Efficacy of stem cell in improvement of left ventricular function in acute myocardial infarction - MI3 Trial.

Background & objectives: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 108 autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. Methods: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). Results: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 108 (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. Interpretation & conclusions: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.

Brassica nigra and cuminum cyminum: Inhibitors of food borne pathogens.

Dried seeds of spices namely Brassica nigra (mustard) and Cuminum cyminum (cumin) were screened independently, in culture media, in their different forms (aqueous extracts, essential oils and powders) against some bacterial strains of spoilage and health significance. Test microorganisms included one gram+ve bacterial strain i.e. Bacillus cereus (MTCC 430) and three gram-ve bacterial strains viz. Enterococcus faecalis (MTCC 439), Psuedomonas aeruginosa (MTCC 1688) and Shigella sonnei (MTCC 2957). Spice agar method was opted for screening antibacterial activities of powdered forms of aforementioned spices at their different concentration levels (0.0, 0.1, 0.2, 0.4, 0.6, 0.8, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0 (% (w/v)). B.nigra more effectively inhibited bacterial strains in culture media. Minimum inhibitory concentrations (MIC) of powdered form of B.nigra were also determined. It was the concentration of spice which arrested the growth of bacterial strain upto 80% level of the total incubation period of 30 days. Agar-well assay was followed for antibacterial screening of aqueous extracts and essential oils of test spices. Aqueous extracts of reference spice samples did not exhibit growth inhibitory zones towards any test bacterial strains. On the other hand, essential oils of B.nigra and C.cyminum showed distinct growth inhibitory zones against all the bacterial strains under observation. Results obtained from agar well assay revealed that essential oil of B.nigra was more potent in inhibiting bacterial strains followed by C. cyminum . It was also noticed that B. cereus (gram+ve) was inhibited at lower concentrations of test substances as compared to all the other three gram-ve bacterial strains under investigation.

Analysis of physicians’ strikes and their impact.

Resident doctors often resort to strikes for reasons concerning safety at the workplace, better working conditions, better remuneration, and policy issues such as caste-based reservations and appointments to institute positions . Although many articles have discussed whether or not physicians should resort to strikes, few have analysed the prevalence of strikes, their direct impact on healthcare delivery, and beneficial outcomes, if any, for physicians . We conducted a single centre retrospective study for analysing the same.

Rural doctors: A solution, or yet another problem in the making.

A stark difference exists in the healthcare facilities available to the rural and urban population in India. The country is currently facing a severe shortage of all categories of staff in the rural health system. While the comment made by Mahatma Gandhi that India lives in its villages holds true even today, rural India has suffered severe neglect as far as provision of adequate healthcare facilities is concerned. In recent years, planners have launched several endeavours to improve the status of healthcare in rural India.

Attitudes and practices of medical graduates in Delhi towards gifts from the pharmaceutical industry.

Pharmaceutical companies use a variety of strategies, including gifts, to influence physicians. In December 2009, the Medical Council of India amended the Code of Medical Ethics to ban medical professionals from accepting gifts from pharmaceutical companies. In view of this ban, it is important to find out the magnitude and contours of the problem amongst Indian medical professionals. We aimed to study, through an e-mail based survey, the attitudes and practices of young resident doctors and interns from two medical colleges of New Delhi regarding acceptance of gifts from the pharmaceutical industry. We e-mailed the questionnaire to 150 fresh graduates. We found that the majority of graduates agreed with existing guidelines: they accepted low cost gifts but considered expensive gifts unrelated to patient welfare unethical. Despite the low response rate, this study is important because data from India on attitudes and practices of medical professionals regarding gifts from the pharmaceutical industry are virtually non-existent.

Seeking better inter-departmental cooperation in healthcare settings.

Hospital healthcare is essentially teamwork. Frequently, however, one comes across incidents where inter-departmental cooperation is compromised. It can create an awkward situation for residents and other staff members involved in the healthcare system. We can recall many such incidents during our training. Studies have indicated that failure in “tightly coupled” organisational relationships between hospital departments imposes a threat to patient safety. Clear guidelines on how to manage certain situations should be in place, leaving no ambiguity as far as issues concerning patient management are concerned. A lot more needs to be done by administrators to avoid such incidents and to promote inter-departmental co-operation. In addition, more caution and effort by administrators, residents and faculty can help avoid such incidents.