adminMorning Health Talk :
New Delhi, June 12, 2018 :
Should we remove tonsils in children?
And now it has been shown in June 7 issue of JAMA Otolaryngology–Head & Neck Surgery that children who have their tonsils or adenoids removed before age 9 years are at higher risk for respiratory, infectious, and allergic diseases up to the age of 30 years. Tonsillectomy was associated with a nearly tripled risk of upper respiratory tract diseases, and that adenoidectomy was associated with doubled risk of [CHRONIC OBSTRUCTIVE PULMONARY DISEASE] and upper respiratory tract diseases and nearly doubled risk of conjunctivitis. Doctors often remove adenoids and tonsils to treat recurrent tonsillitis or middle ear infections. Adenoids and tonsils are parts of the immune system, have known roles in pathogen detection and defence, and are usually removed at ages when the development of the immune system is sensitive.
Now an ultra-thin stent
Often doctors are blamed for putting a costly stent. The government does not differentiate between different stents. The smallest-sized DES currently available is 2.25 mm. Patients with CAD in vessels <2.25 mm are currently managed with bare-metal stents, oversizing with a 2.25-mm DES, or plain old balloon angioplasty, as drug-eluting balloons are not yet available.
Now the first prospective study of a 2.0-mm drug-eluting stent (DES) met its primary end point and was associated with a reassuringly low rate of clinical events in patients with CAD in very small coronary vessels. The 12-month target lesion failure rate was 5%. In addition, there was zero stent thrombosis with the investigational 2.0-mm zotarolimus-eluting stent (Resolute Onyx, Medtronic). This dedicated size of Resolute Onyx allows for the successful treatment of lesions involving extremely small vessels, thereby fulfilling an important unmet clinical need. The mean reference vessel diameter (RVD) in the RESOLUTE ONYX 2.0 mm Clinical Study was 1.91 mm.
Now with all stents in NLEM will the companies introduce the 2.0 stent in India market and if so will they be able to match the current Indian capped prise?
Lightening injury and cricket
Sorry for 21-year-old aspiring cricketer who died on the spot after he was struck by lightning coupled with thundershowers during practice at the Calcutta Cricket Academy here. The club members did CPR but after seeing no response, took him to Ramakrishna Mission Seva Pratishthan where he was declared dead. I hope CPR was continued on the way.
Lightning injuries are responsible for an average of 300 injuries and 100 deaths per year in the United States. 30 percent of those struck by lightning die and up to 74 percent of survivors may have permanent disabilities. Two-thirds of lightning-associated deaths occur within one hour of injury and are generally due to a fatal arrhythmia or respiratory failure.
Prolonged CPR should be undertaken following electrical injury regardless of the initial rhythm, since most victims are young and good outcomes have been noted even among patients with asystole. Usual triage priorities are reversed if multiple victims are present: patients without signs of life are treated first.
Lightning injury (asystole, DC current) can result in clinical signs typically associated with severe brain injury (fixed and dilated pupils) but which may not accurately reflect the patient’s neurologic status. Therefore, prolonged CPR is indicated.
Bone Banks
In Delhi we have now two government bone banks, at AIIMS and GTB hospital. Bone banks collect grafts from cadaver donors. These are used for reconstruction of large bone defects. Unlike the heart and the kidneys that must harvested within 6-8 hours of brain death, bones can be removed within 24 hours, and preserved for more than 20 years at -80 degrees Celsius. One bone graft can be used to treat more than 15 persons.
At Ganga Ram hospital another bank is currently using well processed and gamma irradiated cortico cancellous bone allografts from tibial slices and femoral heads, bones from amputated stumps in various clinical conditions. The grafts are screened for HIV, HCV, HBV and syphilis to eliminate risk of disease transmission. Unlike other transplants, bone graft recipients do not have to take any immunosuppressant or other drugs. They preserve the graft for a year.
Biosimilars
A “biosimilar” is defined by the World Health Organization as a “biotherapeutic product which is similar in terms of quality, safety and efficacy to an already licensed reference biotherapeutic product” and the “similarity” is defined as the “absence of a relevant difference in the parameter of interest.” The biosimilar agents are expected to be marketed at a lower cost than the original biologic medications.
Biosimilars are not the same as generics. A generic drug is an identical copy of a currently licenced pharmaceutical product that has an expired patent protection and must contain the ‘same active ingredients as the original formulation’. A biosimilar is a different product with a similar, but not identical, structure that elicits a similar clinical response. As a result, biosimilars medicines have the potential to cause an unwanted immune response. Whereas generics are interchangeable, biosimilars are not.
The potentially lower cost of biosimilars raises the risk that insurers may favor them over the original reference medicine, even when they may not be appropriate for an individual patient. India must cultivate national guidance on safety of biosimilars.
India (CDSCO) Definition: Similar biologics- A biological product/ drug produced by genetic engineering techniques and claimed to be “similar” in terms of safety, efficacy and quality to a reference biologic, which has been granted a marketing authorization in India by DCGI based on a complete dossier, and with a history of safe use in India. In 2012, India has issued the Similar Biologics Guideline by Central Drugs Standard Control Organization and the Department of Biotechnology.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI
