Health Care

National Cancer Institute to be set up in Haryana

National-Cancer-Institute222The Union Cabinet on Thursday approved setting up of a Rs 2000-crore National Cancer Institute (NCI), which will be housed in an upcoming campus of the All India Institute of Medical Sciences at Jhajjar, Haryana.

To be completed by 2018, the NCI seeks to plug the gap in offering cancer treatment facilities in the public sector including specialised tertiary care.

Cancer has emerged as a major public health concern in India, where every year 11 lakhs new cases are diagnosed with a mortality of 5.5 lakhs per year.

In 2013, an estimated 10,86,783 new cancer cases were reported and the numbers are slated to rise to 1148692 in 2015 — a jump of over 5.5 per cent in two years. Tobacco remains the most prominent disease causing factor.

The data, collated by the Indian Council of Medical Research, however, is not exhaustive as it does not have inputs from 25 regional cancer centres and populous states like Bihar and Utttar Pradesh.

Males have higher occurrence of cancers of lung, mouth, oesophagus and stomach. Cancers of tongue, rectum, liver, lung, prostate, brain, non-Hodgkin’s lymphoma and a type of leukaemia have shown statistically significant increase. Cancers of uterine cervix and gall bladder too is fairly common.

But cancer treatment facilities in India are inadequate, compared to the World Health Organisation norms that requires one radiotherapy machine per million population. India currently has 0.41 machines per million population.

The Rs 2,035 crore institute will operate on the lines of National Cancer Institute, USA and DKFZ, Germany as a nodal center for indigenous research as well as preventive and curative aspects of cancer care.

In addition, the institute aims to conduct research on cancers that are more specific to India such as tobacco related cancers, cancer of the uterine cervix, gall bladder cancer and liver cancers.

The focus will be on understanding, analysing the cause and genesis of the above cancers.
The NCI will have 710 beds for different facilities like surgical oncology, radiation oncology, medical oncology, anaesthesia and palliative care and nuclear medicine.

It will have a tissue repository which is the first of its kind in India, according to a press statement issued at the end of the Cabinet meeting.

Besides the cancer institute, the second campus of AIIMS will also have a National Centre for Heart Diseases along with a full fledged hospital for which the Haryana government had provided 300 acres of land.

Source: Deccan herald

Triplet Births Due to Fertility Treatments Are Declining

More than one-third of U.S. twins, and more than three-quarters of triplets and other multiple births, are now born as a result of fertility treatments, according to estimates from a new study.

In 2011, 36 percent of twin births and 77 percent of triplet and higher-order births (quadruplets, etc.) were aided by fertility treatments, which include both in vitro fertilization (IVF) and other treatments, such as the use of drugs to stimulate the ovaries and induce ovulation, the study found.

Between 1998 and 2011, the national rate of triplet and higher-order births decreased by nearly 30 percent — a trend that researchers called good news.

Part of that decline may be related to a 1998 change in guidelines that discouraged doctors from implanting three or more embryos during a single IVF cycle. After that, the proportion of triplet and higher-order births attributable to IVF declined by 33 percent (from 48 percent in 1998 to 32 percent in 2011).

However, there’s still a lot of work to be done to reduce the U.S. rate of multiple births, said study researcher Dr. Eli Y. Adashi, a professor of obstetrics and gynecology at Brown University. The percentage of twin births resulting from IVF and non-IVF fertility treatments is still on the rise.

Why a decline in multiple births is good

Twin and other multiple births increase the risk of complications for the mother and infant, including the risk of premature delivery. An unintended consequence of fertility treatment technology was an increase in the nation’s multiple-birth rate, Adashi said.

The new study also suggests that non-IVF fertility treatments deserve greater attention, as they now contribute to a greater proportion of multiple births than IVF does. The percentage of triplet and higher-order births resulting from non-IVF treatments increased from 36 percent in 1998 to 45 percent in 2011, the study found.

“When people hear ‘multiple,’ they intuitively point at IVF,” Adashi said. The study found “IVF is an actor,” he said, but “not the leading culprit when it comes to the genesis of multiples.”

But unlike multiple births from IVF, which result from the number of embryos that are intentionally implanted, multiple births from non-IVF fertility treatments are difficult to prevent, Adashi said. That’s because non-IVF treatments, including oral and injectable drugs, stimulate ovulation in ways that cannot be precisely controlled, Adashi said.

How to reduce multiple births

But there are a few steps doctors can take that may reduce the rate of multiple births from non-IVF fertility treatments, such as lowering the doses of the ovulation-stimulating drugs, Adashi said.

“Increased awareness of multiple births resulting from non-IVF fertility treatments may lead to improved medical practice patterns and a decrease in the rate of multiple births,” the researchers wrote in the Dec. 5 issue of The New England Journal of Medicine.

To come up with their estimates, the researchers analyzed information on birth rates between 1962 and 1966 — before the advent of fertility treatments — to get a measure of the natural rate of multiple births. They also used publicly available data on IVF births between 1997 and 2011.

Because no database tracks multiple births due to non-IVF treatment, the researchers estimated this number by factoring in the natural rate of multiple births and IVF births. The researchers also took into account maternal age, which increases the chance of giving birth to multiples, but were not able to account for other factors, like obesity, which some studies suggest increases the chances of giving birth to twins.

source: live science

Obama launches $100 mn HIV cure initiative

President Barack Obama announced Monday the US will shift $100 million into research efforts in the next three years aimed at curing HIV (Human Immunodeficiency Virus).

Obama launched the HIV Cure Initiative at a White House event to mark the World AIDS Day, which was observed Sunday, Xinhua reported.

“Today I’m pleased to announce a new initiative at the National Institutes of Health to advance research into an HIV cure. We’re going to redirect 100 million dollars into this project to develop a new generation of therapies,” Obama said.

He said the US should be at the forefront of new discoveries into how to put HIV into long-term remission without requiring lifelong therapies or eliminate it completely.

According to a White House statement, although several individuals appear recently to have been cured of HIV through aggressive therapy, these approaches are “too toxic or premature to apply beyond the research setting”.

However, these cases provide clues to explore for possible new treatments and this new investment will catalyse further research into this area, and could lead to a new generation of therapies to improve outcomes for people living with HIV, the statement added.

Source: the pioneer

‘One-stop shop’ for tracking diseases in the US

Tracking a nation’s health can be a painstaking business. But now, a team of researchers from the University of Pittsburgh have brought together and digitized all the weekly surveillance reports of diseases in the US since 1888 into one database.

The researchers collated all weekly modifiable disease surveillance tables published between 1888 and 2013 – approximately 6,500 tables. Because of their age, many of these tables were available only in paper format or as PDF scans in online repositories that could not be read by computers and had to be hand-entered.
With an estimated 200 million keystrokes, the data – including death counts, reporting locations, time periods and diseases – were digitized. A total of 56 diseases were reported for at least some period of time during the 125-year time span, with no single disease reported continuously.
Tracing the path of epidemics
Named Project Tycho after Tycho Brahe, a 16th century nobleman whose detailed astronomical observations helped Johannes Kepler derive the laws of planetary motion, the database is free to use and is publicly available.
Dean of the Graduate School of Public Health Dr. Donald Burke explains the

significance of the choice:

“Tycho Brahe’s data were essential to Kepler’s discovery of the laws of planetary motion. Similarly, we hope that our Project Tycho disease database will help spur new, life-saving research on patterns of epidemic infectious disease and the effects of vaccines. Open access to disease surveillance records should be standard practice, and we are working to establish this as the norm worldwide.”
The database enables researchers to track the spread of diseases and also chronicle the impact that vaccines have had in controlling communicable diseases.
The researchers focused on eight vaccine-preventable contagious diseases: smallpox, polio, measles, rubella, mumps, hepatitis A, diphtheria and pertussis.
By overlaying the reported outbreaks with the year of vaccine licensure, the researchers are able to give a clear, visual representation of the effect that vaccines have in controlling communicable diseases.
The results showed that despite a pertussis vaccine being available since the 1920s, the largest outbreak since 1959 was recorded in the US last year. Recurrences of measles, mumps and rubella have also been noticeable since the 1980s.
Lead author Dr. Willem G. van Panhuis, assistant professor of epidemiology at the university, notes:
“Using this database, we estimate that more than 100 million cases of serious childhood contagious diseases have been prevented, thanks to the introduction of vaccines. But we also are able to see a resurgence of some of these diseases in the past several decades as people forget how devastating they can be and start refusing vaccines.”
Steven Buchsbaum, deputy director of Discovery and Translational Sciences for the Bill & Melinda Gates Foundation, which partly funded the research, concludes:
“We anticipate this will not only prove to be an invaluable tool permitting researchers around the globe to develop, test and validate epidemiological models, but also has the potential to serve as a model for how other organizations could make similar sets of critical public health data more broadly, publicly available.”

Source: Medical News Today

 

Headache: Top 5 tests and treatments to avoid

Doctors who specialize in treating head pain, such as chronic migraines, are the latest to list the procedures and treatments they think have risks or costs that may outweigh the benefits to patients.

The American Headache Society’s list is part of the Choosing Wisely campaign from the ABIM Foundation, a not-for-profit foundation established by the American Board of Internal Medicine. The campaign has seen cancer doctors, eye doctors and chest surgeons naming the overused or unproven practices their peers should avoid and patients should question.

The newest Choosing Wisely list was published Thursday in the journal Headache.

“The article and recommendations identify situations that are felt by experts to be cases where patients and doctors should think very carefully before they decide to use that particular treatment or intervention,” said Dr. Elizabeth Loder, an author of the new recommendations.

Loder is the president of the American Headache Society, and chief of the Division of Headache and Pain at Brigham and Women’s Hospital in Boston.

All tests and treatments have risks, Loder said. For example, imaging techniques such as CT scans expose patients to potentially cancer-causing radiation, and certain pain medications sometimes used to treat headaches are easy to get hooked on.

The goal of the recommendations is to encourage discussion between patients and their doctors about which tests are overall beneficial to patients, she said.

“The purpose is to start a conversation about situations, tests, procedures and interventions that do not necessarily benefit the patient, and sometimes can even cause problems,” Loder said.

To come up with the recommendations, Loder and her coauthors asked physician members of the American Headache Society (AHS) to identify tests and treatments they view as being used incorrectly or too often, and which methods of care had benefits too small to outweigh the risks.

The researchers evaluated more than 100 items suggested by AHS members, distilling the list down to five items based on current evidence.

The guidelines advise against imaging the brains of patients who get headaches that have not changed over time.

They also discourage the long-term use of over-the-counter pain pills to treat headaches, and recommend that physicians avoid using certain pain medications – opioids like oxycodone and drugs containing butalbital like Fioricet – for patients who get headaches often.

Finally, physicians should not perform computed tomography, or CT, on a patient with a headache when magnetic resonance imaging, or MRI, is available, except if it’s an emergency, the recommendations state.

The recommendations, Loder said, “are a nice distillation for patients when thinking about their care.” Patients and their families can use the guidelines to start a conversation with their doctor about the pros and cons of a given test or procedure.

“In addition to thinking about the good things that may come about from interventions, it’s also important to think about situations in which caution can be used,” Loder told Reuters Health.

Source: Global post

World Bank Urges Cleaner Stoves to Save Lives, Fight Global Warming

Simple measures to reduce pollution from cooking stoves in developing nations could save a million lives a year and help slow global warming, a World Bank study showed on Monday.

Tighter restrictions on diesel emissions, for instance from car exhausts, could also avert 340,000 premature deaths annually by reining in soot and other heat-trapping pollutants that are also stoking climate change, the report claimed.

The study called for tough limits on pollution from methane and soot, which can settle on snow and ice and hasten a thaw by darkening its surface, in everything from cooking and heating to mining and flaring by the oil and gas industry.

“The damage from indoor cooking smoke alone is horrendous – every year, four million people die from exposure to the smoke,” World Bank President Jim Yong Kim said in a statement of the study “On Thin Ice: How Cutting Pollution can Slow Warming and Save Lives”.

Many people in developing nations cook on open fires with wood or coal, exposing people – mainly women and children – to fumes that cause everything from respiratory problems to heart disease.

“If more clean cook-stoves – stoves that use less or cleaner fuel – would be used it could save one million lives,” the report said.

Permafrost

Mass produced, such stoves can cost a few dollars each.

Monday’s study was co-written by the International Cryosphere Climate Initiative – the cryosphere is the world’s ice, snow and permafrost, from Siberia to Antarctica.

New stoves use fans to improve combustion, or less-polluting fuels such as gas from crop waste or manure.

“If we act fast and cut common pollutants like soot and methane we can slow the rate of warming… and if we did so we can save millions of lives,” Rachel Kyte, World Bank vice president for sustainable development, told a telephone news conference.

Tighter controls on pollution could also boost crop growth, the report said. Plant growth can be hampered by a haze of pollution.

A 2011 U.N. study estimated that measures to limit air pollutants such as methane and soot could slow the pace of global warming by 0.5 degrees Celsius (0.9 Fahrenheit) by mid-century.

A study in August 2013, however, said the benefits would be far less. Temperatures have risen by about 0.8 C (1.4 F) compared to before the Industrial Revolution.

Almost 200 nations will meet in Warsaw from Nov. 11-22 to consider ways to combat global warming. They have agreed to work out by the end of 2015 a deal that will enter into force from 2020.

Source: Voice of America

 

Biosensor to detect brain injuries during heart surgery

 

Scientists have developed a fingernail-sized biosensor that could alert doctors when serious brain injury occurs during heart surgery.

Johns Hopkins engineers and cardiology experts teamed up to develop the device and demonstrated in lab tests that the prototype sensor had successfully detected a protein associated with brain injuries.

“Ideally, the testing would happen while the surgery is going on, by placing just a drop of the patient’s blood on the sensor, which could activate a sound, light or numeric display if the protein is present,” said the study’s senior author, Howard E Katz, a Whiting School of Engineering expert in organic thin film transistors, which form the basis of the biosensor.

The project originated about two years ago when Katz, who chairs the Department of Materials Science and Engineering, was contacted by Allen D Everett, a Johns Hopkins Children’s Center pediatric cardiologist who studies biomarkers linked to pulmonary hypertension and brain injury.

Everett sought an engineer to design a biosensor that responds to glial fibrillary acidic protein (GFAP), which is a biomarker linked to brain injuries.

“If we can be alerted when the injury is occurring then we should be able to develop better therapies. We could improve our control of blood pressure or redesign our cardiopulmonary bypass machines,” Everett said.

“We could learn how to optimise cooling and rewarming procedures and have a benchmark for developing and testing new protective medications,” Everett added.

At present, Everett said, doctors have to wait years for some brain injury-related symptoms to appear. That slows down the process of finding out whether new procedures or treatments to reduce brain injuries are effective.

“The sensor platform is very rapid. It’s practically instantaneous,” Everett said.

To create this sensor, Katz turned to an organic thin film transistor design.

The sensing area is a small square, 3/8ths-of-an-inch on each side. On the surface of the sensor is a layer of antibodies that attract GFAP, the target protein.

When this occurs, it changes the physics of other material layers within the sensor, altering the amount of electrical current that is passing through the device.

These electrical changes can be monitored, enabling the user to know when GFAP is present.

“This sensor proved to be extremely sensitive. It recognised GFAP even when there were many other protein molecules nearby. As far as we’ve been able to determine, this is the most sensitive protein detector based on organic thin film transistors,” Katz said.

The study was published in the journal Chemical Science.

Source:  Zee News

FDA Takes Two Important Actions on Drug Shortages

The U.S. Food and Drug Administration is taking two actions to further enhance the agency’s ongoing efforts to prevent and resolve drug shortages, a significant public health threat that can delay, and in some cases even deny, critical care for patients. Following the President’s 2011 Executive Order on reducing drug shortages, the number of new shortages in 2012 was 117, down from 251 in 2011.

Today’s announcements build on this work. First, the FDA is releasing a strategic plan called for in the Food and Drug Administration Safety and Innovation Act (FDASIA) of 2012 to improve the agency’s response to imminent or existing shortages, and for longer term approaches for addressing the underlying causes of drug shortages. The plan also highlights opportunities for drug manufacturers and others to prevent drug shortages by promoting and sustaining quality manufacturing.

Second, the FDA issued a proposed rule requiring all manufacturers of certain medically important prescription drugs to notify the FDA of a permanent discontinuance or a temporary interruption of manufacturing likely to disrupt their supply. The rule also extends this requirement to manufacturers of medically important biologic products. The proposed rule implements the expanded early notification requirements included in FDASIA.

“The complex issue of drug shortages continues to be a high priority for the FDA, and early notification is a critical tool that helps mitigate or prevent looming shortages,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research (CDER). “The FDA continues to take all steps it can within its authority, but the FDA alone cannot solve shortages. Success depends upon a commitment from all stakeholders.”

Early notification gives the FDA time to:

  • work with manufacturers to investigate the issue leading to the manufacturing disruption;
  • identify other manufacturers who can make up all or part of the shortfall; and
  • expedite inspections and reviews of submissions from manufacturers of drugs that may prevent or mitigate a shortage.

Early notification from manufacturers about possible shortages, as requested in the President’s Executive Order 13588 of Oct. 31, 2011 and then codified into law in FDASIA, has enabled the FDA to work with manufacturers to restore production of many lifesaving therapies. Since the Executive Order, there has been a 6-fold increase in notifications to the FDA.

The notifications received under the existing requirements have resulted in real progress in addressing shortages. The FDA helped prevent 195 drug shortages in 2011 and 282 drug shortages in 2012, leading to a reduced number of new shortages in 2012. The expanded early notification requirements would further enhance the FDA’s ability to address issues prior to the occurrence of a shortage.

The strategic plan, which was required by FDASIA and is being sent to Congress today, describes actions the FDA will undertake to improve its current efforts to respond to early notifications of a potential shortage. These include:

  • improving the FDA’s communications about shortages, such as launching a new mobile app, so that individuals can instantaneously access drug shortage information via their smart phones;
  • clarifying manufacturers’ roles and responsibilities by encouraging them to engage in certain practices that will reduce the likelihood of a shortage; and
  • updating the FDA’s internal procedures for responding to early notifications of potential shortages.

The strategic plan also describes efforts the FDA is considering to address the manufacturing and quality issues that are most often the root cause of drug shortages. These include:

  • broader use of manufacturing metrics to assist in the evaluation of manufacturing quality, as well as incentives for high-quality manufacturing;
  • internal organization improvements to focus on quality, including a proposed Office of Pharmaceutical Quality within CDER; and
  • Risk-based approaches to identify early warning signals for manufacturing and quality problems.

Source: drugs

Helmets May Never Prevent Concussions

A third of Americans said they’re less likely to allow their boys to play football because they understand the head injury risks it poses, a poll showed last week. So it’s no wonder that helmet companies are racing to reassure parents that their products can lessen that risk. Meanwhile, researchers are analyzing whether helmet technology really plays a role in reducing concussions.

A current study of high school players found no differences among brand or age of helmet, said study co-author and University of Wisconsin — Madison Assistant Professor of sports medicine Alison Brooks. She will present the abstract at an American Academy of Pediatrics conference in Orlando today.

What happens to a player’s brain during hard tackles, and what can be done to keep the athletes safe?

“We were surprised that there was not a statistically significant difference in concussion incidence when comparing older age helmets (purchased in 2008 or older) to newer helmets,” she said.

But Stefan Duma, who has studied the Virginia Tech football team for years as head of the Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, says that there are big differences among helmets. His research led to a rating system, the Summation of Tests for Analysis of Risk (STAR) ratings, that ranks helmets from 1 to 5. He’s guessing that most of the players in Brooks’s study were already wearing quality helmets.

“The important thing is, there’s a big difference between the bad and the good,” he said. “There’s a big difference between a 1-star helmet and a 4-star. There’s not so much difference between a  4-star and 5-star.”

Analyzing nine years of data from Virginia Tech, in which players wore helmets equipped with sensors, Duma’s team found an 85 percent reduced risk of concussion in a 4-star helmet vs. a 1-star helmet.

Brooks’ study will factor helmet ratings in in the next year of research, which involves 1,332 players from 36 high schools, she said. Brooks also found that brands of mouth guards probably aren’t important in terms of reducing concussion risk: Players who were generic, school-issued mouth guards actually had fewer concussions than those who wore specialized mouth guards.

Helmets alone won’t solve the concussion problem. That’s partly because of the nature of the brain’s anatomy.

“The anatomy of the brain floating freely inside the skull and the subsequent mechanism of injury will make it difficult to significantly reduce concussion risk using helmet technology alone,” Brooks said. “I think focus could be better spent on rule enforcement and coaching education on tackling technique to limit/avoid contact to the head, perhaps limiting contact practices, and behavior change about the intent of tackling to injure or ‘punish’ the opponent.’”

Duma agrees that future technology probably won’t change concussion rates in football much more. Current technology in football helmets is “about as good as we can get,” he said.

Still, sports in which helmets haven’t been focused on to the same extent may have more room to benefit. Duma’s team will present a rating system for hockey helmets this fall, and they plan on rating lacrosse helmets next. And new technology, perhaps in the form of a headband, may be on the horizon for youth soccer.

Source: Daily me

 

Low treatment costs attract foreign heart patients to India

Low treatment costs and high levels of expertise have made India a leading destination for heart treatment for people from West Asian and African countries, doctors said.

According to doctors, the rates of heart treatment are 1/10th to 1/15th times lower as compared to the United States and Britain.

“India has now become a hub for heart treatment in Southeast Asia and people have been flying in from foreign countries and undergoing treatment for various cardiovascular diseases here,” Subhash Chandra, associate director (Interventional Cardiology), Fortis Escorts Heart Institute, told IANS.
People visiting India for treatment are not only from neighbouring countries like Pakistan, Afghanistan, Bangladesh and Nepal but also from far off countries like Nigeria, Kenya, Uganda, Kazakhstan, Iran, Iraq, Yemen and Oman.

Subhash Chandra said close to 500 patients had undergone treatment in Delhi alone in the last one year.

“Compared to global standards, the rates for any kind of cardiovascular surgery are very minuscule in our country,” said Anil Bansal, chief cardiologist at Columbia Asia Hospital.
Coronary angiography (a test that uses dye and special X-rays to show the insides of coronary arteries, the tube that carries blood to heart) costs around Rs.10,000 to Rs. 15,000 in India and around 500 dollars (Rs. 32,000) in the US.

“I underwent an implant here in just Rs.7 lakhs, while I was quoted Rs. 30 lakhs for this in Europe,” said Bardhan Sarkar from Bangladesh, who was treated by Bansal.

The most popular treatments availed of  by people who come to India are angioplasty, where the blockage in the coronary artery is opened and a thin coil, called a stent, is implanted; open heart surgery where the heart holes are closed and narrow valves opened; and the installation of artificial pacemakers for slower heart rates.

Low treatment costs are definitely one of the major factors attracting people to India, but the expertise and trust in the quality of treatment is another reason for the growth of foreign patients.

“All the latest high quality treatment is available in our country and with high expertise we have been able to establish trust among foreign patients,” said Chandan Kedawat, senior consultant cardiovascular disease at Pushpawati Singhania Research Institute (PSRI).

Similarly, even for treatment of congenital heart disease (diseases affecting infants and children and present since birth) several hospitals are attracting a lot of patients from abroad.

“Treatment of heart disease in children costs 10 to 15 times less here than that in any European country,” said Shreesha Maiya, pediatric interventional cardiologist at Bangalore’s Narayana Hrudayalaya.

In private hospitals, open heart surgery costs Rs.1.5 lakh to Rs.2.25 lakh; for children, open heart surgery costs Rs.1.25 lakh to Rs.2 lakh; valve surgeries cost between Rs.2.5 lakh and Rs.2.75 lakh.

The treatment is even cheaper in government hospitals, with the difference being  usually between Rs.75,000 and Rs. 1 lakh.

Source: Deccan herald