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Indian Pediatr 2013;50: 713 |
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News in Brief |
Gouri Rao Passi,
Email:
[email protected]
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Polio in Maharashtra
A 11 month old child has been confirmed to have
vaccine derived polio virus (VDPV) in the Beed district of Maharashtra
on June 1st 2013. This is the third case of VDPV since March 2012 and
the first in Maharashtra. There is a suspicion of underlying
immunodeficiency in the child since he has been suffering from prolonged
bouts of illnesses. India will not forfeit the polio free label because
of this since VDPV is not enumerated in wild polio numbers. Stool
samples of people in the neighborhood have been sent to National
Institute of Virology, Pune to evaluate extent of spread. The next plan
is 2-3 rounds of immunization rounds which is recommended to break the
extension of disease even in VPVD (The Times of India 7 June 2013).
Reconstructing the Bronchus with a 3-D Printer
Life threatening episodes of cyanosis due to severe
bronchomalacia in an infant has been treated with an artificially
created bronchus and reported in the 22 May issue of the New England
Journal of Medicine. Scientists used an incredible new technology called
3-D printing. So far severe bronchomalacia has been treated with
intermittent ventilation, artificial intraluminal splints and sometimes
even surgical splinting with a rib. However all of these have their
limitations and drawbacks. Glen Green, an otorhinolaryngologist from the
University of Michigan, had been working for some time to develop a
custom made tube to support floppy airways.
A 3-D printer works like an inkjet printer, but
instead of laying down layers of ink it deposits a structural material.
The printer head adds each layer according to a digital pattern to
create a 3-D structure. In manufacturing, 3-D printers have built
prototypes and parts for machines. So far artificial ears, and spinal
disks and bones have been created at an experimental level in the
laboratory. But this is the first time a 3-D printer has been used to
aid tissue reconstruction in a patient. The 3-D printer heats up a
powdered form of the plastic until it melts and can be extruded in a
paste which is made up of a reabsorbable material called
polycaprolactone.
The team first used a computed tomography (CT) scan
to define the patient’s airways. From those images, they then sculpted a
three-dimensional printed cast with the same shape as the patient’s
collapsed bronchus. Hollister, a professor of biomedical engineering at
Michigan then designed a sleeve that would wrap around the outside of
the floppy airway. The sleeve’s structure allows it to expand as the
airway grows and develops while simultaneously resisting spasms that
pull inward, thereby collapsing the airway. The next step was to sew the
tissue of the patient’s bronchus to the inside of the sleeve. The team
needed to obtain an emergency-use approval from the U.S. Food and Drug
Administration before they could implant the device. The surgery was
done in January 2012 and the child has been asymptomatic since then. The
next big challenge will be printing fully functioning organs and tissues
for humans (Nature 28 May 2013).
Marvelous Mucus
Mucus mainly consists of huge molecular complexes
called mucins, which are made up of thousands of glycan sugars attached
to a central protein backbone. This mucus is loaded heavily with
bacteria killing viruses called phages. While phages protect their hosts
from the constant barrage of bacteria, these very bacteria are an ideal
breeding ground for the phages to reproduce. Researchers have shown that
the presence of phages reduced the number of bacteria that can attach to
mucus by more than 10,000 times. It is suspected that phage strains
found most often in mucus will be those that target the most common
bacteria, providing a sort of ‘mucus memory’ against the most relevant
local microbes. Mucus-borne phages also possibly protect bacteria that
benefit their animal hosts, while destroying those that cause harm. The
clinical implications are that deliberately coating a tissue with phage
loaded mucus would boost the basal immunity and may open a whole new
chapter in therapeutics (Nature 20 May 2013).
Healing the City
Nearly 40% of Indians will be living in urban centers
by 2026. A quarter of them will be poor and 10% vulnerable (ie rag
pickers, homeless children etc) with negligible access to health care
services. So, the Union Cabinet’s approval of Rs 22, 507 crore for the
National Urban Health Mission was long overdue. Other highlight of the
NUHM is the inclusion of other urban centric issues such as domestic
violence, sexual exploitation, HIV/AIDS, drug trafficking, child abuse
and gender issues. While the Centre will fund 75 per cent of the mission
and the State 25 per cent, the funding ratio for North Eastern States
and special category States of Jammu and Kashmir, Himachal Pradesh and
Uttarakhand will be 90:10. The existing mechanism and systems created
and functioning under NRHM will be strengthened to meet the needs of
NUHM (The Hindu 21 May 2013).
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