Dr.T.V.Rao MD

MEDICAL ADVANCES (2001 TO 2011)

DR.T.V.RAO MD 1

• The first decade of the

21st Century brought a

number of discoveries,

mistakes, and medical

advances that have

influenced medicine

from the patient's

bedside to the medicine

cabinet.

WHAT IS NEW IN THE LAST DECADE

DR.T.V.RAO MD 2

MAPPING THE HUMAN GENOME ADVANCES

MEDICINE

• Mapping the human genome had become a race

of time and money in the 1990s, with two

competitors at the forefront: the government-

funded Human Genome Project, which

completed its task in 15 years with more than $3

billion in taxpayer money, and a private

company, Celera Genomics, which was financed

with $100 million and took less than a decade.

DR.T.V.RAO MD 3

• " The biggest area of

the future will be

preventive medicine,".

"By understanding the

genetic causes and

links to disease we can

spend more and more

attention on preventing

disease."

GENOMIC SCIENCE ADVANCES PREVENTIVE

MEDICINE

DR.T.V.RAO MD 4

• In 2003 a "final" draft

was released by

researchers, and in

2007 more updates

to the genome were

published by Craig

Venter, PhD, chief

scientist behind

Celera Genomics.

A CRAIG VENTER PUBLISHES THE

FINAL DRAFT

DR.T.V.RAO MD 5

• Doctors have

developed a genetic

test for a gene

associated with

prostate cancer, "and

there's a drug available

that greatly lowers the

risk for prostate cancer

in the future."

GENETIC ASSOCIATION WITH PROSTATIC

CANCER DECODED

DR.T.V.RAO MD 6

• Doctors say the Internet

and information technology

has actually changed the

way they practice medicine

for the better. Even doctors

need to look things up from

time to time.

• With a pad and pen, then

sit in the waiting room while

the nurse pulls their file.

INFORMATION TECHNOLOGY TO

PATIENTS AND DOCTORS

DR.T.V.RAO MD 7

• In the past if you had a clinical

question to research, I had to go

to the library, pull out multiple

years of the Index Medicus, look

up the topic, write down the

references, go to the stacks and

pull the volumes of journals, find

the article, read the article, go to

the copy machine and make a

copy& if I were lucky, I would

have my answer in about four

hours.

• Now you have everything

at your finger tips

THE KNOWLEDGE AT YOU FINGER TIPS

DR.T.V.RAO MD 8

• Now You can be on rounds and

in five minutes have more

information on the topic than I

need& on my iPod Touch or iPad

I can look up a medication, check

the formulary to see if it's

covered, check for interactions

with a patient's other meds and

double-check details of the

pharmacology of the med plus

quickly review the problem I am

treating, and You don't even

have to go online

YOUR IPOD TOUCH OR IPAD BRINGS

EVERYTHING ….

DR.T.V.RAO MD 9

• Information technology

has also, to some

degree, made life safer

for the patient. Once

admitted to a hospital,

they get a bar code

which matches their

blood samples and their

IVs.

INFORMATION TECHNOLOGY MAKES

LIFE SAFE

DR.T.V.RAO MD 10

• But many physicians have

been reluctant to go digital

because there is a

significant upfront

investment, which is why

several of the healthcare

reform measures now

before Congress include

provisions to underwrite

some of this cost.

• The developing countries

should go a long way ?

INFORMATION TECHNOLOGY SHOULD BE

SUPPORTED BY THE HOSPITALS ???

DR.T.V.RAO MD 11

• In a report issued last

October, the Institute of

Medicine said those

public smoking bans

have cut exposure to

second-hand smoke,

which, in turn, has

contributed to a

reduction in heart

attacks and death from

heart disease.

ANTI-SMOKING LAWS AND CAMPAIGNS REDUCE

PUBLIC SMOKING - YES

DR.T.V.RAO MD 12

• Anti-smoking campaigns (at least

in the U.S.), including banning of

smoking in workplaces and

public places, [have] enormous

impact across socioeconomic

classes on many diseases

• In terms of the greatest

good for the greatest

number, there can be no

doubt that the decline in

smoking (through various

means) has had the

greatest impact

ANTISMOKING LAWS HAVE IMPACT

ON SMOKING

DR.T.V.RAO MD 13

• It's probably the

most important

'doable' public

health measure

for decreasing

morbidity and

mortality,

ANTISMOKING LAW REDUCES

MORBIDITY AND MORTALITY

DR.T.V.RAO MD 14

• Those looking for dramatic improvements in public health need look no further than the world of heart disease.

• A mere 25 years ago, when a patient came to a hospital with a heart attack, the best that could be done was to put the patient in a darkened room, give him or her morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats, and hope for the best.

HEART DISEASE DEATHS DROP BY

40 PER CENT

DR.T.V.RAO MD 15

• Today treating a heart attack is all about speed: speed the patient to the hospital so that a clot that blocks the life-saving flow of blood can be "busted" with drugs like the genetically engineered tissue plasminogen activator or tPA.

GENETICALLY ENGINEERED DRUGS FOR

RESCUE IN HEART DISEASE

DR.T.V.RAO MD 16

• Moreover, drugs that didn't

exist 25 years ago -- chiefly

statins like simvastatin,

Lipitor, mevacor, and

Crestor -- are now routinely

used to slow the

progression of

atherosclerosis, the

medical term that describes

the build-up of the hard,

waxy substance called

plaque that narrows

arteries.

NEW DRUGS CHANGES THE FUTURE OF

HEART DISEASES

DR.T.V.RAO MD 17

• Research shows

about half of the

gains in heart

disease came from

new treatment

interventions, the

other half (up to 60

percent) are due to

prevention.

PREVENTIVE CARDIOLOGY SOLVES MANY

ISSUES ON HEART DISEASES

DR.T.V.RAO MD 18

• Importantly, what this

means is that the

community 'gets it.'

Better control of blood

pressure, pre-emptive

lowering of blood

cholesterol levels,

better diets, and

reduced smoking are

resulting in fewer

(cardiac) events,

PROMPT SCREENING GREATLY HELPED

MANY PATIENTS

DR.T.V.RAO MD 19

• Probably no area of

research has so fired

the public imagination

and so ignited the fires

of public controversy as

that of stem cell

research. In reality, this

area has generated

more political action

than reproducible

clinical advances

STEM CELL RESEARCH: LABORATORY

BREAKTHROUGHS AND SOME CLINICAL ADVANCES

DR.T.V.RAO MD 20

• European researchers

genetically manipulated

bone marrow cells

taken from two 7-year-

old boys and then

transplanted the altered

cells back into the boys

and apparently arrested

the progress of a fatal

brain disease called

adrenoleukodystropy

GENETIC MANIPULATIONS HAVE CURE FOR

MANY CRITICAL DISEASES

DR.T.V.RAO MD 21

• Now we can make

embryonic-like stem cells

directly from skin cells,

which makes it possible to

model a multitude of human

diseases in the petri dish.

New drugs based on stem

cells are being developed,

and the first human clinical

trial based on products of

human embryonic stem

cells is expected

NOW WE CAN MAKE STEM CELLS TO OUR

NEEDS

DR.T.V.RAO MD 22

• Two blockbuster-targeted

therapies burst on the cancer

scene in late 1990s, and

arguably changed forever the

concept of cancer treatment,

converting what was often a fatal

disease into a chronic illness.

The first, Herceptin, is a drug

that targets a type of breast

cancer that is characterized by a

specific cancer gene -- an

oncogene -- called HER-2.

TARGETED THERAPIES FOR CANCER

EXPAND WITH NEW DRUGS

DR.T.V.RAO MD 23

• Women whose cancers

express HER-2, which

is estimated to be about

25 percept of women

with breast cancer, will

respond to Herceptin

even when other

powerful chemotherapy

drugs have failed.

NEW DRUGS ARE EFFECTIVE IN

CHEMOTHERAPY FAILURES

DR.T.V.RAO MD 24

• The introduction/approval

of trastuzumab (Herceptin)

and lapatinib (TyKerb) in

breast cancer will prevent

many women's breast

cancers from recurring and

have significantly improved

survival for many women

faced with breast cancer.

More important, these

drugs represent highly

effective agents that target

the cancer, not the patient

NEW DRUGS CHANGES THE SOLUTIONS TO

CANCER

DR.T.V.RAO MD 25

• Other drug, a cancer pill

called Gleevec, targets

genetic mutation called

bcr-abl (b.c.r. able) that

causes cancer cells to

grow and multiply in

patients with a variety

of cancers, including

chronic myeloid

leukemia or with a

stomach cancer called

GIST.

NEW DRUGS TARGET GENETIC

MUTATIONS

DR.T.V.RAO MD 26

COMBINATION DRUG THERAPY EXTENDS HIV

SURVIVAL

• Since the introduction of highly active antiretroviral

therapy, or HAART, as this combination therapy

approach is called, HIV/AIDS has evolved into a

serious, but chronic disease with survival stretching

into decades.

• Moreover, this "cocktail" approach to treatment where

drugs are combined in different ways or different

sequences has become a model for treating other

diseases ranging from lung cancer to heart disease.

DR.T.V.RAO MD 27

• The drop in death rates from HIV

in the developed world (is) due to

improved medications, "There

was the 10 per cent drop in

deaths due to HIV in the US

between 2006 and 2007.

• In Africa, where the HIV/AIDS

crisis hits hardest today, doctors

are slowly making progress-and

in some cases real gains, which

is the case with the use of

antiretroviral drugs to block

mother-to-infant HIV

transmission.

BETTER APPROACHES IN

HIV INFECTIONS

DR.T.V.RAO MD 28

• Advances are being

made in the developing

world, with Botswana

leading the way not with

a 3% vertical

transmission rate. It

was the first and still is

the most effective

prevention strategy

DEVELOPING WORLD TOO SHOW PROGRESS

IN REDUCTION OF VERTICAL TRANSMISSION

DR.T.V.RAO MD 29

• Robotic surgery increased the

ability of cancer surgeons to

get clean margins as well due

to the magnification of the

structures

• he greatest benefit of tiny

openings into the body rather

than large incisions made by

traditional surgery, may --

believers say -- be shorter and

less painful recovery time.

MINIMALLY INVASIVE AND ROBOTIC

TECHNIQUES REVOLUTIONIZE SURGERY

DR.T.V.RAO MD 30

STUDY FINDS HEART, CANCER RISK WITH

HORMONE REPLACEMENT THERAPY

• Until July 2002 most doctors treating middle-age women believed that giving their patients hormones -- either oestrogen alone or oestrogen combined with progestin -- would protect their hearts from the ravages of age that seemed to attack women after menopause.

• Hormone replace therapy, or HRT, was also thought to be good for the bones, the brain, the skin, the figure, and the libido, and was considered the best treatment to control the annoying and sometimes disabling symptoms of menopause such as hot flashes, depression, and sleep disturbances

• However research proves otherwise. >

DR.T.V.RAO MD 31

• And then the world

changed, the National

Heart Lung and Blood

Institute, which was

sponsoring a placebo-

controlled trial of hormone

replacement therapy in

more than 161,000 healthy

women, announced that it

was shutting down the

study because HRT

increased the risk of heart

attack, stroke, blood clots,

and breast cancer.

HORMONE TREATMENTS CAN

INCREASE HEART DISEASE RISKS

DR.T.V.RAO MD 32

• Two biggest advances

in breast cancer this

decade was the

targeted-breast cancer

treatment with

Herceptin and "the

finding that

postmenopausal

hormone replacement

is associated with a

huge increase in the

risk of breast cancer."

HORMONE REPLACEMENT TREATMENT

LEADS TO INCREASED RISK OF CANCER

DR.T.V.RAO MD 33

• Mind-reading has moved

from carnival attraction to

the halls of medicine with

what is known as a

functional MRI.

• The medical mind-readers

are not trying to identify a

card randomly selected

from a deck -- they are

using sophisticated imaging

techniques to map the way

the mind works.

SCIENTISTS PEER INTO MIND WITH

FUNCTIONAL MRI

DR.T.V.RAO MD 34

• The process, often called fMRI,

traces the working of neurons --

brain cells -- by tracking changes

in the oxygen levels and blood

flow to the brain. The more brain

activity in one area, the more

oxygen will be used and the

more blood will flow to that area.

The patient lies awake inside an

MRI scanner. He or she is asked

to perform a simple task, like

identifying a colour or solving a

math problem.

A GREATER UNDERSTANDING

WITH MRI

DR.T.V.RAO MD 35

• As the patient answers the

question, the fMRI tracks

the areas of the brain that

are activated by tracing the

speed at which the cells

metabolize the sugar, or

glucose.

• First developed in the early

1990s, fMRI began to

shape research at the

beginning of the decade

FMRI TRACTS REAL-TIME EVENTS ON

FUNCTIONALITY OF BRAIN

DR.T.V.RAO MD 36

• Using this fMRI technique, researchers

are learning valuable

information about

disease such as

depression, brain

cancer, autism, memory

disorders, and even

conditions such as the

skin disorder psoriasis.

BETTER UNDERSTANDING OF SEVERAL

DISEASES WITH F-MRI USAGE

DR.T.V.RAO MD 37

CLONING OF MYCOPLASMA CHANGES THE

PRINCIPLES OF BIOLOGY

DR.T.V.RAO MD 38

DR.T.V.RAO MD 39

• Programme created by Dr.T.V.Rao MD

for Medical and Paramedical

Professionals in the Developing World

• Email

• doctortvrao@gmail.com