Anurag Khera

Zika virus: Vaccine initiatives and obstacles

Over 130,000 humans in Brazil are infected with Zika virus (ZIKV) since March 2015, and presently 29 countries in Americas have reported local autochthonous ZIKV transmission. Besides the associated clinical features, Brazil has also reported a temporal and spatial association of ZIKV with Guillain-Barre syndrome (GBS) and Zika fetal syndrome. ZIKV vaccine approaches include purified inactivated virus, nucleic acid-based vaccines (DNA, RNA), live vector vaccines, subunit vaccines, virus-like particle technologies, and live recombinant vaccines similar to the technologies used against other human flaviviruses. At present, 15 commercial entities are involved in the development of ZIKV vaccine. Vaccines developed through different approaches would have their own inherent advantages and disadvantages. The presentation of disease in different populations and lack of clarity on the pathogenesis and complications is the most important obstacle. Second, Zika belongs to a genus that is notorious for the antibody-mediated enhancement of infection, which proved to be a stumbling block during the development of the dengue vaccine. Identifying large naive and yet uninfected at-risk populations may be an obstacle to demonstrating efficacy. Next, the association of Zika with GBS is being researched since the vaccine may have the potential to provoke similar neuropathophysiologic mechanisms. Zikas association with adverse fetal outcomes necessitates that pregnant women and women of childbearing age are considered for evaluating vaccines, which form a vulnerable group for vaccine trials.

A study of therapy targeted EGFR/ALK mutations in Indian patients with lung adenocarcinoma: A clinical and epidemiological study

Background Established predictive biomarkers for Non-Small Cell Lung Carcinoma (NSCLC) include sensitizing Epidermal Growth Factor Receptor (EGFR) mutations and Anaplastic Lymphoma Kinase (ALK) fusion oncogene. The primary aim of the study is to ascertain the prevalence of EGFR mutation and ALK gene rearrangement in patients of lung adenocarcinoma in Indian population and the second objective is to impress upon the importance of adequate processing of limited tissue samples. Methods Histopathologically confirmed cases of lung adenocarcinoma, whose tumour had been tested for both EGFR and ALK gene mutations, were included in this study. The EGFR mutations were analyzed using PCR and Gene Sequencing. ALK fusion oncogene was found by Fluorescence In Situ Hybridization (FISH) technique using kit of Vysis LSI ALK Dual colour Break Apart Rearrangement probe. Results A total of 152 cases of lung adenocarcinoma were included. Out of which, 92 (60.5%) were male and 60 (39.5%) were female. After exclusion of 17 cases due to unsatisfactory result, EGFR mutations were found positive in 35.5% cases (48/135). ALK gene rearrangement was found in 7.6% (10/131) after excluding 21 cases with unsatisfactory result. Conclusion EGFR mutations and ALK gene rearrangement was found to be mutually exclusive. Incidence of EGFR mutations (35.5%) is much higher in Indian population than in Caucasians (13%) and is close to the incidence in East Asian countries. The 7.6% incidence of ALK fusion oncogene in Indian patients establishes the importance of molecular studies to give maximum benefit of targeted therapy to the patients.

A study to assess the knowledge of medical students regarding organ donation in a selected college of Western Maharashtra

Context: As per United Network for Organ Sharing, there are over 71,000 people on organ transplant waiting list in the United States. The only way to increase organ donations is to educate the health-care professionals and public about the importance of becoming an organ donor. One of the ways to start this is to promote the awareness of the college students, especially those in the medical field, toward organ donation as they are the most suitable persons to carry the message to the community. Aims: This study aims to determine the knowledge of medical students regarding organ donation. Settings and Design: Cross-sectional study conducted in a medical college of Western Maharashtra. Subjects and Methods: A questionnaire adapted to the study requirements from the published research was designed to capture the knowledge toward organ donation. Final year MBBS students who gave verbal consent to the study were included. Statistical Analysis Used: Microsoft Excel and SPSS version 20. Results: 87% of the students had correct knowledge regarding brain death occurring after road traffic accident. Fifty-four percent (54.45%) of students were not aware that an individual suffering from infectious disease cannot donate organs. 61% of the students were not aware that a National network for organ donation exists in their city. 48.5% of students did not know how to register oneself as an organ donor. Conclusions: The results of the study revealed that there exists a knowledge gap among the medical students regarding organ donation and there is an urgent need for addressing this knowledge gap which will help in improving the organ donation rate in our country.

Zoonotic surveillance for rickettsiae in rodents and mapping of vectors of rickettsial diseases in India: A multi-centric study

Background: The global resurgence of rickettsial diseases and their potential to impact the fitness of military personnel and inflict widespread casualties amongst civil populations has emerged as a major cause of public health concern. Absence of surveillance system, lack of awareness amongst medical fraternity to rickettsial activity along with the difficulty in diagnosis because of their protean clinical manifestations are reasons for the outbreaks of these diseases. Objectives: To determine rickettsial activity amongst rodents and study vector diversity, abundance and their distribution to enable mapping of rickettsial hotspots. Methods: Zoonotic surveillance was undertaken in six selected study areas in India - Jammu, Akhnoor, Rajouri-Poonch, Udhampur-Nagrota, Dehradun and Pune. Weil–Felix test was used for rickettsial sero-surveillance amongst rodents and standard identification keys were used for mapping vector diversity and database preparation. Results: Serological findings revealed positivity to all the three rickettsial antigens (OXK, OX19 and OX2) in Jammu, OX19 in Dehradun and OXK and OX2 positivity in Udhampur-Nagrota belt. The vector database records presence of 16 species of trombiculid mites from three important genera - Leptotrombidium, Schoengastiella and Gahrliepia with ticks from five genera and 8 species of fleas from four genera. Mite fauna of study sites has been enriched with addition of new records of mite species (five mite species at Pune, two at Akhnoor with one mite species each at Jammu and Dehradun). Conclusion: The study reveals rickettsial activity amongst rodents at Jammu, Dehradun and Udhampur-Nagrota belt. The results correlate well with the presence of vectors of scrub and tick typhus and corroborate the occurrence of outbreaks of these diseases in the respective areas.

Impact evaluation of two methods of dental health education among children of a primary school in rural India

Background: Impact of two methods of dental health education (DHE) on knowledge and practices of primary school children in a rural area regarding oral care was planned to be studied. Materials and Methods: Study population comprised of 199 primary school children aged 10-13 years in rural field practice area of a medical college. After collecting baseline data, students were allocated into two groups by block randomization using variable blocks. DHE with educational pamphlets and demonstrations was given to both groups. In addition, the intervention group was also shown videos showing correct oral health practices. Data were proposed to be collected at 3 and 6 months from baseline for impact evaluation. The results at 3 months postintervention are being presented. Results: The results after 3 months of intervention found significant difference in the impact on: (a) Practices regarding method of cleaning teeth (P < 0.001), (b) knowledge on best method of cleaning teeth (P < 0.001), (c) reason for regular brushing of teeth (P < 0.001), and (d) requirement to clean teeth after eating something sweet (P < 0.001) in favor of group receiving additional intervention. Conclusion: There is a significant difference in the impact of health education using integrated modes of pamphlets distribution, demonstrations, and A-V aids (group A) as compared to demonstrations and pamphlets distribution only (group B).

Secondary Outcomes and Peto OR in Meta-analysis.

Th e recent article in CHEST (June 2014) by Dong et al 1 on a systematic review and meta-analysis of randomized controlled trials on the use of inhaled corticosteroids in patients with COPD and the risk of TB and infl uenza was an interesting read. Th e article summarizes the odds of TB and infl uenza in patients with COPD exposed to inhaled corticosteroids. Th e resultant Peto OR of 2.29 is signifi cant (95% CI, 1.04 -5.03).