Innovation in medical management will continue till there is life on earth. Last century saw the discovery of Alexander Fleming’s penicillin in 1928. While receiving the Nobel prize, he had cautioned that it will be easy for microbes to become resistant to penicillin as well if they are not exposed to sufficient dose, lethal enough to kill them. Despite the development of newer generations of antibiotics after penicillin, most are losing their efficacy due to easy accessibility and irrational use even in healthcare settings, leading to a global antimicrobial resistance crisis. Strategic steps are needed to rein in this threat.
The CRISPR-Cas system has been in discussion to counter antimicrobial resistance. It was first detected in the genome of Escherichia coli in the late 80s by Japanese molecular biologist Yoshizumi Ishino. The Spanish microbiologist Francisco Mojica discovered the complete sequence of CRISPR-Cas and described it as an adaptive immune system of bacteria to remain protected from virus and other foreign elements. Finally, understanding the action of CRISPR-Cas led to the development of CRISPR-Cas9 gene editing tool in 2007, and in 2020 Jennifer Doudna and Emmanuelle Charpentier received the Nobel for their pioneering work in CRISPR gene editing. This tool has the potential to snip out antibiotic resistant genes of bacteria to re-sensitize them to antibiotics.
Ever since the first genome sequencing in 2003, new and cheaper next generation sequencing (NGS) technologies have revolutionized the detection of genetic and epigenetic causes of diseases. Currently the second generation NGS is more popular and highly accurate with a high throughput that can sequence multiple fragments of DNA parallelly. The challenge with NGS is the enormous amount of data that gets generated and usage of that data. The developed nations are rapidly switching to NGS to diagnose the genetic causes of diseases, specifically the cancer-causing genes in individuals and making customized drugs for the individual’s disease management. The global NGS market size stands at 13 billion dollars currently with a growth rate of 15.7%. Bangladesh’s enriched pharmaceutical industry has an opportunity to diversify their portfolio and invest in NGS technology or into the consumables needed to perform NGS. However, application and analysis of NGS will require simultaneous investment in developing skilled people, especially in bioinformatics.
Unknown to many, poisoning is responsible for eight to 10 percent of yearly deaths in Bangladesh. A case study of a woman overdosed on tricyclic antidepressant, alprazolam and bromazepam is noteworthy because she was not responding to the standard protocol of sodium bicarbonate usage. Adjunct therapy of lipid emulsion and plasma exchange helped revive her. It must be mentioned that 200,000 yearly deaths from poisoning cases in Bangladesh is a matter of concern. Should we not have strategy to log a person’s prescription when dispensing psychiatric drugs? Also, more awareness generation is needed in seeking mental help.
Lung cancer is the main cancer among all the other kinds of cancer that kills. It is not solely linked to smoking anymore; anyone can get it anytime. Early detection is necessary for better prognosis. Currently multiple targeted therapies are available. Genetic testing has made it possible to recognize novel oncogenic factors of non-small cell lung cancers (NSCLC). More than 65% of patients with advanced NSCLC have a genetic mutation that may be targeted. Osimertinib is a third generation EGFR-Tyrosine Kinase Inhibitor (TKI) that has become the new standard of treatment for advanced NSCLCs with EGFR mutations. However, even with cancer treatment, drug resistance is a big issue.
Kidneys are the body’s chemist that eliminates all the toxins from all the biological activities. Experts state that kidney diseases are the seventh leading cause of death in Bangladesh currently. Although, not yet branded as a leading noncommunicable disease, kidney failure is definitely a global burden. Unfortunately, by the time kidney failure is detected it is already at an advanced stage, and the management with regular dialysis is extremely costly. Regular screening and particularly following a lifestyle to avoid getting diabetes mellitus or hypertension is key to keeping this vital organ healthy.
As Bangladesh aims to move from a developing nation to a middle-income economy, health of its population will play the biggest role in yielding demographic dividend. The aim to achieve Universal Health Coverage by 2032 to fulfill SDG 3.8 is an ambitious plan yet not an impossible one. Here, we propose to start giving school going children the benefit of health screening and early detection of any developmental issue. Since the government plans to give school ID cards, the card can also record health information of individual students on a web portal to ensure monitoring of vaccination, early disease detection including mental health, and interoperability of exchanging health information. A pilot project in Jashore of recording health information of 2006 students along with health history of their parents revealed interesting data.
Information on specific diseases, health systems and population health are a wide range of topics. One is always linked to the other. The Coronal only introduces its readers to certain practices that are out there, information on novel diagnostics and therapeutics, and preventative actions that can reduce the prevalence of communicable and noncommunicable diseases. Diseases are a part of life but also a burden to society. In Bangladesh, although public health system is subsidized, healthcare is an out-of-pocket expense and till a welfare scheme is introduced, we must do our best to remain disease free for as long as possible.