Month: July 2017

Future in Medicine

Future in Medicine

There are many new discoveries or innovations in Medicine slated for the next few years. Thankfully for patients and doctors medicine does not stop moving. Based on recent articles, Medscape and other medical inputs a few have been stated here.

FMT or fecal microbiota transplant has 90% cure rate for Clostridium difficile infection. Earlier it was patient prepared enemas and colonoscopies transfers. Orally administered frozen fecal capsules and stool banks are the future. Microbial imbalance in the gut is associated with medical conditions as Diabetes, Rheumatoid arthritis. Neurological conditions like Autism and Multiple Sclerosis has been associated with altered gut flora profiles.

Antibiotics like Tedizolid, Dalbavancin, Oritavancin are the new antibiotics approved for Methicillin Resistance Staphylococcus aureus infection. Each of these agents have advantages over the currently available antibiotics for MRSA infection. According to Dr John Barlett of John Hopkins Medical School the pipeline of antibiotics is slow but not dry.

According to JAMA Neurology Stroke Care has to go mobile for better patient care and outcomes. The saying is time is brain. Ambulance based stroke care units would increase the chances of thrombolytic therapy in the first golden hour. A large network of ambulances, Emergency teams and hospital network would be required.

Lancet published the greatest surgical gynaecological news of a successful live birth in a transplanted uterus. 35 years old received a uterus from a 61 years old family friend. A year after the patient underwent a frozen embryo transfer. Both the mother and child are doing well.

Bionic pancreas for type 1 diabetes could be a reality as par reports from Southern California Clinical Diabetes programme. A smart phone like device continuously monitors glucose and communicates this to a device that calculates and releases appropriate doses of insulin. A dependable user friendly system could be available in the near future.

MINIMAL INVASIVE CARDIAC SURGERY MANAGEMENT IN FUTURE

MINIMAL INVASIVE CARDIAC SURGERY MANAGEMENT IN FUTURE

Minimal Invasive surgery is already a well-established practice and an alternative to traditional surgery and robotic surgery. For Minimal invasive cardiac surgery, aids were introduced into the field at the beginning of the new millennium and currently the following procedures can be performed by minimally invasive surgery: Mitral Valve repair and replacement, Aortic valve repair, Atrial septal defects repair, Coronary artery bypass, Removal of cardiac tumours, and Ablation of atrial fibrillation.

The benefits of this type of surgery are numerous. Improved cosmetic result is the most obvious advantage. In addition, because Median Sternotomy is avoided keeping the breastbone intact, trauma and postoperative pain are greatly reduced thereby improving quality of life and reducing hospital stay. On the other hand, patients are still exposed to the usual surgical risks such as bleeding, infection. Apart from these ‘Classical heart surgery operative targets’ there is important field where heart surgery will play an important role. First is in the treatment of advanced heart failure. The chronic shortage of organs for organ transplantation has led to a search for mechanical circulatory support. Currently, some research focuses on designing New Ventricular Assistance devices that may serve not only as bridge for transplantation, but also, a permanent treatment for patients with failing heart. Second, atrial fibrillation (AF) is the most common cardiac arrhythmia. Surgical Ablation may provide an efficient therapeutic approach in patients with medically Refractory AF and in patients undergoing cardiac surgery for other pathology who have concomitant AF.

Future Developments in Ophthalmology

Future Developments in Ophthalmology

Mobile Diagnostic and Communication Tools:

  • Eye Netra, a low-cost app Designed to replace auto refractor.
  • Massachusetts Eye and Ear developed a simple technique of fundus (retinal) photography using an I phone and an inexpensive app.
  • A surgeon wearing Google Glass performed the world’s first surgery.
  • Virtual reality augmentation tool-Future surgical training tool.

Robotics

  • Femtosecond laser surgery
  • Robotics may soon be used in vitreoretinal surgery

Genomics

  • Lead to earlier and better treatment of eye-related ailments like diabetic retinopathy and retinitis pigmentosa.

Retinal Prosthetics:

  • FDA approved the use of Argus II, a bionic eye and The Atlas IMS – the first fully implantable, wirelessly controlled retinal prosthetic.

Allow the patients with retinitis pigmentosa and age related macular degeneration to see in black white.

Regenerative Medicine

  • Transplant of a biosynthetic cornea occurred in 2010. It helps restore sight in the vast number of people who are currently waiting for a donated human cornea for transplantation.

Nanotechnology

  • Researchers at the University of Dayton Research Institute recently created “fuzzy fiber” carbon nanotubes.
  • Fuzzy Fibers are biocompatible and can help prevent the build-up of firbroblasts.
  • It has a role in the treatment of Glaucoma and Macular degeneration.

Stem Cell Advances

  • Innovative stem cell treatment – It has developed had corrected the eyesight of an individual with vision 20/400 vision to 20/40.
  • Has a role in the treatment of Stargardt’s macular dystrophy.

Refractive Surgery and IOLs – Future Trends.

Accommodating IOL Channel-

  • Patients after lens implantation will be able to achieve the vision of 20 to 40 year old emmetropic patient.
  • Lens implants will be accommodating biconvex, 9 mm in diameter, customized and repeatedly adjustable in power, toricity and higher – order aberration, and insertable through a 1 – to 2 –mm incision.
  • Multiple laser delivery systems and surgical interventions will be controlled through computer software and robotics.
  • By 2100 genetic engineering will eliminate emetropia.
  • Genetic testing of pregnant women and infants followed by gene modifying treatments that prevent the development of ametropias.

 

 

Future in Oncology

Future in Oncology

Cancer is a transformed cell having altered physiology modulating host resources for it’s growth and survival. Interruption of signal transduction in the form of ligand binding, receptor binding or inhibition of key intracellular pathways with small molecules has revolutionized cancer therapies. Some of the success stories include Rituximab in lymphomas, Trastuzumab in breast cancer, imatinib in chronic myeloid leukemia, bevacizumab, VEGF TKls in number of cancers, EGFR inhibition lung, head neck cancers etc.

Preventing cancer cell from escaping immune system is emerging as revolution in cancer therapeutics Blocking CTLA4, blocking PD L1 and PD 1 with antibodies has already achieved success in melanoma, lung, kidney and head neck cancers and being tried in almost every cancer. CAR modified T cell is another leap forward in immune-oncology. Preventing viral induced cancer with vaccine especially HPV related cancers will bring down the burden of some of the common cancers like cervix and oropharynx significantly.

On the diagnostic side, functional imaging, contrast free imaging, molecular imaging, fused structural and molecular imaging is changing the way we stage and assess cancers. The sciences of ‘omics’ will provide critical information about how the cancer cell is thriving. Liquid biopsies, assessment of circulating tumor cell will provide the opportunity to assess in vivo cancer in real time.

Cancer genome atlas and compilation of BIG DATA is taking cancer informatics forward and will identify new targets for cancer therapies. Next generation sequencing and other advanced lab techniques are already available to provide critical inputs to the clinician.

Finally improving access to cancer treatment to the poor and needy will help us meet the ever increasing cancer burden in our country.

 

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