The thyroid gland is located in front of the neck. It is a butterfly-shaped gland. It has two lobes on either side of the windpipe. It serves a number of important functions in the body. The thyroid hormone secreted by the thyroid gland circulates all over the body. In childhood, it is responsible for the proper growth and development of the brain. Children born with hypothyroidism, if they are not diagnosed early, become mentally retarded. It also affects their growth. Thyroid diseases affect every organ in your body.
Common thyroid disorders are hypothyroidism, hyperthyroidism and swellings of the thyroid glands which are called goitre. Thyroid disorders are more common in women than men.
The test being done.
Hypothyroidism is the under-functioning of the thyroid gland. Thyroid hormone levels will get reduced in the individual. Hypothyroidism may sometimes be very silent, may not have many symptoms. But it can present with a variety of symptoms including weight gain, lethargy, tiredness, loss of memory, depression, and loss of hair from the head. It can also cause constipation and dryness of the skin. Hypothyroidism troubles women with menstrual irregularities. While some women experience heavy periods, some miss their periods due to this.
Because symptoms of this condition are so varied and common, it is often very difficult to tease out whether it is due to hypothyroidism or not. Many people may say that they experience hair fall, tiredness, depression and constipation at times. About a third of the women population may say that they have some kind of menstrual irregularities. So we can’t attribute all these symptoms to hypothyroidism always. Sometimes hypothyroidism may be picked up only on routine testing. Symptoms may not be obvious if the condition is building up slowly. Hypothyroidism is very common in the elderly.
From a physician’s point of view, symptoms of hypothyroidism are very common in public at large. So, one needs to use some discretion when ordering thyroid function tests. From the patient’s perspective, patients also need to understand that not every person who gains weight or every woman who has menstrual irregularities are hypothyroid. Having said that, if there is suspicion, then the tests should be done. TSH and Free T4 tests will help in diagnosing hypothyroidism. Usually, in hypothyroidism, the free T4 will be low and TSH will be raised.
Hyperthyroidism is an overactivity of the thyroid gland. In this condition, thyroid hormones are higher than they should be in circulation—as a result of which you get all the opposite symptoms that you get with hypothyroidism. When hypothyroidism causes constipation, in hyperthyroidism one gets diarrhoea or increased frequency of bowel movements. When hypothyroidism makes you lethargic and dull, with hyperthyroidism you get hyper excited and can have shaky hands, restlessness and sweating. A person with hyperthyroidism may become easily irritable, agitated and can have difficulty sleeping. Hyperthyroidism may also cause palpitation—(rapid beating of the heart) and increased appetite. Here, one would observe that despite eating a lot, the weight is coming down. Hair loss and menstrual irregularities are common in both hyper and hypothyroidism.
Hyperthyroidism is relatively easier to diagnose as the patient would present with the feeling of being unwell along with concrete symptoms of hyperthyroidism including weight loss. From the patient’s point of view, anybody who is losing weight rapidly, feeling very shaky, irritable, feeling hot all the time, fatigued should go for a thyroid function test to see whether their symptoms are due to hyperthyroidism. Generally, hypothyroidism is more common than hyperthyroidism.
Enlargement of the thyroid gland is called goitre. When the gland may swell up as a whole, it is called a diffused goitre. Sometimes there may be nodules in the thyroid gland called nodular goitre. The thyroid gland is right in front of the neck; each time you look at the mirror you can easily pick up the swelling of the neck. Generally, people get alarmed when they see swelling in the neck and they present fairly early thinking that it is cancer. One thing we need to keep in mind is that nodules in the thyroid gland are very common. But thyroid cancer is a very rare disease. As clinicians, our challenge is to diagnose a small number of thyroid cancers among the vast number of thyroid nodules. In fact, in a study conducted at Amrita hospital, we found as much as 11 % of the population affected with thyroid nodules are women.
When a patient presents with swelling of the thyroid gland, an ultrasound scan is done to find out the nature of the swelling. Based on the ultrasonography report, if it seems problematic, a fine needle aspiration will tell us the likelihood of that being thyroid cancer or not. If it is completely normal, as it is in majority of cases, then there is no need to rush into surgery. When you have thyroid nodules, there is no need to panic. But it must get suitably evaluated. The vast majority of thyroid nodules is benign and can be followed up over a period of time without the immediate requirement of surgery.
The writer is Clinical Professor and Head, Centre for Endocrinology and Diabetes, Amrita Hospital, Kochi.
The Daily Guardian is now on Telegram. Click here to join our channel (@thedailyguardian) and stay updated with the latest headlines.
For the latest news Download The Daily Guardian App.
RESEARCHERS USE AI TO ANALYSE LARGE AMOUNTS OF BIOLOGICAL DATA
University of Missouri researchers have applied a form of artificial intelligence (AI), previously used to analyze how National Basketball Association (NBA) players move their bodies, to now help scientists develop new drug therapies for medical treatments targeting cancers and other diseases.
The findings of the study were published in the journal Nature Communications. The type of AI, called a graph neural network, can help scientists with speeding up the time it takes to sift through large amounts of data generated by studying protein dynamics. This approach can provide new ways to identify target sites on proteins for drugs to work effectively, said Dong Xu, a Curators’ Distinguished Professor in the Department of Electrical Engineering and Computer Science at the MU College of Engineering and one of the study’s authors.
“Previously, drug designers may have known about a couple places on a protein’s structure to target with their therapies,” said Xu, who is also the Paul K. and Dianne Shumaker Professor in bioinformatics. “A novel outcome of this method is that we identified a pathway between different areas of the protein structure, which could potentially allow scientists who are designing drugs to see additional possible target sites for delivering their targeted therapies. This can increase the chances that the therapy may be successful.”
Xu said they can also simulate how proteins can change in relation to different conditions, such as the development of cancer, and then use that information to infer their relationships with other bodily functions.
“With machine learning we can really study what are the important interactions within different areas of the protein structure,” Xu said. “Our method provides a systematic review of the data involved when studying proteins, as well as a protein’s energy state, which could help when identifying any possible mutation’s effect. This is important because protein mutations can enhance the possibility of cancers and other diseases developing in the body.”
RESEARCHERS FIND NEW APPROACH FOR TREATMENT OF DEVASTATING BRAIN TUMOURS
The findings from a seven-year research project suggests that there could be a new approach to treating one of the most common and devastating forms of brain cancer in adults, Glioblastoma Multiforme (GBM).
In a peer-reviewed study published by BMC Cancer, scientists from the University of Surrey show that a short chain of amino acids (the HTL-001 peptide) is effective at targeting and inhibiting the function of a family of genes responsible for the growth of GBM – Hox genes. The study was conducted in cell and animal models. The HTL-001 peptide used in the study has undergone safety testing and is suitable for patient trials. These trials are now being considered in GBM and other cancers.
Hardev Pandha, project lead and Professor of Medical Oncology at the University of Surrey, said:
“People who suffer from Glioblastoma Multiforme have a five per cent survival rate over a five-year period – a figure that has not improved in decades. While we are still early in the process, our seven-year project offers a glimmer of hope for finding a solution to Hox gene dysregulation, which is associated with the growth of GBM and other cancers, and which has proven to be elusive as a target for so many years.”
Ironically, Hox genes are responsible for the healthy growth of brain tissue but are ordinarily silenced at birth after vigorous activity in the growing embryo. However, if they are inappropriately ‘switched on’ again, their activity can lead to the progression of cancer. Hox gene dysregulation has long been recognised in GBM.
The project was carried out in collaboration with the universities of Surrey, Leeds and Texas, and HOX Therapeutics, a University of Surrey start-up company based on the University’s Surrey Research Park.
Professor Susan Short, co-author of the study from the University of Leeds, said, “We desperately need new treatment avenues for these aggressive brain tumours. Targeting developmental genes like the HOX genes that are abnormally switched on in the tumour cells could be a novel and effective way to stop glioblastomas growing and becoming life-threatening.”
James Culverwell, CEO of HOX Therapeutics, said, “HOX Therapeutics is excited to be associated with this project and we hope that with our continuing support, this research will eventually lead to novel and effective treatments for both brain and other cancers where HOX gene over-expression is a clear therapeutic target.”
IT’S TIME TO SECURE THE RIGHTS OF MENTAL HEALTH PATIENTS
A recent news report revealed the dire conditions of a Government Mental Health Centre in Peroorkada, a suburb of Thiruvananthapuram, the capital of Kerala. The living conditions of institutionalized patients were worse than in a prison cell. The authorities kept patients confined in tiny, overcrowded cells with poor ventilation and extreme heat, aggravating their existing conditions with dehydration, decreased sleep, and poor drug compliance, among other issues. The description of the mental health centre, with cells covered with grills and iron bars securing windows and doors, is reminiscent of the conditions of the faith-based mental asylum in Ramanathapuram, Tamil Nadu, where a fire in 2001 led to the death of 28 inmates. Overcrowding and confinement are not only disasters waiting to happen but also act as significant impediments to the recovery of persons with mental illnesses. A study on public attitudes to mental health hospitals in 2016-17 in Odisha concluded that the credibility of such institutes has a vital bearing on the negative attitudes that they invoke amongst the populations they serve.
India’s journey towards attaining accessible and safe mental healthcare has been slow and rife with challenges. Following the global trend to shift away from institutional care to community-based treatment, India has enacted laws to ensure better treatment for persons with mental illnesses. However, the battle is ongoing and appears to be a long fight ahead.
According to a recent survey by NIMHANS in 2015-2016, 14% of India’s population lives with some form of mental illness, out of which 1.9% suffer from severe mental illness. The survey also noted a stark treatment gap of 72–92%. Mental health reports released by the National Human Rights Commission in 1999 and 2012 mentioned other infrastructural gaps. The survey also cited severe staff shortages, violations of patients’ rights, involuntary admissions and limited treatments. ActionAid Association’s study on mental illness in Kashmir in 2016 also uncovered severe treatment gaps in a valley widespread with mental illness and extremely high suicidality. Out of the 4000 persons interviewed, only 12.6% could access treatment.
More recently, during the Covid-19 pandemic, mental health needs and gaps were exacerbated. For example, a study of severely mentally ill patients during lockdown found that 80% of patients missed their appointments and failed to contact their mental health professionals, 30% showed features of relapse of symptoms during the lockdown, and 22% stopped their psychiatric medication.
These alarming numbers point to the need for advocacy and evidence-based policy recommendations. ActionAid Association was a member of the National Human Rights Commission Core Group on Health and Mental Health until 2017 and has conducted several research projects and initiatives in mental hospitals in Kashmir, Gwalior, Bhopal, Agra and Ranchi. Learning from these initiatives, ActionAid Association has recommended policy and structural changes to promote mental health.
The Mental Healthcare Act (MHCA) 2017 differs from preceding acts. It treats persons with mental illness equally, protects them from cruel and degrading treatment and makes provisions for community-based treatment. In addition, the law guarantees confidentiality, access to medical records, and legal aid. It also creates barriers against arbitrary institutional care, a practice used by family members against women to resolve disputes.
The Act mandates the creation of regulatory bodies such as State Mental Health Authorities and District Mental Health Review Boards tasked with registering, reviewing, altering, modifying or cancelling advance directives made by individuals.
However, MHCA 2017 does not institute any third-party assessment or monitoring of the human rights situations in mental healthcare facilities. The appointment of an independent human rights monitor would be a transparent mechanism for safeguarding human rights. The Act also misses significant measures for reintegration and rehabilitation of patients with their families. According to a study, one in every four women in mental health centres is abandoned by their families. There is a strong need for a feminist approach to destigmatize mental illness and rehabilitate and reintegrate patients back into mainstream society.
Implementation of the Act has been sluggish. As of 2021, Maharashtra only has eight District Mental Health Review Boards to cater to 36 districts, and Uttar Pradesh has one in Kanpur. In Delhi, the State Mental Health Authority acts as an interim Mental Health Review Board, which leads to the erosion of accountability and the dissolution of responsibilities.
As the MHCA 2017 is on the concurrent list, States are meant to frame rules for the implementation of the Act and set standards concerning mental healthcare facilities. These standards ensure no overcrowding, cruelty or poor sanitation of patients and facilities. However, until October 2021, only eight states and UTs had sent draft rules to the Ministry of Health and Family Welfare for approval.
There also exist lacunae in the budgetary allocations. The preceding four Union Budgets had allocated less than one per cent of the total budget to mental health. In the Union Budget for 2022-2023, an increased allocation amounting to 2.18% of the total budget has been made. However, the lion’s share (94%) of the allocation is towards two centrally run mental health institutes; NIMHANS Bengaluru and Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur. There is a measly 6% of the allocation (Rupees 40 Crores) left for the National Mental Health Program, which ensures the availability and accessibility of minimum mental healthcare to all.
For a more comprehensive approach to promoting mental health, we require measures to make family systems more conducive to rehabilitation. Localized mental health centres can facilitate psychoeducation and case management for at-risk families. We need to activate community leaders to destigmatize mental illness and provide financial incentives to community-based structures to enable the rehabilitation of persons with mental illnesses. The use of halfway homes must be increased to reintegrate persons who have recently recovered from mental illnesses.
The swift and effective implementation of the law, independent monitoring of human rights violations, more robust community-based interventions and increased financial allocations are imperative in ensuring that Peroorkada is not the image that comes to mind when one thinks of mental health hospitals. Such an approach will go a long way in preventing another Erwadi-like tragedy and in ensuring the rights and dignity of persons with mental illnesses.
Iyce Malhotra works with the Policy and Research Unit of ActionAid Association. The views expressed here are personal and do not necessarily reflect those of her organisation.
ABHA WILL ENHANCE DIGITAL HEALTHCARE SYSTEM IN THE COUNTRY
The health insurance sector in India is expecting a growth at a rate of 10.1% in the years between 2021 and 2027. Distribution and affordability are two keywords to get a large number of people insured, said experts.
Introducing the challenges and the need for new policies in health insurance in India, a conference on ‘Health Insurance 2042- Let us Plan for Ambitious Target for 2042’ was organised in Vigyan Bhawan, New Delhi. The conference organised by the PHD Chamber of Commerce and Industry (PHDCCI) highlighted the need to boost the digital healthcare system in the country.
Speaking about the Ayushman Bharat Digital Mission (ABDM), Dr. Malti Jaswal, a Senior Consultant, World Bank and Advisor with the National Health Authority, said, “ABDM plans to create a healthcare infrastructure that will bridge the existing gap amongst different stakeholders in the healthcare ecosystem through digital highways.” A health id for all Indian citizens-ABHA (Ayushman Bharat Health Account) will help maintain personal health records digitally and easily accessible.
The Ayushman Bharat scheme has also been able to cover the bottom 50% and several voluntary schemes cover almost 20%. The government must focus on the remaining 30%. Pradeep Multani, President, PHDCCI, said, “The health insurance sector has undergone a lot of change in the last two years of the pandemic, with people realising its importance.” He also focussed on the need for customising products as per the customers.
Also, while discussing the growth of digital healthcare, Dr. Harsh Mahajan, Chair, Hospital & Diagnostics Committee, PHDCCI and Founder & Chief Radiologist, said, “The digital healthcare market, valued at $116 billion in the year 2018 is expected to touch $485 billion by the year 2024, a growth of 3.5 times. The spurt in growth is primarily due to the pandemic, which accelerated the diagnostics sector to grow at a rate of 20.5 percent. It is valued at $32 billion now, up from just $5 billion in the year 2012.”
Mr. S K Sethi, Co-Chair, Banking, Financial Services and Insurance (BFSI) Committee, PHDCCI & Founder & CEO, Insurance Foundation of India, stated that from Rs 690 crore in 2001 to Rs 73,300 crores in 2022, the sector has grown approximately 106 times. He stated that blockchain technology would help in eliminating the fraud taking place in the insurance sector
Although the pandemic taught us the significance of mental health, health insurance policies exclude the challenges of mental health. According to Deepak Singh, CEO and Co-founder of Tatsam, insurance companies have developed plans but, except for psychiatrists, have yet to recognise counselors and therapists. Most people have often faced a treatment gap while claiming their insurance. Dr. Steward Doss, Professor, National Insurance Academy, Pune, stated that there is a significant treatment gap in India. A lot of these issues can be resolved with insurance cover.
The knowledge paper on Health Insurance 2042 was also released at the event. Other members who participated in the event were Kanya Saraswathy C, Head Commercial and Reinsurance Practice, Insurance Advisory Group & Lead – US West Accounts, BFSI, Tata Consultancy Services Limited, Ashish Agrawal, Co-Chair, BFSI Committee, PHDCCI, Ravi Bhati During the seminar, Teena Jain Kaushal, Senior Editor of Business Today, and so on.
Scientists aim to make cancer immunotherapy safer and more effective, says new study
According to new research, scientists are working to improve immune checkpoint inhibitors to better target tumours and reduce their impact on healthy tissues. The findings of the research were published in the journal ‘Cancer Cell’ by Johnson, the lead author of the study with Adi Diab, MD and Yared Hailemichael, PhD. Immune checkpoint inhibitors have revolutionized the treatment of many cancers by using our body’s immune system to kill cancer. These treatments sometimes can cause our immune system to fight healthy tissue instead, resulting in side effects.
A frequent adverse effect of immune checkpoint inhibitors is colitis or inflammation in the colon. When studying patients receiving these immune checkpoint inhibitors, researchers at MD Anderson and Ochsner Health have uncovered that a particular cytokine, or protein that activates certain immune cells, is expressed at higher levels in colitis tissue than in cancer tissue shrinking from these treatments.
They also showed that by blocking this cytokine in lab models, the immune system’s ability to fight cancer improves as side effects lessen. Daniel Johnson, MD, a medical oncologist at Ochsner Health, is the lead author of the study that identifies interleukin-6 (IL-6) as a potential target in refining immunotherapies.
“This study shows that blocking IL-6 could de-couple autoimmunity from antitumor immunity,” said Johnson, who began the research during a fellowship at MD Anderson and has continued it at Ochsner. “By targeting this particular cytokine in patients receiving immune checkpoint inhibitors to treat cancer, we could potentially improve immune responses in cancer while lowering the risk of inflammation in healthy tissue.”
Scientists are working to improve immune checkpoint inhibitors to better target tumours and reduce their impact on healthy tissues.
IMPROVING ACCESSIBILITY, AFFORDABILITY FOR CHRONIC KIDNEY DISEASE PATIENTS
As lifestyle diseases such as hypertension and diabetes continue to affect a large percentage of the population, there is also a rise in related conditions like nephropathy. Unfortunately, End-Stage Renal Disease (ESRD) and CKD (Chronic Kidney Disease) are not rare in India. While the exact figures cannot be ascertained due to the country’s vast population, the prevalence of CKD is approximately 800 per million population.
The disease burden is significantly greater in the country due to a disproportionate socio-economic landscape. As per NITI Aayog’s report, 25.01% of India’s population suffers from multidimensional poverty, with a lack of access to critical services like health and education. It is no surprise, then, that 70% of patients are forced to abandon their dialysis treatment for CKD midway.
Against this backdrop, the following is an overview of how CKD impacts patients, and the need to boost accessibility and affordability to best-in-class dialysis services for patients suffering from the life-threatening illness.
UNDERSTANDING CKD: THE SILENT KILLER
One of the main reasons why ESRD is a huge cause for concern for the population as well as the healthcare sector is because early chronic kidney disease has no signs or symptoms. It cannot be traced without blood and urine tests, and ultrasounds. While there are risk factors such as blood pressure or diabetes that may prompt doctors to carry out tests for kidney disease, kidney health is often ignored until the condition has worsened. Unfortunately, chronic kidney disease does not just go away and if untreated, and can escalate to total kidney failure, leaving patients no option other than dialysis or a renal transplant to prolong life.
Dialysis is a life-saving procedure when a patient loses 85% – 90% of kidney function. In simple terms, dialysis performs the functions of a healthy kidney by removing extra water, salt, and waste from the blood while balancing the levels of potassium, bicarbonate, and sodium. Doing so helps these toxic elements from building up in the body and improves blood pressure levels to help the patient maintain a good quality of life. Dialysis support is needed throughout life or until a kidney transplant takes place in severe cases.
THE ECONOMICS OF DIALYSIS
When it comes to dialysis cases in India, the numbers have hitherto been grim. There are over a million patients in the country who need to be dialyzed regularly, and 3,00,000 new patients are added to this tally annually. This boils down to 209 million treatments in India. However, the dialysis sector, predominantly situated in the country’s urban centres, comprises only 20,000 machines that cater to only 8% of the total demand.
Unsurprisingly, dialysis is a costly treatment. The cost of one session ranges from approximately INR 150 at government hospitals to more than INR 3,000 at private hospitals. The costs can be restrictive for a large percentage of Indians. Since people who have access to dialysis can lead a normal life – travelling, going to work, enjoying their hobbies – with a healthy diet and light physical activity – it is important to look at ways to make dialysis more accessible to people, regardless of their background.
Apart from costs, another impediment to regular dialysis is the fact that dialysis facilities in the Indian hinterlands are few and far between. Even today, people have to travel between 50-200 km up to 3 times a week to reach their closest dialysis centre. This only adds to the already exorbitant costs of dialysis that a patient incurs. Many patients may not be able to travel long distances every other day due to their condition. Fortunately, government and private players are working together to forge a solution.
PROPOSING A SOLUTION: PUBLIC-PRIVATE PARTNERSHIPS CAN LOWER COSTS AND BOOST ACCESS TO DIALYSIS
The Government of India recognizes and has introduced significant initiatives to address the ongoing issue of an inaccessible dialysis landscape. In 2016, thePrime Minister launched the Pradhan Mantri National Dialysis program to make the life-saving procedure more affordable. Under the program, a Public-Private Partnership (PPP) was deemed not only feasible but also pivotal to ensuring that out-of-pocket expenditure is minimized for CKD patients and their families.
Why does the PPP model work best for a nationwide dialysis program? The answer is simple. To make high-quality dialysis treatments available across district hospitals, we require the convergence of leading private healthcare organizations with world-class facilities and public players with low-cost reach across tier-III, tier-IV, and rural areas. It is by partnering with government organizations that private players can successfully set up their services in the remotest corners of the country.
Apart from low costs, there are other advantages to this model. Leading PPP players establish multiple centres across regions to ensure that every individual can benefit from proximity. They also ensure state-of-the-art infrastructure, consultations with renowned nephrologists, flexible dialysis options, and even access to entertainment to enhance the patient experience.
Such players can also help patients by setting up both haemodialysis and peritoneal dialysis at their homes so that patients can be treated where they are most comfortable. With home dialysis, they can get the right treatment while maintaining their lifestyle. Finally, the expert doctors that are a part of the association can guide individuals about their long-term treatment, such as transplants.
THE ROAD AHEAD: REMOVING INEQUITY AND DISPARITY FROM KIDNEY HEALTH
The establishment of PPP mode dialysis centres across the country is a promising move for CKD patients. With several centres being set up across regions like Andhra Pradesh, Madhya Pradesh, and Bihar, among many others, the demand and supply gap impacting CKD patients is bound to ease over the coming years. With concerted efforts from the government, private players, and the entire medical fraternity, we can ensure that all Indians have access to high-quality dialysis services, with no geographical or economic constraints holding them back from getting the best course of treatment and living long, happy lives.
The writer is Founder and CEO, DCDC
Opinion2 years ago
South Block’s mistakes will now be corrected by Army
Sports2 years ago
When a bodybuilder breaks Shoaib’s record
News2 years ago
PM Modi must take governance back from babus
Spiritually Speaking2 years ago
Spiritual beings having a human experience
News2 years ago
Chinese general ordered attack on Indian troops: US intel report
Legally Speaking2 years ago
Law relating to grant, rejection and cancellation of bail
Sports2 years ago
West Indies avoid follow-on, England increase lead to 219
Royally Speaking2 years ago
The young royal dedicated to the heritage of Jaipur