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Wednesday, October 4, 2017

Indian doctor becomes WHO’s Deputy Director General

The World Health Organization has an Indian doctor for its new Deputy Director General for Programmes. Dr. Soumya Swaminathan, the director general of the Indian Council of Medical Research has been appointed as the same.
A paediatrician by trade, Swaminathan is famous for her research in tuberculosis. The position she now adorns in the WHO is the second highest position in the global organization. It comes only below the Director General. Dr. Tedros Adhanom Ghebreyesus, who took the post in July is the Director General.
Swaminathan's is also the highest position adorned by an Indian in WHO’s history.
The doctor comes with over 30 years of experience in clinical research. She used to be the director of the National Institute of Research in Tuberculosis, Chennai.
She has been largely responsible for heightening the focus on tuberculosis research in India. To this end, she even created a consortium called “India TB Research and Development Corporation.” The organization aimed to bring under the same umbrella all the leading national and international stakeholders to develop new tools that could combat TB including diagnostics, vaccines and drugs.
In a related statement, the WHO said that the new team includes people from 14 different nations. It “includes former ministers of health, some of the world’s leading physicians, scientists and researchers, and programmatic experts in universal health coverage, health emergencies, communicable and non-communicable diseases, climate and environmental health, and women’s, adolescents’ and children’s health.”
“The team represents 14 countries, including all WHO regions, and is more than 60% women, reflecting my deep-held belief that we need top talent, gender equity and a geographically diverse set of perspectives to fulfil our mission to keep the world safe,” said Dr Tedros.
Dr. Sowmya Swaminathan hails from Tamil Nadu and her father is the legendary MS Swaminathan- considered as the pioneer of the Green Revolution in India. 

Wednesday, August 9, 2017

Why the ‘gold standard’ of medical research is no longer enough ?

andomized controlled trials have long been held up as the “gold standard” of clinical research. There’s no doubt that well-designed trials are effective tools for testing a new drug, device, or other intervention. Yet much of modern medical care — perhaps most of it — is not based on randomized controlled trials and likely never will be. In this “dark matter” of clinical medicine, past practices and anecdotes all too often rule. We need to look beyond trials to improve medical care in these areas.
In a randomized controlled trial (RCT), participants are randomly assigned to receive either the treatment under investigation or, as a control, a placebo or the current standard treatment. The randomization process helps ensure that the various groups in the study are virtually identical in age, gender, socioeconomic status, and other variables. This minimizes the potential for bias and the influence of confounding factors.
Despite their strengths, RCTs have substantial limitations. They can be very expensive to run. They can take many years to complete, and even then may not last long enough to assess the long-term effect of an intervention such as vaccine immunity, or to detect rare or long-term adverse effects. Findings from RCTs may not be valid beyond the study population — a trial that included a high-risk population in order to maximize the possibility of detecting an effect, for example, may not be relevant to a low-risk population. RCTs may not be practical for population-wide interventions and often aren’t relevant for urgent health issues such as infectious disease outbreaks, for which public health decisions must be made quickly.
As I write this week in the New England Journal of Medicine, several other study types can generate data that are at least as effective as RCTs, or may be even more effective, at generating evidence for action, especially related to population-wide interventions.
The effectiveness of the nasal spray flu vaccine (also called the live attenuated vaccine) is a dramatic illustration of the limitations of RCTs. Trials suggested that the nasal spray vaccine was superior to flu shots, at least for some populations. In subsequent years, however, observational studies, including case-control studies, documented that, for reasons which are still unclear, the nasal spray wasn’teffective against the flu. That led the Advisory Committee on Immunization Practices to recommend, and the CDC to accept the recommendation, that the nasal spray flu vaccine not be used in the 2016-2017 flu season.
For some public health issues, it isn’t ethical to conduct an RCT. Take sudden infant death syndrome (SIDS). Early case-control studies suggested, but didn’t prove, that babies who sleep on their stomachs are more likely to die of SIDS than babies who sleep on their backs. It wouldn’t have been ethical to randomize some babies to stomach sleeping. A public program to implement putting children to sleep on their backs proved that this measure reduced the incidence of SIDS.
It would be difficult, if not impossible, to do an RCT of community-wide tobacco control measures. But analyses of the results of implementing tobacco control policies, such as taxes, smoke-free laws, and advertising bans, have generated robust evidence of effectiveness that could not have been accomplished through an RCT-style study.
For the several thousand rare diseases, RCTs are unlikely to be conducted due to the small number of people who have them and other logistical constraints. Detailed case studies, registries that collect information about specific conditions and diseases, and other study types can enhance understanding of a particular disease and its treatment to improve the health of affected patients.

The emerging use of “big data,” including information from electronic health records and expanded patient registries, presents new opportunities to conduct large-scale studies with many of the benefits of RCTs but without the expense. One such study used data from the Veterans Health Administration and Medicare to examine outcomes of treatment for type 2 diabetes. This study was many times larger, with much longer follow-up and lower cost, than previous RCTs comparing the effectiveness of different diabetes drugs. It clearly showed that one class of drug, the thiazolidinediones, was much more effective than another class, the sulfonylureas, in reducing hospitalization and death.
Clinical and public health decisions are almost always made with imperfect data. There is no single, best approach to obtain better information about health interventions. Evidence grading systems, policy makers, and researchers must embrace other study types in addition to RCTs. Essential steps in interpreting findings and identifying data for action include promoting transparency in study methods, ensuring standardized data collection for key outcomes, and using new approaches to improve data synthesis.
Despite the global evidence base, around the world there are often claims that “there is no evidence tobacco harms health here” or that “soda isn’t proven to drive obesity in this country.” In part, such claims can be made because some formal systems of analyzing evidence give undue weight to RCTs and inappropriately discount other types of rigorously developed evidence.
A valid ideal is “evidence-based practice,” which means implementing in clinical care and public policy interventions that are proven to work. But it’s also important, and perhaps more so, to develop “practice-based evidence,” — that is, to implement programs and rigorously document whether or not they work. That would both save lives and expand the evidence base of effective interventions.


Sunday, February 5, 2017

The Calla lilly prep in endodontics !!

During patient treatment, the clinician needs to consider many factors that will affect the ultimate outcome. In simple terms, these factors can be grouped into 3 categories:
(I) operator needs,
(II) restoration needs,
(III) the tooth needs.

(I)The operator needs are the conditions the clinician needs to treat the tooth.
(II) The restoration needs are the prep dimensions and tooth conditions for optimal strength and longevity.
(III)The tooth needs are the biologic and structural limitations for a treated tooth to remain predictably functional.

The Cala Lilly is a flower and is the new model for composite preparations.

Modern Molar Endodontic Access and Directed Dentin Conservation, David Clark et al,2010

Thursday, February 2, 2017

DCGI Issues Urgent Notice To MCI

Antibiotic resistance is a result of different environmental factors and behavioral changes. Recently, antibiotic resistance has been on the rise in the past decade. In the recent turn of events, Drug Controller General of India (DCGI) has issued an urgent notice to MCI, PCI, Nursing, and Dental Council on 1st Feb 2017, about the rational use of antibiotics with the aim to limit antimicrobial resistance. Antibiotic resistance is a growing threat which needs to be contained. It has also led to the death of a patient in India. To limit the antibiotic resistance, the office has been advising about the strict requirements and prescription of Schedule H and H1 drugs for sale. Thereby, DCGI advised Indian supply chain system stakeholders for strict compliance of the Drugs & Cosmetics Act and Rules (January 2017): Taking strong policy measures, including strict regulatory action on over the counter sale of high-end antibiotics Raising awareness through different platforms and consumer associations for patient safety, well-being and protection of their health. Further to this notice, DCGI has issued an urgent notice to MCI, PCI, Nursing and Dental Council to alert their council members by raising awareness for rational use of antibiotics, with main intention to curb the antimicrobial resistance in the interest of patient safety. It has also been suggested that these councils can spread awareness on different medical platforms to increase awareness of this national issue.

Tuesday, March 17, 2015

Are your Kidneys ok?
What can you do for your kidneys?
Kidney diseases are silent killers, which will largely affect your quality of life. There are however several easy ways to reduce the risk of developing kidney disease.

Keep fit and active

Keeping fit helps to reduce your blood pressure and therefore reduces the risk of Chronic Kidney Disease.
The concept “on the move for kidney health” is a worldwide collective march involving the public, celebrities and professionals moving across a public area by walking, running and cycling. Why not join them – by whatever means you prefer! Check out the events section of the WKD website for more information.

Keep regular control of your blood sugar level

About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions.
Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep control of blood sugar levels with the help of doctors or pharmacists, who are always happy to help.

Monitor your blood pressure

Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage.
The normal blood pressure level is 120/80. Between this level and 139/89, you are considered prehypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor and montior your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and Cardio- Vascular Diseases.

Eat healthy and keep your weight in check

This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease.
Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients. For more information on nutrition and kidney friendly cooking, visit our nutrition page

Maintain a healthy fluid intake

Although clinical studies have not reached an agreement on the ideal quantity of water and other fluids we should consume daily to maintain good health, traditional wisdom has long suggested drinking 1.5 to 2 litres (3 to 4 pints) of water per day.
Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease, according to researchers in Australia and Canada. The findings, the researchers said, do not advocate “aggressive fluid loading”, which can cause side effects, but they do provide evidence that moderately increased water intake, around two litres daily, may reduce the risk of decline in kidney function. It’s important to keep in mind that the right level of fluid intake for any individual depends on many factors including gender, exercise, climate, health conditions, pregnancy and breast feeding. In addition, people who have already had a kidney stone are advised to drink 2 to 3 litres of water daily to lessen the risk of forming a new stone.

Do not smoke

Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 percent.

Do not take over-the-counter pills on a regular basis

Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.
Such medications probably do not pose significant danger if your kidneys are relatively healthy and you use them for emergencies only, but if you are dealing with chronic pain, such as arthritis or back pain, work with your doctor to find a way to control your pain without putting your kidneys at risk.

Get your kidney function checked if you have one or more of the ‘high risk’ factors

  • you have diabetes
  • you have hypertension
  • you are obese
  • one of your parents or other family members suffers from kidney disease
  • you are of African, Asian, or Aboriginal origin

Thursday, March 12, 2015

Swine flu virus in India turns even more dangerous, MIT study warns

WASHINGTON: The swine flu virus in India which has already killed more than 1,500 people since December may have acquired mutations that make it more severe and infectious than previously circulating H1N1 strains, a new MIT study has warned.

The study by Massachusetts Institute of Technology (MIT) contradicts previous reports from Indian health officials that the strain has not changed from the version of H1N1 that emerged in 2009.

READ ALSO: Four factors that gave the swine flu virus more teeth

MIT researchers found that the recent Indian strains carry new mutations in the hemagglutinin protein that are known to make the virus more virulent.

Hemagglutinin binds to glycan receptors found on the surface of respiratory cells and the strength of that binding determines how effectively the virus can infect those cells.

In the past two years, genetic sequence information of the flu-virus protein hemagglutinin from only two influenza strains from India has been deposited into publicly available influenza databases which makes it difficult to determine exactly which strain is causing the new outbreak and how it differs from previous strains.

"However, those two strains yielded enough information to warrant concern," said Ram Sasisekharan, the Alfred H Caspary, professor of Biological Engineering at MIT and the paper's senior author.

Sasisekharan and Kannan Tharakaraman, a research scientist in MIT's Department of Biological Engineering, compared the genetic sequences of those two strains (of 2014) to the strain of H1N1 that emerged in 2009 and killed more than 18,000 people worldwide between 2009 and 2012.

One of the new mutations is in an amino acid position called D225, which has been linked with increased disease severity, researchers said.

Another mutation, in the T200A position allows hemagglutinin to bind more strongly to glycan receptors, making the virus more infectious, the study found.

Sasisekharan said that more surveillance is needed to determine whether these mutations are present in the strain that is causing the current outbreak, which is most prevalent in Gujarat and Rajasthan and has infected more than 20,000 people so far.

Meanwhile, in New Delhi health ministry officials said they will take up the issue with the Indian Council of Medical Research (ICMR) since the latter has been saying till now that there have not been any mutations.

"So far the ICMR has been saying that there is no mutation. But since the study has come up, we will take it up with ICMR for a final view," additional secretary, health, Arun Panda said.

According to the latest figures from the Union health ministry data, as of March 10, as many as 1,537 people have perished due to swine flu while the number of infected people in the country is 27,234.

source :

Saturday, August 2, 2014

Everything you need to know about Ebola

Right now, West African countries are experiencing the worst outbreak of Ebola in history. Guinea, Nigeria, Sierra Leone, and Liberia have confirmed more than 700 deaths from the disease, which has swept through those countries since appearing just six months ago. In this outbreak, it’s killing more than half of the people it infects — which makes it one of the less lethal strains of Ebola to emerge recently. Perversely, this relatively low mortality rate has a lot to do with its quick and devastating spread; Ebola is the sort of malicious evolutionary creation that exploits anything and everything it can find. It is the disease on which virtually all viral-horror thrillers are based.
Remember that, much like HIV, Ebola is a new disease. The first recorded cases came in just 1976, in and around Zaire and Sudan. Ebola isn’t the sort of long-standing historical hardship that we can shrug off as part of the human experience, like cancer or the flu — this thing is younger than many people alive today, and it’s out to get us.
ebola 4Ebola was first discovered by doctors from the Institute for Tropical Medicine in, of all places, Belgium. It wasn’t hard for these scientists to pinpoint the source of the mysterious and horrific symptoms suddenly moving through several rural areas in Zaire: looked at under a microscope, infected cells displayed an enormous, worm-like structure. It wasn’t a parasite malaria, but a super-sized virus they dubbed Ebola. Soon, this was amended to Ebola Hemorrhagic Fever. The team could not then imagine the actual human suffering the disease could cause — starting with nausea and vomiting, progressing to bleeding from mucous membranes, lesions, skin peeling, excessive swelling, and eventually death through any of a number of means.
Like HIV, Ebola is an RNA virus, meaning that its genome is made from the flimsier, more mutation-capable cousin to DNA that animal cells use only transiently. Unlike HIV, however, Ebola is not a retrovirus. This means that its RNA blueprint is not converted to DNA and inserted into the host cell’s genome. Ebola basically hijack’s a cell’s machinery and redirects it to making more copies of Ebola. After a while, these copies leave the cell — violently. Many of Ebola’s more famous symptoms exist so the disease can spread from host to host, rather than as a natural result of its survival strategy. Viscous little bastard, isn’t it?
Despite even extreme measures, health workers are putting themselves in extreme danger.
Despite even extreme measures, health workers are putting themselves in extreme danger.
For several decades after its emergence, Ebola sprang up over and over throughout Africa. Outbreaks tended to begin as a result of contact with primates or fruit bats, the latter of which can carry the disease without symptoms. Ebola’s high lethality tended to work against it in the long term, limiting potential to spread by making the infected immobile and easily identified. Nearly 300 people died in the early infections, stopped mostly by quarantine zones and education campaigns. Ebola caught the public’s attention through its sheer brutality, but there was an assumption: this is an African problem. People assumed (correctly) that this was most likely due to poor infrastructure and education — it’s not the sort of thing that could affect the first world.
Note the monkey...
Note the monkey…
Ebola is the basis or the major influence for two famous scenarios you’ve probably seen a hundred times. One: The doctor who accidentally pricks his or her finger with a syringe full of deadly virus. Two: A foreign research monkey ferries a deadly foreign virus onto American shores and infects the researchers. The second of these two incidents, which involved a novel strain of the virus eventually called the Reston virus for the Virginia town in which it was discovered, has become an intractable part of our culture. Though nobody died of Reston virus, there were several infections — and that was all that was required to capture the public imagination.
In reality, we need never have worried. While there is no cure, fighting Ebola is all about quickly quarantining the infected and observing heightened hygiene routines for a few months. This ought to be easy, but superstition about the disease and about foreign medicine in rural Africa has led many to hide their infections in the early stages, and others to actively resist global health workers. Additionally, like malaria, Ebola is especailly deadly to people who are already weakened by things like dehydration or malnutrition. If Reston had turned out to be a deadly Ebola strain, our more affluent and science-friendly culture would have been able to deal with it quite effectively.
Map of recent Ebola Virus Disease Outbreak in West Africa, including new cases. Source: WHO International Business Times/Hanna Sender
Map of recent Ebola Virus Disease Outbreak in West Africa, including new cases. Source: WHO International Business Times/Hanna Sender
Ebola’s maddening ability to flare up anywhere, at any time, with any severity, slowly fell back before determined public health work. In 2007 an outbreak killed over 100 people — and in 2012 the virus appeared and killed just a single young girl. The senselessness of the disease was a big part of the fear it was able to create in Africa and around the world. Still, the last 10 years or so have seen a steady relaxation about the disease. This latest outbreak puts an end to that, as the death toll in the last half-year quickly approach 50% of the disease’s lifetime impact.
This isn't what you generally think of when you think "foreign aid," but this is what's needed.
This isn’t what you generally think of when you think “foreign aid,” but this is often what’s needed.
Fighting this outbreak is going to take a lot of determination. Both local and foreign health workers get sick very often, despite masks, sterile clothing, and attempts to avoid direct contact with the infected. Additionally, only top-level biohazard labs are even allowed to do research on Ebola in the Western world, so the progress of pure medical research is slow.
The future of Ebola is very likely to be much like its past: slow, tortured, and terrible. The solutions are banal and difficult to pitch at fundraising dinners — not miracle cures, but multi-language leaflets, boxes of soap, and pay for often destitute foreign health workers.
This will not be the last outbreak of Ebola — but it could be the last major outbreak. If the situation is handled properly, both by international organizations and local African societies, this is a very beatable disease. As always with this Ebola, if is the operative word.


Indian doctor becomes WHO’s Deputy Director General

The World Health Organization has an Indian doctor for its new Deputy Director General for Programmes. Dr. Soumya Swaminathan, the directo...