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Indian Pediatr 2014;51: 327 |
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News in Brief |
Gouri Rao Passi,
Email:
[email protected]
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Option B+ to Cut Perinatal HIV Transmission
The Union Government has announced that Option B+
will be implemented in India to reduce perinatal HIV transmission. In
this option, all HIV positive women will be put on three antiretroviral
drugs, lifelong, regardless of CD4 counts or WHO stage of HIV. Newborns
will be started immediately on once daily nevirapine (10 mg below 2.5 Kg
and 15 mg above 2.5 Kg) till 6 months of age. Caesarean sections will no
longer be required and all mothers will be strongly advised to
breastfeed their babies. Exclusive breastfeeding will be recommended for
6 months and complementary feeding will be advised from 6-12 months.
Option B+ is expected to bring down risk of perinatal
transmission from around 30% in patients without intervention to below
5%. Previously used Option A included short-course zidovudine during
pregnancy and extended infant nevirapine during breastfeeding for women
with CD4 >350/µL and no evidence of WHO stage 3-4 disease, with lifelong
anti-retroviral treatment (ART) for women with advanced disease. Option
B meant ART through pregnancy and breastfeeding regardless of CD4 or
disease stage, with continuation after weaning for women with advanced
disease. Maharashtra, Karnataka, Andhra Pradesh and Tamil Nadu have
already adopted the new regimen and other states will follow. (The
Hindu 20 February 2014)
Now Stem Cell Use is Malpractice
The ICMR and Department of Biotechnology have issued
fresh guidelines according to which every use of stem cells in patients
outside an approved clinical trial will be deemed malpractice. A
decision has been taken to drop the word ‘therapy’ to emphasize that
stem cells are not part of standard care. Stem cell use is at present
only approved for hematopoetic stem cell reconstitution. The action has
been taken to curb malpractice where stem cell is being offered as a new
tool to cure incurable diseases. There are other ethical issues involved
too. India’s in vitro fertilization (IVF) clinics are considered
an established source of embryos for research to which foreign
scientists come for supplies. So when Embryo Stem Cell (ESC) line
research was established at Reliance Life Sciences Laboratory and the
National Centre of Biological Sciences in 2001, its associated publicity
forced the government to announce a crack down on the trade to counter
the international view of India as ‘an embryo surplus’ nation.
What is proposed is a system of review and monitoring
of the field based on the National Apex Committee (NAC) for Stem Cell
Research and Therapy and, at the institutional level, Institutional
Committees for Stem Cell Research and Therapy. All research, including
clinical trials, would require the prior approval of, and be registered
with, the NAC. Prohibited areas of research include reproductive
cloning, implantation of a human embryo into the uterus after in
vitro manipulation, and transfer of human blastocysts generated by
somatic cell nuclear transfer (SCNT) into a human or nonhuman uterus.
Studies of chimeras and the creation of a zygote by IVF or SCNT with the
specific aim of deriving a hES line are restricted but not prohibited. (The
Hindu 24 February 2014; Mittal S. Stem Cell Research- The India
Perspective. Perspect Clin Res. 2013;4:105-7)
The ‘Super Amma’ Story
The new heroine in several villages in the Chitrakoot
district in Andhra Pradesh is ‘Super Amma’. This fictitious character
was developed by researchers of the London School of Hygiene and
Tropical Medicine and St John’s Research Institute, Bangalore. They
invented her as part of a controlled trial of a public health campaign
to encourage hand washing. Eight hundred thousand children aged below 5
years die of diarrhea every year. It is well established that hand
washing with plain soap halves the incidence of both diarrhea and
pneumonia. So far, efforts to change hand washing behavior have used
information about health benefits and risks, and met with little
success. Often the problem is not the lack of knowledge but the
reluctance to adopt a new habit or change an old one.
In this study published in The Lancet Global Health,
emotional drivers instead of knowledge based messages were used. The
multicomponent intervention comprised community-based and school-based
events including an animated film about a savvy rural mother (‘SuperAmma’)
who teaches her beloved son hand hygiene as part of good manners and
comedy plays about ‘SuperAmma’ and a disgusting uncle. Six months after
the campaign was launched, there was a 37% increase in handwashing in
the intervention villages while rates remained fairly unchanged in the
control villages. What was interesting was that rates increased equally
in households with and without access to water within their compounds.
The findings show that creative interventions based on drivers of
behavior change can be effective and potentially scalable. (The
Lancet Global Health 2014; 2:e145-54)
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