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Conventional Classification of diseases Let us see conventionally how the diseases are classified: Infectious diseases Genetic diseases Nutritional diseases Endocrine diseases Mind diseases etc. Examples of Snags in Disease Classification Infectious Disease is not a Nutritional Disease

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slide1

Conventional Classification of diseases

Let us see conventionally how the diseases are classified:

Infectious diseases

Genetic diseases

Nutritional diseases

Endocrine diseases

Mind diseases etc.

slide2

Examples of Snags in Disease Classification

Infectious Disease is not a Nutritional Disease

Nutritional Disease is not an Endocrine Disease

Each disease is being attributed to one cause etc

This creates lot of problems

slide3

Reality

It is seen sometimes that

Certain hormones reverse viral encephalitis

Let us hypothesize that

Viral encephalitis is due to endocrine problem

+ viral infection

slide4

Viral Encephalitis hypothesis

At least one of the factor creating endocrine problem (genetic, drug, malnutrition, stress, improper lifestyle etc) +

One of the viral infection (West Nile virus or Japanese Encephalitis Virus or Herpes Simplex Virus or Chandipura Virus or Measles or Mumps or Chicken pox or Rubella or Cytomegalovirus or HIV etc)

slide5

Solution to the disease

If endocrine disorder precedes viral infection then

Rectifying endocrine disorder would prevent encephalitis due to all viruses,

Hypothetical solution could be preventing stress, fortified foods, sunbath or eating hypoglycaemic foods

Simple solution but complicated research

Normal Delivery

slide6

Alternative approach

Several vaccines to prevent viral encephalitis

And for each viral vaccine

Scientists may perform several studies

Yet results could be disappointing

Simple research but complicated solution

Caesarian

slide7

Prevention is better than cure

Certain diseases make patient vulnerable

Preventing the disease through vaccine for a specific disease

Means

Preventing the specific disease

As well as

Preventing several front-end events

slide8

Prenatal preventive steps to avoid adult disease

Metabolic imprinting and programming

Prenatal and early postnatal development can affect susceptibility to various adult-onset chronic diseases

http://history.enotes.com/food-encyclopedia/metabolic-imprinting-programming

slide9

Hunt for panacea

It is one of the objective of

Disease Informatics

slide10

Priors and posteriors

Health policy can not be full-proof

Unless Priors and Posteriors

Are estimated

Appropriate Health policy document can not be prepared unless

Disease Informatics shapes well

slide11

Disease denominator

Quite a low incidence rate of a particular disease is

result of the big denominator

slide12

Why big denominator?

The disease causative agent is not considered as a component.

It is assumed that it is the whole story

Diseases are really complex

http://www.wordinfo.info/words/index/info/view_unit/1/?letter=B&spage=3

slide13

Component  Sufficient

Component to which

Population exposed is

Part of sufficient causal mechanism

Prof. Kenneth Rothman

Button is not sufficient cause to switch on or switch off the light.

slide14

Sufficient causal mechanisms.> 1

Sufficient causal mechanisms could be more than 1

Component investigated may not share all mechanisms

By Kenneth J. Rothman and Sander Greenland

Prof. Sander Greenland

Three sufficient causes of disease.

slide15

No wiring no switching on of bulb

Encephalitis associated with viruses (Bulb lights)

Occurs in those individuals

Who are predisposed (wiring is completed)

And one of the several viruses (button)

Triggers the disease (Switch on the bulb)

slide16

Why newer viruses emerge?

Examine priors

Viruses can not emerge outside the host

Antioxidant deficiency in host could lead to emergence of new viruses

Dr. Melinda Beck

http://www.jacn.org/cgi/content/abstract/20/suppl_5/384S

slide17

Disease Definition

The disease definitions require set of

intersection of some factors (component causes)

as denominators to

make the definition complete

slide18

What is seen in viral encephalitis?

Most of the encephalitic diseases attributed to viruses

Have low incidence because

Virus is not enough to cause the disease

But it may be required

InSouth Africa a large outbreak of west Nile affected an estimated 18 000 peopleof all ages, yet only one case of encephalitis was reported.

http://bmj.bmjjournals.com/cgi/content/full/326/7394/865

slide19

Component and sufficient causes

Which component causes come together (?)

To make sufficient causal mechanism for disease (?)

This is the challenge in Spatial Epidemiology and

For the Disease Informatics Groups

slide20

Requirement of team effort

Define complex diseases thereby

Identifying all the targets to combat disease and

Design a holistic solution

slide21

Disease features

The disease as it is understood today has

Shared + Variable features

slide22

Conventional disease definition

The universally shared features as against spatiality are

generally considered for diseases definition, however

the most optimum solutions are spatiality dependent

shared by local people than universal

slide23

Communicable diseases

In case of communicable diseases

The conventional approaches to have the definition of disease in 3 phases

Suspected, Probable and Confirmed and

Arriving at a single cause (!!!)

slide24

Why modern approach?

Conventional approach has

Yet to generate feasible solutions for

Most of the real life health problems

slide25

Rigid Disease Definitions

One cause- one effect

It is like expecting honesty from an individual

Who has undergone a forced marriage

slide26

Where lies the solution?

Considering simultaneously

The non-communicable components of the disease

Could really change this picture and

Help in designing the health strategy

slide27

Multiple morbidities

Sufficient cause approach could be

fruitfully used if role of multiple morbidities in the outcome is precisely recognized

slide28

Components working together

It is not A + B

It is A + B + AB

slide29

An interaction can override any main effects

When there is an interaction along with main effects, we must reexamine the main effects to see if they are really worth paying attention to.

Famous statistician Keppel quoted by M. Plonsky

slide30

Factors working together

Statistical interaction isa property of which linear model the researcher selects, nota property of the population, risk factors, or outcome.

http://ajp.psychiatryonline.org/cgi/content/full/158/6/848

slide31

Defining the diseases

The purposes of defining the diseases are

To understand exactly what those are

So that those are prevented or reversed

slide32

The basis of Disease Informatics

To operate on the fact that

“Most outcomes — whether disease or death — are caused by

A chain or web consisting of many component causes”

This has been denoted as Disease Causal Chain (DiCC)

slide33

Modern Epidemiology

Epidemiologists Rothman and Greenland emphasize that the

"One cause − one effect" understanding is

A simplistic misbelief

slide34

Baseline for Disease Informatics

“Existence of chain or web consisting of many component causes”

Connotes lot of information and

Could be difficult to handle manually

Here goes the role of information scientists

slide35

Gurus

Drs. Abhay and Rani Bang and their colleagues have

Successfully provided solutions to several health problems

By performing on multiple morbidities

Dr. Abhay Bang of Gadchiroli

slide36

Approach

After identifying several causes of an infant death and having realized that prevention of any cause could have saved the infant, Abhay and Rani Bang started working to solve the riddle.

slide37

www.indianngos.com/districts/gadchiroli.htm

Gadchiroli

The Gadchiroli approach could be fruitfully used if

Role of multiple morbidities as pointed out by

Drs. Bangs and their colleagues

in the outcome is precisely recognized

Dr. Rani Bang

www.ashoka.org

slide38

Bayesian again

To tackle the problem of Multiple morbidities

Multiple hypotheses are required

Alternatively,

Disease Complex needs to be defined

Rather than several simple diseases

slide39

Disease burden

Burden of several diseases rely on

Certain backend events of Disease Causal Chain

slide40

Backend vs. Frontend measures

Frontend event measures are like

Pruning the branches of disease tree while

Backend event measures uproot the tree

slide41

Disease Causal Chains

The Disease Causal Chains should be studied as

A spatial epidemiological problem for

All the diseases together

Present in the locality.

slide42

Solving problem of Disease Complex

Disease Causal Chain

It could be developed as powerful technique

To handle disease complex

slide43

Target identification

Disease Causal Chain displays

Several targets to solve health problem

And not just the one

slide44

Antiviral Investigation

HTS antiviral assays on New Chemical Entities

These assays does not nullify

The traditionally established utility of certain formulations

slide45

What is neglected?

The ability of

Traditionally established remedy to alter

Disease Causal Chain

Dr. Raghunath A Mashelkar

slide46

Who suffers?

Patients are deprived of

Several nutraceuticals and functional foods or

Lifestyle modalities capable of

Preventing or reversing the viral disease

Dr. V Prakash

slide47

Side effects

Patients of viral diseases are subjected to

Consuming drugs having

Tremendous side effects

Nutraceuticals and functional foods

Have lesser side effects

slide48

Disease Informatics

It is the application of Information Science in

Defining the diseases with least error,

Identifying most of the targets to

Combat a cluster of diseases

(Disease Causal Chain) and

Designing a holistic solution

(Health strategy) to the problem

Depending the severity of the disease

slide49

Reference

  • Disease informatics for setting up Disease definition, drawing Disease Causal Chain / Web, marking Risk Events, Backend and Frontend Events, and Health Problem Solutions

http://bmj.bmjjournals.com/cgi/eletters/331/7516/566#134452

slide50

Thank you

This presentation is dedicated to Dr. Ulhas V Wagh