- [Block-1] Diseases
- D1: Ebola
- Nigeria Model: How to end Ebola?
- India and Ebola
- D2: Malaria
- D3: Kala-Azar: revised strategy
- D4: TB related
- D5: Pneumonia and Diarrhea:
- D6: Dementia / Alzheimer’s
- D7: LASIK Surgery
- D8: Drug Pricing NPPA
- D9: Drugs and diseases: misc.
- [Block-2] Genetic Engineering related
- [Block-3] Affecting entire community
- [Block-4] Medical Gadgets
- Celiac Kits
- More inventions:
How Ebola Spreads
- Originated in Ebola river near Congo
- Hemorrhagic fever, gum bleeding, blood in stool-vomit.
- Symptoms similar to malaria, cholera hence ELISA test to sure-confirm.
- Fruit bats natural host. Bats, primates, antelopes, porcupines affected=> African-juntaa eating those animals (bush-meat)=>disease spreads to humans.
- Most affected: Liberia, Sierra Leone, Guinea, Nigeria.
- Mosquitoes and air can’t spread it.
- Soap, bleach, sunlight will kill it.
- Vaccines under trial: Zebov, Ebov, Oral AD5 etc.
- Patients kept at home due to poverty and stigma.
- UNMEER: UN Mission for Ebola Emergency Response (UNMEER). First ever in history.
- But WTO admitted, lack of funds and mismanagement.
- Aussies unwilling to send volunteers, even imposed travel bans.
Nigeria Model: How to end Ebola?
- Monitoring people with Ebola-like symptoms. Checking body temperature.
- Tracking down everyone who came in contact of such people. Checking their temp. as well.
- Men, vehicles, mobile-hospital infra. Was already available for polio fight. Same used here.
- Flight crew and Airport officials trained.
- >900 people monitored, only ~19 came Ebola positive. But this strict vigilance paid off, & WHO declared Nigeria as Ebola free.
India and Ebola
- We have only 1 nurse per 1000 people, very high population density + poor sanitation in slums. Quarantine=mission impossible.
- Called off the India-Africa summit (54 members) due to Ebola fear. (otherwise running since 2008. This may help China bolster its image among Africans. Its sending men and trial-vaccines.)
- Has Setup Isolation facilities at airports. All incoming travelers being checked.
- Shortage of PPE (personal protection equipment-full body suits) for health workers.
- Australia imposed travel ban on Ebola hit nations. But India should not stop people coming/going to Africa, ELSE others will follow the suit then no outsider will goto work in Africa. It’ll severally damage their economy and society.
Artimisinin Resistant Malaria
- 40 years back, Malaria parasites became resistant to Chloroquine.
- Then doctors began prescribing Artemisinin.
- But now certain ASEAN nations reporting Artemisinin drug resistant malaria cases.
- Asia Pacific malaria alliance @Manila. India also a partner.
- Sanofi working on Malaria vaccine. Will be ready by 2015 end.
Malaria Hemozin-MRI Detection
Traditional method to detect Malaria:Blood sample=>dye on microscope slide=>count parasites in blood.
- Malaria parasite=>eats Hemoglobin from RBC=> releases Hemozin as waste product.
- Using portable MRI (magnetic resonance imaging), you detect the amount of Hemozin in blood sample=> Malaria confirmed.
- Doesn’t need any dye or chemicals. No human errors in counting parasites.
D3: Kala-Azar: revised strategy
- Female sand fly + Leishmania parasite
- Spleen, liver, bone-marrow affected
- Second deadliest parasitic disease after Malaria.
- WHO to give free Amphotericin B drug.
- ICMR’s rapid diagnosis kit.
- Sarkaari insecticides to kill sand fly
- Main focus on Bihar, JH, WB and Eastern.UP
- Social workers like DOTS workers.
D4: TB related
- Caused by TB bacteria.
- Can be treated with first generation drugs.
- Multi-drug resistant TB. It develops when first line drugs are not taken properly (person stops drugs with slight recovery).
- MDR-TB has to be treated with second line drugs, Patient takes longer time to recover.
- 25% of patients are India.
- Govt. planning TB-survey with help of WHO+USAID.
- Develops when second-line drugs are misused.
- e.g. patient not finishing entire course, or doctor giving inappropriate amount of drug
- Multi-drug resistant TB (MDR-TB) can’t be cured with isoniazid / rifampicin.
- WHO approved trials for a new drug: Delamanid.
- Eli-Lily (American Pharma giant) transferred licenses for : Cycloserin and capreomycin to help Indian companies mfg. them @affordable MRP.
D5: Pneumonia and Diarrhea:
||during and after neonatal period
||occurs mainly after neonatal period.
||<30% children get antibiotics
||>600 million defecate in the open and drink unhygienic water
- 3-day antibiotic treatment costing about Rs.25
|oral rehydration therapy
|Long Term prevention
- exclusive breastfeeding for six months
D6: Dementia / Alzheimer’s
Nobel medicine 2014
- O’Keefe, Britt Moser, Edward Moser
- Brain’s positioning system, some cells improve spatial memory, cure Alzheimer’s disease.
- Dementia is a degernative, Non-communicable brain disease.
- Memory loss, impaired judgment, mood swings.
- Alzheimer’s disease is the most common form of dementia
- 1 every 4 second in the world.
- People should use food rich in Omega-3 fatty acids e.g. walnuts, fish, soybean and flax seeds
- Person with AB blood group=82% more chances of getting Dementia.
D7: LASIK Surgery
- LASIK useful to those averse to using spectacles
- Full form: Laser refractive surgery or laser-Assisted In-Situ Keratomileusis (LASIK).
LASIK can correct following defects
- In LASIK, the laser removes tissues to reshape the curvature of the cornea. Therefore, the cornea needs to have adequate thickness otherwise surgery can’t be done.
- Surgery done under “TOPICAL” anesthesia (And not general anesthesia).
- Eligible patient: above 18 years. + spectacles power should remain unchanged for at least one year.
- After surgery, patient discharged immediately. He can resume work in 3-4 days.
D8: Drug Pricing NPPA
- National pharmaceutical pricing authority
- Control prices of 348 “essential medicines” under Essential commodities act=>Drug price control order.
- Pricing formula: take MRP of all companies >1% market share=>calculate their average price. no company can sell above this price.
- Controversy: when included 108 more drugs which are not in the national list of essential medicines (NLEM). NPPA’s logic- extraordinary circumstances.
- Later Government revoked the order which empowered NPPA to do so in ‘extraordinary’ circumstances.
- Now NPPA working to revise the original 318-walli NLEM list.
D9: Drugs and diseases: misc.
- Maintains filtration pressure of blood.
- Essential during organ transplant surgery.
- Each bottle costs 6k rupees. Need 10-30 bottles during liver transplant.
- NPPA lowered its prices to make it affordable.
- Amotrophic lateral sclerosis ALS. Neuro-disorder. Person can’t speak, move his limbs, swallow food etc.
- ALS ice-bucket challenge, USA: pour bucket of ice-water on your head, then nominate three others. Donate money if you can’t finish challenge. (although celebrities donate money despite finishing challenge- for positive PR image).
- For transferring only oxygen and CO2. can’t do other functions of blood- like clotting during wound.
- Can be stored for long time. Compatible to all type of bloodgroups (ABO, perhaps even Bombay Blood).
- Two types
- 1.PFC- Perflorocarbons used in semiconductors.
- 2.HBOC- Hemoglobin based oxygen carriers
- Anti-retroviral drugs shortage.
- They’re used for HIV/AIDS.
- NHRC sent notice to Government.
- Extremely rare ABO group, first found among some Bombay folks.
- doesn’t have any A, B or H antigens.
- Albendazole tables given in Rashtriya Kishor Swasthya Karyakram.
- American giant Gilead science gave license to 7 Indian pharma companies
- To mfg. Hepatitis C vaccine (Sofosbuvir) at affordable MRP for India.
- Desi Vaccine Japanese encephalitis.
- Till now relied on Chinese.
- Bacterial disease can be cured with multi-drug therapy since 90s.
- But patients face social stigma. SC asked why this happening?
- Baba Amte’s Anandwan ashram to supports them, Mahrashtra. Amte had won Templeton prize (Nobel equivalent for religion).
- 2014: India became Polio free because no case reported in last 3 years.
- Till now we’ve used oral vaccine.
- 2015: should switch to injectable vaccine- to prevent any future incidents.
- 2016: should shift from trivalent to bi-valent vaccine just like rest of the world.
- Inside intestine, cause diarrhea, kills 1 lakh a year
- Government to give free vaccine under Universal immunization program (UIP) from 2015.
[Block-2] Genetic Engineering related
- Stem cells can develop into any cell in body. They can be used to create new nerve cells in brain disorders; new insulin producing cells in diabetes, rebuilding heart-muscles after stroke and so on.
- until now Stem cells were harvested from human embryos=> ethical – moral opposition by Christian groups in the West.
- But, Yamanaka developed iPS cells from patients’ skin. They too can be used like stem cells. Hence, no more need for embryos.
- ACTN3 gene instructs the body to produce a specific muscle protein. Affects athletic performance.
- Everybody has two copies of this gene, one inherited from each parent
- Using ATLAS test, parents can find whether child has this gene or not? So, it can predict whether he can become a superstar athlete or not? Although data alone insufficient.
- made from nano tubes, direction control using magnets.
- Application? Sending drug molecule to a desired location in body; egg-fertilisation by putting sperm cell inside biobot.
- tissue structure created using 3-D printer, then covered with cell material. Such bio printed tissues and organs can be transplanted to patient.
- 3-D printed human body can be used for anatomy classes in medical colleges.
- Faulty BRCA gene=more chances of breast/ovary cancer.
- Myriad genetics sells the test for >$3000. Angelina Jolie underwent mastectomy surgery to remove breasts after test found faulty BRCA genes in her body.
- USA did not allow company to patent BRCA genes because its not really an ‘invention’. But now company got patent in Australia.
- In all human cells, there are four genes — Cryptochrome, Period, CLOCK, and BMAL1
- Together they blood pressure, body temperature and rest-sleep cycles etc.
- This is called circadian clock. It keeps us in proper physiological rhythm.
||for solving crime, identifying unclaimed dead bodies and paternity tests. Although, apprehensions about possible misuse, high costs and simple errors.
||A method to transport DNA of one species to another using virus-bacterial vehicle.
- A branch of biotechnology. To manipulate DNA code artificially.
- Tailor-made plants and animals can be created.
- Make bodies better, eliminate Hereditary diseases.
||Project Gene sequencing helps in detecting diseases early-diabetes, cancer to name a few. Personalised medicine can be prepared according to genetic make-up. This helps in speedy recovery.
- Mother + father => This technology creates a digital embryo=> predicts possible genetic diseases.
- Application? Before marriage, before choosing surrogate mother.
|Sickle Cell anemia
- Hereditary. Indian Tribals most affected.
- RBC sickle shaped, can’t flow properly in vessels.
- Modi asked Nobel winner iPS Stem cell researcher Yamanaka to cure it, during Japan visit.
- Create microbial factories. These factories will produce drugs, vaccines, chemicals.
- e.g. producing artemisinin (anti-malarial drug0 using yeast.
- May be in future even doing artificial photosynthesis to create food.
[Block-3] Affecting entire community
- Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy
- Increase raw material, drugs, hospitals, manpower
- Penetrate in remote areas
- Ayush good because Cheap, flexible, less side effects, accepted by large public.
- Till now: only 20% of packet area showing disturbing photos of throat cancer.
- From 1/4/15: companies will need to cover 80% of total packet area showing warning and gory images.
- Latest: ban on loose cigarette selling.
- Electronic Nicotine Delivery Systems (ENDS).
- Electronic pen that vaporizes liquid nicotine from cartridge. => no secondary smoke.
- E-cigars can still do organ damage, lung irritation, contain carcinogenic compounds like Formaldehyde.
- But companies trying to get more customers via attractive package, flavors, deep-discounts.
- Indian Government wants them banned, and setup 24/7 helpline “Quitline”.
- Female vasectomy more dangerous. Need to promote male vasectomy but rural male-mindset opposed to idea.
- Give no ‘incentives/targets’ to sarkaari-doctors.
- Stringent QC for drugs/equipment bough via tenders.
|Global hunger report
- India rank 55/76. no. of malnourished declined thanks to MNREGA, NRHM, ICDS etc but Brazil, Mexico etc. done better though having similar GDP growth rate.
- >50% women & children anemia. Hidden hunger responsible.
- Solutions: iodized salt, fortified flour, biofortifiaction of crops, PDS reform, Education.
|Mental Health Policy
- Financial help to patient and his caretaker.
- HR: New cadre of sarkari employees called “Mental Healthcare providers”, Train midwives, New PG courses, Funding to hospitals.
- Law: Protect their Dignity and human rights. Mental healthcare bill
- Oct 10 as Mental health day.
|National Nutrition Mission
- Reduce malnutrition among women-children in 200 most bogus districts.
- Anganwadi workers training, nutrition council @district, ICT-tablets for data collection.
|New Born Action Plan
- Reduce MMR from 29/1000 to 9/1000 or less (i.e. single digit)
- By 2030
- Using 6 strategies under existing Reproductive, Maternal Child Health and Adolescent Plus (RMCHA+) framework.
- Take Help from ASHA, NGOs and Philanthropists.
- National Organ and Tissue Transplant Organization (NOTTO)
- Special webportal to facilitate organ donations.
- PNDT= Pre Conception and Pre Natal Diagnostic Techniques Act, 1994.
- Prohibits using ultra-sonography to sex determination
- But doctors using new methods in pretext of “genetic testing” to bypass it.
- Child sex ratio down to 918/1000.
- Government made a new expert Committee to investigate + Beti Bachao-Beti Padhao campaign.
- Government thinking About mandatory rural posting for doctors.
- Doctor lobby opposed: lack of infra. So super-specialist PG/MD doctors won’t be able to do anything even if posted. e.g. anesthesia, cardiology, radiology, nephrology.
- Anemia, malaria, TB, diarrhear
- Need infra: housing, clean water, sanitation, electricity, road, communication.
- Use traditional healers to deliver ORS and anti-malaria drugs
- Promote herbal medicine and AYUSH
- Employ tribal youth in local health care service.
[Block-4] Medi-Gadgets, Indigenization of Technology
- Celiac disease= when patient eats gluten (protein in what, rye, barley)- his body mounts an immunological attack on small intestine=> nutrients can’t be absorbed properly.
- Long term leads to Diabetes type1.
- No cure. Just use gluten free food. Two new
- Two diagnostic kits by Indian researchers using Government funding.
- based on indirect ELISA
- For large hospitals with centralized labs and sufficient space for storing large no. of smaples
- Result in 20 minutes.
- For small clinics without facilities.
More inventions: क्योकि इस रात की सुबह नही
- To detect cervical cancer in women by ICMR
- Foreign devices 10 lakh, desi device only 10,000.
- Runs on battery, can work in rural area, even healthworker with basic training.
- Cavilon= cut prevention cream / spray.
- AIBA made cavilon compulsory for boxing matches. Apply 3 layers, prevents cuts, provides moisture, can last upto 72 hours, no petroleum jelly.
- By an Indian researcher Srinivas Murali in Switzerland.
- wearable device that helps the user to track and manage his physical + emotional health
- monitors ECG, breathing, body-fat, stress levels and other and key vital signs to smartphone and to your doctor.
- reverse dot blot hybridization kit.
- Thalassemia detection in kids and pregnant women
- Imported kit too expensive, this kit only Rs.400
- cochlear implant / bionic ear.
- Imported= ~9 lakh. DRDO’s Sravan implant just ~1.5 lakh rupees.
- Undergoing clinical trials at the moment.
- Mammogram tests not 100% accurate in detecting brest cancer.
- New method: Ultrasound elstography has better detection rate.
- To help surgeons get trained in this method, new software designed- Virtual breast.
Next Revision note: GS3: Science and technology (non-medical type).
All the revision notes are archived at Mrunal.org/UPSC#CSE-2014
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