Category: Innovation

Neuro and Spine

Family Medicine Clinics in India: The Next Big Thing for Indian Healthcare?


By Astha Gupta, MSc(BioMed) MHA PAHM

Healthcare in India has fast moved away from general practice to super specialised medicine. As a consequence the erstwhile family physician who had detailed knowledge of his patient’s lifestyle, family history and clinical history has somewhere gotten lost. Family Medicine is a branch of medical sciences which aims to provide comprehensive and continuing healthcare for individuals of all ages and genders. A popular branch of practised medicine across the globe, it provides for the first line of treatment and preventive care. In India, very recent times have seen a resurgence of this concept with a few private players stepping into this arena. The next few sections highlight the potential for this stream of healthcare in India and the challenges associated with it.

Models of Family Clinics 

1. Single Practitioner
A decades old model followed within the Indian market, it typically involves a single physician catering to a small local population. Services provided may range from only consultation to limited pharmacy, basic diagnostics and small procedures like suturing. Word of mouth is the most commonly employed tool for marketing. Mainstreaming and expansion of this model is extremely difficult since it is largely person dependent.

2. Practice Association
Continue reading this post…

The Arogyada
www.arogyada.in
April 2, 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

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    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

    Connecting the Dots

    Was given an assignment to analyze the Stanford commencement speech of Steve Jobs, the one which I have posted in the last post. It was a group assignment and my part was to present the first story from his speech, that is “Connecting the Dots”.

    I like this story very much and also the way in which it has been told by the man. These three words are magical and i thought a simple powerpoint presentation wont be able to do justice to this idea.

    Some days back came across this article of HBR and came to know about an awesome and innovative way of making presentations. It is a web based application called Prezi with zooming user interface. It is a perfect example of a big leap. One of the best feature is that it makes it very easy to express the non linearity and complexity of thoughts; especially for all you right brain dominant individuals who think images and can see the bigger picture behind things.Now when i look back at powerpoint presentations, they look like dwarfs. Am embedding my presentation below…enjoy connecting the dots!


    The Arogyada
    www.arogyada.in
    June 23, 2010 / by drsandeep.net