Diabetes insipidus (DI) is a rare medical condition that disrupts the body's ability to regulate water, resulting in excessive thirst and an unusually high volume of urine. This condition affects the kidneys' ability to concentrate urine and causes individuals to produce between 3 and 20 quarts of dilute, colourless urine daily, compared to an average of 1 to 2 quarts. It is pertinent to note that DI is not related to diabetes mellitus, which disrupts the body's insulin production.

Types Of Diabetes Insipidus

This condition results from damage to the hypothalamus or pituitary gland, which impairs the production or release of vasopressin, a hormone responsible for water retention. When vasopressin levels are inadequate, the kidneys fail to conserve water, leading to excessive urination. It can result from Brain injuries or surgeries, tumours, infections or inflammation and aneurysms.

Nephrogenic Diabetes Insipidus

This type occurs when the kidneys fail to respond to vasopressin, causing excessive fluid loss. Common triggers include chronic kidney disease, and electrolyte imbalances, such as high calcium or low potassium levels. Additionally, medications like lithium

and urinary tract blockages can also cause Nephrogenic DI.

Gestational Diabetes Insipidus

A rare condition seen only during pregnancy, this occurs when the placenta produces an enzyme that breaks down vasopressin or increases prostaglandin levels, reducing kidney sensitivity to the hormone. Symptoms of this are usually mild and often resolve postpartum but can recur in future pregnancies.

Symptoms And Warning Signs

• Severe thirst, often leading to the consumption of over a gallon of water daily
• Frequent urination (polyuria), sometimes exceeding 20 quarts per day
• Nighttime urination and bed-wetting
• Weakness, muscle pain, and preference for cold drinks

In severe cases, dehydration may develop, manifesting as fatigue, dizziness, dry mouth, confusion, nausea, or fainting. Infants and children with DI may exhibit crankiness, poor feeding, slow growth, fever, or vomiting.

Causes And Risk Factors

DI stems from issues with vasopressin production or response. Central DI arises from damage to brain structures, while nephrogenic DI relates to kidney dysfunction. Risk factors include:

- Genetic mutations affecting water regulation

- Certain medications like diuretics or lithium

- Metabolic disorders that alter calcium or potassium levels

- Brain injuries or surgeries

Diagnosis And Testing

Diagnosing DI involves a combination of medical history, physical exams, and specialized tests:

- Urinalysis: Evaluates urine concentration and glucose levels to distinguish DI from diabetes mellitus.

- Blood tests: Check electrolyte, glucose, and vasopressin levels.

- Water deprivation test: Measures changes in weight, blood sodium, and urine concentration during fluid restriction.

- MRI: Detects abnormalities in the hypothalamus or pituitary gland.

- Genetic screening: Identifies inherited risk factors.

Although DI is rare, affecting about 1 in 25,000 people, early diagnosis and targeted treatment can significantly improve quality of life. Researchers continue to explore its causes and treatments to better support those living with this challenging condition.

Longevity expert and multi-billionaire Bryan Johnson has revealed another health condition affecting him. This time, it is meibomian gland dysfunction (MGD).

Johnson also said that the largely asymptomatic condition affects nearly 90 percent of adults over 40. The condition can "lead to permanent eye damage" and also affects younger people because of increased exposure to screens.

“I just learned that I have meaningful meibomian gland dropout. This is why my eyes are irritated,” Johnson said in a post on social media platform X.

“The dropout leads to evaporative dry eye disease, which triggers vision degradation such as blurred text, glare at night, light sensitivity, and neuropathic ocular pain. Left long enough, it can scar the cornea and permanently damage vision,” he added.

What Is Meibomian Gland Dysfunction?

Meibomian gland dysfunction happens when the tiny oil glands in the eyelids become blocked or produce poor-quality oil. This prevents enough oil from reaching the tears, causing them to dry up too quickly.

Major triggers include aging, hormonal shifts, screen use, and skin or eye inflammation, according to Cleveland Clinic.

Johnson explained that there are about “60 meibomian glands per eye, split across the upper and lower lid. They are like pores, secreting nourishing oil (meibum) onto your tear film to prevent rapid evaporation.”

He noted that the glands can become dysfunctional due to conditions or factors including "age, androgen deficiency, menopause, hormone replacement, oral contraceptives, isotretinoin, antihistamines, SSRIs, tricyclics, beta blockers, diuretics, anticholinergics, preserved eye drops, incomplete blinking, reduced blink rate, screen use, contact lens wear, and ocular rosacea".

When these glands become clogged, the meibocytes can die, and the gland can eventually drop out. Johnson said conventional medicine considers total gland dropout irreversible.

Why Can MGD Go Unnoticed?

Importantly, Johnson said that MGD can remain asymptomatic during its initial stages. When symptoms appear, the condition can resemble ordinary dry eye, allowing it to worsen and lead to permanent gland dropout.

Advanced MGD can also numb the cornea, further masking subjective symptoms as the disease progresses.

How Did Bryan Johnson Detect MGD?

Johnson's MGD was detected after he went to the doctor for a chalazion or stye, a painful, red bump on the edge of the eyelid.

He also mentioned undergoing diagnostic tests, including the Schirmer test and infrared meibography.

How Is Johnson Treating MGD?

Johnson began treatment with in-office intense pulsed light (IPL), radiofrequency (RF), and an experimental intraductal probing, known as the Maskin protocol, to address inflammation and physically reopen clogged glands.

The eye-light device combines IPL with 630-nm red low-level light. The proposed mechanism involves stimulating mitochondrial ATP production in meibocytes and reducing inflammation around the eyes.

The probing therapy involved using 1-mm, 2-mm, and 4-mm probes, which were inserted into each gland orifice.

“My doctor then expressed my glands, using a roller device to expel any buildup and kickstart the gland’s natural expression. This is really painful. Brings you to tears,” Johnson said.

Along with IPL, RF, and probing, he was also using warm eye compresses twice a day, in the morning and at night.

“With this protocol, we’ve seen a 30% improvement in meibomian gland function (using imaging). My glands look healthier, eye irritation has lessened, my subjective symptoms have subsided, and when we probe now, we encounter minimal fibrotic resistance (popping),” he said.

Signs of MGD to Watch For

Johnson listed several symptoms and warning signs to watch for, including:

• Burning or a gritty sensation in the eyes
• Vision that blurs and then clears when you blink
• Watery eyes, as dryness can trigger reflex tears
• Red, crusty or bumpy eyelid margins
• Recurring styes
• Contact lenses becoming uncomfortable
• Symptoms worsening when using screens, travelling on planes or staying in air-conditioned environments

Any of these symptoms, particularly after age 40, may warrant a gland examination, Johnson said.

August 18 marks World Breast Cancer Research Day, a day that reminds us that every major breakthrough in cancer care has its roots in research. The medicines that are prescribed, the diagnostic technologies that we use, the targeted therapies that we offer and our growing understanding of why cancers develop and spread, are all outcomes of regular scientific research.

India carries one of the world's largest cancer burdens. According to IARC's GLOBOCAN 2022 estimates, India recorded approximately 1.41 million new cancer cases and more than 916,000 cancer deaths in 2022. Breast cancer alone was the leading cancer among Indian women and also the leading cancer overall.

India as a country, has a large and diverse patient population, significant clinical expertise, strong medical institutions and a pharmaceutical industry with enormous manufacturing capabilities. But there is a crucial gap between manufacturing what the world has already discovered and researching newer medical opportunities.

A significant proportion of cutting-edge cancer research continues to emerge from countries with substantially larger and more established research ecosystems. When scientific discoveries, new molecules, diagnostic technologies or treatment approaches are developed elsewhere, Indian patients benefit from them at a later stage.

We Need To Move Beyond A Few Centres Of Excellence

We have limited institutes that have made important contributions to cancer care and research. But considering India's population and cancer burden, the scale of research infrastructure needs to expand substantially. We need more dedicated cancer-research institutes, stronger university hospital industry collaborations, modern laboratories, biobanks, genomic databases, data-science capabilities and trained physician-scientists.

Cancer is not just one disease. It comprises of multiple biological subtypes, and the way a tumour behaves can vary significantly between individuals and populations. Therefore, India needs research that focusses specifically towards Indian patients.

Also read: Groundbreaking Experimental Vaccine May Prevent Pancreatic Cancer From Spreading, Early Trial Finds

Clinical Trials Can Be Part Of The Solution

India has a formal Clinical Trials Registry, and the registry currently records more than 100,000 trials across areas of medicine.

For eligible patients, participation in an appropriate clinical trial may provide access to an investigational therapy or treatment strategy that is not yet routinely available. Clinical trials generate evidence that can improve future treatment for thousands or millions of patients.

Also read: UK Set To Implement Stricter Protocol For Prostate Cancer Testing; Who Is Eligible To Get Tested?

Research Needs To Become A Policy Priority

We need to create an ecosystem that moves from discovery to translation to patient care. That means incentivizing research institutions and researchers, supporting young physician-scientists, strengthening public-private partnerships and making it easier for promising discoveries to move from laboratories into clinical development.

We need to have an ecosystem, where healthcare research, particularly research addressing diseases with an enormous Indian burden should receive a much greater and more targeted share of national research investment. A large, diverse population can generate valuable real-world evidence. Large patient cohorts can help researchers understand disease patterns. Indian genetic and molecular data can help answer questions that may not be adequately addressed through studies conducted in other countries.

From Manufacturing Medicines To Discovering The Next Generation Of Treatments

India has already demonstrated that it can serve the world as a pharmaceutical manufacturing powerhouse. We should look at also becoming the research hub for the world by combining our pharmaceutical manufacturing strength, clinical expertise, technology capabilities and patient population.

The opportunity is already in front of us.

What we need now is the policy ambition to implement it.

By Dr. Kapil Goyal, Consultant – Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC)

If you believe having a healthy body mass index (BMI) means you have a low risk of heart disease, you may be wrong. A new study suggests that abdominal fat may predict cardiovascular disease risk better than BMI alone.

The study, published in the Journal of the American College of Cardiology (JACC), found that failing to account for waist circumference (WC) or waist-to-hip ratio (WHR) may lead to misclassification of cardiovascular disease risk.

“Indeed, it appears that WC and WHR reclassify risk defined by traditional BMI thresholds,” said Michael J. Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.

“We saw individuals with clinically determined normal weight who had elevated central adiposity and high WHR, associating them with higher risk across most outcomes,” Blaha added.

Why BMI Alone May Not Predict Heart Risk

BMI is calculated by dividing weight in kilograms by height in meters squared and is commonly used to diagnose overweight and obesity. However, BMI does not show where body fat is distributed.

• Visceral fat surrounds the internal organs in the abdominal area and is associated with chronic conditions such as heart disease and diabetes.
• Subcutaneous fat is located directly under the skin and is not as strongly associated with these conditions.

What Did the Study Find?

The study examined whether adding WC and WHR to BMI could better predict future cardiovascular risk. Researchers looked at more than 260,000 people over an average of 20 years. They found that central adiposity could identify cardiovascular risk that BMI alone may miss.

Among people classified as having normal weight by BMI:

• 5% had high waist circumference
• 18% had high waist-to-hip ratio

• 39% had high waist circumference
• 40% had high waist-to-hip ratio

• 9% had low waist circumference
• 45% had low waist-to-hip ratio

People with normal weight or overweight who had clinically defined high WC or WHR had a 15%–50% greater risk for most heart problems.

People with obesity and low WC did not have a significantly different risk of outcomes compared with those who had normal weight and low WC, except for all-cause mortality, for which their risk was significantly lower.

“Our findings emphasize the critical role of identifying elevated central adiposity, even in individuals with a normal BMI or with a BMI in the overweight range. Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes,” said Zeina A. Dardari, lead author of the study.

“We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings,” she added.

What Were the Study's Limitations?

The researchers did not have information on several factors that can influence cardiovascular disease risk, including:

• Physical activity
• Diet
• Genetic risk for obesity

The study also included only one assessment of waist circumference and waist-to-hip ratio. This limited the researchers' ability to understand how changes in abdominal fat accumulation over time may influence cardiovascular disease risk.