|Year : 2017 | Volume
| Issue : 1 | Page : 80-81
Medical news – from around the world
|Date of Web Publication||17-Feb-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Medical news – from around the world. Curr Med Issues 2017;15:80-1
Does behavioral intervention in autism really work?
Autism is a neuro-developmental disorder that is usually associated with lifelong disability and limitation of function. Medical therapy of this disorder is limited to behavioral interventions by a committed team. The question then arises, does behavioral therapy actually work? Does it improve parent-child interaction? The long-term follow up of the “Pre-school Autism Communication (PACT) trial” published in the Lancet attempted to answer that question. This was the largest randomized control trial on this subject and their answer was , “Yes behavioral intervention does work”, even in severe cases. The trial found out that if done in a proper manner, behavioral therapy does work; it has an immediate effect and the effect also persists for several years. Children followed-up even 6 years later showed that they had a lower level of repetitive behavior and their communication skills were better than the control group. This therapy is neither costly nor impractical – it involved sessions once in two weeks for 6 months followed by monthly sessions for 6 months. The most important aspect of the study was that the PACT intervention involved training of the parents of the children and not the children themselves. The parents were taught changes in their behavior which would then be passed on to their children with autism. Among the families that were coached, the percentage of severe autism decreased from 55% to 46%, while the percentage actually increased in families where parents were not trained. This emphasizes the very important role that parents and care-givers play in the therapy of children with autism. The persisting nature of the change seen in the autistic children is another encouraging aspect of this study.
Source: Pickles A, et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. The Lancet , Volume 388 , Issue 10059 , 2501 - 2509
Supreme Court allows medical termination of pregnancy at 24 weeks
The Supreme Court in January 2017 permitted a 22-year-old woman in her 24th week of pregnancy to undergo termination of pregnancy after medical reports suggested that the baby had possible anencephaly. The woman had found out about the defect in the 21st week of gestation when she had a sonography done at a private clinic in the western suburbs of Mumbai. Under the Medical Termination of Pregnancy Act, 1971, abortion is legal in India only up to 20 weeks of pregnancy provided it involves a risk to the life of the pregnant woman or poses a threat of grave injury to physical or mental health, or involves a substantial risk that if the child were born it would suffer from such physical or mental abnormalities. Not too long ago, in July 2016, the Supreme Court permitted a rape survivor to terminate her pregnancy at 24 weeks. The woman, who claimed to have been raped by her fiance, had challenged the 20-week cap as a violation of the right to a dignified life. An amendment drafted in 2014 to a 1971 Act sought to increase the abortion time limit from 20 weeks to 24 weeks. Additionally, the draft bill also recommends that termination be allowed without a time limit in cases where doctors detect a foetal anomaly.
Sources: The New Indian Express, Jan 16th 2017.
Hormonal contraception linked with an increased risk of depression
Women who use hormonal contraception have an increased risk of depression, according to re-searchers in Denmark. The authors based at the University of Copenhagen, found an increased risk of being treated with an antidepressant for the first time increased among users of different types of hormonal contraception (including combined oral contraceptives and progestogen-only pills, with the highest rates among adolescents. The researchers, reporting in JAMA Psychiatry (online, 28 September 2016), say their findings suggest that healthcare professionals should be made aware of the risk of depression, which they describe as “this relatively hitherto unnoticed adverse effect of hormonal contraception”.
Source: Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162.
Two sides of the Bedaquiline controversy
The specter of XDR-Tb or extremely drug resistant tuberculosis has been hanging over India for a while and is a cause of grave concern for both patients and healthcare providers. M. Tuberculosis that causes this form of TB is resistant to all known drugs used in treatment of multi-drug-resistant TB and is extremely difficult to cure. A new drug, Bedaquiline (BDQ), belonging to a new class - Diarylquinoline was recently approved by the WHO and has been released specifically to treat MDR-TB patients. This drug is unique among the currently used anti-tuberculosis drugs in that it interferes with the function of an enzyme required by the tuberculosis bacterium to produce energy and to replicate. BDQ specifically targets Mycobacterial ATP synthase, an enzyme essential for the supply of energy to Mycobacterium tuberculosis. Bedaquiline is currently approved for use in adult MDR-TB patients in whom formulating a treatment regimen with existing drugs have been exhausted. Phase III clinical trials with BDQ are still underway. The drug is available through only 6 centers in India and its administration is based on strict criteria.
A teenage victim's plea
An 18-year-old girl from Patna, who has XDR TB took the Indian government to court after being refused access to bedaquiline (BDQ) as the Health Ministry has delayed the roll-out of the life-saving drug beyond six centres in the country.
Jennifer J. Furin of Harvard Medical School, who is also an expert witness in the court case opined that the decision of the case will have a far-reaching impact on India's tuberculosis patients.
She felt that the delayed roll-out and restrictive criteria are resulting in the unnecessary loss of life for thousands of people living in India. “Earlier, we had limited options for them, but now with bedaquiline we do, and all citizens of India (and of the world) have a right to health and life and access to this medication. Second, the delay means that little is being done to stop the ongoing spread of MDR-TB (multidrug-resistant tuberculosis). By denying people access to this drug — which doubles the chances of cure — they are allowing MDR-TB to spread unchecked throughout the country. And this also affects the international community given that MDR-TB is an airborne disease.”
The NITRD viewpoint
In response to this, The National Institute of Tuberculosis & Respiratory Diseases (NITRD) on Monday told the Delhi High Court that the drug could not be administered without proper tests. Contradicting Dr Furin's claim that administering BDQ would curb the potential spread of XDR TB , the NITRD said: “If BDQ is given with an inefficient backbone regimen, the patient is likely to fail the treatment and develop an additional and fatal resistance to BDQ which may spread to the community and have catastrophic effects.”
On the petitioner's concerns about delayed roll out of BDQ in India, the Institute said: “It is a new drug discovered after five decades of research on TB treatment and its efficacy and effects are still being evaluated and therefore, it is being rolled out in a phased manner to avoid its misuse, development and spread of fatal BDQ resistant bacteria in the community.” The Institute said the girl cannot be simply provided BDQ as the same is provided to the Institute from the government bodies.
The court ruled in the girl's favor and she will now have access to drug Bedaquiline. In a court hearing on January 20, representatives for the government said that the Revised National Tuberculosis Control Program (RNTCP) in India would make bedaquiline available in 70 more centers nationally by mid-2017. The ruling also requires the national drug regulatory agency to process the patient's application for another advanced TB drug, Delamanid.
This controversy highlights the dilemmas faced by public health officials in regulating the use of new and potentially life-saving drugs and making them available to those who need them while also ensuring the safety of the larger community.
Sources: The Hindu, January 8th and 9th 2017, Times of India January 21st 2017.
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