In this year’s Union budget, the Government of India
has laid out the blueprint for what is being described as the world’s
largest healthcare program. The National Health Protection Scheme plans
to cover over 10 crore poor and vulnerable families, and will provide
coverage upto Rs. 5 lacs per family per year for secondary- and
tertiary-care hospitalization. About 150,000 Health and Wellness Centers
will provide comprehensive healthcare, including for non-communicable
diseases and maternal and child health services. These centers will also
provide free essential drugs and diagnostic services. An additional Rs.
600 crore has been allocated to provide nutritional support to all
patients with tuberculosis at the rate of Rs. 500 per month for the
duration of their treatment.
The government also proposes to start 24 new
government medical colleges and hospitals by upgrading existing district
hospitals in the country. The aim is to ensure that there is at least
one medical college for every three parliamentary constituencies, and at
least 1 government medical college in each state of the country. (The
Hindu 1 February 2018)
Methylene Blue in Malaria
Artemesin-resistant malaria is an emerging problem in
South–East Asia. World Health Organizaation’s global plan for containing
artemisinin resistance recommends adding a single dose of primaquine to
reduce ongoing transmission. A study recently published in the Lancet
Infectious Diseases from Mali has shown that giving methylene blue (15
mg/kg/day for 3 days) along with dihydroartemisinin-piperaquine to
patients with falciparum malaria can effectively prevent transmission of
gametocytes from humans to mosquitoes. Transmissibility was assessed by
molecular quantification of sexual stage-specific mRNAs and by membrane
feeding blood to mosquitoes and counting the oocytes that formed. Both
primaquine and methylene blue were highly effective in reducing
gametocytemia and preventing transmissibility within 2 days.
Although primaquine can induce hemolysis in
individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a
single low dose of 0.25 mg/kg is safe and well tolerated, even in
G6PD-deficient individuals. The antimalarial properties of methylene
blue was first described by Paul Ehrlich in the 1890’s. Though in
vitro it acts against many of the stages and species of malaria,
in vivo its clinical efficacy was considered insufficient. Adverse
effects like gastrointestinal intolerance and urinary discoloration are
also seen. This study has shown that methylene blue may be a useful
addition in the armamentarium of drugs to prevent transmission of
malaria from man to mosquito. (The Lancet Infectious Diseases 6
February 2018)
New CSF Reference Values for Young Infants
A large multicentric study evaluating 7766 infants
has tried to relook at the normal values of CSF in very young infants.
In this study, the upper value of normal for cells in the CSF in
neonates (age <28 d) was 15 cells/mm
. The upper cut-off
limit for CSF protein levels was 127 mg/dL and 99 mg/dL for age upto 1
month and between 1-2 months, respectively. The lower limit for CSF
sugar values were 25 mg/dL for upto 1 month and 27 mg/dL for babies
between 1-2 months of age.
In addition to the reported values, the authors use
scatter plots with smoothed centile curves to show the age-related
decline in CSF white-blood-cell counts and protein concentrations, and
the increase in CSF glucose concentrations, during the first two months
of life. The authors are also considering creating an App with
normograms similar to the Bhutani charts for hyperbilirubinemia. (Pediatrics
February 2018)
Chinese Scientists Clone Monkeys
History was written in 1996 when Dolly – the first
cloned animal – was born in Scotland. Since then, scientists have
successfully used somatic cell nuclear transfer (SCNT) to clone more
than 20 other species, including cows, pigs, dogs, rabbits, rats and
mice. However, for mysterious reasons the technique failed in primates.
Chinese scientists have finally managed to clone two identical long
tailed macaques using SCNT, which involves transferring the nucleus of a
cell, which includes its DNA, into an egg that has had its nucleus
removed.
The research was published on 24th January 2018 in
Cell. It took upto 127 attempts by the scientists for which they had to
use various modulators to switch-on and switch-off the genes inhibiting
embryo development. Though the work of these scientists is at the
cutting edge of biomedical research, a broader and deeper viewpoint of
long-term consequences of these ethically gray areas need to be
considered before proceeding on these unchartered seas. (Medscape 24
January 2018).