal pain, pelvic inflammatory disease, pregnancy complications, cervical cancer, birth defects and others. The chances for transmission increase many folds if it remains untreated. It can affect communities, can create a burden on the healthcare sector and the economic growth of the country. 

Can STDs be cured?

Based on the treatment pattern, the STDs are classified into two categories: curable and incurable STDs. The medications can cure some of the STDs caused by bacteria, yeast, or parasites. The STDs such as syphilis, gonorrhoea, chlamydia and trichomoniasis are curable. However, these diseases have a very high prevalence and incidence worldwide. The human immunodeficiency virus (HIV), which leads to AIDS is one of the most dangerous incurable (viral) STD. While human papillomavirus (HPV), hepatitis, cytomegalovirus, genital herpes, are some other STDs that cannot be cured. The virus-based STD are likely to remain for life-long and treatment can only reduce the symptoms. 

Globally Burden of Sexually Transmitted Diseases (STDs)

What are some of the most common STDs?

Based on the number of cases, severity and death, some of the most common STDs are: 

  • Human Papillomavirus (HPV)

Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI). As per the WHO, more than 100 types of HPV are found worldwide, out of them at least 13 known HPV genotypes can cause cancer of the cervix. Similarly, as per the CDC, in the united states, about 79 million people are currently infected with HPV and each year around 14 million new cases are registered in the country.  

There is no permanent cure/treatment for the Human Papillomavirus (HPV). However, the affected individuals with cutaneous warts have various treatment options available including surgical removal, cryotherapy (freezing the infected tissue), irritant or immunomodulating medications, and laser removal. Today, at the global level, some of the key players such as Inovio Pharmaceuticals, ISA Pharmaceuticals, Vaccibody A/S, and others involved in the development for effective therapies to treat patients with Human Papillomavirus (HPV)

  • Human Immunodeficiency Virus (HIV)

The human immunodeficiency virus (HIV) targets cells of the immune system, called CD4 cells, that help the body to fight infection. If remains untreated it can lead to AIDS (acquired immunodeficiency syndrome). The latest figure by WHO cited that till now almost 33 million people have lost their lives due to HIV and at the end of 2019 an estimated 38.0 million people are living with HIV. HIV has a worldwide prevalence, however, the African region is one of the world’s most affected regions with over two-thirds (i.e 25.7 million) cases.

In order to raise awareness about the disease and the health challenge that it causes, worldwide every year the month of December is observed as HIV/AIDS awareness month. As of now, there is no cure for HIV infection, however, it can be controlled by using the combination of drugs called antiretroviral therapy (ART). ART suppresses viral replication and helps the immune system to gain strength and capacity to fight off infections. 

A number of antiretroviral drugs are available in the market today, that can be combined in different ways. Apart from the available therapies, the companies such as Merck, United Biopharma, ViiV Healthcare, Johnson & Johnson are diligently involved in the development of safe and effective therapies for HIV.

  • Chlamydia 

Chlamydia is the most common bacterial STI caused by the bacteria called chlamydia trachomatis. As per the CDC, Chlamydia is one of the most commonly reported STDs in the United States. In 2018, around 1,758,668 cases of chlamydia were reported to CDC from 50 states and the District of Columbia,3 but an estimated 2.86 million infections occur annually. Chlamydia is a ‘silent’ infection and most of the cases usually remain unreported as the disease is an asymptomatic and physical examination of the disease is difficult.

If the Chlamydia remains untreated it can cause long-term health problems and also have the possibility to spread to other body parts. The Chlamydia can be cured with antibiotics. However many companies at the global level are experimenting with their therapies at different stages of clinical development. Some of the key companies including Evofem Biosciences, QureTechBio, Vault Pharma, Genetic Immunity, and others are involved in developing treatments for Chlamydia.

  • Trichomoniasis 

The Trichomoniasis is caused by infection with a protozoan parasite called Trichomonas vaginalis. It is a curable STD; however, it has a very high prevalence. As per the CDC, in the United States, an estimated 3.7 million people have the infection. However, only about 30% of the infected person develop any symptoms of trichomoniasis. Women have a higher prevalence compared to men, similarly, the older women are at greater risk than younger women. 

Trichomoniasis is curable with antibiotic medication. However, the chances for recurrence can’t be neglected. Nearly 1 out of 5 people get infected again within 3 months after treatment. To provide a better treatment option for Trichomoniasis, key companies such as Lupin are involved in the development of therapies for Trichomoniasis.

  • Syphilis (Chancroid)

Syphilis is a bacterial infection caused by the spirochete, Treponema pallidum (T. pallidum). The progress of the Syphilis is divided into 4 stages. The severity of the disease gets higher with each successive stage. At the advanced stage (i.e tertiary syphilis), the brain, nerves, heart, and bones may get damaged, if the infection is left untreated. Similarly, if the pregnant woman has syphilis, the unborn baby can also get infected with it. With the right antibiotics, the Syphilis can be easily cured.

  • Genital Herpes

The genital herpes is a sexually transmitted disease (STD), caused by two types of viruses called herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). It mainly causes genital ulcers and blisters. As per the WHO, around 3.7 billion people under age 50 (67%) have HSV-1 infection globally and while around 491 million people aged 15-49 (13%) worldwide have HSV-2 infection. It is common in America also, CDS has reported that more than one out of every six people aged 14 to 49 years have genital herpes.

According to DelveInsight, the total prevalent population of Genital Herpes in 7 major markets was 82,662,204 in 2017 and is expected to grow for the study period [2017–2030]. Similarly, it is found that Genital Herpes is more prevalent among females as compared to males. There is no cure for Genital Herpes however there are certain medications that can reduce the severity and frequency of symptoms. Presently many pipeline therapies are under development for the Genital Herpes. Some of the key companies in the Genital Herpes market such as Squarex Pharma, AiCuris, United BioPharma, and others are involved in the therapeutic development for Genital Herpes

What are the challenges in sexually transmitted diseases management?

Sexually Transmitted Diseases are a public health concern for the government and health bodies around the world. Its diagnosis, prevention, treatment and vaccination possess a huge challenge to the health authorities. Many of the factors such as poverty, educational, unmarried status, hinders the effective management of these diseases. 

In addition to this, for an affected person the STDs bring many challenges at the individual level. The person often faces negative societal attitudes, inequalities, misconceptions and STD-related shames which are key barriers to the diagnosis and treatment of STDs. Sometimes the perception and exclusion at the workplace make the life of the affected person vulnerable.

However, several initiatives have been taken over the past 3-4 decades by the WHO and the local governments to eliminate STDs. The counselling sessions, community outreach campaigns, education programmes, awareness weeks, contact tracing, have improved the outcome for STDs such as HIV.  Apart from these, some other provisions including systematics data collection, monitoring STDs trends using reliable surveillance, identification of high-risk populations, STD testing, providing rapid and effective treatment to break infection chain, vaccination programmes have improved the situation in countries worldwide. Similarly, emerging technologies such as the point-of-care diagnostic tests for STDs, the introduction of STDs vaccines and other biomedical interventions are expected to mitigate the rising burden of Sexually Transmitted Diseases in the coming years.

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Will Wearable Devices be Streamlined in Healthcare?

Wearable Devices, or “wearables“, include a wide range of electronic devices or accessories, that are worn or embedded on the body. These microprocessors powered devices are capable of collecting and analysing real-time body data that can be traced on smartphone applications and can easily be transferred to the concerned healthcare provider for continuous monitoring. 

The wearable technologies are rapidly making their way in our day to day life and tracking vital body measurements from physical activities to sleep, blood pressure measurements to blood oxygen level and so many. These devices are capable of monitoring nearly every day to day activities that the user performs and in turn, helps in maintaining health, wellness and fitness. 

What areas of health care might benefit from wearable technology?

The wearable devices available in the market analyse a wide range of body data such as heart and respiratory rate, blood pressure, temperature, and sleep activity over a long period of time. The collected data can be helpful for healthcare professionals in the diagnosis and treatment of disease. Similarly, the patients affected with chronic disease such as diabetes, and blood pressure can rely on these devices for the better management and monitoring of their cardiovascular functioning.

What are some great wearable tech devices?

According to the need and function, these devices come in many different shapes and sizes. Some of the most common wearable devices include – 

Smart Health Watches

The smartwatches are one of the fast-growing wearable devices in the healthcare space. The smartwatches provide vital health stats such as step count, heart rate, calories burned, fall detection, sleep tracking, blood pressure, blood oxygen monitoring, emergency SOS and many more. These watches are convenient, fashionable, waterproof and help in achieving fitness goals faster by tracking daily activities. These smartwatches can perform some smart functions also that a smartphone can do. However, limited battery life, BlueTooth range, small screen size, tendency to break and data quality are the critical challenges in smartwatch usage. The smart health watches segment offers a huge opportunity to the tech companies. Worldwide some of the renowned companies such as Apple, Samsung, Sony Corporation, Fitbit, Huawei Technologies Co., Fossil, Garmin, and many others are involved in the development of smart health watches. 

Smart Band (Wristbands)

Like smartwatches, the Smart Band is also worn around the wrist. The Smart Band is quite popular among the younger generation. It provides real-time vital stats related to physical activity, heart rate, calorie consumption, sleep duration, and many others to the user. These Smart Band can easily sync with smartphone apps, and the user can measure its day to day progress. Battery run-time and accuracy are the two key issues with Smart Band; however, in the coming years, these issues are likely to get resolved to a much larger extent. At the global level, many companies are competing in the Smart Band segment. Among them, the key notable players in the SmartBand market include Fitbit Inc., Xiaomi, Samsung, Fitbit, Redmi, Garmin, Samsung, Nike, and many others. 

Smart Clothes

The smart technologies today are not just limited to the fitness band or watches. With the tech innovation, it is making its way in the lifestyle segment also. Smart Clothes are one of the examples of how technology is shaping our manner of living. Smart Clothes are also referred to as electronic textiles or high tech clothing. These clothing are embedded with sensors and hardware that provides additional features to the clothes. Connected with wi-fi or Bluetooth, the cloths collects information about the wearer while maintaining fashion and comfort. The Smart Clothes measures pressure, heart rate, to improve muscle recovery, breathing and movement rate, heat absorption, and many others. Some of the companies in the apparel and tech industry such as AiQ Smart Clothing, Sensoria Inc., Athos, Vulpes Electronics, Cityzen Sciences, Tommy Hilfiger, OmSignal, BioMan, Ralph Lauren, Under Armour, Levi’s, Samsung, are experimenting with Smart Clothes. 

Smart Jewelry

The most basic function of Jewelry is to enhance beauty, appearance and to draw attention, however, in line with other wearables, the Jewelry is also contributing to the health and wellness of the user while maintaining its form and function. Smart Jewelry includes a wide range of rings, bangles, locket, necklaces, earrings and bracelet, that can easily be synchronised with a smartphone. Smart Jewelry has unique features and capabilities that help them in tracking daily activity, including sleep, stress and many others. The Jewelry has an advantage over other wearable devices as these are lightweight, stylish, versatile, compact and easy to carry. The key companies in the Smart Jewelry segment include Oura, Ringly, Totwoo Fashion Technology, McLear Ltd., Bellabeat and others.

Wearable Biosensor / Healthpatch

Healthpatchs is also a type of wearable biosensor that can be easily placed on body parts for data collection. Healthpatch is lightweight, wireless, disposable and has adhesive properties which make them easy to use. These small packages can collect data in a continuous and non-intrusive manner. Depending upon types and size, the Healthpatch is capable of measuring and collecting biometric measurements such as skin temperature, stress, respiratory rate, sleep duration, step count, sleep actigraphy/sub-posture, sleep quality, single-lead electrocardiogram (ECG), posture and many others. Healthpatches is quite helpful for chronic diseases as they collect and transmit real-time, uninterrupted data (or vital stats) to healthcare professionals. 

VitalConnect is the leading player in the Healthpatch Biosensor market. The VitalConnect has received FDA clearance for its HealthPatch MD biosensor for monitoring patients in their home. Gentag, MC10, LifeSignals, and Philips, are some of the other leading players in the Health Patch market. 

Smart Glasses, SmartSleep Wearable, Wearable ECG Monitors, Wearable Blood Pressure Monitors and Smart Hearing Aids are some of the other Wearables gaining attention among consumers.  

What are Pros and Cons of Wearable Health Technology?

The Wearable devices are getting fit into our everyday life as these devices are lightweight, convenient to use & carry, and are available at affordable prices. The devices increase the health & fitness awareness among the user, motivates them to stay fit, helps in achieving fitness goals and have the potential to reduce hospital readmission (doctor appointments). Some devices, like smartwatches and fitness trackers that provide alerts and reminders regarding the crucial meetings, gym, or fitness classes, are quite helpful in increasing productivity and efficiency. The data sharing with family members, friends, physicians or with online communities of people who have similar fitness goals is quite convenient. The data collected such as the intensity of the workout, calorie loss, duration, the pace can be analysed with the help of smart application in the form of graphs and charts. 

However, there are some disadvantages associated with these devices as well. Since wearable collects user data continuously, there is always a threat to data security and privacy. Most of the wearables are comparably new and have issues related to the low battery life, design, UX problems, sync with smartphones and many others. Similarly, the accuracy of collected data and error margin are other disadvantages associated with these devices.

What is the future of wearable technology in healthcare?

Over the past few years, wearable technology has got a very positive response from consumers. In the coming years also with the advancement in technology, many new wearables are expected to launch in the market which will provide momentum to the adoption of products. Companies are exploring the potential for wearable in different apparel segments such as smart vests, smart shoes, smart socks, smart tights and many others. Similarly, the increasing prevalence of chronic diseases such as diabetes, blood sugar, hypertension, cardiovascular diseases and blood pressure will also generate demand for these devices. The improvement in the microprocessors, operating systems (OS), user interfaces (UI) and the introduction of artificial intelligence (AI), the Internet of Things (IoT), and big data will assist to provide faster solutions that will further drive the demand for wearable devices. 

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Bioterrorism: A Threat To The Healthcare And Global Peace

The spread of Covide-19 pandemic has brought significant attention from the government and healthcare bodies around the world towards the threat of biological agents (bacteria, viruses or toxins). Over the course of one year, Covid-19 has created serious health challenges and economic destruction around the world. Motivated by the havoc caused by Covid-19, terrorists in the future might deliberately-induced the disease outbreaks in the countries and regions opposing their ideology. From the present experience with the Covid-19 management, we can say protecting its citizens, and the economy against biological aggression can be a difficult task for the governments. These biological pathogens are relatively low cost, can easily replicate and are transported as these are difficult to detect.

The development in science and technology has significantly improved the quality of life but at the same time, the misuse has led to the development of mass destruction agents such as viruses and bacteria. The deliberate use of viruses and bacteria to harm people or communities is called Bioterrorism. while the intentional use of biological agents in the war scenarios is commonly referred to as Biowarfare. 

As per the CDC, “bioterrorism or biological attack, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops”. These viruses, bacteria, or other germs are often found in nature. However, with the intention to cause severe life-threatening impact their ability is intentionally increased to resist medical treatment. Sometimes these microbes are hard to detect and in some cases, they don’t show any sign, symptoms or any form of illness for days and weeks, which is the most worrisome factor. Among all the biological agents,  Bacillus anthracis, the bacteria that causes anthrax, is one of the most likely agents to be used in a biological attack, owing to the properties such as long shelf life and easy production process. 

What is the purpose of bioterrorism? And how is it achieved?

The main goal of bioterrorism is to create social, political and economical unrest in the country or region through the mortality, morbidity and panic in the public. Within the country, a dissenting group or rival, based on their religious, political and ideological differences may use bioterrorism to intimidate established governments. Another less suited purpose for bioterrorism can be to gain media attention and spread fear in the society. Gaining monetary benefit through extortion, taking revenge or targeting the high profile celebrity or leaders can also be a reason for the use of bioterrorism at the individual level. 

Sing and symptoms caused by exposure to biological material may vary significantly. However, some of the most common signs and symptoms include sore throat, fever, diarrhoea, blurred vision, coughing, exhaustion, confusion, muscle pain and weakness, nausea, abdominal pain, vomiting, encephalitis/meningitis and many others. 

Biological agents can easily spread through the air, water, or food. There are various possible ways such as contaminating the city’s water supply, agricultural crops, kitchen accessories, cash, coins, credit cards and many others. Today, due to globalization the risk of bioterrorism is much higher. Due to global connectivity, transmission from person to person can easily spread it from one part of the world to another.

When Bioterrorism has been used?

The use of microorganisms as war-weapons has been in practice since prehistoric times. Among all the past events, the American civil war and the world wars had observed its devastating effects. After that, it is mainly employed at a very small level due to the rising consensus and efforts put forward by the health bodies and the Biological Weapons Convention at the global level. The most recent use was in 2001 in the United States when anthrax was delivered by mail to several U.S. news agencies and government offices. Around 19 people were delivered anthrax infected mail, that resulted in 5 deaths in the country. 

What are the 3 bioterrorism threat levels? 

According to the transmissibility, severity of illness & mortality and response requirements, the Centres for Disease Control and Prevention (CDC) has categorized bioterrorism threat agents in three Categories, namely A, B and C. 

Category A –  The Category A includes high priority agents (organisms) that pose a severe risk to national and public security of the country. The organisms in Category A are easily disseminated and can cause high mortality and public panic and social disruption. Bacillus anthracis (anthrax) is one of the most likely agents to be used in case of bioterrorism as the spores of Anthrax are easily found in nature and can be prepared in the lab. Along with it can also remain in the environment for a long time. Apart from anthrax, some other agents that can be used as a potential medium to spread bioterrorism include Variola major (smallpox), Francisella tularensis (tularemia), Yersinia pestis (plague), Filoviruses and many others. 

Category B – The Category B agents are moderately easy to disseminate in the environment and can cause moderate morbidity. It includes agents such as Alphaviruses, Brucella species (brucellosis), Coxiella burnetii (Q fever) and many others. 

Category C – This category includes the third-highest priority agents. These infectious agents could be a potential threat in future and can be engineered for mass spread. Hantaviruses, Tickborne, Yellow fever, Nipah virus are some of the agents of this category. 

Medical Care and preparedness required to handle bioterrorism

Worldwide, the expert has different views on the possibility of bioterrorism. Some consider it a more real threat as compared to the nuclear threat. While some see the rare possibility of its occurrence, assuming that If there is a chance it would be at a smaller scale owing to the challenges in the development, production, maintenance and transmission of biological weapons. Despite various opinions, government and health bodies worldwide take bioterrorism seriously and consider it a real threat to society. To handle any public health emergency, the government regularly conducts monitoring, surveillance and risk assessment for the possible attack. The risk assessment task includes focusing on various aspects such as diagnostic and therapeutic capabilities, education and training to front line healthcare providers, rapid surveillance system between hospitals, emergency rooms, laboratories and many others. 

Owing to the huge political and economical destruction that the fear of bioterrorism can cause, countries today have come together to prohibit the development of mass destruction weapons including the biological warfares. Biological Weapons Convention (BWC), the first multilateral disarmament treaty prohibits the development, production and stockpiling of bacteriological (biological) and toxin weapons. BWC at the global level reduces the chance of biowarfare between countries. However, owing to the political and ideological differences between radical and fringe groups in society, the threat of bioterrorism is likely going to remain in the future also.

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