WHO for use of devices to test multiple diseases

A single device can diagnose Tuberculosis, HIV and Hepatitis

The World Health Organization (WHO) on Tuesday released new advice to countries,

recommending the use of multi-disease testing devices for Tuberculosis, HIV and Hepatitis.

A single device called the GeneXpert can be used to diagnose TB and HIV infections, and

quantitatively measure HIV and hepatitis C viral loads. India recently procured 600

GeneXpert machines for the National Tuberculosis programme.

The WHO is recommending use of these state-of-the-art portable machines the size of a

microwave oven, which can run molecular tests. However, most countries do not use them

for multi-disease testing.

“Any good health system must have the capacity to do several tests that are of importance.

Currently, we are mostly investing in single disease testing technologies, while there is great

potential to use the same platform for multiple conditions.” said Prof Madhukar Pai, Canada

Research Chair in Epidemiology & Global Health.

Single platform

“With the power and adaptability of molecular technologies, we are in an era of great

advancement for the rapid diagnosis of many diseases using single platforms,” said Dr Mario

Raviglione, Director of WHO’s Global TB Programme. “These platforms offer technical and

financial efficiencies to countries in their disease control efforts, while expanding access to

care.”

GeneXpert machines — initially procured by countries for the detection of TB and rifampicin

resistance, following an initial WHO recommendation in December 2010 — were

subsequently expanded for use in early infant diagnosis of HIV and viral load testing using

relevant cartridges in the same device.

“We encourage countries to use multi-disease platforms for testing of HIV, TB and hepatitis

as much as possible and feasible,” said Dr Gottfried Hirnschall, Director of WHO’s

Department of HIV and Global Hepatitis Programme.

“Multi-disease devices can increase system efficiencies and improve access to testing for

patients in need. Such devices can also help overcome specific challenges in diagnosis and

treatment, such as HIV early infant diagnosis and viral load monitoring for both HIV and

hepatitis,” he said.

Source: The Hindu

My baby can't swallow: PGI gets 250 cases a year

New-borns who discharge a lot of saliva, breathe with difficulty, and can't take in 

feed need to be checked for a common birth defect--incomplete food pipe--of 

which the PGI receives 250 surgical emergencies a year from around the north region.

The medical term for it is trachea-oesophageal fistula (TEF)--a condition 

characterised by abnormal communication between the oesophagus (food pipe) 

and the trachea (windpipe). It may be congenital (present since birth) or acquired 

(developed due to some disease). The elite medical institute in Chandigarh has 19

 new-borns in its surgical intensive care unit (ICU) who have TEF and associated 

anomalies.And this is the highest number at any given time in India.

Congenital TEF is a common abnormality of the upper respiratory and digestive 

tract, affecting 1 in 3,000 births with increased risk in case there's also family 

history of this defect.The causes range from chromosomal abnormalities and 

environmental factors. The TEF may lead to other organ abnormalities--of the 

heart (13-34%), backbone (6-21%), limbs (5-9%), anus and rectum (10-16%), 

and kidneys (5-14%).

The affected babies need a vigilant paediatrician (child doctor) or a GP (general 

practitioner) who can refer them to a paediatric (child) surgeon.“The PGI gets 

so many cases of TEF because the defect has a large catchment area in north 

India--covering Jammu and Kashmir, Punjab, Himachal Pradesh, Haryana, 

Uttarakhand, and parts of western Uttar Pradesh,“ PGI's paediatric surgery 

department head Dr Ram Samujh said. “Many of these states are devoid of 

expert child surgeons to deal with these cases.“

Child surgeon Dr JK Mahajan recommends long-term follow-up with periodic 

X-ray tests to TEF babies, because they run a risk of developing gastrooesophageal 

reflux (in which stomach contents retreat to the food pipe), recurrent cough 

and chest infections, and tightening of the food pipe. It requires surgery and upper 

GI endoscopy (a look inside the food pipe).The survival of the operatedupon 

babies depends upon prematurity , birth weight, and associated organ abnormalities.

Instead of a complete food pipe, the TEF babies have two pouches (upper and lower) 

separated by a gap. Common types include a blind-ended upper pouch (not connected 

normally to the stomach) and a lower pouch connected to the windpipe.

Source: The Times of India

81 lakh lesser tobacco consumers since 2010

India has 81 lakh lesser tobacco users today than it had in 2010 with the overall prevalence of

tobacco use falling significantly by six percentage points in the past seven years. Relative

reduction measured by the fall in the number of people consuming tobacco has been much

higher at 17 per cent over this time.

The Global Adult Tobacco Survey India 2016-17 reveals massive gains for India’s anti tobacco

efforts, revealing relative reduction in tobacco use by 33 per cent among 15 to 24

year olds and by 54 per cent among minors (15 to 17 years).

A major finding is the delay in the age of initiation into tobacco use by a year between GATS

1 (2009-10) and GATS 2 (2016-17). “There is an increase of one year in the mean age of

initiation of tobacco use from 17.9 years in GATS 1 to 18.9 years in GATE 2,” says the

survey conducted on the Health Ministry’s behalf by the Tata Institute of Social Sciences,

Mumbai.

The study shows Indian adults are using smokeless forms more over smoking forms of

tobacco.

Khaini, bidi and gutkha are the most commonly used tobacco items by Indian men while

women are using betel quid with tobacco, tobacco for oral application and khaini in the order

of preference.

“Smoking is largely a problem among men but smokeless forms are being used by both men

and women,” Dr T. Sunder Kumar of TISS, the lead researcher, said.

In terms of numbers, 26.7 crore (28.6 per cent) adults (everyone above 15 years) are currently

consuming any form of tobacco in India. More people use smokeless tobacco. “Every fifth

adult (19.9 crore people) uses smokeless tobacco and every 10th adult (10 crore) smokes

tobacco,” says the survey. Significantly, tobacco use remains more of a rural phenomenon

with 19.9 crore adults using it as against 6.8 crore in urban areas.

Experts say the findings are consistent with the government’s anti-tobacco policies, including

the recent decision to have 85 per cent of tobacco package area on both sides covered with

pictorial warnings and a previous decision regarding a pan-India ban on gutkha.

The survey shows pictorial warnings are working with 55 per cent smokers and 50 per cent

smokeless tobacco users admitting to have planned quitting tobacco. There is, however, no

change in levels of exposure to second-hand smoke at Indian workplaces despite the survey

reporting lesser exposure in homes.

Survey findings reveal gains

Between 2009-10 and 2016-17, the prevalence of tobacco use in India fell by 6% points

Prevalence down among 15 to 24 year olds from 18.4% to 12.4%. Mean year for tobacco

initiation up from 17.9 to 18.9

Expenditure on cigarette has tripled in 7 years and on bidi and smokeless forms doubled. 

Source: The Tribune

Rare mutations of gene inspire new heart drugs

What if you carried a genetic mutation that left you nearly impervious to heart disease? What
if scientists could bottle that miracle and use it to treat everyone else?

In a series of studies, the most recent published on Wednesday , scientists have described two
rare genetic mutations that reduce levels of triglycerides, a type of blood fat, far below
normal.People carrying these genes seem invulnerable to heart disease, even if they have
other risk factors.

Drugs that mimic the effects of these mutations are already on the way , and many experts
believe that one day they will become the next blockbuster heart treatments. Tens of millions
of Americans have elevated triglyceride levels. Large genetic studies have consistently
suggested a direct link to heart disease.

Added to the existing arsenal of cholesterol-reducers and blood pressure medications, the
new medications “will drive the final nail in the coffin of heart disease,“ predicted Dr. John
Kastelein, a professor of vascular medicine at the University of Amsterdam who was not
involved in the new research. These experimental triglyceride-reducers are in early stages of
development, however, and human trials have only just begun.

At the moment, the optimism of researchers is rooted less in clinical trial data than in the fact
that nature has produced strong evidence they should work. Finding people who are
impervious to a disease like heart disease can open a door to letting the rest of the population
share their genetic luck.

“It's a huge advance,“ said Dr. Christie Mitchell Ballantyne, chief of cardiology and
cardiovascular research at Baylor College of Medicine and a consultant for Regeneron
(although not for the triglyceride studies). “That doesn't mean it's easy .“ Still, he added,
“what we are seeing is a new approach toward drug development.“

Source: The Times of India

Coming soon: Clinical trials transparency

Big Funders Decide To Make Results Public
 

Some of the world's largest funders of medical research, including Indian 

Council of Medical Research (ICMR), UK Medical Research Council 

and international organisations like PATH and Bill and Melinda Gates 

Foundation, have decided to make public results of all clinical trials funded 

and supported by them.

This assumes significance as almost half of clinical trials go unreported currently. 

Moreover, the move will enhance access to crucial data which can be useful 

in advancement of medical research. The decision is part of an agreement on 

standards, framed by the World Health Organisation (WHO), signed by the 

agencies at the ongoing United Nations' World Health Assembly in Geneva. 

Health Minister J P Nadda and senior officials from the health ministry are 

attending the Assembly where delegates from health groups and civil society 

from across the world are present.

The research institutes and other funding agencies agreed to develop and implement 

policies within the next 12 months that require all trials they fund, co-fund, 

sponsor or support to be registered in a publicly-availa ble registry. They also agreed 

that all results would be disclosed within specified time-frames on the registry or by 

publication in a scientific journal.

“We need timely clinical trial results to inform clinical care practices as well as 

make decisions about allocation of resources for future research,“ said Dr Soumya 

Swaminathan, DG of ICMR. “We welcome the agreement of international 

standards for reporting time-frames that everyone can work towards.“

Most of these trials and their results will be accessible through WHO's International 

Clinical Trials Registry Platform, a unique global database of clinical trials that 

compiles data from 17 registries around the world, including the US' clinicaltrials.gov, 

the EU's Clinical Trials Register, the Chinese and Indian Clinical Trial Registries and many others.

Experts say unreported trial results leave an incomplete and potentially misleading 

picture of the risks and benefits of vaccines, drugs and medical devices, and can lead to 

use of suboptimal or even harmful products. A common registry is expected to solve this 

problem. “Research funders are making a strong statement that there will be no more 

excuses on why some clinical trials remain unreported long after they have been 

completed,“ said Dr MariePaule Kieny, Assistant Director-General for Health Systems 

and Innovation at WHO.

Source: The Times of India

Making brain surgeries more cost-effective

Bengaluru doctor designs low-cost stereotactic head frame

In brain surgeries, precision is everything — a shift of a few millimetres can make the

difference between a successful surgery and putting a patient in coma. One device that

improves the accuracy of neurosurgery is the stereotactic head frame, which provides 
a 3- dimensional coordinate system to help surgeons get the precise location of a nerve 
or tumour in the brain.

However, the device currently used is prohibitively expensive, costing between  
₹75 lakh to ₹1 crore. A city-based doctor has designed a low-cost stereotactic 
frame which can be used to operate on both sides of the brain at a time, unlike 
conventional  frames currently used in hospitals.

The frame designed by Murali Mohan, senior neurosurgeon with BRAINS Sparsh 
Hospitals, is made of medical grade titanium and costs one-third the current price. 
Engineers Sharath Bhat and Sadashiv Bhat of the Mahalasa Medical Technology, 
Bengaluru, developed the device.

Dr. Mohan's inspiration was the late Balasubramaniam Ramamurthi, known as the 
father of Indian neurosurgery.

The frame which is CE marked (it conforms to European standards) and is pending 
patent, is currently being used by a doctors in around six to seven hospitals in 
Bengaluru and Hyderabad for biopsies and deep brain simulations.

Source: The Hindu