Health Matters | Test all, treat all — A TB mantra 

This week in health: managing diabetes risk, health hazards of toxic air and how to navigate compassion fatigue.

Updated - November 15, 2023 12:05 am IST

Published - November 14, 2023 02:39 pm IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: AP

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This week, news and feature pages, and much space online have been possibly consumed by discussion on diabetes, given that World Diabetes Day falls today, and given the number of diabetics that India has, maybe even rightly so. But taking a bird’s eye view, one realises that the biggest health news, arguably this week, was the launch of the WHO’s Global TB report. 

A comprehensive view of the progress or regress, as the case might be, the Global TB report provides a status update from across the world, post-pandemic on TB detection, surveillance and care. After the near complete collapse of TB-related outreach activities during the pandemic, the report noted a welcome resumption of clinical and social activities in the sector. The report further says treatment success rates have improved: to 88% for people treated for drug-susceptible TB and 63% for people with MDR/RR-TB. 

Which is good, but the area of concern was the grim news the report dished out: 7.5 million new cases of TB were reported in 2022. This is the highest number since the WHO began global TB monitoring in 1995, above the pre-COVID baseline (and previous historical peak) of 7.1 million in 2019, and up from 5.8 million in 2020 and 6.4 million in 2021. Also

While it notably commends the nations of the world for having restarted efforts to reverse or moderate TB, it does remain the world’s second leading cause of death from a single infectious agent, and global TB targets have either been missed or remain off track. The net reduction from 2015 to 2022 was 8.7%, far from the WHO End TB Strategy milestone of a 50% reduction by 2025. Given the huge numbers of TB patients in the country and the highly infectious nature of pulmonary TB, it is important to find measures to tackle this bull by its horns forthwith, devising additional strategies, if required, to bring down the number of infections and treat all those who are detected with TB. 

The Union Health Ministry chose to selectively highlight points in the report: WHO hailed India’s success in managing TB. India’s efforts have resulted in the reduction of TB incidence by 16% from 2015 to 2022, almost double the pace at which global TB incidence is declining (which is 8.7%). TB mortality has also reduced by 18% during the same period in India, and globally.

The Ministry pointed out that India’s intensified case detection strategies resulted in the highest ever notification of cases in 2022, when over 24.22 lakh TB cases were notified, surpassing the pre-COVID-19 pandemic levels. Key initiatives launched and scaled up by the government include active case finding drives, scaling up molecular diagnostics at the block level, decentralisation of screening services via the Ayushman Bharat Health and Wellness Centres, and private sector engagement have resulted in significantly bridging the gap in missing cases.

And yet, a National Institute of Epidemiology study earlier this year found the quality of active TB case finding suboptimal. At the national level, 9.3% of the population were screened, just 1% of the screened were tested and 3.7% of the tested were diagnosed, the report said. Scaling up molecular testing, prioritising it over sputum testing and ensuring detection of patients with drug resistance is important, experts have said.

And now, to another disorder, present in epidemic proportions in India — diabetes. In this op-ed article, Dr. V. Mohan addresses the elephant in the room. Prominent on Instagram feeds, WhatsApp forwards and on Social Media are hooks, and promises to ‘reverse’ diabetes. Terming it ‘remission’, he writes that while remission of diabetes is desirable, but it is not essential, playing for a diabetes complications-free India over a diabetes-free India. Firstly, he says, the term ‘reversal’ of diabetes is scientifically incorrect; the appropriate term is ‘remission’ of diabetes. Reversal implies that the condition has permanently reverted to normal and a cure has been achieved. ‘Remission’ implies that diabetes has only gone away temporarily. Can everyone with type 2 achieve remission? Some diabetes reversal programmes claim that they can reverse type 2 diabetes at any stage of the disorder. This is not true. There are certain individuals with type 2 diabetes who are more likely to achieve remission. To learn more, hit our link.

In another piece, he highlights the importance of paying attention to the resolute link between diabetes and the liver. what is the connection between diabetes and the liver? So, what is the link? The liver is a storehouse or a factory for various products and one of them is glucose. When there is excess glucose in the body, it gets deposited in the liver as glycogen. Moreover, the excess fat in the blood circulation (triglycerides and free fatty acids) also gets deposited in the liver and this is called ‘fatty liver’. Epidemiological studies have shown that over 50% of people with type 2 diabetes have some degree of fatty liver. The relationship between fatty liver and type 2 diabetes is bidirectional. Thus, a fatty liver can lead to type 2 diabetes and type 2 diabetes can promote fatty liver. Studies have also shown that if both obesity and diabetes are present, over 80% of such individuals will have fatty liver. This leads to a condition called ‘Hepatic Insulin Resistance’ - what this means is that the body’s insulin cannot function properly and that the action of insulin in the liver is considerably reduced. 

On the occasion of Diabetes Day, again, Zubeda Hamid asks if a diet high in fibre actually helps manage blood sugar levels, reporting on a study that used a medical-grade fibre supplement on persons with diabetes. It found that a fibrous diet was linked to significantly lower HbA1C (blood sugar) levels and higher weight loss, along with increased satiety. Jahnavi T.R. and Jayant R. write about a worrisome trend related to nutrition again: Schools are promoting healthy eating for children, but experts continue to see excessive junk food consumption. Of course, not all schools are on the bandwagon yet, and with the availability of delivery apps, and better spending power, children have multiple options to seek and sate themselves with the kind of food they enjoy, not that which is necessarily good for them.

As you read this, do remember to stop at D. Balasubramanian’s story on the health benefits of functional foods, here. Healthy foods that offer benefits beyond their nutritive value are called functional foods.

Diabetic retinopathy is a complication to watch out for, explains Dr. Rajiv Raman here. He also lists out options that will help people with diabetes guard against developing retinopathy which can also lead to loss of vision. Also, do read this comprehensive piece by senior endocrinologist Dr. Usha Sriram where she explains how to recognise your risk and how to response appropriately in case your risk score is high. 

Continuing to explain last week’s study on the link between air pollution and the risk of type to diabetes, Zubeda Hamid’s podcast sheds further clarity in case you are curious about this subject: Can air pollution in India increase the risk of type 2 diabetes?

More on pollution, Haider Ali Khan reports that poor indoor air quality can significantly impair cognitive function. Poor Indoor Air Quality can apparently result in a range of health issues such as asthma, fatigue, irritation, and even headaches. It can have a notable influence on productivity, energy efficiency, and real estate values. Recognising the impact of poor IAQ makes it a crucial aspect of creating a healthy and conducive environment for living and working, and one size does not fit all, he adds.

One more, on the topic, with specific reference to Delhi’s situation: AIIMS doctor says ‘breathing toxic air is equivalent to smoking at least 10 cigarettes a day’, Nikhil M. Babu reports.

Vehicles move on a road amid low visibility due to smog on Diwali, in New Delhi on November. 12, 2023.

Vehicles move on a road amid low visibility due to smog on Diwali, in New Delhi on November. 12, 2023. | Photo Credit: PTI

Back to the bugs, and the diseases they spread, do browse through this report by Afshan Yasmeen, about the Centre asking States to strengthen surveillance with reference to the Zika virus. The letter — written by Union Health Secretary Sudhansh Pant to Chief Secretaries/Administrators of all States on November 6 — referred to the recent detection of Zika Virus Disease (ZVD) cases in Kerala and Maharashtra in routine surveillance.

There is good news here, with the U.S. approving the first vaccine against chikungunya virus. The vaccine, developed by Europe’s Valneva which will be marketed under the name Ixchiq, was approved for people 18 and over who are at increased risk of exposure, the FDA said. Ixchiq’s green light by the U.S. drug regulator is expected to speed the vaccine’s rollout in countries where the virus is most prevalent.

Looking at health through the gendered lens, again, do read The Hindu’s editor on the draft menstrual policy, following up on earlier reports on the same: Women in red: On an optimum menstrual hygiene policy. It must be intuitive that policies are in place already for something that affects a substantial percentage of half the population, but the reality is far from that. There is hope however that the menstrual policy when ready would be able to improve access and information on hygiene products and access to clean toilets and water for women. The policy should also cater to the life-cycle of menstruation, providing support throughout.

In context, it is significant that the Tamil Nadu Government has modified the State’s maternity benefit scheme to prevent delays. This has been done primarily to ensure that any delay on the part of the Union Government in the disbursal of funds does not affect its implementation. From now on, the scheme will be implemented in three instalments as against five, Health Minister Ma. Subramanian said. 

In a week when multiple medical professionals enriched our health content with their articles, Dr. Christianez Ratna Kiruba writes this very important piece on how women doctors lose out on breastfeeding benefits thanks to their rigorous work schedule.                

Multiple States in the country have differing viewpoints on the implementation of NEET for medical admissions, but here is a story that is crucial for the National Medical Council to see, and act upon, since it involves the future of many students. Bindu Shajan Perappadan profiles students whose dreams of becoming doctors have been shattered by the very institutions they sought admission in. Regulation in the medical sector is key, this story highlights again, in the context of mushrooming medical colleges, with little or no supervision.

As the humanitarian crisis continues in Israel-Palestine, we keep our readers up to date with the health developments, worsening by the day. Do read the following stories to catch up:

Palestinians line up for food during the ongoing Israeli bombardment of the Gaza Strip in Rafah on Monday, November 13, 2023.

Palestinians line up for food during the ongoing Israeli bombardment of the Gaza Strip in Rafah on Monday, November 13, 2023. | Photo Credit: AP

Battles force Palestinians out of hospitals in Gaza, leaving patients, babies and medics stranded.

Israeli strikes hit near several hospitals as the military pushes deeper into Gaza City.

Communication with Al-Shifa hospital in Gaza restored, says WHO chief.

In this week’s tailpiece, Parth Sharma talks about navigating compassion fatigue, something that became real and present what with subsequent humanitarian crises and wars the world has had to face in recent years. In times of global crisis, as consumers, we often remain sensitive to the suffering of others, he recounts. However, as weeks pass, the statistics of a genocide can start to feel like detached numbers rather than representations of the people behind them. As individuals living our daily lives, we have the opportunity to hold those in power accountable for their role in such matters. Yet, we also find ourselves turning off live streams, and moving past articles that share the same gruesome truths. It is okay to self-soothe when a genocide is hankering for our attention, he adds.

From the Health page

If you have some extra time, do check out the following links:              

If medical memoirs are your thing, this one is for you. write on life and death, and how doctors deal with real intimations of mortality everyday.

For a broad range of regional news from our bureaus across the country, this is where you go:

Andhra Pradesh

K. Umashanker reports: Medical camp set up after 30 people were infected with diarrhoea in Chittoor village.                

Experts caution people against growing trend of antimicrobial resistance.

Karnataka

Karnataka High Court takes cognisance of a report on the shortage of medical professionals in the State’s health services.

Kerala

A.S. Jayanth on the concern over medical interns, students practising during night-time in private hospitals in Kerala.

Patients suffer as shortage of doctors plagues government hospitals in Malabar.             

Kerala’s Mahatma Gandhi University constitutes its own disaster management team.

Rajasthan

Vibha Attri, Sandeep Shastri, Abhinav Pankaj Borbora and Sanjay Kumar say only 3% of Kota’s students have visited a mental health professional.

The stressful lives of students in Kota, documented by Abhinav Pankaj Borbora, Suhas Palshikar, Sanjay Kumar, Jyoti Mishra.

Tamil Nadu

Serena Josephine M. records that the T.N. Health Department launches drive for leprosy awareness.

Another piece on Chennai’s newly-designated 8km Health Walk stretch, this time by S. PoorvajaFancy a long walk? 

Ahead of Deepavali, special wards to treat burn injuries set up in 95 government hospitals.

Tamil Nadu public health body issues guidelines to treat burns cases during Deepavali.

Allow additional round of counselling for vacant PG seats in Tamil Nadu, says Health Minister.

Mobile medical camps screen people for fever in rain-affected areas in Erode district.

Tamil Nadu’s overall immunisation coverage has crossed 95%, says DPH.

People above 30 years should get screened for diabetes periodically, say MMHRC doctors.   

Telangana

Deepavali sees a surge of patients with eye injuries in Hyderabad, reports Siddharth Kumar Singh

Medical colleges enforcing strict dress code for students in Telangana.                

Low salt intake nearly kills 60-year-old, doctors advise normal salt consumption. 

All 62 freezer boxes at Gandhi morgue functional, Telangana Government informs High Court.

ICMR-NIN scientists find alarming obesity levels in Telangana and Andhra Pradesh.

Uttar Pradesh

Falling short of NMC norms, a government medical college in Badaun stares at derecognition, reports Mayank Kumar     

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here

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