The world’s first intensive care unit on rails has
been commissioned in India by the Central Railways. The idea was born
after the Roha derailment in May 2014 when more than 20 people died due
to lack of medical facilities in the vicinity. It had taken 3-4 hours
for people to reach Sion Hospital Mumbai which proved too long for many.
The Central Railways has refurbished two condemned air conditioned
coaches and transformed them into an intensive care unit (ICU) on
wheels. It can transport 7-8 patients at a time, and will ferry patients
at a radius of 200 Km. It will have the ability to travel at a maximum
speed of 140 km/hour, and will be given a green signal right through
when on emergency duty. The Central Railway also plans an air ambulance
in the future. (The Times of India 2 June 2015)
First Live Birth After Uterine Transplant
A 35-year-old woman with congenital absence of the
uterus (Rokitansky syndrome) underwent uterine transplantation from a
61-year-old donor in Sweden. A year after transplant, she underwent
embryo transfer after in vitro fertilization. She received
immunosuppression with tacrolimus, azathioprine and corticosteroids
throughout her pregnancy. After 3 minor rejections managed with
steroids, she delivered a preterm (31 wk) baby weighing 1.7 kg. This
first live delivery after uterine transplant was reported this year in
the Lancet. This report will bring hope to the thousands of women with
an absent or non-functioning uterus. (Lancet. 2015;385:607-16)
Writing in Capitals
Doctors in India will be now required to write drugs
with generic names, and also write prescriptions in capital letters.
This was announced by the Union Health Minister of India. The central
government has approved to amend the Indian Medical Council Regulations,
2002 for the same. This is an attempt to reduce prescription errors
which are rampant. This will be a medical council of India (MCI)
regulation; however, there will be no penalties or punishments for not
following the notification.
In the US alone, 100,000 prescription errors are
estimated to occur every year while data from in India is lacking.
Several studies have shown that computerized prescriptions reduce errors
by about 50% in comparison to handwritten prescriptions. Since
implementing this would be a gargantuan task, a cheaper alternative is
to make writing in capitals compulsory. Most doctors accept that this
will overall benefit the patient though it may increase the workload on
the doctor. (The Hindu 11 June 2015)
Antibiotic Alternatives
Since Penicillin created a storm in the world more
than 80 years ago, the strategic war between bacteria and man continues
unabated. Today the specter of pan-resistant bacteria has forced
scientists to look at creative alternatives to antibiotics. Many new
avenues were unveiled in the Annual Meeting of the American Society of
Microbiology in June this year in New Orleans.
One possibility is the use of predatory bacteria such
as Bdellovibrio bacteriovorus. This attacks prey bacteria and
replicates within it till the bacteria ruptures and releases more B.
bacteriovorus into the environment. The US Defence Advanced Research
Projects Agency has a Pathogen Predators program to research this area.
The other innovative approach is to use peptides from other organisms
like amphibians and reptiles which are unusually resistant to bacteria.
Several peptides with antibacterial activities have been isolated from
frogs, alligators and cobras, and are under trial for healing of wounds.
Phages, ie. viruses that attack bacteria have long been a favorite with
researchers, but it is only recently that they are being targeted to
handle the antibiotic crisis. A multicentric trial will soon commence to
assess phage treatment for burns-associated infections. Gene editing
using the now famous CRISPR technique is also a hot favorite for
researchers. The aim is to target genomes of specific bacteria or kill
the genes which confer antibiotic resistance. There is renewed interest
in metals and the antibacterial effects of metal nano particles are
being investigated. (Nature 28 May 2015)
Legacy of Evidence-based Medicine
David Sackett, clinical epidemiologist par excellence and pioneer of
evidence-based medicine died this May leaving behind an enviable legacy.
His experiments with "marching to a different drummer" began as a final
year student when he was looking after a patient with hepatitis A. The
patient was unwilling to follow conventional teaching that bed rest was
imperative to avoid permanent liver damage. Sackett combed literature
till he chanced upon an elegant paper which clearly proved that bed rest
was not obligatory. Inspired by this incident, Sackett began his
lifelong journey of constantly questioning conventional clinical wisdom.
The consequence was the birth of "Evidence Based Medicine" (EBM). He set
up the Clinical Epidemiology Unit in Canada’s McMaster University where
he developed and taught the skills of critical appraisal in assessing
evidence. He was a master in skepticism and loved to provoke people to
change the way they thought. Today thanks to him, evidence based
medicine is an established norm in clinical medicine. (Lancet 13 June
2015)