1. [Block-1] Diseases
    1. D1: Ebola
      1. Nigeria Model: How to end Ebola?
      2. India and Ebola
    2. D2: Malaria
    3. D3: Kala-Azar: revised strategy
    4. D4: TB related
    5. D5: Pneumonia and Diarrhea:
    6. D6: Dementia / Alzheimer’s
    7. D7: LASIK Surgery
    8. D8: Drug Pricing NPPA
    9. D9: Drugs and diseases: misc.
  2. [Block-2] Genetic Engineering related
  3. [Block-3] Affecting entire community
  4. [Block-4] Medical Gadgets
    1. Celiac Kits
    2. More inventions:

[Block-1] Disease

D1: Ebola

How Ebola Spreads

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.

Challenges:

  • 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

  1. We have only 1 nurse per 1000 people, very high population density + poor sanitation in slums. Quarantine=mission impossible.
  2. 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.)
  3. Has Setup Isolation facilities at airports. All incoming travelers being checked.
  4. Shortage of PPE (personal protection equipment-full body suits) for health workers.
  5. 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.

D2: Malaria

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.

Solutions:

  • 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.

New method

  • 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.

Revised strategy:

  • 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

“Normal” TB
  • Caused by TB bacteria.
  • Can be treated with first generation drugs.
MDR-TB
  • 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.
XDR-TB
  • Develops when second-line drugs are misused.
  • e.g. patient not finishing entire course, or doctor giving inappropriate amount of drug

MDR-TB: Delamanid

  • 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:

Pneumonia Diarrhea
Period during and after neonatal period occurs mainly after neonatal period.
Cause <30% children get antibiotics >600 million defecate in the open and drink unhygienic water
Treatment
  • 3-day antibiotic treatment costing about Rs.25
 oral rehydration therapy
Long Term prevention immunization
  • Sanitation
  • 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.

What’s Dementia?

  • 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

  • Myopia
  • Hyperopia
  • astigmatism
  • 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.

Albumin
  • 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.
ALS bucket
  • 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).
Artificial blood
  • 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
ARVS
  • Anti-retroviral drugs shortage.
  • They’re used for HIV/AIDS.
  • NHRC sent notice to Government.
Bombay Bloodgroup
  • Extremely rare ABO group, first found among some Bombay folks.
  • doesn’t have any A, B or H antigens.
De-worming
  • Albendazole tables given in Rashtriya Kishor Swasthya Karyakram.
HepC
  • American giant Gilead science gave license to 7 Indian pharma companies
  • To mfg. Hepatitis C vaccine (Sofosbuvir) at affordable MRP for India.
JenVAC
  • Desi Vaccine Japanese encephalitis.
  • Till now relied on Chinese.
Leprosy
  • 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).
Polio
  • 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.
Rotavirus
  • 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

  • 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
  • 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.
Biobots
  • 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.
Bioprinting
  • 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.
BRCA genes
  • 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.
Circadian Bodyclock
  • 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.
DNA fingerprinting for solving crime, identifying unclaimed dead bodies and paternity tests. Although, apprehensions about possible misuse, high costs and simple errors.
Gene splicing A method to transport DNA of one species to another using virus-bacterial vehicle.
Genetic engineering
  • A branch of biotechnology. To manipulate DNA code artificially.
  • Tailor-made plants and animals can be created.
  • Make bodies better, eliminate Hereditary diseases.
human genome 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.
Matchright technology
  • 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.
Synthetic biology
  • 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

Ayush Mission
  • 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.
Cigar labelling
  • 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.
E-cigars
  • 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”.
Family planning
  • 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.
NOTTO
  • National Organ and Tissue Transplant Organization (NOTTO)
  • Special webportal to facilitate organ donations.
PNDT
  • 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.
Rural service
  • 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.
Tribal health
  • 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 Kits

  • 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.
Celiac Microlisa
  • based on indirect ELISA
  • For large hospitals with centralized labs and sufficient space for storing large no. of smaples
Celiac Card
  • Result in 20 minutes.
  • For small clinics without facilities.

Magni-visulizer

More inventions: क्योकि इस रात की सुबह नही
AV-Magnivisualizer
  • 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
  • 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.
Inner You
  • 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.
RDB kit
  • reverse dot blot hybridization kit.
  • Thalassemia detection in kids and pregnant women
  • Imported kit too expensive, this kit only Rs.400
Sravan Implant
  • cochlear implant / bionic ear.
  • Imported= ~9 lakh. DRDO’s Sravan implant just ~1.5 lakh rupees.
  • Undergoing clinical trials at the moment.
Virtual Breast
  • 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