artificial kidney by an indian scientist


A coffee cup sized implantable artificial kidney being developed by a US researcher of Indian origin, is awaiting animal and human trials to bring affordable treatment to millions of kidney failure patients worldwide.

Shuvo Roy, working with a team of engineers, biologists and physicians at the University of California, San Francisco, to shrink the device to the size of a coffee cup, is “excited about advancing it towards large animal and human trials”.

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“Obviously, a key requirement is financial support and the team. We have most of the latter in place, and the former is a work-in-progress,” Roy, an associate professor in the UCSF School of Pharmacy who specialises in developing micro-electromechanical systems (MEMS) technology for biomedical applications, told IANS.

“There are almost 1.5 million people worldwide on dialysis. The primary cause of end stage renal disease (ESRD) is diabetes and hypertension, which are both growing problems in South Asia,” noted Roy who has a connection with both India and Bangladesh.

Born in what is now Bangladesh, Roy spent part of his childhood in India and Bangladesh and received most of his education in Uganda, where his father worked as a public health physician. He later obtained his undergraduate degree from Mount Union College in Alliance, Ohio.

“As it turns out, most of my father’s family is in India, while most of my mother’s side is in Bangladesh,” he said.

The ideal treatment for kidney failure patients is transplant, but there is a shortage and the patients require expensive drugs and dialysis costs $9,000-14,000 per patient in India assuming dialysis twice a week instead of three times as in the US, said Roy.

Given “the shortage of transplant kidneys and associated complications like transmission of infectious agents from donor to patient and ethics, our device might provide some benefits”, he said.

“With the right financial support, I think we could reach clinical trials in as little as five years,” Roy said. But “it’s hard to say how long after that it becomes commercially available due to the uncertainties of the FDA and commercialisation prospects”.

He said it was hard to predict how much it would cost “as we just don’t know the development costs associated with regulatory and reimbursement issues. We think the device cost should be less than $25,000 in the United States.”

The artificial kidney that would do away with the need for dialysis would include thousands of microscopic filters to remove toxins from the blood and a bioreactor to mimic the metabolic and water-balancing roles of a real kidney.

So far Roy’s team has done trials using a large system called Renal Assist Device or RAD built using off-the-shelf components in human patients with acute renal failure.

The trial led by David Humes of the University of Michigan was designed to test whether the concept of a hemofilter plus cell bioreactor could provide a benefit over conventional renal replacement therapy.

In his peer-reviewed publications, Humes reported that the RAD conferred a significant survival benefit relative to conventional therapy.

“Based on these results, we undertook a miniaturisation effort towards an implantable device using silicon membrane technology,” Roy said.

“The efficiency of our membranes allows for a smaller package that can operate at lower driving pressures comparable to blood pressure. We have tested the scaled-down versions of our silicon membrane technology in small animals.”

“To get to patients, we will need to build scaled-up versions and test safety first in large animals and then patients,” he said.

Roy, whose background is in the development of medical devices using micro-electromechanical systems (MEMS) technology, has also worked on the development of miniature wireless sensors for remote monitoring of physiological parameters such as pressure and catheter-based ultrasound imaging chips for assessment of coronary plaque for accurate deployment of stents.

Coffee, tea linked to lower risk of brain tumor


Coffee and tea lovers may have a decreased likelihood of developing the most common form of malignant brain tumor in adults, a new study suggests. And even if coffee and tea have some direct effect on glioma risk, the impact would be small. Brain tumors in general are uncommon; in Europe, for instance, annual rates are estimated at between four and six cases per 100,000 women, and six to eight cases for every 100,000 men. The findings, come from an ongoing study in 10 European countries investigating potential risk factors for cancer. At the outset, 521,488 men and women between the ages of 25 and 70 completed detailed questionnaires on their medical history, diet, exercise habits, smoking and other lifestyle factors.

source: reuters

Reduced Melanoma After Regular Sunscreen Use


Regular sunscreen use prevents cutaneous squamous cell carcinoma long term, but the effect on melanoma is highly controversial. We evaluated whether long-term application of sunscreen decreases risk of cutaneous melanoma.

Participants and Methods In 1992, 1,621 randomly selected residents of Nambour, a township in Queensland, Australia, age 25 to 75 years, were randomly assigned to daily or discretionary sunscreen application to head and arms in combination with 30 mg beta carotene or placebo supplements until 1996. Participants were observed until 2006 with questionnaires and/or through pathology laboratories and the cancer registry to ascertain primary melanoma occurrence.

Results Ten years after trial cessation, 11 new primary melanomas had been identified in the daily sunscreen group, and 22 had been identified in the discretionary group, which represented a reduction of the observed rate in those randomly assigned to daily sunscreen use (hazard ratio [HR], 0.50; 95% CI, 0.24 to 1.02; P = .051). The reduction in invasive melanomas was substantial (n = 3 in active v 11 in control group; HR, 0.27; 95% CI, 0.08 to 0.97) compared with that for preinvasive melanomas (HR, 0.73; 95% CI, 0.29 to 1.81).

Conclusion Melanoma may be preventable by regular sunscreen use in adults.

source: JCO

Comparison of the once-daily levofloxacin-containing triple therapy with the twice-daily standard triple therapy for first-line Helicobacter pylori eradication: a prospective randomised study.


Simple compound of Helicobacter pylori eradication therapy may improve drug compliance of patients. The aims of this study were to compare the efficacy and tolerability of a simple combination containing levofloxacin 7-day once-daily with standard twice-daily triple therapy.
PATIENTS AND METHODS: This was a prospective, randomised, open-label trial. A total of 189 consecutive patients diagnosed with peptic ulcer and H. pylori infection were enrolled. Patients were randomly divided into two groups: LEC group–levofloxacin 500 mg, esomeprazole 40 mg and clarithromycin 500 mg once daily for 7 days; AEC group–amoxicillin 1 g, esomeprazole 40 mg and clarithromycin 500 mg twice daily for 7 days.
RESULTS: There were 90 patients in the LEC group and 99 patients in the AEC group. By intention-to-treat and per-protocol analysis, the H. pylori eradication rate was 78.9% [71/90; 95% confidence interval (CI), 70.3-87.5%] and 83.5% (71/85; 95% CI, 75.5-91.6%) respectively, in the LEC group; and 74.8% (74/99; 95% CI, 66.0-83.5%) and 86.0% (74/86; 95% CI, 78.6-93.5%) respectively, in the AEC group. The incidence and tolerability of side effects were similar between these two groups.
CONCLUSION: The efficacy and tolerability of once-daily levofloxacin-containing triple therapy are equal to those of the standard twice-daily triple therapy in this study. However, none of the treatment regimens evaluated achieved enough eradication efficacies to be considered as a recommendable first-line treatment.

Prevention of endemic healthcare-associated Clostridium difficile infection: reviewing the evidence.


Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea. Because of the increasing incidence and severity of endemic C. difficile infection (CDI), interventions to prevent healthcare-associated CDI are essential. We undertook a systematic review of interventions to reduce healthcare-associated CDI.
METHODS: We searched multiple computerized databases, and manually searched for relevant articles to determine which interventions are useful in preventing CDI. Studies were required to be controlled in design and to report the incidence of endemic CDI as an outcome. Data on the patient population, intervention, study design, and outcomes were abstracted and reviewed using established criteria.
RESULTS: Few randomized controlled trials exist in the area of CDI prevention. The interventions with the greatest evidence for the prevention of CDI include antimicrobial stewardship, glove use, and disposable thermometers. Environmental decontamination also may decrease CDI rates, although the level of evidence is not as strong as for the other proven interventions. Treatment of asymptomatic carriage of C. difficile is not recommended. There is insufficient evidence to make a recommendation for or against the use of probiotics. In cases of known or suspected CDI, hand hygiene with soap and water is preferred over use of waterless alcohol hand rub. Many nonrandomized trials included in our analysis used multiple interventions concurrently, making the independent role of each preventive strategy difficult to determine. We chose to include only studies that focused on endemic CDI because studies of outbreaks have used multiple strategies, making it difficult to measure the relative efficacy of each strategy. Environmental disinfection and probiotics need to be studied further to evaluate their roles in the prevention of CDI. Although there have been no studies assessing the utility of isolation and cohorting for the prevention of endemic CDI specifically, it is a widely used intervention for containment of this and other similar multidrug-resistant pathogens.
CONCLUSIONS: Antimicrobial stewardship, glove use, hand hygiene, and disposable thermometers should be routinely used for the prevention of CDI. Environmental disinfection and probiotics should be studied further for their role in reducing CDI.

source: americal journal of gastroenterology