As World Diabetes Day is observed, Omnia Health examines monogenic diabetes, a rare form of the condition, caused by a single gene mutation. Estimates reveal at least 80 per cent of monogenic cases remain undiagnosed which is impaired by the high incidence of diabetes in the region. In the Middle East and North Africa, 192,500 children and adolescents live with Type 1 diabetes. The prevalence of diabetes in the UAE stands at a staggering 16.3 per cent compared to 9.3 per cent worldwide.

The first step in managing monogenic diabetes is identifying the genetic mutation responsible which involves genetic testing. There are over 30 different genes that cause this condition. Mutations in HNF1A, HNF4A and HNF1B were identified in the late 1990s, mutations in KCNJ11 and ABCC8 causing neonatal diabetes were identified in the mid-2000s and new genes causing monogenic diabetes continue to be discovered.

Related: The future of diabetes care in a digital world

Depending on the genetic mutation, monogenic diabetes may respond differently to medications. In some cases, oral medications may be sufficient to manage blood sugar levels and in others, insulin may be necessary. Regular monitoring and lifestyle modifications also play a significant role in managing monogenic diabetes.

Training nurses for monogenic diabetes care

One leading expert in the field who has made significant strides in monogenic diabetes is Nurse Margaret Shepherd, Associate Director of Nursing Research and Honorary Clinical Professor of Monogenic Diabetes at the Royal Devon University Healthcare NHS Foundation Trust. As the distinguished winner of the 2nd edition of the Aster Guardians Global Nursing Award, her journey in transforming the care for this rare condition emphasises the power of education and highlights the vast opportunities that exist to enhance the lives of patients. A substantial portion of her award prize, a generous US$250,000, is dedicated to supporting genetic testing globally.

Through her network of trained nurses and her commitment to global healthcare, she is contributing to reducing the diagnostic gap, improving the quality of care, and ultimately, changing the lives of patients.

“This type of diabetes affects around 3.6 per cent of those diagnosed below 25 years of age, however, it is initially misdiagnosed in around 80 per cent of cases. Ensuring the correct genetic diagnosis is crucial. Many patients, often initially treated with insulin injections, may be better treated with low doses of tablets depending on the genetic cause identified, leading to improvements in blood glucose levels and quality of life,” Nurse Margaret explained.

Related: The rise of diabetic tech is revolutionising healthcare delivery

Nurse Margaret's research, focusing on the UK's paediatric diabetes population, revealed a 2.5 per cent prevalence of monogenic diabetes, most were managed through tablets rather than insulin. A significant finding was a child under six months old with diabetes, referred to as neonatal diabetes, is highly likely to have a single gene change causing diabetes. Referral for genetic testing is crucial, as it can result in improved treatment options, potentially leading to better blood glucose control and quality of life.

To bridge this diagnostic gap and bring about accurate and timely diagnoses, Nurse Margaret has been a driving force and set up a national network of genetic diabetes nurses in the UK.  The project ran from 2002 – 2021 and was successful in increasing referrals for genetic testing, confirming more cases, and ensuring correct treatment and follow-up of other family members.

“This aimed to train diabetes specialist nurses across the UK in monogenic diabetes and by using a model of ‘train the trainer’ enabled them to teach others across their regions about these rare genetic types of diabetes. We continue to offer virtual masterclasses and the training materials can be accessed for free by anyone across the world.”

Since its inception, around 4,500 patients in the UK have received a confirmed diagnosis of monogenic diabetes. Nurse Margaret’s mission continues as she focuses on establishing a global network of nurses passionate about monogenic diabetes who can seek support from experienced peers within the field.

Margaret Shepherd is the Associate Director of Nursing Research and Honorary Clinical Professor of Monogenic Diabetes at the Royal Devon University Healthcare NHS Foundation Trust.

 

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Back to Management

Healthcare professionals and systems are facing increasing pressure as the estimated number of people living with diabetes worldwide stands at 537 million. Projections suggest this figure could rise to 783 million by 2045. However, cutting-edge tools and new technology are redefining the future of diabetes care and are set to alleviate this pressure by streamlining processes, enhancing patient care, and ultimately enabling patients to take more control.

The rise of smartphones, remote monitoring and new diabetes devices continue to positively impact diabetes management. During the recent American Diabetes Association's 83rd Scientific Sessions, Glyconics Ltd. introduced the Glyconics-DS which offers needle-free diabetes testing with infrared technology, providing a quick risk assessment based on fingernail blood sugar levels.

Fractyl Health Inc. also demonstrated the efficacy of their Revita procedure in lowering blood glucose levels and encouraging weight loss. The Revita procedure, an FDA breakthrough, utilises endoscopic hydrothermal ablation to rejuvenate the duodenum's surface. Developed by Fractyl in Lexington, Massachusetts, it is designed for use in conjunction with empagliflozin, an SGLT-2 medication for type 2 diabetes. Preliminary results from the Revitalize 1 study, presented at the ADA meeting, showcased significant improvements.

Related: The rise of diabetic tech is revolutionising healthcare delivery

Dr. Omar Dhaimat, an expert in the field of diabetes and Consultant Endocrinologist at Clemenceau Medical Center Hospital Dubai, explains how technology is helping the health sector to manage this pandemic.

“Until we reach the stage of a fully automated artificial pancreas, using various technology devices in monitoring the glucose and delivering insulin, is a major milestone. Using continuous glucose monitoring devices (CGMs) and having access to them remotely has helped ease the pressure and workload on the health sector and has improved the outcome of managing diabetes for patients. There have been many studies to show the benefit of those devices on HBa1c control, patient satisfaction and better outcomes. Using telemedicine and having access to those monitoring devices have also improved the care of patients.”

Telemedicine and teleconsultation platforms provide an excellent layer of support, enabling healthcare professionals to engage in virtual consultations and enhancing convenience for both patients and providers. This innovative approach significantly reduces the logistical burdens associated with in-person visits, offering welcome respite for patients.

More advanced technology delves into data analytics and predictive insights, combing through extensive datasets to reveal intricate patterns in a patient's glucose levels. Armed with this knowledge, healthcare professionals can detect potential issues and intervene, ultimately reducing the number of emergency medical visits.

Technology plays a vital role in empowering patients by equipping them with educational and self-management tools. This enables patients to make informed decisions and lessens their reliance on constant guidance. Dr. Dhaimat elaborates on the various ways technology has enhanced self-management in diabetes care.

“Firstly, to monitor the glucose level for 24 hrs per day, generates what we call ‘time in range’, so the health professional will know what happens to the glucose levels all the time. That will lead to adjusting the management of diabetes during the day. It will also alert the patient and the health care provider about low glucose levels and try to avoid having severe hypoglycaemia, which is a potentially lethal complication.”

Related: Diabetes prevention remains UAE’s top priority

Dr. Dhaimat says better monitoring will lead to lower HBa1c and less risk for future complications. “Diabetes affects the kidneys, eyes, cardiovascular system, and the nerves. Better monitoring, ultimately will prevent those complications from happening. Finally, the communication between the healthcare provider and the patient is much easier. Since they both have access to the monitoring device and can provide assistance in real-time.”

Dr. Dhaimat, highlights the remarkable progress already witnessed in diabetes management. He notes that significant advancements, such as automated insulin pumps equipped with sensors to detect hypoglycemia and even administer glucagon when needed, have transformed treatment. The emergence of insulin patches with their own reservoir, controllable through smartphones, represents a significant step forward. Dr. Dhaimat believes we are on the brink of achieving the long-anticipated closed-loop insulin pump system. He also highlights the option of pancreatic beta cell and pancreas transplantation, which are now viable solutions in specific cases. In essence, technology can ease the workload of healthcare professionals, enhancing patient care quality and allowing experts to focus their expertise on complex cases.

According to Dr. Dhaimat, within the next decade, a significant shift is anticipated, where all diabetic patients will transition to AI-based management. Through the identification of optimal algorithms, diabetic individuals will gain the ability to proactively anticipate their glucose levels, enabling them to take early corrective actions. Dr. Dhaimat states that AI is poised to redefine the future of diabetes care, potentially eliminating the necessity for in-person doctor visits, as all aspects of care could be efficiently administered remotely. This transformative approach holds the promise of enhancing the overall quality of life for diabetes patients while reducing the risks associated with complications.

A remarkable transformation is underway in the heart of Saudi Arabia. The intersection of artificial intelligence (AI) and healthcare has brought about a paradigm shift in the way we approach medical diagnosis, treatment, and patient care. A wave of innovative homegrown start-ups in the kingdom is harnessing the power of AI to create ground-breaking healthcare solutions that not only cater to the local population but also hold the potential to make a global impact.  

The digital health market in Saudi Arabia is projected to grow by 9.06 per cent from 2023 to 2027, resulting in a market volume of US$1.16 billion. With the generous support of the Saudi government and a fertile ecosystem for innovation, entrepreneurs are finding themselves at the forefront of a healthcare revolution. 

The healthcare landscape of Saudi Arabia 

Saudi Arabia's healthcare system has evolved significantly over the years, but challenges such as access to quality healthcare in remote areas and efficient management of patient data persist. In 2016, well before the COVID-19 pandemic forced health services online, a small start-up was laying down its roots in Riyadh.  

Cura is a locally developed telemedicine platform that uses AI-powered telemedicine to bridge the gap between patients in remote areas and medical specialists through virtual consultations, democratising healthcare access and reducing the burden on urban medical facilities. Today, it is the largest platform in Saudi Arabia and has over 150 doctors serving up to 430 medical consultations a month. 

Related: Saudi Arabia navigates new frontiers in healthcare

"We aim to help redefine the model of care in which patients access healthcare services in Saudi and move towards a digital-first approach where seeing a doctor online becomes people’s first choice and to move as many health services as possible to be in patients' hands," says Wael Kabli, Chief Executive and Founder of Cura. The COVID-19 pandemic catalysed the app’s growth, and in 2021, Cura raised an impressive US$4 million in a series A funding round led by local venture capital firms ELM and Wa'ed, the entrepreneurship arm of Saudi Aramco.   

Another Saudi trailblazer, Nala.ai, is an artificial intelligence platform that enables instant medical diagnosis in Arabic. Developed in collaboration with a panel of dozens of medical practitioners, the AI-powered platform streamlines diagnostics and access to healthcare and serves over 200,000 patients.  

"Our mission is to reduce the cost of healthcare by tenfold while providing an exceptional healthcare experience,” Othman Abahussein, founder and CEO of Nala, says. "Our whole team is in Riyadh, and all of our human capital investments go into local talent. We made a bet on local talent, and I can say with full confidence that it pays very well."  

The company raised US$1 million in its first funding round in the same year of its launch. In May 2023, Nala was acquired by Integrative Health, a local network of patient-centred digital-first urgent care centres for an undisclosed amount.  

Government support and the healthtech landscape 

Over the past few years, there has been a steady increase in venture capital investment in Saudi’s healthcare sector, providing start-ups with the financial resources needed to scale their operations and bring their innovative solutions to market.  

Improving the healthcare sector in collaboration with private sector investors is a significant component of Saudi Arabia's Vision 2030 initiative, which aims to diversify the kingdom's economy and lessen its dependency on oil. As part of its Vision 2030 strategy, the Saudi government is actively investing in AI technology and infrastructure. Saudi Arabia has allocated US$50.4 billion in its 2023 budget to healthcare, with a focus on smart technologies.  

The uptick of venture capital funding 

Venture capital in Saudi Arabia began with a few renowned family offices filling funding gaps not met by institutional banks. They mainly invested in manufacturing and trading, leaving Internet and software businesses to bootstrap or use friends' and family's money. Saudi Arabia now has around 65 venture capital firms, angel investment groups, incubators, and accelerators that have invested in start-ups. The bulk, over 90 per cent, were founded in 2017 and 2018. BADIR's accelerators, KAUST's Entrepreneurship Centre, Saudi Aramco's Entrepreneurship Centre, OQAL Angel Investor Network, Wa'ed Ventures, Women Spark Angel Investor Network, Vision Ventures, and Ra'ed Ventures were pioneers before the kingdom’s roll-out of Vision 2030 in 2016.  

Nine funds totalling US$2.4 billion were unveiled during a recent LEAP 2023 event in Riyadh to support start-up growth, while VC funding in Saudi companies surged 72 per cent in 2021 and 2022, totaling US$987 million across 144 deals. 

Related: Embracing the future: Saudi Arabia's digital healthcare revolution

The kingdom also boasts a young and tech-savvy populace that is hungry for digital services, making it appealing to investors. Ninety per cent of young people surveyed by the Global Entrepreneurship Monitor thought that starting a business in Saudi Arabia was simple, putting the country first among global economies. Furthermore, 80 per cent of respondents saw the potential to establish a business as a result of the pandemic's effects. 

"We have seen tremendous month-over-month growth during the lockdown, and we can’t wait to keep innovating our technology and services to help people in need live the healthiest and most convenient lifestyle we can possibly offer them," Mohammad Zekrallah, co-founder and Chief Technology Officer at Cura, says. “It’s definitely exciting times for the digital health industry in the region nowadays, especially post-COVID-19 pandemic." 

The year 2023 has been the best-performing year for Saudi Arabian venture capital, aggregating US$446 million in H1 alone. Seventy-five per cent of the investments in Saudi start-ups came from local investors, suggesting the potential for a robust sandbox-style domestic market for innovation that can be iterated and expanded beyond the kingdom.   

According to Dr. Nabeel Koshak, CEO and board member at Saudi Venture Capital (SVC), a Saudi government investment company, the Kingdom’s leading position in the VC scene in the region comes as a result of the many governmental initiatives launched to stimulate the start-up ecosystem.  

SVC was established in 2018 and aims to stimulate and sustain financing for start-ups and SMEs from pre-Seed to pre-IPO by investing US$1.6 billion through investment in funds and co-investment in start-ups. To date, SVC invested in 43 funds that have invested in 674 companies through 1,257 deals. In November 2022, SVC invested US$10 million in TVM Capital Healthcare’s Afiyah Fund to invest in innovative companies in the healthcare sector in the Kingdom of Saudi Arabia. Koshak explains that this is one of a series of investments to develop and sustain financing for start-ups and SMEs in strategic sectors, such as healthcare. 

 

 

Source: Magnitt 

The convergence of AI and healthcare is reshaping the landscape of medical services, and Saudi Arabia's burgeoning start-up ecosystem is playing a pivotal role in driving this transformation. Aspiring young entrepreneurs in Saudi Arabia have a golden opportunity to leverage AI's potential to develop innovative healthcare solutions that not only cater to local needs but also have the potential to shine on the global stage.  

Through the power of AI and other advanced technologies, these start-ups are revolutionising healthcare delivery, improving patient outcomes, and creating new opportunities for economic growth. With government initiatives and venture capital funding support, the future looks bright for healthtech start-ups in Saudi Arabia. As they continue to innovate and collaborate, these start-ups will play a crucial role in shaping the future of healthcare in the Kingdom and beyond. 

The impact of healthtech start-ups 

The rise of healthtech start-ups in Saudi Arabia has the potential to revolutionise healthcare delivery and improve patient outcomes in several ways: 

• Enhanced access to healthcare: Teleconsultation platforms like Cura and Labayh are breaking down geographical barriers, allowing patients to access healthcare services remotely. This is particularly beneficial for individuals in rural areas or those with limited mobility. 
• Improved efficiency and accuracy: Start-ups like Nala.ai are harnessing AI and machine learning algorithms to improve the accuracy and efficiency of medical diagnosis, leading to faster interventions and better patient outcomes. 
• Streamlined healthcare journeys: Platforms such as Tabib Group and Clinicy are simplifying the healthcare journey by digitising workflows and providing personalised solutions. This reduces administrative burdens, enhances patient satisfaction, and improves the overall healthcare experience. 
• Empowering healthcare professionals: Healthtech start-ups are empowering healthcare professionals by providing them with advanced tools and technologies. This enables physicians and clinics to deliver high-quality care, improve patient engagement, and optimise practice management. 

The rise of healthtech start-ups 

Saudi Arabia, with its rapidly growing population and increasing healthcare needs, presents fertile ground for healthtech start-ups to thrive. The government, recognising the importance of a robust healthcare system, has made significant investments in infrastructure development and healthcare reforms. As a result, the healthcare sector has become a priority, attracting both local and international investors. 

Cura: Transforming access to healthcare 
One of the most exciting healthtech start-ups in Saudi Arabia is Cura, a mobile app that offers remote consultation services with doctors. With over 150 doctors across 34 medical specialties, Cura provides users with convenient access to medical guidance and consultations. The app has gained significant traction, serving over 430 consultations in a month. Cura's success highlights the potential of teleconsultation services in improving healthcare accessibility and reducing barriers to quality care. 

Labayh: Empowering mental health 
Labayh is another notable start-up in the Saudi healthtech scene, focusing on teleconsultation services for mental health. The platform offers online consultations with psychologists, psycho-educational resources, and corporate wellness programmes. By leveraging technology, Labayh aims to address the growing mental health challenges faced by individuals and organisations. The start-up's dedication to mental health exemplifies the wide range of healthcare services that technology is revolutionising. 

Nala.ai: Innovating diagnosis tools 
Nala.ai is a Saudi healthtech start-up focused on developing innovative diagnosis tools. By harnessing AI and machine learning algorithms, Nala.ai aims to improve accuracy and efficiency in medical diagnosis. The start-up's cutting-edge technology has the potential to enhance the diagnostic process, leading to faster and more accurate medical interventions. Nala.ai's work exemplifies the transformative power of AI in healthcare. 

Tabib Group: Redefining medical concierge 
Tabib Group is a Saudi start-up that offers medical concierge services, providing personalised healthcare solutions to individuals and families. By leveraging technology and partnerships with leading healthcare providers, Tabib Group aims to streamline the healthcare journey, offering convenience and peace of mind to its clients. The start-up's commitment to customer-centric healthcare reflects the changing expectations of patients in the digital age. 

Clinicy: Empowering physicians and clinics 
Clinicy is a Saudi healthtech start-up that focuses on empowering physicians and clinics through innovative digital solutions. The start-up provides various services, including practice management software, electronic health records (EHR), and patient engagement tools. By digitising healthcare workflows, Clinicy aims to improve efficiency, enhance patient care, and reduce administrative burdens for healthcare providers.  

 

This article appears in the latest issue of the Omnia Health Magazine, read more here

Back to Technology

The Kingdom of Saudi Arabia stands at the threshold of a healthcare renaissance, with a profound opportunity for growth, innovation, and excellence. Over the next five to seven years, there are tremendous prospects for healthcare development in the country, according to Reenita Das, Senior Vice President at Frost & Sullivan.  

In an interview with Omnia Health, she highlighted that while the rest of the world is moving digital healthcare technologies into the home, Saudi Arabia is working towards establishing a sophisticated healthcare system and can leapfrog by many years to build systems which are “made-to-order” for the country.  

Related: The future of health and medicine: where can technology take us?

For instance, Saudi Arabia is investing resources heavily in general medicine, endocrinology, plastic surgery, and neurology. However, Das highlighted that by 2030, there will be an oversupply in these areas. “Currently, areas such as psychiatric, renal medicine, gastroenterology, immunology and infection, rheumatology, respiratory medicine, urology, and orthopaedics are undersupplied. These are where the growth opportunities exist. So, companies should consider these areas as investment avenues,” she explained. 

 

Figure 1: Gaps in Healthcare by 2030, Source: Frost & Sullivan 

Other areas where Saudi Arabia needs to focus its efforts are in developing robust public-private partnerships (PPPs) and manufacturing. Das shared that, at the moment, private investment in healthcare in the country is less than 20 per cent. It needs to go up to 50 per cent, be it in Greenfield clinics, managed services, healthcare education or virtual care platforms. 

“The industry needs PPPs as these partnerships leverage the strengths of both sectors to enhance service delivery, drive investments, and expand healthcare accessibility,” she added. “Regarding manufacturing, pharmaceutical companies in Saudi Arabia should focus on biosimilars. Pharma companies focused on biosimilars will have the highest growth by 2030.”  

 

Source: Frost & Sullivan 

 

Capitalising on opportunities 

Saudi Arabia's Vision 2030 is a comprehensive blueprint for the nation's future and places healthcare at the forefront of its priorities. The government's commitment to diversifying the economy and enhancing the quality of life for its citizens includes extensive investments in healthcare infrastructure, services, and technologies. Below, Das highlighted several healthcare opportunities ripe for substantial advancements. 

Community-based care: There will be a significant focus on moving care to the community and building clusters towards integrated care. The country should look at offering facilities such as rehabilitation, dental or renal care near the home. The investment should also be focused on setting up the digital front door of hospitals, the concept of anytime, anywhere care, electronic medical records to ensure healthcare transparency and building electronic digital pharmacies to drive healthcare consumerisation.  

Decentralisation: Das believes that the bed size of hospitals will go down in the future and become leaner. There will be an increase in day surgeries. For instance, OBGYN procedures, maternal and childcare, diabetes, and cardiovascular disease care need to be separated from the hospital so that the facility becomes the Intensive Care Unit (ICU). “Decentralisation is an important trend that's happening. We don't need so many hospitals; what we need is building community-based care, which is accessible for people to go to anytime,” she added. 

Mental health care: Saudi Arabia will look towards building an entire system for mental health, and the country has already put it into its plan. The government should focus on understanding the different areas of mental health and build systems, whether it's long-term care systems, addiction and rehabilitation systems, care at home, family counselling or virtual counselling. All of these need to come together to provide holistic care. 

Value-based care: The country should also build efficiency in its hospitals, not only in terms of reducing cost but also in enhancing patient outcomes. There needs to be a system in place to measure the outcomes. Those results should then be tied to the clinician. Accountability needs to be built into care, and the only way to achieve it is through data. 

Wellness and preventative care: Saudi Arabia is concentrating more on investing in diagnostics and screening. It is creating awareness around prevention to offer more personalised, predictive, and preventative care. Many private hospitals and clinics are also stepping up their wellness programmes. 

Focus on chronic disease management 

Saudi Arabia reportedly has a higher number of people suffering from obesity and diabetes. In 2022, the diabetes population in Saudi Arabia was four million, while the pre–diabetes population stood at three million. Between 2021 and 2030, the rate of diabetics in the country will reportedly see 1.7x growth. “The only way to stop the pre-diabetes population from getting into diabetes is screening, education, and running community-based programmes,” Das added. 

According to her, the country needs to create systems and programmes to provide education and awareness of obesity. This starts with creating awareness in schools by ensuring that food is labelled correctly. Also, it should be mandated that anyone who visits a doctor should get their body mass index (BMI), weight and blood pressure checked. If they are over a certain point, they need to have a consultation with a nutritionist or an educator, which should also be an insurance requirement. 

Related: Unravelling the power of Sheconomy in healthcare

Das said: “The whole aspect of chronic disease management needs to be removed from the hospital. It needs to be moved into a community or clinic-based system with an online-offline (O2O) model. More patient engagement programmes need to be created, where patients are not just given glucometers but also told how to use them and monitor their vitals. There needs to be a closed-loop system, integrated either by an app or a virtual care system, and a nursing care centre or call centre that can follow up with the patient and understand them better holistically by asking about how much they are sleeping, etc. At the end of the day, it's a family disease; it's not a person's disease. We look at the person in silos, but we don't look at how difficult it may be for them to get access to healthy food or transportation to get their blood tests done.” 

Another suggestion Das gave was to build a subscription model around HbA1c tests to incentivise people to get monthly tests. Some KPIs (Key Performance Indicators) should then be tied to the diabetes clinic, which must maintain benchmarks and share best practices. 

Spotlight on women’s health 

At the Global Health Exhibition, Das will discuss ‘Growth opportunities in women's health.’ She shared that women’s health topics are often relegated to issues around menstruation, infertility, and pregnancy, but her discussion will focus on areas not usually highlighted.  

“I will be speaking about cardiovascular disease, obesity, endometriosis, and mental health in women’s health because these are areas where little research is done. Women get treated with drugs they are not meant to have, which can cause adverse side effects. There are not enough clinical trials done where women are participating. And yet, almost one in three women over 65 years has cardiovascular disease in the region. I want to bring up these points, which even I don't have answers for. But I want people to be aware that more inclusion of women needs to happen in these areas,” she concluded. 

 

This article appears in the latest issue of the Omnia Health Magazine, read more here

 

Back to Technology

Sleeping patterns and stress hormones could be the key to understanding how and when people with epilepsy are likely to experience seizures, a new study reveals. 

Researchers used mathematical modelling to understand the impact of different physiological processes, such as sleep and changes in concentration of the stress hormone, cortisol, on key signatures of epilepsy, known as epileptiform discharges (ED).

Epilepsy is a serious neurological disorder characterised by a tendency to have recurrent, spontaneous seizures. Classically, seizures were assumed to occur at random, until the discovery of ED activity with timescales that vary from hours and days through to months.

The scientists analysed 24-hour EEG recordings from 107 people with idiopathic generalised epilepsy and discovered two subgroups with distinct distributions of epileptiform discharges: one with the highest incidence during sleep and the other during daytime.

Related: Can technology enhance the way we sleep?

Publishing their findings in PLOS Computational Biology, the international research team led by the University of Birmingham, revealed that either the dynamics of cortisol or sleep stage transition, or a combination of both, explained most of the observed distributions of ED.

Lead author Dr. Isabella Marinelli, from the University of Birmingham’s Centre for Systems Modelling & Quantitative Biomedicine (SMQB), commented: “Some 65 million people have epilepsy worldwide, many of whom report specific triggers that make their seizures more likely — the most common of which include stress, sleep deprivation, and fatigue.

“Our findings provide conceptual evidence that sleep patterns and changes in concentration of cortisol are underlying physiological drivers of rhythms of epileptiform discharges. Our mathematical approach provides a framework for better understanding what factors facilitate the occurrence of ED activity and potentially trigger the seizures which can be so debilitating for epilepsy sufferers.”

The researchers’ mathematical model describes the activity of connected brain regions, and how the excitability of these regions can change in response to different stimuli — either transitions between sleep stages or variation in concentration of cortisol.

Related: Blue light exposure triggers sleep disorders among clinicians

ED frequency increases during the night, early in the morning, and in stressful situations in many people with epilepsy. The team discovered that sleep accounted for 90 per cent of the variation in one subgroup and cortisol around 60 per cent in the other subgroup.

Cortisol is one of the primary stress hormones in humans, with production and secretion controlled by the hypothalamic-pituitary-adrenal (HPA)-axis. In stressful situations, HPA-axis activity increases, resulting in a higher secretion of cortisol.

“Sleep alone cannot account for the changes in ED likelihood during wakefulness observed in our first subgroup,” explained Dr. Marinelli. “There is a reduction in ED likelihood during the sleep time after an initial sharp increase during the first hours.

“This can be explained by the fact that deep sleep, which is linked to an increase in EDs, is predominant during the first third of the sleep period. We found an increase in ED occurrence before waking — which given that the level of cortisol is known to increase around waking — suggests a combined effect of sleep and cortisol.”

 

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Back to Clinical

Vaccines have been one of the most groundbreaking medical interventions in history that led to significant improvements in public health and healthcare outcomes worldwide. GlaxoSmithKline (GSK) has made strides in this focus area, ranking high as a leading pharmaceutical company with its continued commitment to providing accessible healthcare solutions for different stages of life. A chat with Rudi Rosolen, Vice President, Head of Industrial Operations for GSK in Belgium, revealed the organisation’s rich 140-year history of vaccine development to aid disease management and improve public health through a broad portfolio of 21 vaccines that are supplied to 160 countries across the globe.

“GSK has a network of 12 manufacturing sites in nine countries. Last year, we distributed more than 500 million doses, which is probably the largest volume of vaccines that has been distributed by a company worldwide, excluding COVID and pandemic figures. Our massive manufacturing capacity and extended reach from a commercial perspective are ways we contribute back to society,” Rosolen said.

“Last but not least, we also have the broadest portfolio of vaccines in the industry, covering the needs of babies, children, adults, and now older adults with more recent vaccines against shingles and respiratory syncytial virus (RSV).”

Related: Shingles awareness is critical among HCPs in the MENA region

Yan Sergerie, PhD, Vice President of Global Medical Portfolio Lead at GSK, highlighted that RSV is highly contagious and become a growing area of concern due to its significant risk of complications, especially among people with weakened immune systems. The disease has also posed a challenge for scientists for decades because the virus has multiple strains, which led to severe consequences during early experiments.

This global setback was only recently overcome by GSK, bringing hope to not only senior citizens and high-risk patients. “I am very proud to say that, as of 2023 GSK now has two approved and recommended RSV vaccines for adults aged 60 years and above, and for pregnant women. This is a massive innovative achievement,” Sergerie added.

Looking back, GSK marked several firsts as a pioneer in biopharma solutions. For instance, they became the first to introduce US FDA-approved medicine for adult and paediatric patients with active lupus nephritis in 2011 and 2022, respectively.

The development of vaccines is a complex one that involves multiple stages, each requiring the utmost care to ensure efficacy and effectiveness, according to Sergerie. The research and development cycle alone may take up to several years, starting from identifying and producing antigens to pre-clinical testing, clinical development, manufacturing, and finally, registration. However, recent events such as the global COVID-19 pandemic are changing the narrative to drive faster vaccine development. Additionally, the integration of data-driven AI in the healthcare space promises to predict and monitor new strains, which in turn would give scientists an early start to identifying antigens.

Infographic courtesy of GlaxoSmithKline (GSK)
 

Dr. Piyali Mukherjee, Vice President, Head of Global Medical Affairs, Vaccines at GSK, explained that through immunisation programmes, governments can reap economic benefits, which include a significant return on investments as it unlocks healthy ageing and an improvement in the overall GDP of a country.

Related: Shedding light on emerging trends in public health

“Building awareness overall is a powerful force, and it is seen that the healthcare professional is the most influential source of information for patients. Various discussions triggered by the healthcare professional, or even by educated individuals after a visit to an informed doctor, can reduce the burden of disease through early prevention and diagnosis, and aid immunisation efforts,” she said.

Sergerie added: “It is essential to create awareness around indications of the mass population, the devastating impact of infectious diseases, the role vaccination plays in preventive measures, and indicate the governmental and political efforts that are being made to build those infrastructures. The goal is to make it easy to understand, accessible, and very convenient. That is the key to success, and I think this is where we could all partner and collaborate on that.”

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Back to Management