Arogya Setu wristbands to monitor patients’ movements

The Centre is preparing to procure thousands of wristbands which will be embedded with its Arogya Setu app to monitor movements of patients in both hospital and house quarantine, and also help frontline workers take adequate care when they visit houses for screening of patients.

Broadcast Engineering Consultants India will pitch the designs to AIIMS and other government hospitals this week and then to state governments. BECIL will look at the commercial aspect of procuring technology the government needs and is working with Bengaluru and Gurgaon-based startups on designing the tool.

As the emphasis is on home quarantine, wristbands will help in remote monitoring, help health professionals know people’s temperature and symptoms. The numbers are going to be significant as more and more people will be asked to self-isolate, an official said. Technical bids for the wristbands closed on Monday, and now the PSU, along with senior government officials, is reviewing the designs.

“Each infected person has the ability to infect 100 others. So the numbers under monitoring will be huge in the coming days. The wristbands will ensure that people quarantined with suspected infections stay at a designated place. If they take it off, the hospitals will be informed. Once integrated with Arogya Setu app, there will be many more parameters which will be available for the health officials’ supervision,” the official said.

Online meetings have been set up with company heads to discuss the 'proof of concept,' of the design, an official said.

“Several states have told us how they are using a lot of manpower and resources to track movements... This will be helpful to frontline workers to monitor patients’ health and also be warned when they enter risk zones,” he added. The wristbands could be priced at around 2,200 a piece, which could be less if the demands go down.

Maharashtra and Karnataka already have a home quarantine tracking system, while Kerala uses GPS solutions extensively.

According to the technical document, the tool will also “detect, prevent and investigate threats to national security using CDR, IPDR, Tower, Mobile Phone Forensics Data, and Open Street Maps, Google Maps and Offline Maps without internet”.

The band would monitor “everyday behaviour of the person, including where s/he orders food from and the places s/he regularly visits, the multiple routes s/he could take”.

"The tool should be able to easily identify close contacts, frequent contacts as well as occasional contacts such as Uber drivers etc, and be able to collect information like where the suspect has spent most of his/her time and who all he or she has met," the document said.

Several countries have ramped up their surveillance to keep track of COVID-19 patients. Taiwan has a mobile phone-based ‘electronic fence’ that uses location-tracking technology, while Hong Kong had mandated an electronic wristband on infected people to keep them quarantined.

Experts, however, have also raised serious questions about privacy and civil liberties with the use of these tools.

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Here’s Why Some Women Are Forgoing Treatment For This Type of Breast Cancer

When Laura Colletti was told that she had ductal carcinoma in situ (DCIS), or early-stage breast cancer, she dreaded what the diagnosis would mean for her life. Laura’s daughter had some straightforward advice: “Mom, if it was me I’d take it out. You just get rid of it.”

But Laura wasn’t ready for a mastectomy. She and her husband researched DCIS, which is known as stage 0 cancer, and found that at her stage, her lump was made of pre-cancerous cells fully contained inside the ducts of the breast. The cells might never break out of the duct and become an invasive cancer. Laura says she found that, “really we don’t have to have surgery. That it’s not life-threatening, and I’ll probably die from something else.”

Some doctors agree. Surgeon Shelley Hwang, Chief of Breast Surgery at Duke Medical Center, says it makes her sad when patients feel they have to undergo a major mastectomy surgery in order to rid themselves of the anxiety of breast cancer. Dr. Hwang explains that in ductal carcinoma in situ, the in situ phrase means that the abnormal cells are contained, and if they stay contained, they pose much less risk than having a preventative surgery.

Doctors are now finding breast cancer tumors at higher rates because of how detection technology has improved in recent years. But while early detection has improved, breast cancer death rates have stayed about the same from 2002 to 2015. Shouldn’t more detection, especially early detection, mean more lives saved?
Cases of DCIS account for 20- 25 % of breast cancers detected by screening, whereas DCIS made up about 3 percent of detected cancers before screening became more popular in the 1980s. The reaction of many doctors and patients, understandably, is to want to remove any tumors regardless of stage. Even if a woman does have very early stage breast cancer, it may seem far better to undergo surgery than to worry over whether or not the cancer will become invasive.

But not all tumors are the same, and some are so slow-growing that they might not ever cause death, or even symptoms. They key is to know which ones are which. Cancer is the blanket term applied to low-risk DCIS and to stage IV metastatic cancer, but they don’t pose near the same amount of risk, though the terminology can cause an equal amount of fear in both cases.

But even stage 0 DCIS poses some risk of becoming invasive; isn’t it better to operate and be done with it? According to Dr. Hwang, not always: “There have been a couple of very important studies that have been published lately which have shown that for the really low risk DCIS, whether you ever operate on them, whether you do a lumpectomy or whether you do a mastectomy, the patients are equally likely to not die of breast cancer.”

This is a serious consideration, especially because treatment comes with its own set of risks. The side effects of chemotherapy and radiation are both short-and long-term, and even a double mastectomy is not a magic bullet. Aside from the emotional side effects, a mastectomy may involve  revisions, prolonged pain, loss of sensation, or hernias. 

Some doctors are beginning to think there are times when treatment risks outweigh the benefits, and they’re putting a new option on the table: active surveillance. Active surveillance involves screenings every six months and may include estrogen-blocking drugs. This is the route that Laura Colletti chose. Her daughter was, understandably, against the decision at first. But after talking to her mom about the research the the pros and cons of more aggressive treatment, she become supportive.

Laura was relieved that she wouldn’t have to, at least at this stage, undergo surgery. “I feel great about my decision. If options were given to women, more women would choose active surveillance. But because there’s no options out there, people don’t know to even ask.”

Dr. Hwang is not suggesting that people stop getting mammograms; she’s simply questioning the rapid-fire reaction to all types of cancer. If active surveillance can help women avoid surgery without sacrificing peace of mind, it may be a good option for those with very low-risk DCIS—at least it should be one of the options presented. 

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MRI guided prostate biopsy best way of active surveillance for prostate cancer

Prostate cancer is a common type of male cancer which is highly treatable in the early stages. All over the world tens of thousands of men are diagnosed with low-risk prostate cancer. All such patients are asked just to monitor their slow-growing tumours as they need no active treatment.

Magnetic resonance imaging-guided prostate biopsy best way of active surveillance for prostate cancer, find researcher. MRI imaging, let doctors see the majority of prostate tumours and take a biopsy from the exact location of cancer within the prostate.

Doctors relied  on ultrasound to guide a biopsy needle into the prostate in the past. However,  ultrasound doesn't allow the visualisation of prostate tumours, so a biopsy may have missed a tumour. Over the past decade, it's become possible to instead perform a MRI guided biopsy.

Prostate cancer is typically detected with a blood test measuring levels of prostate-specific antigen (PSA). However, elevated PSA levels detect not only aggressive prostate tumours, but also very slow-growing cancers that are unlikely to become life-threatening. Men with higher than usual PSA levels are referred to get a biopsy, in which cells are collected from the prostate reveal more details about a tumour.

We've found that when you use an MRI-guided biopsy to confirm what appears to be a low-risk prostate cancer, you can then tell the patient with pretty good accuracy what the future is going to entail and what his risks are of having a cancer that will require treatment in the future, said the senior author of the study.

If you know exactly where to put the biopsy needle, you've a much better chance of getting answers about a tumour, said a researcher. Earlier this year, his group reported that combining MRI-guided biopsies with a more traditional approach of sampling throughout the prostate detects more cancers than either approach alone. However, he said questions have lingered about the clinical benefit of MRI imaging guided biopsies and exactly when they should be used in the monitoring process.

From 2009-2018, 606 men with prostate cancers of apparent low risk were enrolled in the active surveillance program. For the new study, researchers analysed data on 332 of those men, all of whom received an initial MRI-guided biopsy and at least one follow-up biopsy an average of 3.9 years later.

The researchers found that when a man's prostate tumour had a Gleason Score of 7 at the time of an MRI-guided biopsy, there was a three-and-a-half times greater risk that the man would develop higher-risk cancer compared to men who had a negative biopsy. ( The Gleason Score is a grading system used to determine the aggressiveness of prostate cancer). A score of 6 is generally considered low-risk cancer recommended for active surveillance, while a score of 7 or more may require radiation or surgery.

Moreover, combining an MRI-guided biopsy with the more standard approach of taking a systematic sampling of biopsies from around the prostate boosted the likelihood that a positive initial biopsy result was truly positive.

In the study, the risk of later developing high-grade prostate cancer was less than 8% for men whose biopsies were negative, 11% if the biopsy revealed a Gleason Score of 6, and 23% with a score of 7.

While MRI-guided biopsy is being used, it is still not being very widely used and our results have the potential to establish a new standard for using it in active surveillance, said the researcher.

MRI-guided biopsy can be used to determine which men should receive more frequent follow-up biopsies or even active intervention before a higher-grade tumour develops, he said.

The study also integrated the use of tracked biopsies- in which technology lets physician take a follow-up biopsy from the same location as a previous biopsy to determine how cancer is changing. The team found that the tracked biopsy detected more upward changes in the grading of cancer-- from a low-grade to high-grade tumour-- than non-tracked biopsies. However, more work is needed to study the value of tracked biopsies.

All these new technologies are advancing the field and serving patients better, he said.

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