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VAIDHYA


VAIDHYA India’s first video magazine of medical fraternity

A comprehensive knowledge sharing video series for Govt. doctors

VAIDHYA


Editor’s Note Dear Doctors, Seasons Greetings!

We

take this opportunity to introduce M/s Temple Bell infotainment, a leading television and media production company having over a decade experience in producing medical related documentaries to leading national and international television channels. From path breaking treatment procedures to critical surgeries, we have showcased India’s medical science capabilities to the world. In fact some of our programs are used as testimonials to attract International patients to India to avail treatment thus boosting the medical tourism . In our endeavor to create an innovative and path breaking programs, we are pleased to announce the launch of monthly Medical magazine VAIDHYA an exclusively published for Karnataka state Govt. Medical doctors. Vaidhya is one of its kind, India’s first hybrid magazine for medical fraternity. Published every month, Vaidhya magazine is distributed with a video DVD featuring latest trends in medical treatment and diagnosis in India. From surgeries to medical science to latest equipments, the new magazine will help the professionals to get to know the latest developments in the medical field. With eminent experts from medical fraternity as advisers, the content is exclusively produced for the magazine. The program features critical and innovative surgeries, treatments coupled with views from performing doctors. We humbly requests for your continues support to spread the knowledge among the fraternity Enjoy the Issue

- S B Sanjay Kumar

Published by : Temple Bell Infotainment, Bangalore , India Ph: 91 98450 76400

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Anna Hazare, UT Khader awarded with Gandhi DarKarnataka Govt. ready to hire private doctors as conTechnique Developed to Control Cervical Cancer liS remodiLung Transplant Patients May Fare Better With Larger OrBooming Medical Tourism in India Brief Fever Common in Kids Given Influenza, Pneumo-

NABH Accreditation Standards

INDEX

The changing scenario of Healthcare IT in 2014

GE Healthcare announces collaboration to accelerate inUnion Health Minister Lays Foundation Stone for New Facilities in AIIMS Government to Track Mother and Child Health Armed Forces Medical College proposes PG course in Delaying Dialysis Now Recommended for Chronic Kidney Health Statistics - India

Causes of Blindness In India Breakthrough in DNA Mutations will Improve TB and Cancer Working Towards Healthier India

Study Suggests Fertility in Women Linked to Their ImWhat is Osteomyelitis? India Celebrates three years without Polio Another Possibility at Life Bone Marrow Transplants Skin Cancer Can Strike Anyone Rajya Sabha Introduces Bill to Protect HIV Patients from Discrimination Survival of Breast Cancer Predicted by 55 Genes Linking to a Powerful Tumor Suppressor Blood Vessel Plaques Exactly Identified by Nanoparticle VAIDHYA


Anna Hazare, UT Khader awarded

with Gandhi Darshan

Anti corruption activist Anna Hazare and Karnataka minister for health and family welfare U T Khadar have been honored with the Gandhi Darshan awards and by a Thiruvananthapuram based Media Research Institute here at the Putharikandam Maidan in Thiruvananthapuram on Wednesday, January 29. The Gandhi Darshan award given to Mr. UT Khader was shared by renowned Malyalam writer T P Rajeevan.

Anti-corruption activist Anna Hazare also spoke on the occasion and said that to receive an award named after Gandhiji was more honorable than even Padma shri awards. He stressed on the need to develop villages and said -The nation will not develop unless the villages develop.” “We should always remember our freedom fighters and their struggle even if we were not part of it or we have not witnessed it,” he added.

The awards ceremony was inaugurated by AoL spiritual guru Sri Sri Ravishankar. Addressing the gathering, Sri Ravi Shankar said : -In this country, we honour people who have selflessly served the nation. There are three qualities such persons should possess: clarity in mind, purity in action and spontaneity of action,’’

Anna Hazare was given the Special Jury Lifetime Achievement Award while health minister Mr. UT Khader was honored with the Gandhi Darshan award along with Malayalam writer and journalist TP Rajeevan for rural health and literature, by the hands of Sri Ravi Shankar.

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Karnataka Govt. ready to hire

private doctors as consultants Minister for Health U.T. Khader on Monday told the Legislative Council that the government is ready to hire the services of private doctors, on consultancy basis, in hospitals that do not have specialists.

“We are ready to hire them even if they want to work only twice a week.” Replying to BJP member Bharathi Shetty during Question Hour in the Legislative Council, the Minister said the government was willing to pay private doctors either on the basis of number of hours or the number of patients attended by them. Government is also considering providing opportunities for doctors to take up postgraduation in a bid to attract them to government service In addition, the Vijayanagar Institute of Medical Sciences (VIMS), Bellary and Kempegowda Institute of Medical Sciences (KIMS), Hubli will be upgraded at a total capital cost of Rs.150 crore each under the Central government sponsored scheme of ‘Pradhan Mantri Swasthya Suraksha Yojana’ (PMSSY). The Union government will provide Rs. 120 crore towards this capital expenditure. Proposals have been submitted to the Union government to establish Tertiary Care Cancer Centres at the Institute of Medical Sciences in Mandya and Gulbarga for which the approval is awaited. In addition, the State has submitted to Centre for an assistance of Rs. 120 crore towards upgrading infrastructure of the Kidwai Memorial Cancer Institute.

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A group of researchers from Mexico’s General Hospital, Health Secretariat, Medicine Faculty and the Institute of Cellular Physiology of the National Autonomous University of Mexico (UNAM) identified a therapeutic target for cervix cancer: gene CDKN3. The researched performed at the lab indicates that when this gene is blocked in culture cancerous cells, the neoplastic proliferation greatly diminishes. Jaime Berumen Campos, who coordinates the research said that this gene is blocked by a “siRNA” (small interference RNA), molecular technique applied to several strands of cervix cancer cells making them incapable of proliferating, and confirmed that tumors in mice stopped growing. To achieve this, researchers first analyzed eight thousand and 638 genes in 43 samples of cervix cancer cells, identifies six suspect of making cervical cancer grow. One of these genes is CDKN3, which apparently is the most important, given that its activity was highly elevated in most of explored cancers. Later, clinical evolution of 42 patients was studied during five years, and was found that when CDKN3 is very active, patients have little survival, Berumen Campos explained, who because of this research won the Award of Medical Research “Dr. Jorge Rosenkranz” 2013, in the clinical area. “70 per cent of the patients with a high activity of this gene, died less than two years of developing the illness, meanwhile only 15 per cent of patients with a low activity of this indicator died while the study was being performed”.

Technique Developed to Control Cervical Cancer lis remoditius Experimentation in culture cells and observation in women with cancer, indicate that this gene is linked to the aggressiveness and malignant growth of the tumor. Besides, the findings indicate that this gene could be a good therapeutic target, meaning, that overriding its primary function (promoting cellular growth), it would be possible to diminish the proliferation of tumors in women.

Cervical cancer is treated by surgery, chemo and radiotherapy or a combination of all the above, according to the clinical stage. The success and survival diminish as the disease advances. The percentage of women who survive five years is reduced by 93 percent in the first stage, and to 15 percent in the fourth stage. Contrary to other types of cancer, for which drugs against specific molecular targets exist, this have not been developed for cervical cancer. Finally, Berumen Campos said that this found methodology still requires clinical trial and validation, but preliminary results look promising and will become an important tools for oncologist to identify women with cervical cancer that have a high risk of dying in less than two years and, therefore, require a more intense medical treatment.

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Lung Transplant Patients May Fare Better With Larger

Organs

A higher predicted total lung capacity ratio, suggestive of oversized donor lungs, is associated with improved survival following lung transplantation, primarily among patients who undergo double-lung (bilateral) transplants, according to a new study in the August 2013 issue of The Annals of Thoracic Surgery.x “An unresolved question in the field of lung transplantation is how the size of the donor lungs relative to the recipient affects transplant success,” said lead author Michael Eberlein, MD, PhD, from the University of Iowa Hospitals and Clinics in Iowa City. “It is commonly believed that transplanting oversized lungs is problematic, but no data were available to substantiate that idea.”

Among patients in the BLT group, each 0.1 increase in the pTLC-ratio was associated with a 7% decrease in the risk of death at 1 year post-transplant. This decrease was independently associated with improved survival following additional adjustment to account for any bias from oversizing. Among SLT patients, each 0.1 increase in pTLC-ratio was associated with a 6% decrease in the risk of death at 1 year post-transplant; however, this association was not present following the same additional adjustment to account for any bias from oversizing. “Our study suggests that transplantation of oversized lungs does not compromise patient survival; on the contrary, we found that oversized allografts, up to a point, were associated with improved survival after lung transplantation,” said Dr. Eberlein. “We would hope that recipients, within surgically feasible limits, could be listed for higher donor height ranges and ultimately have a better chance of receiving an acceptable donor lung.” Need for Standardized Method of Matching Lung Donors

Currently in the United States, lung transplant candidates are listed by designated donor height ranges, as height is used to estimate lung size. Another way to determine organ size matching is by using a “predicted total lung capacity” (pTLC) ratio. The pTLC is estimated by height and sex. Taller people have larger lungs, and a man’s lungs are larger than lungs in a woman of the same height. The pTLC-ratio is determined by dividing the donor’s pTLC by the recipient’s pTLC. A ratio of 1.0 is a perfect size match, whereas, for example, a ratio of 1.3 indicates that the donor lung is significantly larger than the recipient’s lung. Dr. Eberlein and colleagues used data from the United Network for Organ Sharing (UNOS) lung transplant registry for all adult patients (aged 18 years and older) who underwent first-time lung transplantation between May 2005 and April 2010. Of the 6,997 patients included in the study, 4,520 underwent bilateral lung transplant (BLT) and 2,477 underwent single lung transplant (SLT).

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“Utilizing a methodology that has some data behind it, as opposed to matching by height, may actually increase utilization of lungs by allowing centers to feel more comfortable with significant size discrepancies between donor and recipient lungs,” said Dr. Force. “The data in this manuscript make a compelling argument for the lung transplant community, as well as UNOS, to consider changing to a pTLC method for lung sizing for listed patients.


Booming Medical Tourism in India

India as a global healthcare destination. Consequently, it is expected that the country’s medical tourism market will grow at a CAGR of over 26% during 2011-2013. India is a perfect destination for medical tourism that combines health treatment with visits to some of the most alluring and awe-inspiring places of the world. A growing number of tourists are flocking in large numbers because of the superlative medical care, equipments and facilities that India offers.

Government hospitals, some of which are among the best hospitals in India, provide treatment at taxpayer expense. Most essential drugs are offered free of charge in these hospitals. Government hospitals provide treatment either free or at minimal charges. For example, an outpatient card at AIIMS (one of the best hospitals in India) costs a onetime fee of rupees 10 (around 20 cents US) and thereafter outpatient medical advice is free. In-hospital treatment costs depend on financial condition of the patient and facilities utilized by him but are usually much less than

India excels in providing quality and cheap health care services to overseas tourists. The field has such lucrative potential that it can become a $2.3 billion business by 2012. Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with “raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties�. The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.

the private sector. For instance, a patient is waived treatment costs if he is below poverty line. Another patient may seek for an air-conditioned room if he is willing to pay extra for it. The charges for basic inhospital treatment and investigations are much less compared to the private sector. The cost for these subsidies comes from annual allocations from the central and state governments

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Brief Fever

Common in Kids Given Influenza,

Pneumococcal

Vaccines Together

Giving young children the influenza and pneumococcal vaccines together appears to increase their risk of fever, according to a study led by researchers from Columbia University Medical Center (CUMC) and the Centers for Disease Control and Prevention (CDC). However, the fever was brief, and medical care was sought for few children, supporting the routine immunization schedule for these vaccines, including the recommendation to administer them simultaneously. The study, which looked at children 6-23 months old, was published online on Jan. 6, 2014, in JAMA Pediatrics. Public health experts agree that timely immunizations are an important means of protection against serious diseases and infections for people of all ages. The CDC and other medical professional organizations often recommend giving the influenza and pneumococcal vaccines at the same visit, if both are due – both to prevent getting influenza or other infections between visits and to avoid a possible delay in vaccinations due to difficulty returning to the clinic (because of work schedules or other competing priorities).

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“While our data suggest that giving children the influenza and pneumococcal vaccines together at the same visit increases the risk of fever, compared with getting only one of the vaccines at the visit, these findings should be viewed in context of the benefit of vaccines to prevent serious illness in young children, as well as the recognized need to increase vaccination rates overall,” said Study first author Melissa S. Stockwell, MD, MPH, Florence Irving Assistant Professor of Pediatrics and Population and Family Health at Columbia College of Physicians and Surgeons, with a joint appointment at Columbia’s Mailman School of Public Health. “Parents should be made aware that their child might develop a fever following simultaneous influenza and pneumococcal vaccinations – but that the benefits of these vaccines outweigh the risk of fever and, in most cases, the fever will be brief,” said Dr. Stockwell. “For the small group of children who must avoid fever, these findings provide important information for clinicians and parents.” The study followed 530 children recruited during the 2011-2012 influenza season from three community-based clinics affiliated with NewYork-Presbyterian /Columbia University Medical Center, who were receiving their usual vaccinations.


Parents received a text message on the night of vaccination and the seven subsequent nights, asking them to report the highest temperature in their child since the temperature had last been taken. Messages were sent in English or Spanish, based on parent preference. More than 90 percent of families who were confirmed to have received a text message on the day of or day after vaccination responded to the message, and 85 percent of parents reported being very satisfied with their participation in the study. After controlling for age and other factors, among children who received simultaneous influenza and pneumococcal vaccines, about a third (37.6 percent) had a fever of 100.4 F (38 C) or higher on the day of or day after vaccination, compared with children who received only the pneumococcal (9.5 percent) or only the influenza (7.5 percent) vaccine. In other words, children receiving the influenza and pneumococcal vaccine together were about three times as likely to have a fever on the day of or day after vaccination, compared with children who received either vaccine alone. There were no differences among the groups in rates of fever in the 2?”?? days after vaccination. Overall, for every 100 children there were an additional 20-23 cases of temperatures of 100.4 F (38 C) or higher in childrenwith simultaneous influenza and pneumococcal vaccination, compared with those who received only one of the vaccines.

There were also 15 additional cases of temperatures of 102.2 F (39 C) or higher in children who received both vaccines, compared with the influenza vaccine alone, but not compared with the pneumococcal vaccine. “We are committed to making sure that the safety of vaccines is continuously monitored and to better understanding any potential risks associated with vaccination,” said Claudia Vellozzi, MD, MPH, deputy director of the Immunization Safety Office at the Centers for Disease Control and Prevention, and the study’s senior author. “This study also demonstrates how novel approaches, like text messaging to assess fever following vaccination, can be used to enhance vaccine-safety monitoring.” “Before our study, text messaging had not been used to address a specific vaccine-safety question,” said Dr. Stockwell, who is also medical director of the NewYork-Presbyterian Hospital Immunization Registry (EzVac) and a pediatrician at NewYorkPresbyterian/Morgan Stanley Children’s Hospital. “Unlike conventional surveillance methods, such as paper or phone, in which reporting may be delayed, text messaging appears to enable rapid, large-scale data collection.” “These findings are a first step; the next step is to figure out if there are any measurable biological markers, such as findings in a blood sample, that are associated with increased risk of fever after vaccination,” said study co-author Philip S. LaRussa, MD, professor of pediatrics at CUMC and specialist in pediatric infectious diseases at NewYorkPresbyterian/Columbia.

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The changing scenario of Healthcare IT in

2014

Every New Year brings the promise of change, but even though it’s still early, when it comes to the world of health IT, 2013 is already bringing more change – much more change – than ever before. For providers, payers and vendors, this year is presenting opportunities and challenges.

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Analytics and business intelligence are deemed necessary to improve care and manage risk. n 2013, it will become increasingly clear that the future of healthcare for providers will revolve around being able to measure both the level of financial risk and the quality of outcomes in providing care for patients. Consequently, providers will search for technological solutions that can help them do more evidence-based medicine at the point of care. One such solution is Sandlot’s Digital Envelope, which is designed to be seamlessly integrated at the point of care, within the clinician’s normal workflow, in the electronic health record, thus providing extensive information, both claims-oriented and clinical, for a rich view of patient history.

The footprint for accountable care organizations (ACOs) takes a giant leap forward. ust consider the numbers: Not so long ago there were 32 Pioneer ACOs that had been approved by the Centers for Medicare & Medicaid Services (CMS). Then there were 89. Now, there are hundreds of organizations across the country officially designated as ACOs.

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n other words, an increasing number of healthcare organizations are taking the core tenets of healthcare reform – improve care and reduce costs – to heart. The result is a rapidly expanding landscape of alliances, consisting of providers and payers of all types, who are banding together to share the responsibility for patients.

Behavioral health gets better integrated into the broader healthcare continuum. n 2013, it will become increasingly clear that the future of healthcare for providers will revolve around being able to measure both the level of financial risk and the quality of outcomes in providing care for patients. Consequently, providers will search for technological solutions that can help them do more evidence-based medicine at the point of care. One such solution is Sandlot’s Digital Envelope, which is designed to be seamlessly integrated at the point of care, within the clinician’s normal workflow, in the electronic health record, thus providing extensive information, both claims-oriented and clinical, for a rich view of patient history.

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Healthcare organizations will be forced to band together to survive reform.

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raditionally, providers and payers alike have been reluctant at best to share patient data. But in order to provide better and more efficient care for patients, the information that has long been considered the property of one organization or another will need to be available anytime, anywhere. To give the best care, providers must know what care has been provided before, from diagnostic tests to prescriptions to recent emergency incidents.

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NABH

Q F

What are the accreditation standards in India for infection control in hospitals?

or accreditation in India, hospitals are required to follow certain standards for infection control and prevention. NABH accreditation Standards for Hospitals has an entire Chapter- Hospital Infection Control (HIC) enumerating requirements for infection control and prevention. The first thing hospitals must have is a documented Infection Control Program which requires hospitals to measure and act appropriately to prevent/ reduce Healthcare Associated Infection (HAI). No program can be made effective unless supported by adequate facilities and resources and the same hold true for an Infection Control Program. This program aims for patients, visitors and healthcare workers, and includes surveillance activities to capture and monitor data related to infection prevention and control.

Accreditation Standards

HIC 1 – The organisation has a well-designed, comprehensive and coordinated Hospital Infection Prevention and Control (HIC) programme aimed at reducing/ eliminating risks to patients, visitors and providers of care.

HIC 2 – The organisation implements the policies and procedures laid down in the Infection Control Manual.

HIC 3 – The organisation performs surveillance activities to capture and monitor infection prevention and control data.

HIC 4 – The organisation takes actions to prevent and control Healthcare Associated Infections (HAI) in patients.

HIC 5 – The organisation provides adequate and appropriate resources for prevention and control of Healthcare Associated Infections (HAI).

HIC 6 – The organisation identifies and takes appropriate actions to control outbreaks of infections.

HIC 7 – There are documented policies and procedures for sterilisation activities in the organisation.

HIC 8 – Bio-medical waste (BMW) is handled in an appropriate and safe manner.

HIC 9 – The infection control programme is supported by the management and includes training of staff and employee health.

Qdisplay their infection record?

Should hospitals be asked to furnish or

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far as NABH accreditation is concerned, hospitals are required to furnish records of infection rates and associated activities during on-site assessment. Further, NABH has defined eleven mandatory indicators including surgical site infection rate, intra-vascular device infection rate, respiratory infection rate, urinary tract infection rate for which data must be submitted to NABH every quarter.As a best practice, hospitals should display their infection rates, however there is a risk to the reputation of hospitals. Moreover, in India we do not have any such policy on that and hospitals displaying their rates might be frowned upon.Further, there is lack of awareness and the patient/public is not educated for that matter in order to comprehend infection rates, worse still compare them. In current circumstances, hospitals should be encouraged to follow best practices to prevent/ control infections to not only provide ‘Safe Care’ but also make the hospital a ‘Safe Place’.

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GE Healthcare

announces collaboration to accelerate innovation for a healthier India GE Healthcare, the US$18 billion healthcare business of General Electric Company (NYSE: GE) and Healthcare Technology Innovation Centre (HTIC), a multidisciplinary R&D center of IIT Madras today announced a three-year collaborative research and development agreement for innovating a range of disruptive and affordable healthcare solutions. Commenting on the partnership, Terri Bresenham, President & CEO, GE Healthcare, South Asia, said, “We at GE Healthcare are at work for a healthier India through development of innovative and affordable technology solutions. Accelerating innovation for affordable healthcare requires an ecosystem of partners and collaborative efforts by all stakeholders. We firmly believe that the ideas and innovations developed by the next generation of researchers will be an added benefit to the healthcare ecosystem. This collaboration between HTIC and GE Healthcare will bring together start-up dynamism and corporate scalability to healthcare innovations while putting the unserved customer at the centre of healthcare innovation”. Dr. Mohanasankar Sivaprakasam, Head, Healthcare Technology Innovation Centre, IIT-Madras said, “We at HTIC believe that a collaborative ecosystem is essential for innovative and disruptive solutions for affordable and accessible healthcare. HTIC today anchors a dynamic med-tech innovation ecosystem of healthcare institutions, industry and government agencies in pursuit of delivering high impact healthcare technologies.

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We are pleased to join hands with GE Healthcare, a healthcare technology leader with tremendous knowledge on disruptive innovations” This initiative will address the unmet and unvoiced needs in the areas of mother and child health, cardiology and cancer. GE will provide a grant of Rs. 75 Lakhs to HTIC towards research and development of these disruptive solutions that can benefit all emerging markets. The collaboration will encourage “open innovation” and leverage co-creation of solutions with the involvement of multiple stakeholders such as academia, start-ups, governments, NGOs and clinicians to achieve these goals.

“IIT Madras is proud that HTIC is partnering with GE Healthcare to address the challenges of unmet healthcare needs in India and other similar emerging economies. We need to take a completely new approach to screening, diagnosis and treatment in order to make healthcare affordable and universally accessible”, said Prof. Bhaskar Ramamurthi, Director, IIT Madras. “Making Healthcare accessible and affordable is a global challenge and requires a unique approach. Last year, during a very brief visit to the Healthcare Technology Innovation Centre (HTIC) at the IIT Madras research park, I was impressed with the work and caliber of the organization. I am extremely delighted with this partnership and am excited about the potential impact of the joint work in the Healthcare segment.” said, Gopichand Katragadda, Managing Director, John F Welch Technology Center. This partnership will combine HTIC’s Med Tech innovation ecosystem and GE Healthcare’s deep expertise in bringing disruptive innovations to address healthcare’s biggest challenges


Union Health Minister Lays Foundation Stone for New Facilities in AIIMS Union Health Minister, Ghulam Nabi Azad on Monday laid the foundation stone of two blocks at the AIIMS that will add facilities of 600 beds and 24 operating theatres at a total cost of Rs 255 crores. Together these initiatives constitute a major breakthrough in the development of AIIMS infrastructure which has come under the severe strain due to increasing pressure of teaching, research and patient care activities.

The surgical block, will be spread over an area of 17000 sq meters and will have three basements and nine floors. It will have 200 beds, 12 operation theatres, a national endoscopy centre, a high dependency unit and transplant facilities. The facilities would be constructed at an estimated cost of Rs 55 crores approximately and is expected to be ready by April 2015. Further, the state-of-the art Mother and Child block will be built over an area of about 45,000 sq meters and will also have three basements and nine floors. The block will have adequate facilities for department of paediatrics as well as obstetrics and gynaecology and will house inter-alia, 400 beds, 12 operation theatres, ICUs , day care facilities seminar halls.

The project will cost around Rs 200 core and expected to be completed in about 2 years. Also, the 6 new AIIMS and 19 institutions taken up in 1st and 2nd Phase of PMSSY would provide speciality and super-speciality care in all disciplines with a net addition of more than 11,000 beds covering 27 locations spread across the country. Azad said that the Cabinet has approved 71 new Cancer Institutes in December, 2013 at the national, state and tertiary levels. The National Cancer Institute being set up at the second campus of AIIMS at Jhajjar, Haryana at a cost of nearly Rs. 2,000 crores, an amount of Rs. 3, 200 crores has already been approved by Government of India for setting up 70 more Institutes in different parts of the country, specifically for cancer, with facilities for chemotherapy, radiotherapy and onco-surgery. The Chittaranjan National Cancer Institute at Kolkata is also being expanded with a second campus at a cost of Rs 400 crores.

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Government to Track

Mother

and Child The Mother Child Tracking System (MCTS) is a web-based service that records details of pregnant women and children up to five years and also tracks delivery of dueservices to them. The aim of MCTS is to ensure that every woman gets complete and quality pre-and-postnatal care and every child receives a full range of immunisation services, Health Minister Ghulam Nabi Azad said here while launching the service. Regular text messages would also be sent to pregnant women and parents of children to make them aware of the services due to them so they could get them. Azad said the tracking system would help gather valuable data from the states on health schemes and facilities reaching beneficiaries. Besides monitoring delivery of mother-child health services, the MCTS system would also communicate with the health workers, pregnant women and parents of young children on their mobiles. It will also generate awareness about their entitlements under various government programmes and schemes.

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Health


Karnataka allocates Rs. 6,023 crore towards

healthcare and medical education in its Budget 2014-15 The Karnataka government in its State Budget for the year 2014-15 has announced a total provision of Rs. 6,023 crore towards the departments of Health, Family Welfare and Medical Education. The portion constitutes four per cent of the total State Budget allocation of Rs. 65,600 crore. In his Budget presentation, Karnataka chief minister unveiled an initiatives like the State’s Oral Health Policy with an allocation of Rs. 2 crore which is proposed to provide free dentures to senior citizens belonging to Below the Poverty Line (BPL) category. Under ‘Mukhyamanthrigala Santhwana Yojane’ it has provided Rs. 5 crore where the government’s compensation amount of Rs. 25,000 will be given through Suvarna Arogya Suraksha Trust to road accident victims admitted to identified hospitals within the ‘Golden Hour’ to save critical cases. The State allocated Rs. 52 crore for its ‘Prasuti Aaraike and Madilu Kit programme’ under the maternal and child health segment to expand the offering to all the beneficiaries in Bidar, Gulbarga, Koppal, Raichur, Yadgiri, Bellary, Bijapur, Bagalkote, Gadag and Chamarajnagar districts. A new programme “Aaspathre Nairmalya” will be launched to encourage cleanliness of government hospitals. Ayush department has developed energy biscuits aimed at preventing malnutrition in children.

For the treatment of rare diseases like haemophilia, thalassaemia, sickle-cell anaemia and primary immuno deficiency a special unit will be set up in Indira Gandhi Institute of Child Health, Bengaluru on experimental basis to provide medicines and treatment to patients suffering from these diseases. In the area of medical education, the government has proposed to set up three 250- bed super speciality hospitals in the revenue regional headquarters at Mysore, Belgaum and Gulbarga for which it has provided Rs. 6 crore. The policy of the State is to provide one government medical college in every district in a phased manner. As part of this, it is proposed to set up six new medical colleges in Tumkur, Chitradurga, Chikkaballapur, Bagalakot, Haveri and Yadgiri districts during 2014-15 which would be in collaboration with Rajiv Gandhi Health Sciences University, said the Karnataka chief minister.

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After a very successful pilot in Punjab, Philips Healthcare’s flagship Women’s Healthcare Outreach Mobile program, Asha Jyoti, is being showcased in Delhi as a great example of a public-private partnership to address the issue of accessibility of healthcare in India. The program, run with close collaboration between Philips Healthcare, Postgraduate Institute of Medical Education and Research (PGIMER), and RADAID was launched on 22 April 2012 and has successfully screened more than 4000 women in less than 20 months. Asha Jyoti is a population-based screening program of women aged between 40 and 60 years, which aims to ensure early detection of breast cancer, cervical cancer and osteoporosis, even before the individual has any signs or symptoms. It was established as a model for preventive healthcare for semi-urban and rural areas in northern India and involved the creation of a special mobile outreach van with imaging technology and clinical referral services to efficiently and effectively address multiple care needs. The initial goal of this program was to screen 500 women in first six months and 2000 women every year thereafter. However, it has already successfully achieved its goal to provide breast cancer, cervical cancer, and osteoporosis screening to more than 4000 women.

“Our vision for Asha Jyoti was to develop a high quality, mobile screening facility to provide decentralized primary healthcare on people’s doorsteps, to detect three major diseases effecting women’s health earlier, and to provide diagnostic follow-up and therapy to the community;” commented Dr. N. Khandelwal, Professor and Head, Department of Radiodiagnosis, PGIMER. “A multidisciplinary team of health care specialists from PGIMER, formulated this program, and the teams from Philips Healthcare and RAD-AID supported the initiative to make it a reality and ensure that we reached the underserved population in the northern part of India.”

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Philips India and PGIMER Showcase Asha Jyoti in New Delhi In addition to being a model for integratin g women’s health services, the collaboration is a unique public-private partnership between government (PGIMER) entities, non-profit non-governmental organization (RAD-AID) and the private sector (Philips Healthcare).

To make the Asha Jyoti program work, PGIMER delivers the clinical services, RAD-AID is providing educational training and program planning support to health workers and staff and Philips has donated all the equipment and also donated the entire van which was designed and built in India with local suppliers. Philips India is now working on extending the program to other parts of India as well.


“While the Punjab chapter has been extremely successful, we hope that this program can be extended to other parts of India, so that we are able to help save more lives by detecting cancer at an early stage,” added Dr. Khandelwal. The design of the Asha Jyoti van itself is exemplary, keeping in mind the need to reach the remotest areas of India. Built by Philips Healthcare, the van uses trailer with double axle to meet the tough Indian road conditions. It has a horse-cart structure so that the truck can negotiate in narrower turns as compared to single bus-like chassis. The van has been compartmentalized in radiation area and nonradiation area. The workflow has been optimized through this division such that time taken during cervical examination is equivalent to time taken for breast and bone scans – this allows screening of two women simultaneously.

The van is supported by air suspension to avoid damage to the equipment. The van has three options of power sources – external power supply, 30kV generator and a set of batteries. The robust van design has allowed use of the van across cities and rural areas around Chandigarh.

The mammograph unit on board is a digital mammograph that obviates the need of any film chemistry and provides highest resolution images. It also provides only a fraction of usual mammography radiation because of special detection technology used in the Philips mammography unit. The cervical cancer screening is being done with a new technique. The usual screening using acetic acid (vinegar) is pictured using a colposcope at various intervals and using green filter. These pictures are cross-checked by gynecologists at PGIMER for validation of the findings of the colposcopy technologist on board.

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The guideline panel recommends an “intent-to-defer” strategy over an “intent-to-start” early approach, in which patients with an estimated glomerular filtration rate (eGFR) below 15 mL/ min per 1.73 m2 are closely monitored by a nephrologist. Dialysis is initiated when clinical indications emerge or the eGFR is 6 mL/min per 1.73 m2 or less, whichever of these occurs first.

Delaying Dialysis Now Recommended for Chronic Kidney Disease

The recommendation is based on evidence from 23 studies, including the Initiating Dialysis Early and Late (IDEAL) study, a large recent clinical trial that looked at survival rates, costs and other factors in early versus deferred start of dialysis. The study also found that there were substantially higher costs per patient with early initiation of dialysis.

“There was no detectable evidence of benefit with intent-to-start-early as compared with intent-todefer dialysis for mortality, quality of life or hospital admission in either the RCT or the observational studies,” writes Dr. Louise Moist, guideline chair, professor of medicine and epidemiology at the Schulich School of Medicine & Dentistry at Western University and a scientist with the Lawson Health Research Institute, London, Ontario. “Time on dialysis and associated resource use were significantly greater in the intent-to-start-early group. For an asymptomatic patient, an intent-to-defer approach avoids the burden and inconvenience of an early start.”

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Previous guidelines placed more emphasis on lab tests than on patients’ symptoms to determine when to begin dialysis. They also recommended starting dialysis earlier (at higher eGFR rates) for people with diabetes. This new guideline places the emphasis on symptoms and other complications of kidney disease as reasons for starting dialysis. “Delaying dialysis in people without symptoms appears to be safe, as long as they are closely followed by their kidney specialist,” says Dr. Gihad Nesrallah, lead author and associate scientist at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital and a nephrologist at the Humber River Hospital, Toronto, Ontario. “This approach is sure to be preferred by patients, who generally enjoy a better quality of life off dialysis than on it. Many recommended treatments require a trade-off between a beneficial effect and a potential risk or side-effect. In this case there don’t appear to be any trade-offs, as long as dialysis can be started promptly once it is needed.” Although the guideline panel did not consider costs in formulating the recommendation, it did note that an intent-to-defer strategy would most likely result in substantial cost savings. The new recommendation targets adults aged 18 years and older with stage 5 chronic kidney disease, also known as end-stage-kidney disease, in which kidney function is so impaired that the organs cannot keep people alive without dialysis. The guideline was created by a working group of the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) and the Canadian Society of Nephrology.


Health Statistics -

India

India contributes 17.5% of world’s total population. Its highest populated state is Uttar Pradesh with 195.4 million people, which alone equals to the population of Brazil Government has increased the plan allocation for the public health spending to Rs. 26,760 crore in 2011-12 from Rs. 22,300 crore in 2010-11 and Rs.19,534 crore in 2009-10 respectively. This information was given by Union Minister of Health & Family Welfare Sh. Ghulam Nabi Azad in written reply to a question in the Lok Sabha

The total plan expenditure incurred by the Union Government for public health for the years 2007-08 to 2010-11 is as follows:

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Causes of Blindness In The blind population in India is estimated to rise to 15 million by the year 2020. Cataract is the leading cause of blindness in India while refraction error and glaucoma are the second and third leading causes of blindness respectively in India. In India since trachoma is limited, onchocerciasis is non-existent; glaucoma, diabetic retinopathy and corneal diseases form priorities under India’s VISION 2020 action plan.

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India


The slightest variation in a sequence of DNA can have profound effects. Modern genomics has shown that just one mutation can be the difference between successfully treating a disease and having it spread rampantly throughout the body. Now, researchers have developed a new method that can look at a specific segment of DNA and pinpoint a single mutation, which could help diagnose and treat diseases such as cancer and tuberculosis. These small changes can be the root of a disease or the reason some infectious diseases resist certain antibiotics. The findings were published online in the journal Nature Chemistry. “We’ve really improved on previous approaches because our solution doesn’t require any complicated reactions or added enzymes, it just uses DNA,” said lead author Georg Seelig, a University of Washington assistant professor of electrical engineering and of computer science and engineering. “This means that the method is robust to changes in temperature and other environmental variables, making it well-suited for diagnostic applications in low-resource settings.”

Breakthrough in DNA Mutations will Improve TB and Cancer Treatment DNA is a type of nucleic acid, the biological molecule that gives all living things their unique genetic signatures. In a double strand of DNA, known as a double helix, a series of base pairs bond and encode our genetic information. As genomics research has progressed, it’s clear that a change of just one base pair – a sequence mutation, an insertion or a deletion – is enough to trigger major biological consequences. This could explain the onset of disease, or the reason some diseases don’t respond to usual antibiotic treatment. Take, for example, tuberculosis �” a disease that’s known to have drug-resistant strains. Its resistance to antibiotics often is due to a small number of mutations in a specific gene. If a person with tuberculosis isn’t responding to treatment, it’s likely because there is a mutation, Seelig said. Now, researchers have the ability to check for that mutation preventatively. Seelig, along with David Zhang of Rice University and Sherry Chen, a UW doctoral student in electrical engineering, designed probes that can pick out mutations in a single base pair in a target stretch of DNA. The probes allow

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Working Towards Healthier India A key GE priority is to help prevent the ‘analysis paralysis’ that practitioners face today, by using technology to surface the most relevant data, contributing to accurate and faster care. Terri Bresenham, President & CEO, South Asia, GE Healthcare, shares her views and vision with Shahid Akhter, ENN

Q

GE Healthcare’s spirit of volunteerism is laudable. Can you please tell us more about the ‘Mission on wheels’ that you flagged off recently.

Q

I

I

t is a special purpose vehicle called “Mission Healthier India” with about 20 low cost healthcare technologies on board. The vehicles will travel to the nooks and corners of rural India. One of the things we realized is that there is a gap of awareness on how the technologies are benefiting the people in a primary care. And even if they know that, they assume that these technologies are expensive. So, we are trying to accomplish both – giving them their first hand exposure into the technologies and explain what it can do in patient diagnosis and discuss its affordability.

Q O

Considering GE’s global outreach in Healthcare, Indian market is just a small fraction. How do you perceive and address this small fraction? ndia is an incredibly important market for us. One of the unique characteristics of the Indian market is that it’s not like other markets in the sense of government reimbursements or private insurance. There is much lesser government reimbursement and relatively little private insurance. The market is driven more by consumerism than any other market in the globe so that makes it one level more competitive and also very focused on value and super value. So I’d say that’s a very defining characteristic. It’s a very big market with a lot of people

Q

Please tell us more about GE’s Health care public-private partnership in India.

G

E Healthcare is the first company in India to create a PPP model in the space of radiology imaging way back in 2007. Today, we have PPP projects in 12 States and the recent one with Maharashtra will equip over 22 hospitals. It is a great value proposition for all parties involved – Government do not have to invest in expensive medical technologies or skilled manpower to run these centres. It is taken care of by a consortium involving GE and a service provider. Government has to simply provide space for setting up these high end centres that are world class and can provide world class service at Government fixed rates to more patients who need them. It is also an additional benefit for government run medical colleges to provide access to students to get their hands on technology training.

GE Healthcare is believed to have invested $2 billion in software development. Please elaborate on this aspect of Industrial Internet.

ur industrial internet mission is to create and enable technology and services that can improve the way healthcare is delivered to patients globally. “By identifying, liberating and analyzing the data captured by software and technology, caregivers will have the information they need when they need it to help enable them to prevent, diagnose, treat and cure. We’re on a positive path but more must be done to build productivity which can lead to higher quality patient care. A key GE priority is to help prevent the ‘analysis paralysis’ that practitioners face today, by using technology to surface the most relevant data, contributing to accurate and faster care.”

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Q

” GE can fuse its 100+ year track record of revolutionizing healthcare with tomorrow’s technology to stay ahead of constantly evolving healthcare needs. “Please tell us about GE’s foray into the Diagnostics (imaging) in the Indian market.

G

E Healthcare has a rich 115 plus years in providing healthcare solutions including healthcare imaging, life sciences, detection and navigation systems, healthcare IT and care solutions. GE Healthcare has been present in India from early 70s. GE Healthcare formally entered India through a joint venture with Wipro in 1990 and is the leader in healthcare technology solutions in India. Wipro GE Healthcare was the first company to set up a high end manufacturing plant for healthcare imaging systems like ultrasound, CT etc. as early as 1991. GE Healthcare was the first company to set up a world class R&D Centre for healthcare solutions. Today, GE Healthcare has 3 manufacturing plants in India and the largest healthcare R&D Centre to design and develop newer, lower cost solutions to improve access to quality healthcare in India and the world. GE Healthcare is the largest domestic healthcare company in India with $570 million revenue. Every year, we release between 50-60 new innovations in imaging and diagnostics area. Our technologies help do 700,000 procedures or support as many lives every day in the country. It is a great achievement and we thank the Indian healthcare fraternity for their trust and support in our growth. Today, GE Healthcare is at work for a healthier India focusing on 5 critical components – Firstly,we are working to bring down the maternal and infant mortality rates.

Q

Please outline some of the innovative products launched recently and products in pipeline?

T

here are a number of innovations we do in India and a number of innovations we bring to India from our labs across the world. We launch about 50-60 newer innovations every year. In India, we are targeting to develop 100 new solutions and have launched about 25 including few this week spanning across all healthcare imaging and other specialties. For example – Brivo XR 115 is a mobile high frequency system we are launching today. This is a first of its kind system and offers lower radiation that is safe even for newborns. Another example is a series of ultrasound systems – LOGIQ- Both LOGIQ and Voluson are high end platforms. They were also expensive as they were being imported and now we have redesigned them in India to lower the cost thereby making them more accessible to doctors. We have also made imaging easy with tools such as Scan Coach. Silent MRI is an exclusive and first of its kind of technology to hit the market recently. We will see a series of innovations getting introduced in the upcoming RSNA including features like Dose Watch to help users manage radiation dose better. In India, you will see new super value technologies coming in the area of oncology, maternal infant care, patient monitoring and general imaging in the next few months.

• • •

The second part of the mission is to lower the cardiac disease burden and especially address the ‘golden hour’ in a cardiac attack to save lives. The third area is oncology as it being a huge burden in India and growing. We expect to launch a cost effective India designed PET/CT soon. The fourth area is about designing products in India for India and the world which can provide super vaue to our users. We target to bring about 100 lower cost solutions that can improve healthcare access. We have already launched 25 solutions from India and most of them are distributed around the world too.

A

s on today, we are launching a low cost solution called “Akta Start” to automate and lower cost of protein purifications at laboratory scale.

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A new study conducted by University of Illinois anthropology professor Kathryn Clancy suggests that fertility in women could be linked with their immunity as a body’s first priority is maintenance, which includes immune function. Any leftover energy is then dedicated to reproduction; there is a balance between resource allocation to maintenance and reproductive efforts, and environmental stressors can lessen available resources, Clancy, who co-directs the Laboratory for Evolutionary Endocrinology at Illinois, said. The researchers collected the urine and saliva samples from a group of healthy, premenopausal, rural Polish women who participate in traditional farming practices, during the harvest season, when physical activity levels are at their peak. They then measured participants’ salivary ovarian hormone levels daily over one menstrual cycle and also tested urine samples for levels of C-reactive protein (CRP), a commonly used marker of inflammation. They observed a negative relationship between CRP and progesterone in the Polish women - in women with high CRP, progesterone was low, further they found that estradiol and the age of first menstruation were the strongest predictors of CRP levels. Clancy believes that there are two possible pathways that explain these results. “One is that there is an internal mechanism, and this local inflammation drives higher levels of CRP, and that is what’s correlating with the lower progesterone.”

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Study Suggests Fertility in Women Linked to Their Immunity “The other possibility is that there is an external stressor like psychosocial or immune stress driving allocation to maintenance effort, which in turn is suppressing ovarian hormones,” she said. The study has been published in the American Journal of Human Biology.


What is

Osteomyelitis? Osteomyelitis results from inflammation of the bone and marrow cavity which almost always means infection. Osteomyelitis may arise as a complication of systemic infection or as a solitary focus of disease. Penetrating wounds, surgical procedures, dental extractions can all be precipitating factors for osteomyelitis. Diabetes in the host predisposes to osteomyelitis due to loss of sensation and impaired immunity in the host.

Complications of osteomyelitis can be many and may even lead to loss of function of the bone and surrounding tissue. Awareness about the sites of infection and maintaining strict infection control practices especially prior to surgery can go a long way in prevention of osteomyelitis.

History tells us that osteomyelitis has been part of vertebrate biology since the time of the dinosaurs with fossil evidence of healed bone infection from the Pleistocene era to early humans. Thus the relationship between pathogenic bacteria and vertebrates is really long standing. A wide variety of bacteria, fungi, viruses and parasites can cause osteomyelitis. Bacteria cause pyogenic osteomyelitis and mycobacteria cause tuberculous osteomyelitis. The disease can be extensive or localised to a single bone. The patient presents with fever, swelling, pain and this can be accompanied by a discharge at the site. Even in innocuous looking painless ulcers, especially in diabetics, the index of suspicion should be high and treatment should be started early after the necessary investigations to prevent the infection from becoming chronic. The outcomes vary depending on the treatment provided, the follow up by the patient, the site of involvement and the presence of underlying disease.

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India Celebrates 3 years without Polio India in celebration as the nation defeats crippling disease Polio. India completed three consecutive years without a single case of wild Polio virus, today and hence achieving the three-year milestone necessary to achieve Polio-free certification from WHO. Commemorating the day, Rotary International illuminated India’s iconic monuments and buildings, all across the nation. In the capital city, the historic India Gate and Red Fort was lit up with ‘Celebrating 3 Years of last Polio case in India’ message. Other illumination sites in the country included the Air India in Mumbai, Hyderabad Public School in Hyderabad, Red Fort in Agra, Teeli Wali Masjid in Lucknow, Junagarh Fort in Bikaner, Sojati Gate in Jodhpour and other equally important sites in cities and towns across the country were lit-up with the message ‘Celebrating 3 Years of last Polio case in India’. The three-year milestone was celebrated with much fanfare by countrymen across the country.

Globally only 3 countries are still endemic with polio, namely, Pakistan, Afghanistan and Nigeria. “There is a constant fear of polio virus importation from neighboring endemic countries. Therefore, we cannot afford to be relaxed till the time Polio is eradicated globally and will have to continue our efforts of protecting our children against Polio, till the world is certified Polio-free”, observed Mr. Raja Saboo, Past President (global) of Rotary International.

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The country reported the last polio case in Howrah, West Bengal, on January 13, 2011. Members of Rotary International, one of the spearheading partners in the Global Polio Eradication Initiative (GPEI), have been working for years to sensitize and motivate people to get their children vaccinated against Polio.

Rotary club members worldwide have contributed more than US$1.2 billion and countless volunteer hours to the polio eradication effort. Rotary is a global humanitarian organization with more than 1.2 million members in 34,000 Rotary clubs in over 200 countries and geographical areas. Rotary members are men and women who are business, professional and community leaders with a shared commitment to make the world a better place through humanitarian service. Rotary’s top priority is the global eradication of polio and is the leading partner of GPEI. The other spearheading partners in the Global Polio Eradication Initiative are the World Health Organization, UNICEF, and the U.S. Centers for Disease Control and Prevention


Hilary Koprowski self-administered the live-virus oral vaccine he developed before the 1950 trial – about two years before Salk’s injectable version using a dead form of the virus began testing with the backing of the National Foundation for Infantile Paralysis, now the March of Dimes. Sabin, who Koprowski’s son said sometimes collaborated with his father, was the first to get the moreeffective oral version, which didn’t require boosters, licensed for use in the U.S. Koprowski went on to be the director of The Wistar Institute in Philadelphia from 1957 to 1991. Under his leadership, the independent research institution developed a rubella vaccine that helped eradicate the disease in much of the world, Wistar officials said. It was during that time the institute also developed a more effective rabies vaccine

Pioneer behind Polio vaccine dies at 96

Dr Hilary Koprowski, the Polish-born virologist who developed the first successful oral vaccination for polio, died this week at his Philadelphia home. He was 96. Although not as well-known as fellow researchers Jonas Salk and Albert Sabin, Koprowski’s 1950 clinical trial was the first to show it was possible to vaccinate against polio, the crippling and sometimes fatal disease that’s now all but eradicated. Koprowski’s son, Christopher, said Saturday his father liked the scientific recognition his work received without the celebrity of Salk and Sabin. “He enjoyed not having his scientific work disrupted,” said Christopher Koprowski, chief of radiation oncology at Christiana Care Health System in Wilmington, Del. “Not that he was a modest individual, mind you Christopher Koprowski said his father had been sick for several months before dying Thursday in the same Wynnewood home he’d lived in since 1957.

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“Another Possibility at

Life”

Bone Marrow Transplants “I was a senior in high school, on a nationally ranked basketball team,” recalls David Lindsay, 40, of Charlotte, N.C. “But during practices, I felt really fatigued and achy. So, before our first game, I went to my doctor for what I thought would be iron pills. “But when he saw me, he said I looked like Casper the Ghost, and took some blood tests. Two hours later, I was diagnosed with acute lymphoblastic leukemia (ALL). That was the end of my glory days.”

Thanks to his sister, David has led a full life. He’s married, the proud father of two children, and now serves as the executive director of Project Life, a non-profit organization that educates college students about the promise of bone marrow transplantation and facilitates their joining the National Marrow Donor Program (NMDP). Would Lee donate her bone marrow again? “Look at David. I can’t think why anyone wouldn’t do it,” she says. “It’s an opportunity to save someone’s life. It’s beyond amazing.”

Leukemia is cancer of the white blood cells, which are formed in the body’s bone marrow and help to fight infection. According to the National Cancer Institute (NCI), cancer in children and adolescents is rare. But ALL is the most common cancer in children, representing 23 percent of cancer diagnoses among those younger than 15. It occurs in about one of every 29,000 children in the United States each year. In quest of a cure, Lindsay began six months of intensive chemotherapy. And, by the following summer of 1989, “feeling terrific” and with his hair grown back, he started his freshman year at Davidson College. Through weekly blood tests and monthly bone marrow checks, everything went well. Then, at exam time, the cancer came back. “It was a shock. That’s when the doctors told us that my best— and only—chance for a cure was a bone marrow transplant,” says Lindsay. In a transplant, a patient’s diseased bone marrow is destroyed, then replaced with healthy bone marrow from a donor. Most times, donors must have the same genetic typing as the patient, so that their blood-forming cells in the marrow “match” the patient’s. Typically, a patient’s full brothers and sisters have the highest chance—25 percent each—of being a perfect match. In Lindsay’s case, his then 7-year old sister, Lee, now 28 and a social worker in Raleigh, proved a perfect match. “It’s become happy family lore that Lee and I are twins, 12 years apart!” Lindsay smiles. Two months later, on February 28,1990, at the University of Minnesota Hospitals in Minneapolis, Lindsay got his transplant from Lee. Another long year would pass before DNA testing finally confirmed that the bone marrow in David’s body was 100 percent Lee’s, and he was cured. “The only chance he had was my bone marrow. I donated two bags,” Lee recalls. “He was my big brother hero, and he needed me. Bone marrow transplants are another possibility at life.”

David Lindsay, now 40 and playing here with his children, is alive today because of a bone marrow transplant he received while in college. His sister, who was just 7 at the time, donated the bone marrow. They were a perfect match.

Photo: Wendy Yang, Charlotte Observer

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Skin Cancer Can Strike Anyone In the U.S., skin cancer is the most common cancer. Melanoma, the most dangerous type of skin cancer, is still on the rise. More than 2 million people are treated each year for the most common forms of skin cancer—basal cell and squamous cell. Basal cell skin cancer is several times more common than squamous cell skin cancer. Each year, more than 68,000 Americans are diagnosed with melanoma, and another 48,000 are diagnosed with an early form of the disease that involves only the top layer of skin.

Fast Facts

• Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. Melanoma, a more serious type of skin cancer, is less common. • More than 2 million people are treated for basal cell or squamous cell skin cancer each year. Basal cell skin cancer is several times more common than squamous cell skin cancer. • The number of cases of skin cancer has been increasing. Exposure to the sun is a major factor. • Estimated new cases and deaths from melanoma in the United States in 2013: New cases: 76,690; deaths: 9,480. Melanoma is less common than the others, but far more dangerous—even deadly. It involves the cells that produce the skin pigment melanin, which is responsible for skin and hair color. Melanoma can spread very rapidly, and the incidence of melanoma in the United States is steadily increasing. It is the leading cause of death from skin disease. The development of melanoma is related to sun exposure, particularly to sunburns during childhood. It is most common among people with fair skin, blue or green eyes, and red or blond hair.

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Rajya Sabha Introduces Bill to Protect

HIV Patients from Discrimination

To protect people suffering from HIV/AIDS against discrimination, a bill has been introduced in the Rajya Sabha. The HIV/AIDS (Prevention and Control) Bill 2014 was introduced in the upper house amid din. The draft of the bill was finalised in 2006, and civil society groups and HIV/AIDS-affected people have long been demanding passage of the draft legislation. According to official information, a fine up to Rs.10,000 and two years’ imprisonment has been proposed as punishment for spreading hatred against people with HIV/AIDS. The bill also proposes a legal commitment to provide Anti-Retroviral Therapy (ART) by the government to the patients as far as possible.

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Under the proposed law, HIV/AIDS-affected people will be provided protection against discrimination in employment, healthcare, education, travel and insurance, in both public as well as private sectors. The bill proposes imprisonment and fine for those spreading hatred and discrimination against HIV patients.


Survival of Breast Cancer Predicted by

55 Genes Linking to a Powerful Tumor Suppressor The prediction of progress of breast cancer and its chances of survival could be possible from a panel of 55 genes, almost all of which are impacted by the loss of a particular protein, researchers at Georgetown Lombardi Comprehensive Cancer Center report in PLOS ONE. The panel represents loss of a powerful tumor suppressor gene, SYK, as well as genetic alterations in 51 other genes that are directly affected by the loss of a copy of the SYK gene and the absence of its protein. “Without SYK, the protein it makes, and genetic disruption in a set of genes thought also to be controlled by SYK, cancer invades and metastasizes,” says the study’s senior investigator, Susette C. Mueller, PhD, professor of oncology emeritus at Georgetown Lombardi. Mueller and her colleagues examined the loss of SYK in tissue from breast ductal carcinoma in situ (DCIS), a cancer contained within the breast ducts that sometimes morphs and invades surrounding tissue. Samples that had a loss of one copy of the SYK also had evidence of invasive ductal carcinoma nearby. None of the normal breast tissue samples, or of the DCIS-only tissue, had loss of SYK. “This was the first time that a loss of a SYK gene was found in DCIS breast tissue, but we needed information about the outcomes of these cases to determine the significance of this finding,” says Mueller.

So the scientists turned to The Cancer Genome Atlas at the National Institutes of Health, a catalog containing gene sequencing and gene mutations from cancer patients with invasive disease, along with outcome information. When they matched changes in the 55 genes to the patients’ outcomes, the researchers found that the panel was predictive of which breast cancer patients fared better, Mueller says. “Survival was much better in the invasive ductal carcinoma patients who did not have any change in the 55 genes,” she adds.At the end of more than 18 years of follow-up, an estimated 80 percent of patients without gene changes were still alive. In contrast, about 20 percent of patients with changes in one or more of the genes were alive. “The panel is not ready for use as a prognostic tool in the clinic, and much work is required to test it in that way,” Mueller cautions.

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Blood Vessel Plaques Exactly Identified by Nanoparticle A multifunctional nanoparticle that enables magnetic resonance imaging (MRI) has been developed that can now pinpoint blood vessel plaques caused by atherosclerosis, by a team of researchers, led by scientists at Case Western Reserve University. The technology is a step toward creating a non-invasive method of identifying plaques vulnerable to rupture-the cause of heart attack and stroke—in time for treatment. Currently, doctors can identify only blood vessels that are narrowing due to plaque accumulation. A doctor makes an incision and slips a catheter inside a blood vessel in the arm, groin or neck. The catheter emits a dye that enables X-rays to show the narrowing. However, Case Western Reserve researchers report online today in the journal Nano Letters that a nanoparticle built from a rod-shaped virus commonly found on tobacco locates and illuminates plaque in arteries more effectively and with a tiny fraction of the dye. More importantly, the work shows that the tailored nanoparticles home in on plaque biomarkers. That opens the possibility that particles can be programmed to identify vulnerable plaques from stable, something untargeted dyes alone cannot. “From a chemist’s point of view, it’s still challenging to make nanoparticles that are not spherical, but non-spherical materials are advantageous for medical applications” said Nicole F. Steinmetz, assistant professor of biomedical engineering at Case Western Reserve. “Nature is way ahead of us. We’re harvesting nature’s methods to turn them into something useful in medicine.”

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The rod-shaped nanoparticles are made from tobacco mosaic virus, tiny tubular organisms that infect plant cells but are benign outside the plant. Steinmetz, a specialist in bioengineering plant viruses, teamed with Xin Yu, a professor of biomedical engineering, who specializes in developing MRI techniques to investigate cardiovascular diseases. They created a device that transports and concentrates imaging agents on plaques. The research team includes: Michael A. Bruckman, a postdoctoral researcher, and Lauren N. Randolph, an undergraduate student, in the Steinmetz lab; Kai Jiang, a PhD student in Yu’s lab; and Leonard G. Luyt, assistant professor, and Emily J. Simpson, a PhD candidate, both at department of chemistry at Western University, in London, Ontario. Elongated nanoparticles have a higher probability of being pushed out of the central blood flow and targeting the vessel wall compared to spheres. Further the shape allows more stable attachment to the plaque, the researchers said.


The virus surface is modified to carry short chains of amino acids, called peptides, that make the virus stick where plaques are developing or already exist. Luyt and Simpson synthesized the peptides. “The binding allows the particle to stay on the site longer, whereas the sheer force is more likely to wash away a sphere, due to its high curvature,” said Yu, an appointee of the Case School of Engineering. The virus surface was also modified to carry near-infrared dyes used for optical scanning, and gadolinium ions (which are linked with organic molecules, to reduce toxicity of the metal) used as an MRI contrasting agent. They used optical scans to verify the MRI results. By loading the surface with gadolinium ions instead of injecting them and letting them flow freely in the blood stream, the nanoparticle increases the relaxivity—or contrast from healthy tissue—by more than four orders of magnitude. “The agent injected in the blood stream has a relaxivity of 5, and our nanoparticles a relaxivity of 35,000,” said Steinmetz who was appointed by the Case Western Reserve School of Medicine.

Steinmetz and Yu, members of the Case Center for Imaging Research, are now proposing to take the work a step further. They want to tailor the nanoparticles to show doctors whether the plaques are stable and require no treatment, or are vulnerable to rupture and require treatment. A rupture sets off the cascade of events that lead to heart attack and stroke. To do this, they must first find different biomarkers of stable versus vulnerable plaques and coat the nanoparticles with different peptides and contrast agents that enable the MRI to tell one from the other. “Our understanding of vulnerable plaques is incomplete, but once we can diagnose vulnerable plaques from stable plaques, it will be a paradigm shift in diagnosis and prognosis,” Yu said. In addition to using the technology to find vulnerabilities, it may also useful for delivering medicines and monitoring treatment, the researchers say.

That’s because the nanorod carries up to 2,000 molecules of the contrast agent, concentrating them at the plaque sites. Secondly, attaching the contrast agent to a nanoparticle scaffold reduces its molecular tumbling rates and leads to additional relaxivity benefit, the researchers explained. While the view is better, they are able to use 400 times less of the contrast agent because it’s delivered directly to plaques. The tobacco virus-based nanoparticle, they said, offers another advantage: Most nanoparticles that have been developed to carry contrast agents are based on synthetic materials, some of which may stay in the body a while. The tobacco virus is made of protein, which the body is well equipped to handle and flush from the system rapidly.

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A comprehensive knowledge sharing video series for Govt. doctors

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