Category: Global Trends in Healthcare

Neuro and Spine

All you need to know about COVID 19 (PART 1)

Here on things are becoming pretty clear that living amidst Covid 19 virus is going to be a new reality until we get a vaccine. In this series of posts we will be answering many frequently asked questions regarding COVID 19. 
COVID 19 coronavirus

When you get some product from outside during covid-19, How much time should you leave it alone for?

To take a decision regarding how long you have to leave the product alone depends on the type of material. This infographic below is self explanatory to make you understand how long the virus lasts on various types of surfaces.
You can leave the home deliveries that you receive at least for 15-30 minutes in direct sunlight. Corona viruses degrade quickly in temperatures higher than 56 degrees Celsius, and in direct UV light. 
For small articles you can use following to clean surfaces
  • Diluted bleach
  • Diluted Detergents 
  • Alcohol solutions 

How does alcohol in hand sanitisers (and soap) kill the coronavirus?

Novel coronavirus has a lipid envelope. Soap being a detergent destroys the envelope. Similarly sanitizers having 60% alcohol or above also destroy the envelope of the virus.

What is the extent of success against COVID 19 by Government of India?

We should all commend the efforts of government of India, atleast till now the virus growth rate has been kept in control. They have also been successful in implementing one of the most strictly implemented lockdowns in the world. It is not possible to eliminate Covid 19 virus transmission as of now without the aid of a vaccine, but until a vaccine comes into the picture, controlled transmission and gradual strengthening of the herd immunity seems to be only way forward. Here is a video posted by a popular vlogger Project Nightfall which has lauded the efforts of Indian government:

Which hospital to successfully launched plasma therapy to treat COVID 19 in India?

  • SMS hospital, Jaipur  – Link
  • Max Hospital, New Delhi – Link
  • ICMR has approved PLACID Trial to test the effectiveness of plasma therapy – Link. Following are the hospitals which have been approved to participate in this study:
  1. Postgraduate Institute of Medical Education and Research in Chandigarh
  2. Madras Medical College in Chennai
  3. Smart NHL Municipal Medical College in Ahmedabad
  4. BJ Medical College and Civil Hospital in Ahmedabad
  5. Sawai Man Singh Medical College in Jaipur
  6. Government Medical College, Nagpur
  7. Gandhi Medical College, Telangana 
  8. Gandhi Medical College, Bhopal.
However it should be understood that plasma therapy is not a magic bullet or it is going to make a big dramatic difference. It is going to be one of various options to treat severely ill Covid 19 patients along with other drugs. (Link)

Can famotidine 20mg tablets protect us from COVID 19?

Preliminary study has shown that “Compared to the rest of the patients, those who received famotidine had a greater than two-fold decreased risk of either dying or being intubated” (Link) . To come to a conclusion regarding its real effectiveness, a randomized control trial is required (Link).

References

The Arogyada
www.arogyada.in
May 11, 2020 / by drsandeep.net

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

My daily dose of Air Pollution in Hyderabad

Past few weeks I have been observing municipal employees in Hyderabad burning waste in open in the stretch between Road no 10, Jubilee Hills and the areas around the KBR park, my route for going to work. I see at least 10-12 heaps of waste burning just in this 4 km stretch everyday and that is just a small part of the larger picture across other areas of Hyderabad and other cities in India. Open burning constitutes up to 20% of overall air pollution in some of the big cities in India.

I am sure we guys from India are so used to such open burning of waste, that our brain has just stopped responding to the sight and the discomfort of suffocation caused by it. Many a times we just pass by a burning pile of waste holding our breath pretending that
we didn’t inhale that smoke full of carcinogens, failing to realize that it is not just the momentary exposure which will kill us but the overall degradation of air quality in and around our locality, our workplace and the places we visit on regular basis. It is that daily silent dose which is doing the work as we speak.


The worst part is that the open burning of waste is being done by the employees of the municipal authority which is supposed to regulate the air quality in the city (posting the pics along).

For those who are not aware, typically smoke constitutes mainly of particulate matter, hydrocarbons, carbon monoxide, sulphur dioxide and carcinogenic dioxins/furans. Air pollution is a significant risk factor for various diseases including increased frequency of respiratory infections, chronic heart diseases, hypertension and lung cancer, according to the WHO. Apart from our health, our actions are also catalyzing climate change (read here how air pollution from Asia is affecting world’s weather).

Of all the causes of air pollution, I guess it is relatively easier to prevent open burning of waste. Even then, I am not aware of any regulation against the open burning of wastes in India neither are there any awareness campaigns or at least some advertisements in mass media which can change this behavior of people around.

Hope somebody takes a notice of this!

Do share this post and your stories too so that our voice can be heard. 

The Arogyada
www.arogyada.in
January 27, 2014 / by drsandeep.net

Differences between Healthcare Systems of India and the UK

Continuing with our series on comparison of Indian healthcare system with various healthcare systems across the  globe, here are some gross differences.

The Indian healthcare system, though evolved from its colonial roots of the British empire, started with many similarities but has not been able to maintain the strength of its public arm and consequently the private arm has far overtaken and established deep roots in the Indian healthcare scenario.

——–
UK:
A healthy proportion of 9.6% of the GDP is spent towards healthcare expenditure.Public spending contributes to 81.7 percent of overall healthcare expenditure.

India:
4.1% of the GDP is spent on healthcare expenditure while the public spending is as low as 1.2% of the GDP or 26.2% of the total expenditure(2010).

——–
UK:
Healthcare is publicly funded from general taxation, and is free to all permanent residents.There is also a thriving private healthcare sector which is considerably smaller than its public equivalent. The cost of private healthcare is mainly covered via private health insurance.

India:
Majority of healthcare expenses are out of pocket with private sector playing a major role. There is no single universal scheme covering the entire population. Though there are a multitude of health benefit schemes at central and state level for specific sections within the population.


———
UK:
Fifteenth best in Europe and eighteenth in the world (amongst 191 member states in the World Health Report, 2000)

India:
Ranked at 112 in the world (amongst 191 member states in the World Health Report, 2000)

———
UK:
Coordinated care is a norm. For elective care, patient has to visit a General Practitioners (GPs) first who acts as a referral authority for referral to specialists and super-specialists as necessary.

India:
Coordination of care is weak, almost non existent. Anybody can directly approach any specialist or super-specialist without proper referral system in place.

———
UK:
Single holistic health services under National Health Services(NHS) England cover entire spectrum of primary to tertiary healthcare, acute to chronic services and vaccination to adult screening programs.

India:
Multiple centre and state level programs which cover same issues amongst the same set of beneficiaries on one end. For instance, maternal health has schemes such as Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojna (JSY)  and Indira Gandhi Matritva Sahyog Yojna (IGMSY) running in parallel apart from innumerable schemes in every state. On the other hand there is no focus on other set of health issues like geriatric health.

———
UK:
Pharmacies (other than those within hospitals) are privately owned but have contracts with the NHS to supply prescription drugs. Systematic and only on prescription sale of drugs is the standard practice.

India:
Pharmacies are predominantly privately owned by single owners with no affiliation to public health systems except for licensing
formalities. There is indiscriminate sale of drugs over the counter including antibiotics leading to a very imminent risk of widespread bacterial resistance

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

Cancer death rates: US vs India

Cancer is a rampant public health problem globally. There is an interesting emerging global trend in Cancer incidences  and death rates. While the rates are decreasing in the United States and many other western countries, they are increasing in less developed and economically transitioning countries[1]. Taking in perspective US and India, this trend is apparent from recent National cancer projections.

A recent report by American Cancer Society (ACS) published on January 17th 2013, revealed that overall cancer deaths in US have declined by 20% since their peak in 1991. The report notes that cancer deaths rates have fallen from 1991 (their peak) to 2009 (the most recent figures available), decreasing from 215.1 to 173.1 per 100,000 [2].

However looking at the current trends in India, it has been projected that the total cancer cases are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020 [3].
The latest available figure of cancer death rate is from national representative study conducted by Tata Memorial Hospital in 2001—03 [4]. The Age-standardised cancer mortality rates per 100 000 were: Rural- M=95·6  F=96·6 and Urban- M=102·4 F=91·2.

Taking cancer seriously and taking public health measures for prevention and early detection has started paying dividends for US. While in India we are walking the same path already travelled by the developed nations;  by failing to stop the adoption of unhealthy western lifestyles such as smoking and physical inactivity and consumption of calorie-dense food.  Measures in the form of awareness creation, prevention and early detection are required to cut this trend.

[1]  Ahmedin Jemal, Melissa M. Center, Carol DeSantis and Elizabeth M. Ward : Global Patterns of Cancer Incidence and Mortality Rates and Trends
[2] Rebecca Siegel MPH; Deepa Naishadham MA, MS; Ahmedin Jemal DVM, PhD : Cancer Statistics 2013 (CA: A cancer journal for clinicians)
[3] Ramnath Takiar,Deenu Nadayil,A Nandakumar : Projections of Number of Cancer Cases in India (2010-2020) by Cancer Groups
[4] Rajesh Dikshit, Prakash C Gupta et al. : Cancer mortality in India- a nationally representative survey

View Dr Sandeep Moolchandani's profile on LinkedIn

The Arogyada
www.arogyada.in
January 21, 2013 / by drsandeep.net

Healthcare IT: Is it helping us?

Yeah it is helping us, that’s what most of the doctors perceive as per a recent survey conducted by Accenture across eight countries with a sample size of 3700 doctors. The sample included baskets having 500 doctors per country in Australia, Canada, England, France, Germany, Spain and the United States and 200 doctors in Singapore between August and September 2011.

Figure 1: Source- Accenture Newsroom
http://newsroom.accenture.com/news/doctors-agree-on-top-healthcare-it-benefits-but-generational-divide-exists-according-to-accenture-eight-country-survey.htm

Key areas where Healthcare IT was strongly rated to have a positive impact were:

  • Better access to quality data for Clinical research (70.9 percent of the sample reported positive benefits)
  • Improved coordination of care (69.1 percent)
  • Reduction in medical errors (66 percent).

What is one common thing amongst these three areas? The key variable behind these three areas is efficient data management and interchange which has been brought about by the healthcare IT revolution. Healthcare delivery being a complex cognitive environment, there is always a need for complex decision making which is mostly critical in nature. The attribute of providing right information at right time has resulted in these positive perceptions towards role of IT in enabling clinical research, improving coordination of care and reducing medical errors.

There are some areas about which the study population seems to be skeptic about (where they have responded with “negative impact”, “no impact” or “didn’t know”)

  • reducing unneeded procedures (43.6 percent)
  • improving access to services (43 percent)
  • improving patient outcomes (39.2 percent)

If you notice, all these three areas are potential outcomes which have multiple-causality. There are many direct and indirect causations which can impact these areas. Most of the clinicians have a viewpoint which sees more direct cause-effect and looks for direct impact of clinical actions on the outcomes rather than indirect causations, owing to their experiences. From the viewpoint of a clinician, “unneeded procedure” is more a function of clinical choice, similarly “patient outcome” for doctors is more a function of success of clinical regimens and surgical procedures. IT may play a role of enabling tool in these but to ascribe the direct causality of “reducing unneeded procedures” and “improving patient outcomes” is rather too much to expect and ask for.

Another interesting finding of this survey is that U.S. physicians have rated the benefits of EMR and HIE lower than their international colleagues. This comes from a country which is investing the most when it comes to healthcare IT. Why is that? Is it because excess of reforms and IT fume already doing rounds in the air have made them obnoxious? Or is it that IT has reached a point of diminishing return and they are increasingly seeing less value in it?

The Arogyada
www.arogyada.in
January 16, 2012 / by drsandeep.net