Indian Physicians Research Articles

Integrative nanomedicine: treating cancer with nanoscale natural products.

Finding safer and more effective treatments for specific cancers remains a significant challenge for integrative clinicians and researchers worldwide. One emerging strategy is the use of nanostructured forms of drugs, vaccines, traditional animal venoms, herbs, and nutraceutical agents in cancer treatment. The recent discovery of nanoparticles in traditional homeopathic medicines adds another point of convergence between modern nanomedicine and alternative interventional strategies. A way in which homeopathic remedies could initiate anticancer effects includes cell-to-cell signaling actions of both exogenous and endogenous (exosome) nanoparticles. The result can be a cascade of modulatory biological events with antiproliferative and pro-apoptotic effects. The Banerji Protocols reflect a multigenerational clinical system developed by homeopathic physicians in India who have treated thousands of patients with cancer. A number of homeopathic remedy sources from the Banerji Protocols (eg, Calcarea phosphorica; Carcinosin—tumor-derived breast cancer tissue prepared homeopathically) overlap those already under study in nonhomeopathic nanoparticle and nanovesicle tumor exosome cancer vaccine research. Past research on antineoplastic effects of nano forms of botanical extracts such as Phytolacca, Gelsemium, Hydrastis, Thuja, and Ruta as well as on homeopathic remedy potencies made from the same types of source materials suggests other important overlaps. The replicated finding of silica, silicon, and nano-silica release from agitation of liquids in glassware adds a proven nonspecific activator and amplifier of immunological effects. Taken together, the nanoparticulate research data and the Banerji Protocols for homeopathic remedies in cancer suggest a way forward for generating advances in cancer treatment with natural product–derived nanomedicines.

Carotid intima-media thickness: Current evidence, practices, and Indian experience

As the developed and developing nations cope up with increasing predisposition to cardiovascular diseases (CVD) by adopting lifestyle changes the burden of coronary artery disease continues to rise globally. The presence of modifiable risk factors, which account for more than 90% of the cardiovascular (CV) risk, cannot always be interpreted as the presence of atherosclerotic heart disease and absence of modifiable risk factors do not guarantee absence of atherosclerotic changes in the arterial tree. Increasing awareness about primordial prevention and primary prevention of CVD is of vital importance in such scenarios. Ultrasonographic measurement of intima media thickness has been reported as a procedure to detect the early stages of atherosclerosis. Carotid intima media thickness (CIMT) testing is a safe, noninvasive and cost effective method to detect early atherosclerotic vascular diseases. This method of CV risk evaluation drew attention worldwide and of Indian physicians because of its feasibility in Indian population. Hence, detection and management of atherosclerosis in asymptomatic individuals will go a long way in preventing atherosclerotic diseases and prolonging survival and improving quality of life.

The new international multidisciplinary histological classification of lung adenocarcinoma and clinical implications for Indian physicians

The new international multidisciplinary histological classification of lung adenocarcinoma and clinical implications for Indian physicians

UTILIZATION OF PANCHAKARMA IN HEALTH CARE: PREVENTIVE, NUTRITIVE AND CURATIVE TREATMENT OF DISEASE

The importance of Ayurveda in global scenario is because of its holistic approach towards positive life style. Ayurveda is a science of life, which is continuously developing as a result of various discussions and researches from ancient time onwards. It gives equal importance to preventive and curative aspects of diseases. Panchakarma therapy is an integral part of Ayurveda (Indian Medical System). Panchakarma is a term used to symbolize five medical procedures for internal purification of body. It helps in detoxifying and rejuvenating body by simple techniques that can be done easily applied in outdoor practice. Failure of contemporary medicines in the prevention of major health burdens force us to revert back for the original detoxifying naturopathy. Panchakarma is an effective therapy in managing autoimmune, neurological, psychiatric and musculo-skeletal diseases of chronic and metabolic origin. In the current scenario, these unique procedures are widely practiced by physicians in India and many other countries globally for prophylactic and therapeutic purposes.

The Little Brown Woman

Drawing on 121 in-depth interviews with first- and second-generation women and men physicians of Indian origin in the U.S. Southwest, I examine the incidence and nature of gender-based discrimination in American medicine. I focus on two aspects: (1) gender discrimination by employers and colleagues against women physicians of Indian origin and (2) the interaction of gender discrimination with race in the professional lives of first- and second-generation physicians. U.S. healthcare has become increasingly dependent on immigrants, in particular women physicians, from the developing world. I document the significant impact gender and race can have in molding the professional trajectories of Indian women physicians. The experiences of these physicians help clarify the interaction of skilled migrant workers with racial/ethnic and gender relations in U.S. workplaces.

A focus on the burdens, boosters, and bonuses of the bearers of bad news in India

Objectives: This study was done to explore the experiences of physicians in India about being the messengers of bad news and management of psychosocial burdens associated with such consultations. Methods: Narrative data was collected from 27 physicians working in four teaching hospitals, using a semi-structured interview schedule. Constant comparison analytic procedures were used to examine physicians’ perceptions and behaviors related to their role as the bearers of bad news. Results: Physicians perceived that being a messenger of bad news was very challenging throughout the course of their careers, although their self-confidence increased over time. Two types of patient care contexts were identified based on the intensity and duration of distress experienced by the physicians. Treatment failure with children and young adults, patients’ inability to access care at the initial stages of the disease, and withdrawal of life-saving treatments due to financial constrains caused intense distress among physicians. Physicians used a number of strategies to cope with the burden of bearing bad news. Clinical bad news puts physicians at risk for burnout, and in some cases is an opportunity for growth. Conclusions: Clinical skill trainings should increase clinicians’ ability to assess and attend to the psychosocial impacts of delivering bad news as much as teaching them the procedures of conveying such information. More studies about the impacts of bad news disclosure on physicians working in societies or settings with inequitable access to health care will improve such training programs.

Oncologists’ perceptions of cost and cancer care in India: A comparison of private practice (PPOs) and non-private practice oncologists (NPPOs).

e17562 Background: Cancer incidence is increasing in India, where most patients lack health insurance. Little is known about how out-of-pocket costs affect cancer treatment decision-making by Indian physicians and patients. Methods: We conducted a cross-sectional survey of PPOs and NPPOs in 6 Indian metropolitan areas. Oncologists were surveyed about cost of care and cost discussions with patients. Descriptive statistics and Fisher’s exact tests were used to describe differences in cost perceptions and discussions. Results: 59 oncologists were surveyed (61% response). 78% (n=46) were men. 59% (n=34) were PPOs, and 41% (n=25) were NPPOs. Oncologists routinely discussed cost with their patients (96%, n=57); PPOs and NPPOs were equally likely to do so (p=1.00). According to oncologists, patients seeing NPPOs or PPOs were equally likely to discuss costs before deciding on treatment (p=0.14). 55% (n=32/58) of oncologists discussed cost with patients before prescribing diagnostic tests, and 79% (n=46/58) discussed cost before making treatment decisions. PPOs were more likely than NPPOs to believe that costs may discourage patients from presenting for an initial cancer evaluation (88% vs. 44%; p=0.0009). However, 71% of NPPOs (vs 44% of PPOs; p=0.06) believed that, once diagnosed, more than half of their patients found costs to be a barrier to receiving standard care. Oncologists reported the most costly components of care for their patients to be: 1) chemotherapy; 2) radiotherapy and diagnostic imaging (tied); 4) surgery; 5) indirect costs from lost wages and inpatient admission (tied). When asked about how to reduce costs, oncologists identified: lowering chemotherapy prices (88%, n=52); judicious use/ lowering cost of diagnostics (36%, n=21); optimizing the referral process (22%, n=13). Insurance/subsidies were identified by 15% (n=8). Conclusions: Cost is routinely discussed by Indian patients and oncologists across care settings. Cost can be a deterrent to initial evaluation and a barrier to receiving standard care. Oncologists more commonly suggested reducing costs of diagnostics and therapeutics, rather than expanding insurance or changing referral practices.

Which doctor for primary health care? Quality of care and non-physician clinicians in India

The scarcity of rural physicians in India has resulted in non-physician clinicians (NPC) serving at Primary Health Centers (PHC). This study examines the clinical competence of NPCs and physicians serving at PHCs to treat a range of medical conditions. The study is set in Chhattisgarh state, where physicians (Medical Officers) and NPCs: Rural Medical Assistants (RMA), and Indian system of medicine physicians (AYUSH Medical Officers) serve at PHCs. Where no clinician is available, Paramedics (pharmacists and nurses) usually provide care. In 2009, PHCs in Chhattisgarh were stratified by type of clinical care provider present. From each stratum a representative sample of PHCs was randomly selected. Clinical vignettes were used to measure provider competency in managing diarrhea, pneumonia, malaria, TB, preeclampsia and diabetes. Prescriptions were analyzed. Overall, the quality of medical care was low. Medical Officers and RMAs had similar average competence scores. AYUSH Medical Officers and Paramedicals had significantly lower average scores compared to Medical Officers. Paramedicals had the lowest competence scores. While 61% of Medical Officer and RMA prescriptions were appropriate for treating the health condition, only 51% of the AYUSH Medical Officer and 33% of the prescriptions met this standard. RMAs are as competent as physicians in primary care settings. This supports the use of RMA-type clinicians for primary care in areas where posting Medical Officers is difficult. AYUSH Medical Officers are less competent and need further clinical training. Overall, the quality of medical care at PHCs needs improvement.

Early Muslim Medicine and the Indian Context: A Reinterpretation

Abstract The past few decades have witnessed a remarkable shift in the way scholars study the field of sciences in Muslim societies. Up to the 1980s, research focused on Muslim scientists’ role as transmitters of science to the West, and as contributors to Western science. The Muslim world was commonly viewed as a link between ancient Greece and Latin Christendom, its scholars serving as translators of Greek treatises, and as preservers of Greek knowledge. Recently, the theme of Indian-Muslim cultural-scientific relations has attracted growing attention. Following this trend, we maintain that the eighth and ninth centuries reveal an interaction between Indian and Muslim medicine and physicians. Building on the past work of scholars such as Michael W. Dols and more recently Kevin van Bladel, we reinterpret medieval Arabic sources to reveal that the interest in Asian science was not a brief and untypical phenomenon that lacked long-lasting implications. By rereading Arabic chronicles and biographical dictionaries, we will portray how a rather brief contact between ʿAbbāsid Iraq and India proved to yield enduring influences. We will focus on two aspects of Muslim medical practice for demonstrating the Indian connection: the presence of Indian physicians in Baghdād in and around the ʿAbbāsid court, and the emergence of early Muslim hospitals.

Ignorance: a blessing or a curse-awareness among Indian physicians on NDM-1 and its impact on antibiotic selection

Ignorance: a blessing or a curse-awareness among Indian physicians on NDM-1 and its impact on antibiotic selection

Nutrition in Chronocardiology: We are Indebted Professor Franz Halberg

Franz Halberg had very many experiences in India. The word circadian and chronobiology, chronocardiology and chronoastrobiology were coined by him. He also discovered that in studies of single daily meals, eating breakfast was associated with weight loss compared to dinner, despite similar energy intake. The role of time-adjusted drug intake, especially in the early morning, was also known to ancient Indian physicians. In Ayurveda, drinking of large amounts of water in the early morning is advised, which appears to be in an attempt to increase vagal tone due to gastric distention. A circadian cell cycle resides in every cell, and peripheral timing mechanisms are being documented in molecular biologic terms at about 24-hour (circadian) and higher (ultradian) frequencies, with coordination, in mammals, by the adrenal and the pineal-hypothalamic-pituitary network. The suprachiasmatic nuclei (SCN) and clock gene contribute to the coordination of the circadian rhythms' phase and amplitude, in every day life. The SCN are influenced by the daily alternation between light and darkness directly via the eyes and by plasma melatonin concentrations secreted by the pineal gland, which is a window to both light and geomagnetics. A clinical event occurs when our neuroendocrine time structures (chronomes) are not able to cope with the adverse effects of stimuli from within or from without, acting, e.g., via the sympathetic nervous system. Triggering of the neuroendocrines by environmental factors may activate the pineal gland, pituitary functions and adrenal secretions, resulting in adverse effects on circadian variations, heart rate variability (HRV) and blood pressure variability (BPV). Circadian rhythm was known to ancient man from the time of Homoerectus and Homosapiens who use to have intercourse in the early morning hours, before going for hunting to forests, causing increased secretion of testosterone in the morning as a circadian rhythm. Frey considered the mean distribution of deaths along the scales of the day and the year. In one industrial population, Pell and D'Allonzo, discussed time-macroscopically the occurrence of a peak in the morning hours in a study of acute myocardial infarction (AMI), a proposition also ascertained and extended to the yearly pattern time-microscopically. The subsequent reports from other countries, the erstwhile Soviet Union and the extensive data by WHO in the report of myocardial infarction Community Registers from 19 European centers demonstrated a peak incidence of onset of chest pain due to AMI from 8.00 to 11.00 AM with a ratio of 1:2, approximately. In one study from India, in 605 AMI patients, 39% of those who had Q wave infarction (n=174) had the onset between 6.00 AM to 12.00 noon. A further study from India, among 202 AMI patients, the incidence of onset of chest pain was highest in the second quarter of the day (41.0%), mainly between 4-8 a.m., followed by the 4 th quarter, usually after large meals (28.2%). Emotion was the second most common trigger (43.5%), which was commonest in the patients with onset of chest pain in the second quarter of the day (51.8%). Cold weather was a predisposing factor in 29.2% and hot temperature (40°C) was common in 24.7% of the patients. A large meal, especially large breakfast in the morning was an important trigger of AMI in this study. It is possible that modern men can prevent AMI and stroke, if they eat small super foods breakfast, containing w-3 rich egg, vegetables, fruits, walnuts, almonds, raisins and yogurt which are known to be protective against cardiovascular diseases.

Attitudes of Pediatricians and Primary Health Center Physicians in India Concerning Routine Immunization, Barriers to Vaccination, and Missed Opportunities to Vaccinate

India has some of the lowest immunization rates in the world. The objective of this study was to determine the attitudes and practices of pediatricians and physicians working in primary health centers (PHCs) regarding routine immunization and identify correlates of missed opportunities to vaccinate children. We focused on Uttar Pradesh and Bihar, which has faced some of the greatest challenges to achieving high routine immunization coverage. A sample of pediatricians from Uttar Pradesh and Bihar was selected from the national membership of the Indian Academy of Pediatrics to participate in either a phone or mail survey. For the sampling frame, the PHCs within selected blocks were enumerated to provide a list from which individuals could be randomly sampled. In all, 614 PHCs in Uttar Pradesh and 159 PHCs were selected for in-person surveys. The response rate for pediatricians was 47% (238/505) and 93% for PHC physicians (719/773). The greatest barrier to vaccinating children with routine immunizations, reported by both pediatricians (95.7%) and PHC physicians (95.1%), was parents' lack of awareness of their importance. Correlates of missing an opportunity to vaccinate for PHC physicians included holding other health care workers responsible for vaccination. PHC physicians were 50% to 70% less likely to vaccinate a child themselves if they thought another type of health care worker was responsible. Future interventions to increase vaccination coverage should address parental knowledge about the importance of vaccines. Understanding and addressing factors associated with missed opportunities to vaccinate may help improve vaccine coverage in Uttar Pradesh and Bihar.

Empowering primary care physicians in India

Empowering primary care physicians in India

Physicians′ perceptions of a national consensus guideline on insulin therapy: Data from the IMPACT study

Introduction:The effectiveness and impact of the Indian insulin guideline in clinical practice was evaluated by the Improving Management Practices and Clinical Outcomes in Type 2 Diabetes (IMPACT) Study. The study also evaluated the participating physicians’ perceptions on the use of IIG versus RCP for management of diabetes.Materials and Method:This 26 week multicenter, open label, randomized, prospective study aimed to evaluate effectiveness of Indian insulin guideline (IIG) versus routine clinical practice (RCP) in patients with type 2 diabetes (T2D).Results:Out of 426 physicians who completed the physicians’ perception questionnaire, 189 (44.4%) felt that it was “easy” to initiate insulin in their patients using IIG. Cost of therapy (52.3%), followed by poor adherence (40.3%), and lack of motivation among physicians (40.4%) were the most important reasons cited for delay in initiation of insulin therapy. Two hundred and thirty three (54.7%) physicians felt that insulin titration was made “easy” in their patients using IIG, while 104 (24.4%) had a neutral approach. A total of 222 physicians (52.1%) felt it was “convenient” applying IIG in their practice, and 239 (67.8%) physicians felt “satisfied” with using IIG for achieving the targeted HbA1c <7%. One hundred and seventy seven (41.5%) physicians felt that there was scope for improving the IIG further by simplifying and revising the titration charts [117 (27.5%)].Conclusion:Primary care physicians in India have perceived the IIG to be easy algorithm to initiate and titrate insulin therapy. These results will encourage the use and facilitate future revision of the guideline.

A crusade against scorpion sting: Life and works of Dr. Himmatrao Bawaskar

In the times of rapid advancement of science and technology, advance medical equipment and hi tech hospitals represent the face of medical science. The aspirations and ambitions of medical professionals are also shifting, with growing concerns of deterioration of doctor patient relationship as well as disconnect between services and the community needs. The life of Dr Himmatrao Bawaskar defies several conventions of today's medical practice. His outstanding dedication towards patients and commitment to provide high quality care in resource poor setting makes him an ideal role model for younger generation of physicians in India.

The rise of E-learning and opportunities for Indian family physicians

The IT (information technology) revolution is sweeping across the globe. Distance, location and costs have become irrelevant. With availability of newer communication tools, medical education and practice are bound to be transformed. Rapid advancement of science requires medical professionals to update their knowledge constantly. Online interface for CME (Continued Medical Education) presents an exciting opportunity as an E learning tool.

Contributions of ancient Indian physicians - Implications for modern times

Ayurveda traces its origins to contributions of mythological and real physicians that lived millennia earlier. In many respects, Western medicine also had similar origins and beliefs, however, the introduction of anatomical dissection and progressive application of scientific evidence based practices have resulted in divergent paths taken by these systems. We examined the lives, careers, and contributions made by nine ancient Indian physicians. Ancient texts, translations of these texts, books, and biographical works were consulted to obtain relevant information, both for Indian traditional medicine as well as for Western medicine. Ayurveda has retained principles enunciated by these physicians, with minor conceptual advances over the centuries. Western medicine separated from ancient Indian medicine several hundred years ago, and remains the foundation of modern medicine. Modern medicine is evidence based, and randomized clinical trials (RCTs) are the gold standard by which efficacy of treatment is evaluated. Ayurvedic medicine has not undergone such critical evaluation to any large extent. The few RCTs that have evaluated alternative medical treatment recently have shown that such therapy is no better than placebo; however, placebo treatment is 30% effective. We suggest that foreign domination, initially by Mughals, and later by the British, may have contributed, in part, to this inertia and protracted status quo.

Urgent need for formal medical training in infectious diseases in India

Urgent need for formal medical training in infectious diseases in India

Routine analysis of cirrhotic ascites for evidence of infection – not worth the effort?

Spontaneous bacterial peritonitis (SBP) is a serious complication of advanced cirrhosis of the liver. Usually patients with SBP show symptoms such as fever, abdominal pain, worsening of renal function, hypotension or development of encephalopathy. The frequency of SBP among hospitalised patients with advanced cirrhosis varies from 10% to 30% [1]. The mortality of SBP was 80% to 100% in the 1960s, but has declined to 30% to 40% with early diagnosis and effective therapy with broad-spectrum antibiotics [2, 3]. A high index of suspicion followed by analysis of ascitic fluid for evidence of infection is helpful in making an early diagnosis of SBP, and is today considered the standard of care in patients with cirrhosis and symptoms listed above. The International Ascites Club recommends mandatory analysis of ascitic fluid in all cases of new onset of ascites, worsening of ascites, and in all other cases whenever there is a suspicion of SBP [1]. The recommendations of the American Association for the Study of Liver Disease (AASLD) differ from those of the International Ascites Club. The AASLD thus recommends testing of ascitic fluid for cell count and differential count, but not necessarily culture, for patients undergoing serial outpatient therapeutic paracentesis, each time the fluid is removed [4]. Given the low prevalence of SBP in asymptomatic patients, the question is whether we need to undertake ascitic fluid cell count routinely in all cases of paracentesis. This issue is of particular importance for gastroenterologists and physicians in India and other developing countries, since such

Mobilizing political will to contain antimicrobial resistance

Vemu Lakshmi is one of several Indian physicians who had long been calling for more to be done about drug resistance. Then, last year, a whirlwind of controversy blew up in her country about the highly resistant superbugs, bacteria containing the so-called NDM-1 enzyme. [ILLUSTRATION OMITTED] Some Indian microbiologists had been flagging the urgent need for micro biological laboratory support for doctors and strict guidelines on antibiotic prescriptions and policies for quite some time;' says Lakshmi, who is professor and head of the Department of Microbiology at Nizam's Institute of Medical Sciences, in Hyderabad. Lakshmi and her colleagues knew that antimicrobial resistance would be the inevitable result of inappropriate use of antibiotics in hospitals and in the community (including sub-therapeutic doses due to ignorance about resistance mechanisms), widespread over-the-counter sales of antibiotics and patients failing to complete their courses of antibiotics. She discussed these problems in detail in an article in the Indian Journal of Medical Microbiology in 2008. The spread of the resistant bacteria in India, Pakistan and the United Kingdom of Great Britain and Northern Ireland was described in a paper published in the Lancet Infectious Diseases in August 2010. NDM-1, or New Delhi metallo-beta-lactamase, was first identified in a Swedish patient who had returned from New Delhi in 2008. Experts were particularly concerned about the fact that the enzyme was found in one of the most commonly encountered bacteria in the human population, Escherichia coli, and that at least one in 10 of the strains containing this enzyme appeared to be resistant to all known antibiotics. Antimicrobial resistance is a global problem that affects all countries. year's World Health on 7 April aims to make governments more aware of the problem and to encourage them to take measures to combat this global threat. [Antimicrobial resistance] is a real public health problem and it is emerging globally and in Europe. We have to do much more about it--both in the World Health Organization (WHO) and also in Member says Zsuzsanna Jakab, WHO Regional Director for Europe. Jakab is well aware that the struggle against antimicrobial resistance in Europe requires continuous vigilance if problems such as drug-resistant tuberculosis are not to get worse. This is the start of a process; we can and have to raise awareness among policy-makers and the public, and follow up with strategies after World Health Day Jakab says. is not the first time WHO has tackled the issue. In 2001, WHO released the Global Strategy for Containment of Antimicrobial Resistance, containing recommendations that countries could customize for their own use. But the launch in Washington DC coincided with the attacks of 11 September 2001 in the United States of (USA) and any momentum was lost in the subsequent turmoil. For Dr Gerald Dziekan, from WHO's Patient Safety Programme, the 2001 initiative nevertheless provided a start for some countries in tackling the problem. [ILLUSTRATION OMITTED] It certainly triggered the development of national plans in some countries, but all in all the response was quite weak in the sense of global awareness and coordinated action,' Dziekan says. One of the challenges governments face in Dziekan's view is enforcing laws banning over-the-counter sales of antibiotics. This is particularly difficult in [low- to middle-income] countries where there are often no doctors to prescribe medicines but people need to get the drugs somehow. But it is also in these countries where the problem is increasingly being felt. Antibiotic resistance is not confined to the emergency rooms of rich countries in Europe and North America according to Anthony So, professor at the Sanford School of Public Policy at Duke University in the USA. …