Indian Health Care Sector

[nithish]

India faces risk of growing cardio-vascular diseases: WHO

High physical inactivity among India's middle class due to rising incomes and changing food habits has put India on the cusp of becoming the country with the highest number of cancer and heart diseases, the WHO has warned.
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Having become the so-called global IT services hub, India's rising middle class has become physically more inactive due to sedentary working habits despite increasing consumption of high-calorie fast foods. India is now on the cusp of becoming the country with highest cardio-vascular diseases and cancer.

Though India currently suffers more from cancer caused by tobacco-chewing as well as cervical cancer in women, it would soon face the threat of other stomach and other related cancers due to increasing physical inactivity among its people.

Regular physical activity reduces the risk of coronary heart disease and stroke, diabetes, hypertension, colon cancer, breast cancer, osteoporosis, and depression.

Indian women face growing incidence of cervical cancer which is caused by human pailloma virus that is sexually transmitted. The government must provide early vaccine to prevent cervical cancer, said the WHO official.

"Some states like Kerala have done well in providing early cancer prevention vaccines and other states must emulate this," he said.
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Ahead of the World Cancer Day this year, World Health Organisation (WHO) today issued The Global Recommendations on Physical Activity for Health.

These recommendations call for at least 150 minutes of moderate intensity aerobic physical activity throughout the week for all people aged 18 and over to prevent noncommunicable diseases, including breast and colon cancers.

[SSridhar]

Indigenous critical care ventilators rolled out

Now Indian hospitals need no longer depend on imported ventilators for critical care of its patients. ‘Inventa', India's first indigenous critical care ventilator has started rolling out of Coimbatore.

A joint project of the Society for Bio-Medical Technology (SBMT), a division of the Defence Research and Development Organisation (DRDO), National Institute for Mental Health and Neuro Sciences (NIMHANS), Bangalore, and PSG College of Technology, Coimbatore, ‘Inventa' is gaining entry into Indian hospitals, albeit slowly.

The ventilator, manufactured by a Coimbatore-based firm, can be used by patients admitted to Intensive Care Units and all those who require assisted breathing.

“The work on this, which began in 2003, has borne fruit and the commercial production has begun. The first lot of 100 units has been sold out. It is a fully indigenous product that is sleek, portable and cost-effective,” W. Selvamurthy, Distinguished Scientist and Chief Controller of Research and Development, DRDO, said here on Monday.

As against the imported one which costs approximately Rs. 13 lakh, the indigenous version costs Rs.4.5 lakh. With the country's annual requirement being 2,000 units, it is expected that mass production of ‘Inventa' will address this need in the most cost-effective manner.

Speaking to The Hindu, P. V. Mohan Ram, Principal Investigator, ‘Design and Development of Indigenous Critical Care Medical Ventilator', PSG College of Technology, said the SBMT approached the college to submit a proposal for a ventilator that was initially proposed for use by soldiers working at high-altitudes.

“In 2003, we came out with a bench model. The SBMT suggested changes and based on these a prototype of a ventilator was designed with the help of medical advice from NIMHANS. The final prototype and its operation were shown to SBMT in 2007. It was approved and accordingly the technology transfer was made to Pricol Medical Systems Limited here,” Mr. Mohan Ram said.

When the DRDO found the final prototype suitable for medical use, ethical clearance was obtained from Drug Controller General of India before handing it over for commercialisation.

The first 100 units have been procured by Government hospitals and medical colleges. Since it is a viable product, the DRDO is seeking patronage of Central and State governments for promoting its use.

“We are approaching the Director-General Armed Forces Medical Services for using the ventilator in military hospitals and Government officials for installing them in Government hospitals,” Mr. Selvamurthy said.

Since the design of ‘Inventa' has been a success, PSG College of Technology has been entrusted with the project of developing paediatric ventilators also. These are for critical care of premature babies and children.

According to Mr. Selvamurthy, the first prototype will be ready for demonstration in June 2011.

[Yugandhar]

http://www.livemint.com/2011/02/2200064 ... r.html?h=E

IISc designs India’s first needleless drug device

Bangalore: Scientists at the Indian Institute of Science (IISc) have designed a pen-shaped, needleless drug delivery device, the first such in India that will use supersonic shock waves for painless delivery of medicines into the body.

Aerospace, molecular and cell biology researchers at the institute have combined their expertise to develop the prototype of the device that is expected to start selling in two-and-a-half years, after human trials are completed, said Dipshikha Chakravortty, a faculty member at the department of microbiology and cell biology at IISc and a co-author of the research paper. The device will cost $200 (around Rs9,000) and can be reused, reducing the cost.



Painless method: Scientists at the Indian Institute of Science demonstrate the drug delivery system. Aniruddha Chowdhury/Mint

Companies and researchers across the world are working on needleless drug delivery systems, including nasal inhalers and skin patches, which will provide a painless, economical and more effective way of administering drugs. Around 12 billion injections are used globally, IISc said, citing figures compiled by the World Health Organization (WHO). The market value of transdermal delivery, or injecting drugs through the skin, is estimated to increase to $31.5 billion in 2015 from $21.5 billion last year, according to Research and Markets, a researcher.

[SSridhar]

Rotary India to fund heart surgeries for 5000 kids

Rotary India Humanity Foundation, an arm of Rotary International, will pump in Rs.75 crore over the next three years for 5,000 surgeries on under-privileged children suffering heart diseases in the country.

Disclosing this at the launch of the Foundation’s programme “Saving Little Hearts”, Rotary International president Kalyan Banerjee said the number of surgeries may also reach 7,500 within the three-year period.

“We are committed to doing at least 5,000 heart surgeries over the next three years, and most probably we will take this number up to 7,500,” he said.

The programme has been formulated and designed to ease the suffering and give normal life to children suffering from congenital heart diseases.

“Among the children in need for urgent medical treatment, 60,000 to 90,000 need immediate surgery to stay alive. Unfortunately, most of these cases are among those children who are below the poverty line and cannot avail of these expensive surgeries.” he said.

“With each of these surgeries costing between Rs. 1,00,000 to Rs. 2,50,000 and the parents generally earning about Rs. 3,000 monthly, the surgeries remain beyond their reach,” he added.

The next three years will witness a fund output of Rs. 215 crores, including the money allotted for the programme “Saving Little Hearts”.

[Vasu]

Hidden in the news of the Cricket World Cup and the UPeeA scandals - 13 young women died after giving birth in 2 hospitals in Jodhpur within a span of two weeks. The Health Minister of the state visited one of the hospitals after the first few deaths were reported, and gave the hospitals a clean chit. Although a high level committee of some doctors has been formed to submit a report, it is said that bad IV fluids were the cause of the deaths. All these women bled to their death after giving birth.

It has come to light that the company, based in Indore, was not even on the approved list of vendors of the hospital, and the MP Police have arrested some of their management. In addition, Mr. Gehlot reached Jodhpur and dismissed two or three small officials.

However, in this NDTV news.....

While hospital authorities say they are convinced that spurious glucose administered to the victims resulted in their deaths, the administration's clean chit to the doctors and denying the presence of infection in the operation theatres before the probe has ended has surprised many.

Even two similar deaths in such short span of time should have sent alarm bells ringing. Its absoutely criminal that so many innocent women had to lose their lives.

Also, the government seems to be waking to the dangerous issue of counterfeit medicine. They are proposing bar codes and unique ID's to medicines to assure their genuine make. Smaller manufacturers are already opposing it because it will raise their manufacturing costs.

[joshvajohn]

Fight for empowering the differently-abled
http://www.ndtv.com/article/india/fight ... bled-88176

‘State failed to train enumerators’
http://articles.timesofindia.indiatimes ... led-people

A growing India needs to make sure such people are not helped. Of course it is essential to invest in schools and colleges that make differently abled people to work like normal people in those cases where it is possible. If not support systems should be developed for differently able people. Particularly the law for access to all the buildings at least in urban areas should be enacted in a way that differently abled people have access to all govt and private buildings.

[SSridhar]

In India's forgotten diseases, an opportunity

India has the extraordinary opportunity to link its leading government research institutes and pharmaceutical companies in a unique public private partnership to address the diseases of the poor throughout South Asia.

Despite India's dramatic modernisation over the last decade, it remains “ground zero” for some of the world's most dreaded tropical diseases. A recent report in The Lancet reveals that 205,000 people in India die annually from malaria, mainly in Orissa and the surrounding states of Chhattisgarh and Jharkhand, with almost one-half of those deaths in children. Similarly, India and its South Asian neighbours account for one-quarter of the world's intestinal worm infections such as hookworm and roundworm, and more than one-half of the world's cases of elephantiasis, leprosy, and visceral leishmaniasis (VL). The State of Bihar alone accounts for a large percentage of the world's cases of VL, a serious parasitic infection also known as kala-azar that affects the bone marrow, liver, and spleen, and is associated with high mortality. Thus, while much of the global health attention is largely focused on sub-Saharan Africa, the truth is that India and adjoining Bangladesh, Bhutan, Nepal, Pakistan, and Sri Lanka are just as devastated by neglected tropical diseases (NTDs).

A little known fact about NTDs is that they not only adversely affect the health of the poorest people in India and elsewhere, they also have the capability to cause and prolong poverty. For instance, the disfigurement and swelling of the limbs and genitals resulting from elephantiasis prevents adults from going to work or working effectively. Dr. K.D. Ramaiah of the Indian Council of Medical Research in Pondicherry has estimated that India suffers almost $1 billion in annual economic losses as a result of this NTD. Similarly, chronic hookworm infection occurring in over 70 million Indians stunts the growth and intellect of children to the point where a child's future wage earning is reduced more than 40 per cent. In the first-ever comprehensive report on NTDs released in October, the World Health Organization (WHO) reported the economic burden of dengue costs India $30 million annually. NTDs can impoverish entire families and communities. The bottom line is that NTDs are one of the reasons why India is trapped in a vicious cycle of poverty.

The good news is that India is beginning to fight back and show global leadership in solving its own NTD problem and, to some extent, the challenge of NTDs among its neighbouring countries. According to the World Health Organization, the Indian National Vector Borne Disease Control Programme has scaled its mass drug administration programme to treat 85 per cent of the 600 million people at risk in India for elephantiasis. As a result, the overall prevalence of this disease in India has been cut in half since 2004, and there is the prospect that this ancient condition, which has affected the people of India for centuries, could be eliminated in the next decade. Similarly, India is aggressively implementing leprosy elimination through multi-drug therapy programmes, while in 2005 the governments of Bangladesh, India and Nepal signed a memorandum of understanding to eliminate kala-azar by 2015, with an emphasis on the border districts of these three countries where more than 50 per cent of the cases occur. Another notable achievement for India was the elimination of yaws in 2006, a chronic infection affecting the skin, bone and cartilage.

With these successes, India has the opportunity and indeed the moral obligation to take these NTD control and elimination activities to a higher level. India, together with nations such as Brazil and China, are sometimes referred to as innovative developing countries (IDCs). The concept of the IDC refers to the fact that while these countries may have chronic and debilitating poverty and high NTD prevalence, they also benefit from having top universities, medical research institutes and biotech companies. The track record of scientific publications and patents among the IDCs indicates that nations such as India have the capacity to produce a new generation of drugs, diagnostics, and vaccines for NTDs such as hookworm and kala-azar which require technologies in order to ensure that they can move towards disease elimination.

However, a big problem with new biopharmaceuticals for NTDs is that these products will almost certainly not become money makers. Almost by definition, NTDs occur exclusively among people living on less than $1.25 (or roughly Rs.56.4) per day. The people who need new NTD vaccines and treatments the most can never afford to pay for it. Hence, there is no financial incentive for India's private industry to embark on research and development activities for NTDs. Therefore, India urgently needs new strategies to link its government institutions and its powerful private biopharmaceutical companies together in a public-private partnership to stimulate innovation for the poor. Examples of this include a handful of non-profit product development partnerships (PDPs) supported by the Bill & Melinda Gates Foundation and sources. The PDPs include a joint venture between Merck & Co. and the U.K.'s Wellcome Trust, which is now being established in New Delhi. Brazil has set a strong example through two well-established public vaccine manufacturers, FIOCRUZ and Instituto Butantan, that collaborate with PDPs, including the Sabin Vaccine Institute, where I serve as president. As a result Brazil is producing a new generation of NTD vaccines.

The reason there are not more than a handful of PDPs is the dearth of adequate government funding specifically targeting PDPs as well as well-financed private philanthropies beyond the Bill & Melinda Gates Foundation. In addition to increased support, there are formidable obstacles for applying complex technologies to solving global infectious disease problems, working with national regulatory authorities in low- and middle-income countries, and the difficulties of conducting clinical trials in resource poor settings.

Having had the pleasure of meeting the current and past leadership of the Indian Council of Medical Research, I know first-hand that a vision does exist that can link industry, government and the PDPs in an innovative partnership to address diseases of poverty.

An Indian public-private partnership for NTDs could produce a new generation of drugs, diagnostics, and vaccines that will benefit all of South Asia, and indeed the entire world's “bottom billion” — the 1.4 billion people in the world who live in extreme poverty. Innovation for the poor could truly become India's greatest gift to the world.

(Peter Hotez is president of the Sabin Vaccine Institute, a product development partnership for NTDs, which also hosts the Global Network for Neglected Tropical Diseases. He is the author of Forgotten People, Forgotten Diseases .)

[SSridhar]

Antibiotic challenges, dilemmas & policies

India was recently in the news for the wrong reasons. The serious threat posed by the newly discovered microbe, NDM-1 (New Delhi metallo--lactamase-1), resistant to many antibiotics, triggered alarm and panic. Predictions that the country will not meet the millennium development goal for child mortality caused dismay. They highlighted the nation's paradox. The country faces two conflicting challenges. The urban rich with their easy access to medical treatments often receive inappropriate antibiotic therapy. On the other hand, the rural poor, with their lack of basic medical facilities, find it difficult to obtain such medication. The former results in microbial resistance, while the latter in preventable deaths. The official reactions to both these problems and their implications were denials. However, after the short-lived indignation and outrage, it is back to business as usual, the old inertia with its deceptive calm.

Microbial resistance

Resistance of microbes to standard antibiotics is well known. Hospital-acquired infections, in circumstances where the use of antibiotics is high, are common. The development of bacterial resistance to antibiotics is natural and occurs due to adaptation to hostile environments. However, the rapidity of its development and increased prevalence of such resistance documented in many tertiary hospitals reflect a serious problem. In addition, the life-threatening nature of many infections, a limited availability of existing antibiotics and the absence of new ones in the drug development pipeline are causes for alarm. This is true for many bacteria, including those causing tuberculosis. It indicates the emergence of new and lethal dimensions for old diseases, which had effective and affordable cures. The increase in antibiotic resistance in community-acquired infections compounds the problem. It suggests that resistant microbes, usually found in hospital environments, are now prevalent in the community.

The misuse and abuse of antibiotics by physicians is serious. Inadequacy of training in prescribing rational antibiotic therapy is a major lacuna. Prescribing antibiotics for simple viral infections to prevent possible secondary bacterial infections is common practice among physicians, despite good clinical trials showing no value of such prophylaxis. Absence of sentinel surveillance and regular guidance for prescribing also makes practice difficult. Indiscriminate prescription of newer antibiotic medication while allowing for recovery in individual patients, risks development of microbial resistance.

The generally safe profile of antibiotics, their minimal side effects and short duration of the course of medication are factors that lend themselves to abuse. The pharmaceutical industry contributes to the problem by promoting the sale of antibiotics independent of patient need. Pharmacists readily dispense antibiotics without a doctor's prescription. A widely prevalent belief among the general population that all infections respond to antibiotics also perpetuates inappropriate use. Many fail to realise that the majority of fevers are due to viral infections, which do not respond to antibiotic therapy.

Poor access

The lack of surveillance of microbial resistance at primary and secondary hospitals and the absence of guidance in prescribing encourages the use of newer broad-spectrum drugs in situations were older medication would have sufficed. The poor state of the public health care system, the private sector with its focus on profits and deficiencies in the regulation and sale of antibiotics also muddy the waters.

While NDM-1 grabs the headlines, the true magnitude of the problem of antimicrobial resistance to common antibiotics remains unknown. Widespread multi-drug resistance essentially implies a return to the pre-antibiotic era and represents a major crisis in health. On the other hand, the lack of affordable access to basic medical facilities for the poor in Bharat complicates the issues. Pneumonia, an acute respiratory infection, is the leading cause of child deaths in the world and a common cause of under-five mortality in India. The World Health Organisation (WHO) estimates that less than a quarter of children with pneumonias receive antibiotics, resulting in significant mortality. Similarly, mortality in adults with bacterial infections is also a major concern. The absence of adequate and timely antibiotic therapy due to a lack of access to affordable medical care (for the vast majority of the rural population in the country due to the urban-centric nature of our health care delivery system) contributes to preventable deaths.

The way forward

Urban and rich India, with its inappropriate use of antibiotics, requires strict practice guidelines, tighter regulation and an audit of antibiotic utilisation. On the other hand, poor and rural India needs improved access to antibiotics and affordable health care.

Rational antibiotic therapy prevents the development of resistant micro-organisms, superbugs and untreatable infections. Rational use will also result in a massive reduction in the cost of health care. High-income countries have managed to decrease the rate of antimicrobial resistance through a multi-pronged approach. Their well-regulated health-care systems allow for monitoring of antibiotic consumption and resistance, prescriber and consumer education and regulation of use.

Fighting antibiotic resistance in India with its inadequate public health care infrastructure, unenforced regulation and poor health education is a major challenge. Continuing physician education, guidance on prescribing and monitoring practice is necessary. Regulating the sale of antibiotics and microbial surveillance are mandatory.

India should start sustainable action to contain antibiotic resistance. It should raise awareness using the mass media. Hand washing routines, to prevent the spread of infection within hospitals, are observed more in the breach in most health facilities. These need to be made mandatory. Antibiotic sensitivity patterns, minimum inhibitory concentrations and a strategy of de-escalation of an antibiotic regimen should guide therapy in tertiary hospitals. The latter mandates a change to an appropriate “older” antibiotic rather than continuation of a newer broad-spectrum drug, after obtaining information on microbial sensitivity.

The formation and functioning of hospital infection control committees are obligatory. They should monitor hospital-acquired infections at surgical sites and secondary to the use of intravenous access, urinary catheters and ventilators. The committee should compile sensitivity patterns, recommend prescribing guidelines, audit practice and educate health professionals. Specialist hospitals should have consultants in infectious diseases who should advice in making rational choices for complex clinical situations. Modern technology allows for support in prescribing, tracking of antibiotic use and in containing the spread of resistance. In fact, it should be mandatory for hospitals to make public their rates of hospital-acquired infections and microbial sensitivity patterns, to allow for informed choice for patients.

The surveillance of microbial resistance should not be restricted to tertiary hospitals, as currently practiced. It should also involve primary and secondary care centres to identify local and regional patterns. The people of Bharat need a different surveillance network and practice guidelines tailored to meet their specific needs. Sentinel centres in primary and secondary care hospitals, with regional coordinating facilities, should be set up to help smaller hospitals. National and regional databases and advisory councils are mandatory. The implementation of such systems is the challenge facing the country.

The solution to improve access to basic health care for poor and rural constituencies may lie in a different set of practice guidelines. Regulation of antibiotic use for this sector must be balanced by adequate availability and access to such treatments. Antibiotic policies should factor in different microbial resistance profiles. Simplified antibiotic prescribing protocols for use by highly trained paramedical workers and nurse practitioners have been found to be useful in many low-income countries. Such strategies merit consideration for increasing access and availability in rural and remote parts of the country.

Another cause for concern is the use of antibiotics in the agriculture-food industry (e.g. poultry, pig, fish farming and in honeybee hives) where these drugs are used as growth promoters. Policies for rational use in this sector are also urgently required.

A decade has passed since the flagging-up of concerns about antibiotic resistance and increased mortality due to untreated infections. The divergent and complex demands of the different segments of the country have resulted in inertia and inaction. There is an urgent need to put in place suitable policies and mechanisms for reductions in antibiotic resistance and yet provide easy access to antibiotics in areas with poor penetration of health-care services. The challenges for India and for Bharat are different and demand different solutions. The country is yet to have a comprehensive antibiotic policy. Implementation plans remain on paper. The country needs carefully tailored strategies to meet the dissimilar challenges of its diverse contexts.

( Professor K.S. Jacob is on the faculty of the Christian Medical College, Vellore.)

[Murugan]

Ayurveda answer to healthcare challenge: Pitroda

Taking healthcare to the masses will be India's biggest challenge in the next two decades, and the ancient medicinal system of ayurveda is the only reliable way of doing so, Sam Pitroda, adviser to the PM, said. "We can't adopt the western model - the five-star culture of health delivery system. Hea lth care has to reach the masses," Pitroda, chairman of the National Innovation Council, said at the inauguration of the Institute of Ayurveda and Integrative Medicine (I-AIM) on Thursday.

Tata Group chairman Ratan Tata inaugurated the 100-bed healthcare centre that aims to integrate traditional medicine with modern health science. The centre is wholly supported by Tata Trusts (Mumbai), the group's philanthropic arm.

Pitroda, who is also the co-founder and chairman of the Centre's precursor Foundation for Revitalization of Local Health Traditions, said the integration of modern medicine and traditional health sciences was the best way to deal with challenges that lie ahead.

Darshan Shankar, who along with Pitroda had floated the foundation 17 years ago, said the healthcare centre aspires to be a modern Nalanda University for traditional health sciences.

The Nalanda University, one of the world's oldest centres of learning, had a highly regarded centre for medicine.

"I-AIM already has research centres in several disciplines including conservation of medicinal plants, pharmacognosy, pharmacology and pharmaceutics, community health, clinical medicine, botany, medical manuscripts. It plans to establish a museum on the contemporary history of India's medical heritage," Shankar said.

http://www.hindustantimes.com/Ayurveda- ... 74706.aspx#

[SSridhar]

Paediatric Cardiology

The Care Hospital at Banjara Hills here {Hyderabad} will hosting a workshop on interventional procedures in paediatric cardiology in association with Paediatric Cardiac Society of India

K. Nageswara Rao, head, paediatric cardiology department of the hospital, told a press conference that 40 paediatric cardiologists across the country would share their experiences, particularly closure of holes in the hearts of children.

He said his own team would present its work on retrograde closure of ventricular septal defect (VSD) by planting umbrellas through artery as against vein. The holes were closed in the past by conventional method with the aid of surgery which exposed the children to great risk. Now, this was a surgery free procedure which took less time and money. The children could move around in six hours. The umbrellas which cost about Rs. 70,000 were made of biologically inactive material, leaving no scope of side effects.

The children could also conceive normally later in their life. The procedure could be performed even on babies with a weight of five kgs. Their weight should be ten to twelve kgs for conventional surgery. Dr. Rao said some rare cases of congenital heart disease would be taken up as part of the workshop. Some umbrellas would be given free with the support of industry. The hospital will apply for patent rights on the procedure in a couple of weeks. It would be introduced in Europe later this year.

[SSridhar]

Lancet refuses to publish Indian rebuttal to the New Delhi Superbug theory

British medical journal The Lancet has refused to publish India's rebuttal in connection with an article in which a drug-resistant superbug was named after New Delhi.

The National Centre for Disease Control (NCDC), in the rebuttal, disagreed with the naming of the bacteria as New Delhi Metallo Beta-lactamase-1. However, Lancet Editor Richard Horton, while on a visit to India later, apologised for the naming.

Responding to the rebuttal, Editor of Lancet Infectious Diseases John McConnel sent a letter to the then Director of NCDC, R.L. Ichhpujani, refusing to publish the document, saying the journal had received far more submissions than it had the space to publish.

Mr. McConnel's letter said:

“Thank you for submitting your manuscript to the Lancet Infectious Diseases. The journal's editors have discussed the manuscript and our decision is that it would be better placed elsewhere. We currently receive far more submissions than we have space to publish and, therefore, have to reject many otherwise worthy papers.

“We are sorry we cannot be more helpful on this occasion, and we hope you will think of us again in the future.”

The letter was dated November 2, 2010.

The Lancet first reported on the new superbug in a study titled “Emergence of a new antibiotic resistance mechanism in India, Pakistan and the U.K.: a molecular, biological and epidemiological study.” It was published online dated August 11, 2010. The Government of India protested against this.

The journal again came out with an article last week claiming to have found the presence of NDM-I in the capital's public water supply. This report was dismissed by the Union Health and Family Welfare Ministry.

[SSridhar]

Can India prevent 200 children dying every hour ?

It is estimated that India lost 1.8 million children under five in 2008. That is more than 200 child deaths every hour, each day, or more than three deaths every minute. Out of about 25 million babies born every year in India, one million die. Most who survive do not get to grow up and develop well. About 48 per cent are stunted (sub-normal height) and 43 per cent are under-weight. Additionally, about one-third of babies are born with a low birth weight of less than 2,500 grams.

MDG target

In South-East Asia, the Maldives, Sri Lanka and Thailand have reduced newborn and childhood mortality significantly. India has also demonstrated steady progress. Under-five mortality decreased from about 150 per 1,000 live births in 1990 to 74 per 1,000 live births in 2005-06. But at this rate of decline, India will not be able to achieve the Millennium Development Goal 4 (MDG) target of 50 under-five deaths per 1,000 live births by 2015. Moreover, progress has been uneven in various States in the country.

Causes

The causes of death among children are well understood in India. Newborn mortality (death within the first 28 days of life) contributes to more than half of under-five mortality. In newborns they are asphyxia (inability to breathe at the time of delivery), infections and prematurity. After 28 days of life, they are the result of acute respiratory infections (pneumonia) and diarrhoea. Undernutrition contributes to 35 per cent of deaths. In addition to these, immediate causes of childhood deaths, there are several socio-cultural factors including poverty, poor water and sanitation facilities, illiteracy (especially among women), the inferior status of women in society, and pregnancy during adolescence (that can be attributed to early marriage). Child mortality rates are also higher among rural populations when compared to their urban counterparts.

We know what needs to be done to save these precious lives. Newborn deaths can be prevented by ensuring nutrition of adolescent girls; delaying pregnancy beyond 20 years of age and ensuring a gap of three-five years between pregnancies; skilled care during pregnancy, childbirth and post-natal care; and improved newborn care practices that include early (within first hour of birth) and exclusive breastfeeding; preventing low body temperature and infections; and early detection of sickness and prompt treatment. Childhood deaths can be prevented by exclusive breastfeeding for six months and complementary feeding from six months of age with continued breastfeeding for two years; immunisation; and early treatment of pneumonia, diarrhoea and malaria. In addition, it is important for the mother and other caretakers at home to invest in appropriate child caring practices, right from birth to support early childhood development and lay a foundation to maximise human potential.

India needs to provide these life-saving interventions to most, if not all, newborn and children who need them. However, their (interventions) coverage has been quite low. For example, in 2005-06 (the National Family Health Survey – NFHS 3 report), the rate of initiation of breastfeeding within an hour of birth was only 26 per cent and exclusive breastfeeding at six months was just 46 per cent. Yet these two interventions have the potential to prevent 19 per cent of deaths. The use of oral rehydration salts in cases of diarrhoea, the most recommended treatment, was just 43 per cent and only 13 per cent cases of suspected pneumonia received antibiotics. Immunisation coverage has been relatively better, suggesting that high coverage is achievable.

Intervention

The main causes of poor coverage of interventions include ineffective planning and implementation, mainly due to weaknesses in the health system. To address the systemic challenges, India launched a flagship programme, the National Rural Health Mission in 2005-06, to strengthen the health system in rural areas. Commendable initiatives have been put in place such as training about 8,00,000 village level health volunteers (Accredited Social Health Activist, or ASHA), hiring additional staff, strengthening the infrastructure of health facilities, augmenting programme management capacity at State and district levels, and enhancing community participation. However, much more needs to be done to minimise health inequities that exist among different subpopulations in the country.

Public health expenditure in India has remained at a low — about one per cent of GDP — for quite some time. This needs to be scaled up. Considering that about 70 per cent of health care is accessed from the private sector in the country, better regulation and participation of private health service providers must be ensured. Synergy between the health and nutrition sectors must be fostered through better coordination between the Ministry of Health and the Ministry of Women and Child Development, which are responsible for the ICDS (Integrated Child Development Services) programme.

To reach unreached newborns and children, there is a strong case for providing home-based newborn care as well as community-based management of non-severe pneumonia and diarrhoea in children by trained ASHAs and other community health workers. This initiative needs to be supported by provision of incentives, necessary drug supplies, close supervision and appropriate referral linkages. At the same time, the quality of health services at first-level health facilities and referral hospitals must continue to be strengthened.

Fortunately, there is renewed commitment at the global and national levels towards achievement of MDG 4. To save newborns and children, national governments, development agencies, civil society and other stakeholders must work in close collaboration.

( Dr. Poonam Khetrapal-Singh is WHO Deputy Regional Director for South-East Asia Region.)

[SSridhar]

TB among Indian Children- Dr. Soumya Swaminathan

A severely malnourished young girl, about one and a half years old, was brought to the out-patient department of a busy teaching hospital with symptoms of fever, cough and lethargy for about 10 days. Pneumonia was suspected and confirmed by a chest x-Ray and she was given a course of antibiotics and asked to return for follow-up after a week.

Her frantic mother brought her back to the emergency room after 4 days – by then, she was unconscious and despite all efforts, died the next day. Tests done then showed that she had TB meningitis or TB of the brain in addition to the infection in her lung.

This incident, which I witnessed, has always served as a grim reminder to me, that TB in children is not only poorly understood and mis-diagnosed, but often has little room for error and can progress very rapidly in the young child leading to long-term disability or death, as it did in this case.

Worldwide, at least 1 million TB cases occur each year in children under 15 years of age, 75 per cent of these occur in 22 high burden countries. In 2009, India had the highest number of TB cases in the world (approximately 2 million new patients), suggesting that the prevalence in children is also likely to be high.

The true burden of TB in children is unknown because of the lack of child-friendly diagnostic tools and inadequate surveillance and reporting of childhood TB cases. This is a disease where the infection in children is directly related to the prevalence in adults, as it spreads by airborne droplet infection and close contact.

While about half of all Indians have silent or “latent” TB infection, only a small fraction (10 per cent) develop signs and symptoms in their lifetime, in the rest the bacteria seem to live quietly, in harmony with the host. Whether the infection flares up into disease depends on many things, notably the body's immunity and if that is defective due to HIV or malnutrition or diabetes, then TB gets the upper hand in the battle with the immune system. Age is another important factor and children below 2 or 3 years old not only have a higher risk of developing disease, it is often more severe and widespread.

Pneumonia or infection of the lungs is a leading killer of children, world-wide, accounting for about 20 per cent of deaths in under-five children. Recent studies in Africa showed that TB was a common cause of “pneumonia” in both HIV infected and uninfected children – it was detected only when a special effort was made as part of a research study.

It is likely that more children will be correctly diagnosed if TB is considered as a cause of other common childhood infections. However, it is important to note that the correct tests need to be performed and interpreted properly — another challenge as x-Rays in children are notoriously difficult to read and prone to reader bias.

Perhaps due to the lack of a “gold standard” diagnostic test in children (the sputum test serves as one in adults), a number of unnecessary and useless tests are performed, contributing to a bigger hole in the pocket of the parent, but little else! It has been estimated that in India alone, 15 million dollars are spent annually on serological (ELISA) tests for TB – resources that could be better spent, considering there is no evidence that these tests are useful.

Children with TB infection today represent the reservoir of TB disease tomorrow.

If the global goal of eliminating TB by 2050 is to be met, treatment and prevention of TB in children needs as much attention as in adults. Unfortunately, BCG, the only licensed TB vaccine, has limited efficacy against the most common forms of childhood TB and its effect is of limited duration.

There are several clinical trials ongoing to test newer vaccines for TB, but it will take 8-10 years for a more efficacious vaccine to be available for wide use. Mostclinical trials for new TB drugs and drug combinations (that will be effective against both drug sensitive and drug resistant TB) are being conducted in adults and do not include children.

While there are obvious ethical as well as practical and logistical issues that need to be addressed while conducting trials in children, excluding them only ensures that they do not benefit from advances in diagnostics, new drugs or preventive strategies. Scientists and researchers need to do a better job of raising awareness, educating and engaging with the community about clinical trials in general and trials in children, in particular, especially since most participants in TB clinical trials tend to be poorly educated and socially disadvantaged.

The National TB Control Program is one of the largest and most successful public health programs in the world, providing high quality services to over 1.4 million patients every year.

However, screening of household contacts of adult TB patients and provision of preventive drugs to young children must receive higher priority. As India moves towards universal access to prevention, diagnosis and treatment of TB, the little ones amongst us must not be forgotten.

The author is Coordinator, Research Special Programme for Research and Training in Tropical Diseases, WHO, Geneva

[joshvajohn]

Family medicine & medical education reform
P. Zachariah
http://www.hindu.com/2011/03/29/stories ... 201000.htm

‘Language still the biggest hurdle in medical education’
http://www.indianexpress.com/news/langu ... on/770672/

New initiative to impart teaching skills to doctors
http://www.thehindu.com/health/article1700037.ece

[joshvajohn]

Can Kerala persuade India to ban endosulfan?
http://www.ndtv.com/article/india/can-k ... fan-100875

In Kasargod district in north Kerala, 28-year-old Shailini has had two stillbirths and her third pregnancy had to be aborted. Doctors have linked her condition to years of exposure to endosulfan.

Congress leader criticises Pawar on Endosulfan issue
http://ibnlive.in.com/generalnewsfeed/n ... 57000.html

Press for global ban on endosulfan at Stockholm Convention:LDF
http://ibnlive.in.com/generalnewsfeed/n ... 54870.html

Even US, one of the greatest producers of the pesticide, had also banned it in 2010, the release said.

The Food and Agriculture Organization of United Nations has concluded that long-term intake of residues of endosulfan from uses that have been considered by the JMPR is unlikely to present a public health concern.[33] Endosulfan is one of the most toxic pesticides on the market today, responsible for many fatal pesticide poisoning incidents around the world.[34] Endosulfan is also a xenoestrogen—a synthetic substance that imitates or enhances the effect of estrogens—and it can act as an endocrine disruptor, causing reproductive and developmental damage in both animals and humans. Whether endosulfan can cause cancer is debated.

http://en.wikipedia.org/wiki/Endosulfan

[SwamyG]

Medical Tourism Round-up
Medical Tourism, Separating Facts From Fiction

Of these, India has the greatest potential for growth.

{a good teaser, huh?}

India ridicules Obama’s comment on cheap medical care

Shobha Mishra, a director with the industry lobby group FICCI, dismissed the im­pact of any US policy change, “Even if the policy is imple­mented, I don’t think it is going to have any visible im­pact in the immediate future. Most of our health tourism comes from either NRIs or Middle-eastern countries or African nationals. The NRIs will anyway prefer coming to India, as our healthcare facil­ities are at par with the world standards.” She also felt that such patients prefer to be treated at a place which feels closer to home. "Most Middle East and African nationals prefer India as a healthcare destination due to cultural proximity," she added.

{a good reason why India should continue to extend its cultural sphere of influence. Nukkad dhaaga was discussing the ownership of Buddhism}

1.6 Million New Jobs to be created in 2011: Ma Foi Randstad Survey

Healthcare:

Total Employee Base: 3,377,652 New Jobs: 248,500

Healthcare sector remained a leading employment provider in the country, contributing to more than 16% of total estimated employment in 2010. The industry in India is anticipated to reach US$ 75 billion by 2012, growing significantly in 2011. Thus, continuing as the major employment generating sector in India. Penetration of Health Insurance, expansion to Tier II & Tier III Cities and increase in foreign investment are opening up new avenues for employment generation. The increasing popularity of medical tourism & alternative therapies are also creating new job opportunities. This sector is expected to grow at a rate of 7.4% and also lead the table by creating 248,500 jobs in 2011.

[joshvajohn]

Stockholm Convention approves recommendation for ban on Endosulfan
http://www.hindu.com/2011/04/30/stories ... 700900.htm

[SSridhar]

Need to distinguish between bacterial & viral forms of CAP stressed

Paediatricians need to differentiate between bacterial and viral forms of community-acquired pneumonia (CAP) to plan an effective antibiotic strategy, S. K. Kabra, Professor, Paediatric Pulmonology Division, AIIMS, New Delhi, said on Sunday.

Delivering the XX Dr. M.S. Ramakrishnan Memorial Endowment Oration under the auspices of the CHILDS Trust Medical Research Foundation (CTMRF), Dr. Kabra said an effective antibiotic intervention was imperative to raise treatment efficacy, reduce costs and minimise drug resistance.

CAP is the biggest cause of death in children worldwide accounting for about 1.5 million children under five annually. It is particularly rampant in developing countries where the acute respiratory infection accounts for 151 of the 156 million global cases annually. India alone records 43 million cases a year, Dr. Kabra said.

In his key-note address, Satish Kumar, Chief of Field Office, UNICEF, Chennai, said teaching hospitals and medical institutions had an important role in achieving the Millennium Development Goals as five of the eight targets set for 2015 related to child health.

[SSridhar]

What ails public health research

Why has the incidence of tuberculosis in India remained around 170 per 100,000 people for the last 20 years despite DOTS, the directly observed treatment strategy, being in place? Answer: DOTS is a passive system that kicks in only after a person takes the initiative and gets tested for the disease. Despite the high prevalence and mortality rate, researchers are yet to figure out a system that works proactively, identifying all people with active TB and treating them. The compulsion to identify and treat people with active pulmonary TB as early as possible arises from the fact these patients stop infecting others only at the end of two months of treatment. The reason for the overall failure to identify an efficient and effective system for tracking down people with tuberculosis boils down to a grievous lack of public health research originating from India. India has the greatest total disease burden in the world, and is plagued by both communicable and non-communicable diseases. Yet the total number of research reports and journal papers on public health is small.

[nithish]

Non-communicable diseases cost Indian economy $9 bn in 2005

Heart disease, stroke and diabetes together cost the Indian economy $9 billion in 2005.

According to the first global status report on non-communicable diseases (NCDs) launched on Wednesday by the World Health Organisation in Moscow, the contribution to poverty of high out-of-pocket expenditure for health care is significant in India.

An estimated 1.4 million to 2 million people experienced `catastrophic' spending in 2004 with 6-8 lakh Indians ending up being impoverished by the cost of caring for cardiovascular disease and cancer alone.

[joshvajohn]

When the whole world wanted Endosulfan to be banned why India only wanted it?

Sharad Pawar supports Endosulfan -why? allow this at the cost of many children being born differently abled! a few people had cancer after its surface level use and other health problems in particular areas of Kerala! even in other places where such health hazards are often unnoticed and unaccounted for!c

India takes care of lobbies
http://expressbuzz.com/opinion/columnis ... 70497.html

The endosulfan controversy is typical of India, of Indian politics, of Indian corruption, and of Indian morality. There were 173 countries in the Stockholm Convention that debated whether or not there should be a global ban on this notorious pesticide. Of these, 125 had banned it outright. All 47 of the remaining 48 sat on the fence and generally kept quiet. Only one argued vehemently on behalf of endosulfan. That one-in-the-world nation was India.

Many things happen in India that cannot happen in countries concerned about public welfare. The needle of suspicion must naturally point to the possibility of corruption. We hear pesticide lobby’s arguments from the mouths of government leaders. We hear arguments in favour of chemically engineered brinjal from agricultural experts who have received lucrative research grants from GM companies. World opinion has now forced India to agree to a phase-out of endosulfan over the next 11 years. Given the hold the lobbies have on India’s power structure, there is no guarantee that the phase-out will work as transparently in India as it did in the US. Scepticism is in order when decisions about poisons in our water bodies and soil and food chains are in the hands of people like Sharad Pawar.

Congress leader criticises Pawar on Endosulfan issue
http://ibnlive.in.com/generalnewsfeed/n ... 57000.html

We will be far better off without Endosulfan
http://www.dailypioneer.com/335662/Kill ... anned.html

BJP demands ban on endosulfan
http://www.indianexpress.com/news/bjp-d ... an/782411/

Karnataka minister takes on Pawar on endosulfan
http://www.zimbio.com/Sharad+Pawar/arti ... endosulfan

India will not ban Endosulfan pesticide, says Sharad Pawar
http://www.whybanendosulfan.org/ecosyst ... so-he-adds

http://www.youtube.com/watch?v=WPZYPsTffP4

Endosulfan ban: SC seeks Centre, States response
http://www.indlawnews.com/Newsdisplay.a ... 50de91050f


Government’s Refusal to Ban Endosulfan Receives Jolt
http://newstonight.net/content/governme ... eives-jolt

Eliminating endosulfan
http://www.thehindu.com/opinion/editori ... 988896.ece


Pesticide will go - eventually
http://www.atimes.com/atimes/South_Asia/ME04Df02.html

[joshvajohn]

Endosulfan banned as agreement is reached with India
http://www.rsc.org/chemistryworld/News/ ... 051102.asp

Endosulfan Banned Worldwide
http://pubs.acs.org/cen/news/89/i19/8919notw9.html

[kmkraoind]

E. coli outbreak is a new strain

Early evidence suggests the bacteria has genes from two distinct groups of E. coli: enteroaggregative E. coli (EAEC) and enterohemorrhagic E. coli (EHEC).

Dr Paul Wigley, reader in foodborne diseases at Liverpool University said: "One nasty bacteria seems to have acquired a toxin from another nasty bacteria which has resulted in an even nastier bug.

I am naming it European/England E. Coli (EEC or E2C).

[Vipul]

Turned away by AIIMS, city doctors give cancer patient 10 extra years.

An Indore resident, at a highly advanced stage of appendix cancer, got a new lease of life in the city. The case of 63-year-old Sadashiv Patidar is a feather in the cap of Mumbai’s medical fraternity.

Asked to try his luck in Mumbai by the famed All India Institute of Medical Sciences (AIIMS) Delhi, Patidar underwent a surgery two weeks ago at Hiranandani Hospital in Powai. It was the first of its kind in India, which added around 10 years to his life.

It all started a few months ago when Patidar dismissed a bout of vomiting as stomach upset. However, a series of medical tests revealed he was suffering from stage four cancer of appendix, which had spread to the entire abdominal cavity. Patidar, a farmer from Dawana village near Indore, went to the AIIMS.

Doctors at AIIMS told him they didn’t have the equipment to carry out such a complicated surgery. Patidar was crestfallen; imagine being turned away from the centre dubbed as India’s best.

He met an oncosurgeon in Mumbai, who told him that Hiranandani Hospital may have a cure for him. He was operated upon at the hospital for 19 hours.

Doctors said Patidar is the first patient to have undergone the combination process involving a cytoreductive surgery (reducing the number of cancer cells) and hyperthermic intraperitonial chemotherapy (a very high concentration chemotherapy).

Senior oncosurgeon Dr Sanket Mehta, who operated upon Patidar said, “The chemotherapy Patidar underwent is given at a very high concentration, temperature and flow rate, using a special machine that we got only a month ago. All these years, patients requiring such procedures were referred to hospitals in Europe or the US.”

Patidar’s surgery involved removing a 5-kg tumour, including 3 litres of jelly-like material. Mehta said, “We had to remove parts of the patient’s large intestine, small intestine, rectum, spleen and pancreas. It’s a huge breakthrough for the country. Many patients just ignore such surgeries as they can’t afford the treatment abroad. Now, it can be done in India, at a much lesser cost.”

Patidar, who has sugarcane and cotton farms, had to spend around Rs 11 lakh for the treatment. “I couldn’t have afforded it,” he admitted, “My children and relatives helped a lot. When several doctors turned me away, I gave up. I am grateful to God for finding a way out for me.”

Mehta said the treatment has increased the patient’s survival chances by up to 10 years. “He is eating well and there is no weakness. He has recovered extremely well,” he said.

[VikramS]

Folks: While medical tourism is good, it should serve as a springboard to expand the availability of medical services in India. Perhaps a legislation or something which asks for some portion of total medical tourism revenue (say 5%) be set aside to develop new facilities both for training medical employees and offering services.

[VikramS]

E. coli outbreak is a new strain

Early evidence suggests the bacteria has genes from two distinct groups of E. coli: enteroaggregative E. coli (EAEC) and enterohemorrhagic E. coli (EHEC).

Dr Paul Wigley, reader in foodborne diseases at Liverpool University said: "One nasty bacteria seems to have acquired a toxin from another nasty bacteria which has resulted in an even nastier bug.

I am naming it European/England E. Coli (EEC or E2C).

I hope at least a few enterprising Indian researchers write papers on this. If it was China, they would have already been working on it on war footing. Unfortunately Indians do not have that centrally planned rebuttal and attack system.

[ramana]

X-posting...

gkakkad: There is an existing thread on Medicine in India in GDF, started five years ago but it still has not reached its 72.
http://forums.bharat-rakshak.com/viewto ... f=2&t=5375
The US medical lobby is very well funded and also faces an existentialist threat. So the knives are going to be out. Eventually medical tourism is going to be an economic necessity. Because of the distances involved from the US India is less likely to be the preferred destination. Latin America, or even cruise ships might be the easier way out. There is opportunity there for Indians in the West Indies; Europeans are more likely to travel to India hence the heartburn.

VikramS, Can you work on a business plan for a cruise ship based medical tourism? Will get you in touch with some groups.

[nithish]

Researchers find new molecule to fight TB

CHENNAI: The Tuberculosis Research Centre (TRC) in the city, on Wednesday, announced that it had isolated a molecule that fights both tuberculosis and some strains of HIV.

Researchers isolated the molecule from a marine microorganism Streptomyces sp found in soil collected near coral reefs off the Rameshwaram coast. They found that the molecule was effective against Mycobacterium tuberculosis, the bacteria that causes most forms of TB. The molecule also acts against the B and C strains of HIV, that are the most common. The TRC collaborated with Periyar University and IIT-Madras on the research which first began in 2008.

Dr Vanaja Kumar, the principal investigator, and head of department of Bacteriology, TRC, said the compound had been named Transitmycin. “This one was selected as it was from an extreme environment which man is not part of, and therefore cannot be immune to. It is also pigmented and has a simple structure with a small molecule.”

These factors meant the molecule could be easily absorbed by the human body and if developed into a drug, it’s side effects would be minimal.

According to Dr Mukesh Doble, of the department of Biotechnology, IIT- Madras, a co-investigator on the project, as Transitmycin was a simple compound, its structure could be changed every few years. “This will help in preventing resistance from forming,” he said pointing out that the bacteria causing TB had developed a multidrug resistance making the effective treatment of patients more difficult.

Dr Luke Elizabeth Hanna, scientist, TRC had also started testing the new molecule on the most common HIV strain in India — HIV C. Over the last two weeks, she found that it the molecule had an inhibitory action on the virus. “This is a breakthrough,” she says, “Those with HIV are very prone to TB. Some drugs for TB cannot be given at the same time as the treatment for HIV. When developed, this would have the potential to be a single cure for both diseases.”

The next stage of research would involve pre-clinical trials and animal and human testing. Dr Vanaja said that the molecule had been tested on human cell lines.

“The toxicity is within permissible levels. We have filed a patent for intellectual property rights and have requested funding.” Dr Doble estimated that a minimum of `200 to `300 crore would be required for the next stages.

Dr Vanaja added that a drug made with the molecule would not be ready for the next seven to 10 years. “TB is a disease which develops slowly in both animals and humans. So the clinical trial will take longer,” she said.

“Even if we find a more effective cure, we will continue research on Transitmycin. The world could do with many different medicines against TB,” she added.

[VikramS]

X-posting...

gkakkad: There is an existing thread on Medicine in India in GDF, started five years ago but it still has not reached its 72.
http://forums.bharat-rakshak.com/viewto ... f=2&t=5375
The US medical lobby is very well funded and also faces an existentialist threat. So the knives are going to be out. Eventually medical tourism is going to be an economic necessity. Because of the distances involved from the US India is less likely to be the preferred destination. Latin America, or even cruise ships might be the easier way out. There is opportunity there for Indians in the West Indies; Europeans are more likely to travel to India hence the heartburn.

VikramS, Can you work on a business plan for a cruise ship based medical tourism? Will get you in touch with some groups.

ramana: Just saw this message.
My knowledge of the entire space is rather limited. On a larger perspective, cruise-ships operate at the same or better price than land based resorts so it is unlikely that the infrastructure cost is going to be an issue.

One potential challenges could be related to stability. A ship can never be as stable as a land based system. Can sophisticated medical equipment work properly in an environment which has some roll/vibrations in it? Would a surgeon want to perform precise surgery on an unstable platform?

Another issue is cleanliness and infections: Outbreaks of infections are not that uncommon in cruise liners and can have an impact on the outcomes in a medical setting.

Latin America, especially the Caribbean might be a better option. There are medical schools there which some Americans attend since they are less expensive. There is a big enough Indian origin population there which can help facilitate the operations. Further, Americans associate the Caribbean with fun so it is going to be a much easier sell.

http://www.sea-code.com/ was a company started in 2005 to do IT outsourcing on ships. It got some press then but have not heard anything after that.

[joshvajohn]

Impact of Free Trade Agreements on People Living With HIV
http://www.weeklyblitz.net/1516/impact- ... ple-living

[SSridhar]

One month old baby undergoes complex heart surgery

Chennai: One-month-old baby Asiffa slept peacefully in her father's arms on Wednesday. Eleven days ago, the infant underwent a complex heart surgery for a condition called leiomyoma of the heart.

Three cardiologists at the Fortis Malar Hospital here – Director (Cardiac Sciences) K.R. Balakrishnan, Senior Cardio Thoracic surgeon Nandkishore Kapadia and Head of the Department, Cardiac Anesthesia and Cardiac Critical Care Suresh Rao performed the surgery and removed the benign walnut-sized tumour.

“It is very difficult to handle tumours in a newborn,” said Dr. Balakrishnan. “This kind of tumour is usually found in the uterus and finding this in a newborn's heart is of great scientific interest,” he said.

Asiffa's condition came to light when her parents noticed that she turned blue and breathless every time she cried. “We went to the Government Children's Hospital in Egmore for a scan and they recommended surgery,” said Hayath Basha, her father.

An echocardiograph performed at the Fortis Malar Hospital revealed a large mass on the right side of the baby's heart. “We saw her when she was three days old and we advised immediate surgery. In the newborn child, who weighs 2.5 kg, the tumour occupied most of the heart,” said Dr.Balakrishnan. The baby's body temperature was cooled to 15 degree Celsius and the blood circulation was stopped to create a bloodless field. “This gave us a 30 to 45 minute window period to operate,” he said.

“The patient's heart is very small and it was a real surgical challenge,” said Dr. Suresh Rao. During the surgery, the child collapsed since the tumour obstructed one of the valves of the heart leading to low oxygen levels. “We had to slightly change the baby's position so we could continue with the procedure,” said Dr.Rao.

After removal of the tumour, the heart was repaired and the baby's body temperature was restored to normal. This surgery, which was “stressful even for surgeons,” as Dr.Rao put it, lasted three hours. The cost of the surgery was estimated by doctors to be around Rs.3 to Rs.4 lakh. “Initially, we only paid a small sum of money. Beyond which we availed the Chief Minister's Insurance Scheme (now withdrawn) and the Trust Fund from Malar hospital,” said Mr.Basha.

[SSridhar]

Neonatal Ambulance Services launched in TN

In an attempt to reduce neonatal mortality rate in the State, the government in association with EMRI, launched neonatal ambulance services on Wednesday.

At present the neonatal mortality rate in the State was 28/1000 and the State government wanted to bring down the number to 20/1000. In a phased manner, the neonatal ambulance would be introduced in all the districts in the State.

With the launching of ambulances, the neonatal mortality rate would decline in the State, as transporting babies to health care centres is the crucial link that was missing so far.

The basic stabilisation of a neonate, as part of the pre-hospital care comprising of managing and maintaining the airway, breathing and circulation would be taken care of in the ambulance.

The focus would also be on preventing hypoxia, hypothermia and infection, which were the leading causes for death in the neonatal age group.

Advanced life support systems such as incubator with ventilator, pulse-oxymeter, trans-illuminator and specialised equipment to monitor the vitals would be available in the ambulances

[Gus]

heart wrenching..

http://www.hindustantimes.com/18-infant ... 15742.aspx
18 infants die in hospital in two days

Pal also confirmed that most of the babies were either pre-mature or suffering from septicaemia or low-birth weight problems when they were brought to the hospital.

The BC Ray Memorial Hospital for Children, a state-run referral hospital, where the deaths happened was in the news in 2002 as well when 22 infants died in a span of 72 hours.

"No doctor or nurse was seen in the general ward where our babies were admitted," said Perveen Samshed, a resident of Gopalnagar in North 24 Parganas, who lost her baby. "My baby was gradually turning blue, but the concerned doctor did not pay any attention despite repeated requests."

[Airavat]

India promotes health tourism

[SSridhar]

AIG Surgeons perform robotic endoscopy

Hyderabad: Bringing to fruition a six-year collaborative effort between doctors and technologists, surgeons at the Asian Institute of Gastroenterology (AIG) here performed a rare robotic flexible endoscopy scar-less surgery to remove a cancerous tumour.

An upgraded technology of Robotic Flexible Endoscopy was developed following collaboration between Dr. Louis Phee of Nanyang Technological University, Dr. Ho Khek Yu Lawrence of National University Hospital from Singapore and the AIG.

While many of the endoscopic procedures with conventional endoscopy take a long time, with the new technology the tumour was removed in less than five minutes on a 30-year-old patient, who was sent home four hours later. The AIG claimed that this was the world's first such surgery.

A second surgery was also carried out on another 45-year-old patient to remove a 4 cm cancerous tumour from his stomach. Announcing the details at a press conference here on Sunday, AIG chairman D. Nageshwar Reddy said the same procedure would have taken eight hours with conventional endoscopy. Apart from removing gastric cancers, the equipment could also be used for ulcers and other lesions in the stomach, intestines and colon. In this technology, small robotic arms attached to the tip of the endoscope would be used by the surgeon sitting far away from the patient.

It was similar to using joysticks in TV games, he added.

He said while the cost for a surgery with conventional endoscope would range anywhere between Rs.50,000 and Rs. 1 lakh for removal of cancerous gastric tumour, the AIG was currently doing such surgeries free with the new equipment.

However, this could not continue and it was planned to bring down the cost to Rs.5,000-Rs.6,000 per procedure.

[ASPuar]

Iceland plans to ban smoking completely, and make cigarettes a controlled substance, issued only to confirmed addicts under a doctors prescription.

http://www.thehindu.com/health/policy-a ... 201195.ece

[SSridhar]

Southern States way ahead in achieving Millennium Development Goals

South India is way ahead in achieving the millennium development goal (MDG) targets for maternal mortality ratio, infant mortality rate and the total fertility rate.

The latest figures of the Sample Registration System (SRS), released by the office of the Registrar General of India suggest that the undivided Bihar, Madhya Pradesh, Uttar Pradesh, and Assam still lagged behind in improving their respective MMR, IMR and TFR figures despite being high focus States where the bulk of Centre's attention and funds are directed.

As in every other sector, Kerala tops the list of performance by having achieved the MDG well ahead of the schedule. The MMR in Kerala is 81 as against the stipulated 109, the IMR is 12 as against the required 28 and the TFR at 1.7 as set by the United Nations. The under five mortality rate is already 14, though India had to achieve a figure of 42 by 2015.

Closely following Kerala is Tamil Nadu that has managed to bring down its MMR to 97, IMR to 28, TFR to 1.7 and U5MR to 33.

Andhra Pradesh is closing in with its MMR at 134, IMR at 49, TFR at 1.9 and U5MR at 52. Karnataka's MMRis at 178 and IMR at49 and it has achieved a TFR at 2 and U5MR is 50. Maharashtra and West Bengal have also shown remarkable improvements.

The worst performers have been the undivided States of U.P, Madhya Pradesh and Bihar – clubbed as the empowered action group (EAG) and Assam. The MMR is highest among these States at 308. The maximum IMR (67) and U5MR (89) has been reported from Madhya Pradesh while Bihar has the highest TFR of 3.9, closely followed by Uttar Pradesh, Chhattisgarh, and Jharkhand – all with a TFR of over 3.

[SSridhar]

Unconventional Thyroid Surgery Performed

The shorter route is not necessarily the best route. As surgeons at Sri Ramachandra Medical Centre, Porur, discovered when a 23 year old female patient reported to the hospital with swelling of her thyroid gland.

Conventionally, the removal of the gland is done by making a cut on the neck (where the butterfly-shaped gland is located) right above the swelling and directly targeting the thyroid. The problem with this, however, is that it would leave a scar, and as a young 23-year old, the patient was not quite ready for that.

Her condition was a swelling of the right lobe of the thyroid. So the doctors decided to approach the thyroid through a roundabout route – the armpit. They made three small incisions in the armpit (one about one cm, the other two .5 cm each) through which they sent an endoscope to cut off the lemon-sized swelling of the right lobe.

[SSridhar]

Johnson&Johnson DePuy sets up orthopaedic & neurological centre

DePuy, a Johnson & Johnson outfit and a globally well-known name in the fields of orthopaedics, spinal care and neuroscience therapies, is hoping to secure a strong presence in the Indian market by fixing a solution to the critical issues of ‘4As'.

According to Michael del Prado, Company Group Chairman, Johnson & Johnson Medical Asia Pacific, the ‘4As' — accessibility, awareness, affordability and adaptability — have been a huge impediment for a larger section of the Indian population to get treatment for orthopaedic problems.

He estimated that there could be around five million people in India with orthopaedic diseases.

However, the number of orthopaedic surgeons was just around 1,000 across the whole country.

These limited surgeons had only limited access to latest procedures in the field. Even where there was access, adaptability to the local needs had proved to be a key resistance factor, he felt.

The setting up of an institute for advanced education and research in orthopaedic and neurological care at the Mahindra World City near here {Chennai} by DePuy, he felt, would go a long way in providing an effective combat to the increasing number of orthopaedic cases that cut across age groups.

Mr. Prado was confident that the DePuy centre, its second orthopaedic and neurological care centre outside the U.S., would be able provide training in advanced procedures to 1,000 surgeons every year. Essentially, the institute, he said, would serve as a hub for education, training and research across the continuum of orthopaedic and neurological care. He said the courses offered by the institute would be certified by the Medical Council of India (MCI). The MGR University too had agreed to provide ‘credit' to those students who successfully completed the courses conducted by the institute.

The institute, according to Gary Fischetti, Company Group Chairman, DePuy Franchise, would offer both basic and advanced surgical courses. Though these courses were priced, DePuy would subsidise courses that involved training in the use of its own instruments/devices and technologies. The institute would also offer distance learning opportunities by partnering faculties across the globe. Primarily, Mr. Prado said, the institute would aim at bridging the skill gap in healthcare, in general, and in orthopaedic care, in particular.

Mr. Prado said that Depoy had only a long-term vision for India. Given the growth of the insurance industry and with public-private participation, DePuy, he felt, would be well positioned to play a greater role in the burgeoning Indian healthcare industry.

[SSridhar]

A Rare Surgery Performed

When 48-year-old flower seller Kanthammal walked into the general clinic at the Government Kilpauk Medical College and Hospital, complaining of severe back pain and head ache, she had no idea how close to a cardiac arrhythmia she was. The ultrasound exam revealed a massive cyst-like presence in her left adrenal gland. “Though the incidence is extremely rare, we suspected that she might have a tumour in the adrenal gland,” says medical superintendent Dr R Sukumar.

Though curable if detected, finding an adrenal tumour is a difficult procedure, because there are very few external symptoms that indicate a serious problem, explains Dean Dr S Geethalakshmi. If unattended, it can cause fatality through rapid hypertension, cardiac arryhthmias and other complications.

A CT scan confirmed the presence of pheochromocytoma or adrenal tumour. “A continous urinary test confirmed our fears that it was a functioning tumour,” adds Santhaseelan, for if it had been non-malignant, the risk factor was low. After a consultative meet, the six-member team of surgeons steeled themselves for the complex surgery, the likes of which had never been attempted at KMC. “It was an anaesthetic challenge like no other,” says Dr S Gunasekaran, chief anaesthesiologist. “We used three times the amount of drugs used on a normal patient to keep her stable,” he adds.

When the surgery began at 10am on July 27, Kanthammal’s daughter Revathi had very little hope that her mother would survive the pain. The doctors were riddled with complications, foremost of them being the fluctuating blood pressure of the patient. “When we began, her BP was around 275/145 and we had to stabilise it by giving her suitable anaesthetic drugs,” explains Gunasekaran.

However, when the tumour was being severed, the loss of adrenal hormones that it had been secreting, resulted in a rapid plunge in her BP. “It plummetted to 20/50 and stayed there for a while,” he adds. Once the tumour was removed, the BP spiked again, necessitating more drugs that made her system unstable, “We lost hope and thought that she would go into (cardiac) arrest soon,” recounts Sukumar. Miraculously, the woman’s condition stabilised around 4 pm.

“They replenished her body with 10 units of blood and equal quantities of plasma and platelets. Besides this we used an intra-arterial pressure monitor for the first time,” says Geethalakshmi. Other than some internal bleeding, the flower vendor was fine when the doctors put her on ventilator for the next 48 hours. Dr V Selvaraj, Professor of Urology says that he was surprised at the size of the removed tumour. “Normally tumours can range from 2x2cm but this one was 12x12cm; roughly the size of a small ball,” he says. Though feeble, the patient is recovering well and will be discharged in a few days, says Sukumar.