Category: Evolution of Medical Technology

Neuro and Spine

Novel Antimalarial drug from India completes Phase I trials

The dwindling efficacy of commonly used antimalarials has contributed substantially to the resurgence of
malaria during last three decades. Although new antimalarials have appeared in the market during this time, none has yet supplemented chloroquine. Thus there has been a need for continued efforts on new antimalarial drug development.

The Central Drug Research Institute has developed a novel antimalarial drug which was given an in house name “Compound 97/78”. CDRI 97/78 has shown efficacy in animal models of falciparum malaria. Recently, it was tested for the first time in-human phase I trial in healthy volunteers. In the study, the compound was found to be well tolerated by healthy volunteers. The few adverse events noted were of grade 2 severity, not requiring intervention and not showing any dose response relationship.

Compound CDRI 97/78, a fully synthetic 1,2,4 trioxane derivative has been identified for development as a viable alternative to artemisinine derivatives for use against drug resistant P. falciparum and cerebral malaria cases. Clinical development of this compound is being pursued under Licensing agreements with IPCA Pharmaceuticals Ltd., Mumbai

The Central Drug Research Institute (CDRI) is a multidisciplinary research laboratory in Lucknow, India which has been the leader in new antimalarial drug development. Its objective is to develop new blood schizontocidal antimalarials / drug combinations for control of drug resistant parasites, development of new safer Gametocytocidal, Prophylactic and Anti-relapse agents, harnessing of malaria parasite genome for identification of new drug targets, molecular mechanism of drug action, biochemical markers for characterization of resistant parasites, evaluation of immuno-prophylactic agents, development of newer in vitro assay / tests for parasiticidal activity.

References:
http://www.ncbi.nlm.nih.gov/pubmed/24800100
http://www.cdriindia.org/parasitic2.htm
http://www.cdriindia.org/malaria.htm

The Arogyada
www.arogyada.in
May 17, 2014 / by drsandeep.net

Biomarker for Glioblastoma Multiforme identified

SAN DIEGO – March 19, 2014

Researchers from Aethlon Medical, Inc. (OTCBB:AEMD), and its diagnostic subsidiary, Exosome Sciences, Inc. (ESI), have identified a biomarker for  Glioblastoma multiforme (GBM), an aggressive cancer of the brain.

The team was able to identify, quantify, and characterize circulating Glioblastoma multiforme (GBM) exosomes, which hold promise as
both a disease biomarker and therapeutic target as GBM exosomes are shed into the circulatory system to promote tumor growth and stimulate angiogenesis.

Glioblastoma multiforme (GBM), WHO classification name “glioblastoma”, is the most common and most aggressive malignant primary brain tumor in humans, involving glial cells.  Median survival with standard-of-care radiation and chemotherapy with temozolomide is just 15 months.

The ability to characterize disease specific exosomes in circulation will enable improved diagnosis to identify type and grade of these aggressive brain tumors and may additionally help to advance novel treatment strategies.

Read More: http://www.investorideas.com/CO/AEMD/news/2014/03191.asp

The Arogyada
www.arogyada.in
March 20, 2014 / by drsandeep.net

Emerging Device Based Approaches to Treat Hypertension

Need for new therapies to treat Hypertension

A very tight control of blood pressure is required to produce reduction in risk of developing complications especially in patients with comorbidities like Diabetes Mellitus which tend to accelerate the development of complications. Difficult to treat hypertension is a commonly observed problem world-wide.

Hypertension is classified as resistant if the blood pressure is ≥140/90 mm Hg and they reported using antihypertensive medications from 3 different drug classes or drugs from ≥4 antihypertensive drug classes regardless of blood pressure. Among US adults on antihypertensive therapy with drugs, 12.8% of the hypertensives had resistant hypertension as per above criteria [1].
Since multiple factors contribute to hypertension, achieving control using a single agent acting via one single path may not always be successful. Though single drug treatment may be effective in some, more than 50% will require more than one drug for appropriate control of their BP [2]. It is very common to see regimens with Fixed Dose Combinations (FDCs) or drugs being added sequentially.
The challenge of multidrug regimens is getting the patient to adhere to it; since for the patients the condition is largely asymptomatic and the perceived value of being on continuing long term therapy is low. Researchers have been focusing on innovative treatment modalities which can produce long lasting results while keeping it easy on compliance terms and low on side effects.
Novel Device based therapies on the anvil
Renal Denervation

It is a percutaneous, catheter-based radiofrequency ablation for renal sympathetic denervation.
Mechanism:
By applying radiofrequency pulses to the renal arteries, the nerves in the vascular wall (adventitia layer) can be denervated. This causes reduction of renal sympathetic afferent and efferent activity and blood pressure can be decreased [3].

Simplicity HTN1 Trials [4]:

  • Single Arm with extended cohort
  • 45-treated patients with treatment resistant hypertension (baseline BP of 177 /101 mmHg; +/- 20/15 ).
  • Mean office BPs after the procedure were reduced by -27/-17 at 12 months
  • Responder rates (defined as a >10 mm Hg reduction) among patients completing follow–up is 69 percent at one month to 82 percent at 24 months.

Simplicity HTN2 Trials [5]:

  • Randomized controlled trial
  • 106 patients with resistant hypertension (baseline BP of 178/96 mm)
  • Mean blood-pressure reductions of -32/-12 mm Hg six months [n=49] after the procedure in patients with drug-resistant hypertension as against controls where the change was +1/0(n=51) (p<0.0001).
  • The percentage of patients with at least 10 mm Hg drop in systolic blood pressure from the baseline following the procedure was 84%.
Chronic Baroreflex activation

It requires surgical implantation of a device, with leads that electrically stimulate the carotid baroreceptors in the carotid sinus. It is implanted just below the clavicle and delivers four to six volts to the carotid arteries, mimicking the carotid baroreflex, which prompts a fall in blood pressure.

Mechanism:

  • It activates the baroreceptors located in the carotid sinus
  • Activation provides a signal to medullary brain centers that blood pressure is elevated
  • This triggers a reduction in sympathetic activation and promotes parasympathetic activation

    Rheos DEBuT-HT trial [6]

    • 45 patients from 4 European centers
    • 16 patients completed the 2-year follow-up
    N=16 Baseline 1 year 2 year 3 year
    Systolic BP (mmHg) 190 ± 30 -38 ± 8 -34 ± 8 -37 ± 10
    Diastolic BP (mmHg) 111 ± 22 -25 ± 5 -20 ± 6 -23 ± 7

     
    Pivotal Trials [7]

    • Prospective randomized double-blind trial
    • 322 patients at 49 sites
    • 55 roll-in patients / 265 randomized (2:1)
    • The average SBP drop at 12 months among responders was 44 mmHg
    • 81% of patients were responders (SBP ≥ 10 mmHg relative to preimplant)

     
     

    [1] Persell SD.; Prevalence of resistant hypertension in the United States, 2003-2008: Hypertension. 2011 Jun;57(6):1076-80. doi: 10.1161/HYPERTENSIONAHA.111.170308. Epub 2011 Apr 18.
    [2] Sanjay Kalra, Bharti Kalra and Navneet Agrawal- Combination therapy in hypertension: An update
    [3] Esler, MC; Krum, H, Sobotka, PA, Schlaich, MP, Schmieder, RE, Böhm, M (2010 Dec 4). “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trian): a randomized controlled trial.”. Lancet 376 (9756): 1903-9
    [4] Simplicity HTN1 Trials

    [5] Thomas Unger, Ludovit Paulis, and Domenic A. Sica; Therapeutic perspectives in hypertension: novel means for renin–angiotensin–aldosterone system modulation and emerging device-based approaches
    [6] C Venkat S Ram; Baroreceptor activation therapy for treating resistant hypertension : a status report
    [7]http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_425401.pdf

    View Dr Sandeep Moolchandani's profile on LinkedIn

    The Arogyada
    www.arogyada.in
    January 13, 2013 / by drsandeep.net

    Virtual Dissection Table: Dissection by Taps and Glides of Fingers

    Norbert von der Groeben (http://med.stanford.edu/ism/2011/may/dissection-0509.html)
    Remember your Anatomy dissection hall, the karma-bhoomi (action-arena) for every medical student in the first year of medical education. Remember that pungent smell of formalin mixed with foul smell of decomposing tissue that goes to the deepest parts of your brains, just to leave you intoxicated for rest of the day. I am sure, that is an unforgettable experience for every medical student. After dissection class of 2 hours, there is not much of human anatomy you can identify or appreciate that too with 20 of your classmates flocking around a single cadaver. We have a new solution which can change the anatomy of the anatomy dissection hall.
    I bet many of you will not have heard of the Virtual Dissection Table, a new innovative technology which takes studying anatomy to a whole new level. The Virtual Dissection Table, developed by Anatomage in collaboration with Stanford University’s Division of Clinical Anatomy, is a breakthrough in visualizing human anatomy. It is another example of how an ordinary technology can be used for an extraordinary purpose. This virtual dissection table is effectively a computer with powerful graphics using a 3D anatomy software coupled with a life size display. It has potential to revolutionize the study of anatomy and the practice of image guided surgery. Check out these videos.
    Video 1

    Video 2

    Features of Virtual Dissection Table
    Touch screen interface: You can rotate, drag, and slice through the subject with a finger tip and change between Hard tissue, Soft Tissue and X-Ray radiology images.
    Rendered 3D images: The skeletal structures, muscles, radiographic cross-sections, and textured soft tissue representations are all merged together into one data set that can be manipulated with virtual dissection tools.

    Virtual Dissection Table: What can it be used for?
    Teaching Anatomy: Complementary aid for cadaver based dissection courses. With its flexible annotation tools, institutions can create innovative programs, quizzes, and methods of study
    Source: Anatomage
    Clinical Practice: The table also can use real data from MRI and CT scans of patients. It can be used for diagnosis and treatment planning, and for patient education and consultation
    How much a Virtual Dissection Table costs?

    $60,000

    Further Reading…
    http://stanmed.stanford.edu/2011summer/article8.html
    http://www.anatomage.com/product-TheTable.html
    http://www.bbc.co.uk/news/world-radio-and-tv-16421866
    The Arogyada
    www.arogyada.in
    January 21, 2012 / by drsandeep.net

    Microsoft Kinect: A Revolutionary Technology searching for a niche in healthcare

    Remember “Superhuman Samurai”, a 1994 TV series?? Sam Collins who’s the leader of a rock band becomes a victim of a sudden energy surge and becomes a character in one of his (self- programmed) game named “Servo”. Microsoft Kinect is a technology which could do something similar by capturing your movements in the virtual world. {FYI: Shahrukh’s recent movie RA-ONE, picked the concept from Superhuman Samurai }.

    Microsoft Kinect comes with motion sensor, skeletal-tracking, voice recognition and facial-recognition capabilities. It sounds fascinating, when you hear that your body movements can be captured as it is in the digital world. Microsoft Kinect Camera originally released in November 2010 as a new addition to Microsoft’s Xbox 360 product line, is slowly finding its use in the healthcare world.

    Siemens recently launched a concept product for hands-free navigation through CT/MRI/Ultrasound images utilizing Microsoft’s Kinect for detection of hand gestures which is potentially useful in operating rooms. Two computer science students from the University of Pennsylvania, Eric Berdinis and Jeff Kiske, came up with a tactile feedback system for the visually impaired using Microsoft Kinect.

    Another system being developed by a team of researchers from the University of Missouri to detect and prevent elderly falls uses security system motion sensors and the Kinect to produce 3D silhouettes of residents, which can then be monitored for falls. In addition to detecting falls, the system can also help prevent falls altogether by picking up on changes in a resident’s gait which might suggest an elevated risk of falling, and automatically alerts nurses when intervention is required.

    What can be other potential uses of this technology, time will tell us. But for now, Microsoft has started Kinect Accelerator incubation program to give a boost to the use of this technology in allied fields other than gaming.

    View Dr Sandeep Moolchandani's LinkedIn profileView Dr Sandeep Moolchandani’s profile

    The Arogyada
    www.arogyada.in
    January 7, 2012 / by drsandeep.net

    Evolution of Medical Technology: Key Drivers

    The innovations in medical technology are evolving at a very rapid pace driven by both scientific and economic interests. 
    In the current scenario, most developments in medical technologies have been limited to secondary and tertiary domains of healthcare where the complexity of technology has increased exponentially.
    On the other hand, governments of various countries and international agencies like WHO are backing the development of medical technology in the realm of public health.
    Strong economic growth, increased burden of disease, higher public spending and private investments in healthcare, increased penetration of health insurance and emergence of new models of healthcare delivery are the key drivers of the  Indian Medical technology industry which is expected to grow from US$ 2.75 billion in 2008 to US$ 14 billion in 2020, says a FICCI-PwC report.
    The  FICCI-PwC report on ‘Medical Technology in India: Enhancing Access to Healthcare through Innovation’ notes that success in medical technology innovation would be dependent on five pillars viz, powerful financial incentives, creating capacity for quality research, supportive regulatory system, demand and supply of  health services and a supportive investment community.
    For the markets like India it will be wise to consider developing low cost solutions in coordination with local governments; in addition to high end medical technology and diagnostics.

    View Dr Sandeep Moolchandani's LinkedIn profileView Dr Sandeep Moolchandani’s profile

    The Arogyada
    www.arogyada.in
    December 9, 2010 / by drsandeep.net

    Evolution of Medical Technology: Glimpse into the history of Medical Technology

    Today the medical technology has come a long way from eliciting of physical signs and symptoms to evidence based medicine which allows us to extend our vision to deepest of viscera and the most complex of genes and molecules. 
    There has been continuous change in our understanding of the human body and disease which has progressed from early and sacred theories of disease to contemporary modern theories.
    The first medical diagnoses made by humans were based on what ancient physicians could observe with their eyes and ears, which sometimes also included the examination of human specimens. 
    With the discovery of microscopy and the science of the small, the doctors were able to get the understanding of what eyes cannot see. This lead to renunciation of ancient theories of disease, thus paving way for the germ theory. 
    This helped in developing treatments for some of the most dreaded diseases to humanity. More sophisticated diagnostic tools and techniques such as the thermometer for measuring temperature and the stethoscope for measuring heart rate were not in widespread use until the end of the 19th century. The clinical laboratory gained popularity only at the beginning of the 20th century.
    Following is the timeline for the inventions of some of the path breaking technologies:
    ·         1816 – Rene Laennec invents the stethoscope
    ·         1895 – Wilhelm Conrad Röntgen discovers medical use of X-rays in medical imaging
    ·         1903 – Willem Einthoven discovers electrocardiography (ECG/EKG)
    ·         1910 – Hans Christian Jacobeus performs the first laparoscopy on humans
    ·         1927 –  First modern practical respirator
    ·         1943 – Willem Kolff build the first dialysis machine
    ·         1957 – William Grey Walter invents the brain EEG topography (toposcope)
    ·         1960 – Invention of Cardiopulmonary resuscitation (CPR)
    ·         1963 –  Laser treatments to prevent blindness
    ·         1965 – Frank Pantridge installs the first portable defibrillator
    ·         1965 – First commercial ultrasound
    ·         1971 – Sir Godfrey Hounsfield invents the first commercial CT scanner
    ·         1970s (Late) – Arthroscope introduced
    ·         1980 – Raymond Damadian builds first commercial MRI scanner
    ·         1980s – Controlled drug delivery technology developed
    ·         1982 –  First permanent artificial heart implant
    ·         1987 –  First laser surgery on a human cornea
    ·         1990 –  Human Genome Project

    View Dr Sandeep Moolchandani's LinkedIn profileView Dr Sandeep Moolchandani’s profile

    The Arogyada
    www.arogyada.in
    December 9, 2010 / by drsandeep.net