AIIMS doctors devise new technique for complex spine surgery


Doctors at AIIMS have devised a new technique for complex spine surgery involving the joint at the upper part of the neck that supports and articulates with the head.

“The procedure called ‘distraction, compression, extension and reduction (DCER)’ removes the compression over the spinal cord and also reduces the deformity through a single surgery performed only from the back of the neck,” said Prof P Sarat Chandra (Dept of Neurosurgery) who conceptualised the innovative surgery.

The surgery normally is arduous, requires two separate procedures performed at the same sitting or in two different sittings and is a full day job, explained Chandra.

It first involves drilling out the piece of bone compressing the spinal cord (operated through the mouth) followed by a second procedure performed from behind the nape of neck resulting in stabilising the head and neck using rod and screws.

Surgery in this area is quite complex, technically demanding and requires intensive training. However, this procedure reduces the time of surgery by 50 per cent and has also been shown to reduce the rate of complications and hospital stay significantly.

The complication involving this area (called technically as atlanto-axial dislocation and basilar invagination) results in the uppermost portion of the neck slipping from its articulation with the base of the Lead causing compression of the spinal cord.

If untreated, the patient develops weakness of all limbs, becomes incontinent, bed-ridden and finally succumbs to the disease, said Chandra.

“The technique currently does not require any special instrumentation and utilises the existing instruments to perform a 2-axis motion which reduces the deformity,” stated Prof BS Sharma (Dept of Neurosurgery) who also has been part of the study.

The concept of the technique is connection based on the law of levers, first described by Archimedes, Prof P Sarat Chandra said.

He further added that the technique will be of immense use for our patients as it does not require any additional cost, reduces the hospital stay and also the complication rate thus benefiting the patients and the hospital in the long run.

The initial results of this procedure has been published in various prestigious international and national journals and has been also presented in various conferences.

Source: Business standard

Malaria: High risk focused in 10 African countries


Gains in fighting malaria in sub-Saharan Africa have left the highest risk for the disease concentrated in 10 countries, according to a study published by The Lancet medical journal.

Nigeria, Democratic Republic of Congo, Uganda, Ivory Coast, Mozambique, Burkina Faso, Ghana, Mali, Guinea and Togo together account for 87 percent of areas that have the highest prevalence of malaria, it said.

The study assessed the effectiveness of the battle against malaria, which went into higher gear with the launch of the Roll Back Malaria initiative in 2000.

Since then, financial support has risen from $100 million (73 million euros) annually to about $2 billion (1.46 billion euros).

The researchers drew up a map of the changing face of malaria from thousands of surveys of prevalence of the disease among children in 44 countries.

They set down three categories of risk: high, meaning places where more than 50 percent of the population were likely to be infected by the Plasmodium falciparum parasite; moderate (10 to 50 percent of the population infected); and low (less than 10 percent).

From 2000 to 2010, the number of people living in areas of high-risk infection fell from 219 million to 184 million, a decline of 16 percent.

But the numbers living in moderate-risk locations rose from 179 million to 280 million, a rise of 57 percent.

The good news was that the tally of people living in low-risk areas rose from 131 million to 219 million.

Four countries — Cape Verde, Eritrea, South Africa and Ethiopia — joined Swaziland, Djibouti and Mayotte in the elite club of countries where transmission levels are so low that elimination of malaria is a realistic goal.

The researchers said the overall picture was mixed, and important gains had been partly offset by population increase — over the decade, an extra 200 million people were born in places with malaria.

“Substantial reductions in malaria transmission have been achieved in endemic countries in Africa over the period 2000-2010,” the paper said.

“However, 57 percent of the population in 2010 continued to live in areas where transmission remains moderate to intense and global support to sustain and accelerate the reduction of transmission must remain a priority.”

In its 2013 report on malaria, the World Health Organisation (WHO) last December said 3.3 million lives had been saved worldwide since 2000.

Even so, the mosquito-borne disease still killed 627,000 people last year, mainly children in Africa and Southeast Asia.

The agency pointed to a shortage of funding and a lack of access to artemisinin malarial medicines and basic remedies such as bednets remained a serious problem, it said.

Source: New vision

Sitting linked to increased risk for disability, study shows

Here’s another reason desk jockeys need to get up and move. Researchers are finding that sedentary behaviors like sitting even just an hour extra per day can up your risk for disabilities in later life — even if you are a moderately active gym rat.

The study published Wednesday in the Journal of Physical Activity and Health is the first to show that sedentary behavior alone may be an independent risk factor for disability, separate from lack of moderate physical activity, its authors say.

To be clear, exercise is important, but it is only the beginning of a healthy lifestyle, said lead author Dorothy Dunlop, Ph.D., professor of medicine at Northwestern University Feinberg School of Medicine in Chicago.

“The message is that we can work on what the government recommends in terms of moderate physical activity, but we need to reduce sitting time by replacing it with some light activity,” Dunlop said. That doesn’t mean sweat and spandex, but rather simple activities like pushing a grocery cart, strolling through a museum, and even getting up once an hour to walk around.

The researchers strapped devices to the waists of some 2,200 adults aged 60 and older to monitor their activity and found that every additional hour a day spent sitting was strongly linked to a doubling of the risk of disability. So, if one 60-something year old person is sedentary for 12 hours a day, and another is sedentary for 13 hours a day, the second individual is 50 percent more likely to be disabled, according to the study.

“I’m not surprised that 30 minutes of activity several times a week doesn’t compensate for nine hours a day sitting around,” said family medicine specialist Dr. Robert Truax of University Hospitals Case Medical Center in Cleveland. The good news, he said, is that it’s never too late to get up off our butts and get healthier.

Source: NBC news

FDA approves Chelsea Therapeutics drug for low blood pressure

Chelsea Therapeutics International Ltd’s drug Northera, which treats a rare form of low blood pressure associated with neurological disorders such as Parkinson’s disease, has won U.S. approval, the Food and Drug Administration said on Tuesday.

The company’s shares rose 34 percent to $6.63 in after-market trading.

The drug’s label will carry a boxed warning, the most serious possible, of the risk of supine hypertension, or increased blood pressure while lying down, a danger that can cause stroke.

In January, an advisory panel to the FDA recommended approval but also suggested the company conduct a follow-up study to prove durable benefit. Panelists said gaps in clinical data made it hard to determine whether Northera, which appears effective after a week’s treatment, is effective over the long term.

The FDA followed the recommendation and approved the drug on an “accelerated” basis. This allows for approval a drug to treat a serious disease based on an intermediate measure while the company conducts more trials.

In the meantime, the FDA said, “it is essential that patients be reminded that they must sleep with their head and upper body elevated. Supine blood pressure should be monitored prior to and during treatment and more frequently when increasing doses.”

Chelsea first filed for approval of Northera in 2011. The FDA rejected the drug in 2012 and asked for additional data. The company is also testing the drug, known generically as droxidopa, in mid-stage studies to treat fibromyalgia and intradialytic hypotension.

Source: yahoo news


Lilly lung cancer drug improves survival in late-stage trial

An experimental cancer drug developed by Eli Lilly and Co, touted by some to be the company’s next blockbuster, significantly improved survival rates in lung cancer patients, sending the company’s shares up 3 percent in early trading.

Lilly needs new drugs to offset declining sales of its older drugs as they lose patent protection.

Ramucirumab, designed to treat multiple cancers, has the potential to generate annual sales of $1.5 billion by 2020, according to some analysts.

The drug has already been shown be successful in treating stomach cancer, and Lilly is waiting for approval from the U.S. Food and Drug Administration to market it for that disease.

The latest results could help allay some concerns about the drug after it failed to delay the progression of breast cancer in a late-stage trial last year.

The late-stage lung cancer trial compared a combination of ramucirumab and a common chemotherapy drug, docetaxel, with a combination of a placebo and docetaxel in treating patients with non-small cell lung cancer.

The trial, known as Revel, showed that ramucirumab significantly improved overall survival rates as well as improving survival rates without the cancer worsening.

Lilly did not provide details of the trial results, which it said would be presented at a scientific meeting.

The company said on Wednesday that it planned to submit the first application for marketing approval later this year.

Data from two other studies to test the drug’s effectiveness to treat liver and colorectal cancer are expected later this year, Lilly said.

BMO Capital Markets analyst Alex Arfaei expressed caution about the latest results.

“We believe Revel needs to show at least (a) 2-3 month improvement in overall survival to be considered clinically meaningful,” he said in a note.

Ramucirumab, which Lilly acquired through its $6.5 billion purchase of ImClone Systems Inc in 2008, works by blocking development of blood vessels that feed tumors – a process known as angiogenesis.

Source: Fox news

Fecal Transplant Regulations Are Too Strict, Researchers Say


Physicians use fecal transplants to treat certain intestinal infections, but the procedures recently came under strict regulations, with the Food and Drug Administration managing the transplants as though they were a drug treatment.

This regulation has made it harder for patients to receive fecal transplants, and in a new paper, some researchers are calling for the transplants to instead be regulated as a tissue, akin to blood donations.

The raw material for fecal transplants isn’t hard to come by, and so in the face of what some see as current over-regulation, an underground market for the transplants will likely spring up, the researchers argued today in the journal Nature.

At the same time, they said, more research is needed on the long-term effects of fecal transplants.

Regulating fecal transplants as a tissue may allow for better research on their possible uses in treatments, while protecting patients from harm, the researchers, from MIT and Brown University, wrote.

“I think regulating it as a tissue product would both provide access as needed and the research that could bring some pretty exciting new treatments on the scene,” said Mark B. Smith, an author of the article and a doctoral candidate at MIT.

Fecal transplants have been tested since the 1950s, and last year the first randomized controlled trial showed a strong benefit in helping patients with recurrent C. difficile, a bacterial infection that causes painful diarrhea, often following the use of antibiotics, and kills 14,000 people yearly in the United States.

But following the treatment’s success, some doctors began offering fecal transplants for other conditions as well — including those for which any potential benefit remains unproven. The FDA took action in 2013, regulating the treatment, but also granting an exemption for its continued use in patients who had C. difficile infections. This use would not require special permissions.

However, the result may be a case of both under- and over-regulation, today’s editorial argues. While medical societies have issued guidelines for using the treatment, there are no hard and fast rules for screening fecal matter, as there are with blood donations.

Source: Huffington Post

Carmat artificial heart patient in satisfactory condition

A patient with terminal heart failure is in “satisfactory condition” two months after becoming the first person to be fitted with Carmat’s artificial heart which is designed to beat for several years, his hospital said.

The 76-year-old man is eating normally, no longer needs constant respiratory assistance and is able to walk a little further every day thanks to physical therapy, the Georges Pompidou European Hospital in Paris said in a statement on Tuesday.

“The Carmat bioprosthesis continues to function satisfactorily, without any anti-clotting treatment since January 10,” said the hospital, where the implant surgery was performed on December 18 and where the patient is being treated.

It praised the patient’s “exemplary courage, sense of humour and family support” for playing a role in his recovery.

Heart-assistance devices have been used for decades as a temporary solution for patients awaiting transplants, but Carmat’s product is designed to replace the real heart over the long term, mimicking nature using biological materials and sensors.

It aims to extend life for thousands of patients who die each year while awaiting a donor, while reducing the side-effects that can be associated with transplants, such as blood clots and rejection.

Three more patients in France are due to be fitted with Carmat’s device. The people selected in this first series of clinical studies suffer from terminal heart failure – when the sick heart can no longer pump enough blood to sustain the body – and would otherwise have only a few days or weeks to live.

Success will be judged on whether the patients survive with the implant for at least a month. If deemed safe, the device will then be fitted into about 20 lower-risk patients.

A spokeswoman for Carmat declined to say when the other three patients in the first round of tests would be fitted with its artificial heart.

The company estimates around 100,000 patients in the United States and Europe could benefit from its artificial heart, a market worth more than 16 billion euros ($22 billion)

Chief Executive Marcello Conviti told Reuters in November that Carmat hoped to finish human trials of the heart by the end of 2014 and to obtain approval to market them in the European Union by early 2015.

Among its competitors for artificial heart implants are privately-held SynCardia Systems and Abiomed, both of the United States.

Source: Diabetes Support

Prostate’s Early Growth May Reveal Cures for Later Illnesses

Dr. David Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City and is a board-certified urologist and oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer and prostate cancer. Samadi also specializes in many advanced, minimally invasive treatments for prostate cancer; is one of the few urologic surgeons in the United States trained in oncology, open-, laparoscopic- and robotic-surgery; and was the first surgeon in the nation to successfully perform a robotic surgery redo. He contributed this article to Live Science’s Expert Voices: Op-Ed & Insights.

For a surgeon who has successfully treated prostate cancer in many thousands of men by removing their prostate gland, the idea that science might one day be able to regenerate this gland using stem cells is a foreign one — and yet highly intriguing. But this advancement is just one of many potential treatments for prostate cancer or benign prostate enlargement that may eventually arise from important new research on the cellular building blocks of prostate gland development.

In a study published Feb. 11 in the journal Stem Cell Reports, scientists from the University of York in England detailed their discovery of a “signaling pathway,” a set of signals that tell proteins inside stem cells how to evolve into prostate tissue cells called basal cells and luminal cells. The researchers learned there are 80 genes involved in this process, and that the main signals responsible for activating prostate development are retinoic acid and male sex hormones — the balance of which are disrupted in prostate cancer.

Source: live science


New layer of cornea discovered by Indian doctor Harminder Dua

A new layer in the human cornea was discovered by the Indian doctor Harminder Dua at The University of Nottingham in 2014. It plays a vital role in the structure of the tissue that controls the flow of fluid from the eye.

The research was published in a paper in the British Journal of Ophthalmology.
The new finding could shed new light on glaucoma. The new layer named as Dua’s Layer is just 15 microns thick but incredibly tough. Comprised of thin plates of collagen, it sits at the back of the cornea between the corneal stroma and Descemet’s membrane.

It makes an important contribution to the sieve-like meshwork, the trabecular meshwork (TM), in the periphery of the cornea.

The TM is a wedge-shaped band of tissue that extends along the circumference of the angle of the anterior chamber of the eye.

It is made of beams of collagen wrapped in a basement membrane to which trabecular cells and endothelial cells attach. The beams branch out randomly to form a ‘meshwork’.
Scientists had previously believed the cornea to be comprised of five layers – from front to back— the corneal epithelium, Bowman’s layer, the corneal stroma, Descemet’s membrane and the corneal endothelium.

Pressure within the eye is maintained by the balance of aqueous fluid production by eye tissue called the ciliary body and drainage principally through the TM to the canal of Schlemm, a circular channel in the angle of the eye.

Defective drainage through the TM is an important cause of glaucoma, a condition that leads to raised pressure in the eye that can permanently affect sight. Around 1 to 2% of the world’s population yearly have chronic glaucoma and globally around 45 million people have open angle glaucoma which can permanently damage the optic nerve – 10% of whom are blind.

It is hoped the discovery will offer new clues on why the drainage system malfunctions in the eyes of some people, leading to high pressure.
Glaucoma is a devastating disease caused by defective drainage of fluid from the eye. Glaucoma is the second largest leading cause of blindness of world.

Source: Zee News


New ‘painless’ treatment to repair teeth

A novel “regenerative” technique to repair infected teeth – claimed to be painless and cheaper than the traditional root canal treatment – has been developed by doctors at the All India Institute of Medical Sciences (AIIMS) in New Delhi, says IANS.

Termed as “SealBio”, the technique uses body’s own stem cells and eliminates the need for cumbersome root canal fillings.

Developed by doctors Naseem Shah and Ajay Logani at the Department of Conservative Dentistry and Endodontics, it has obtained an Australian patent, while an application with the US Patents office is under process.

Root canal treatment demands rigorous training, clinical skills and several cumbersome sittings with dentist. It involves thorough cleaning and shaping followed by filling of the entire root canal with one of several sealer cements.

The AIIMS technique is claimed to be the first that dispenses with the need for root canal filling. Instead of filling the root canal with artificial materials that may pose bio-compatibility problems, it makes use of regenerative potential of stem cells and growth factors available at the root of the teeth. Stem cells act as a repair system for the body capable of replenishing adult tissues.

In case of this technique, the stem cells at the root of the decayed teeth are stimulated to induce regeneration and deposition of a natural tissue barrier (seal) to fill up the root canal in just one sitting.

In other words, a “biological seal” is achieved at the root canal rather than attempting to seal it with artificial filling materials with all its drawbacks, the doctors say. The root canal is restored to health by gradual build up of tissue by stem cells over a period, extending from a few weeks to some months.

The AIIMS doctors say that this treatment simplifies the whole procedure with minimal use of equipment, less time and cost of treatment.

“Shah has been able to successfully carry out this new procedure in dozens of patients and the 4-5 years follow up results have been very encouraging,” Seyed Hasnain, a professor at the Kusuma School of Biological Sciences of the Indian Institute of Technology, Delhi, told IANS on phone. “In my opinion this is a path breaking innovation, a game changer,” Hasnain said.

He said that the success achieved by AIIMS doctors could trigger research in regenerative techniques in other clinical situations in dental science.

Source: The Free Press