THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 13, No.3, 2000

Correspondence163

Deemed universities are dismal failures!

The comments by M. K. Mani in his 'Letter from Chennai' , betraya certain lack of understanding of the functioning of deemed univer-sities. Of the 39 deemed universities, only 4 are unaided, the restreceive government grants like other government universities. Thenomenclature of the functionaries is variable. Deemed universitiesgenerally have a Chairman, not a Chancellor and usually a Director,not a Vice Chancellor. Some deemed uni versities are multidisciplinary.It is not accurate to state that deemed universities 'have completefreedom in the sphere of higher education'. They are subject to theregulations of the University Grants Commission (UGC) and statu-tory councils.

It is neither fair nor factual to assert that deemed universities havebeen dismal failures. Several deemed universities have achieved newheights in academic performance after receiving deemed universitystatus. Some noteworthy examples are the Indian Institute of Science,Bangalore; Birla Institute of Technology and Sciences, Pilani; andthe Tata Institute of Social Sciences, Mumbai.

Five colleges of the erstwhile Dr T. M. A. PaiFoundation werecollectively granted deemed university status in 1993 under theManipal Academy of Higher Education (MAHE). The five collegesincluded two medical, two dental and a nursing college. With itsnewfound administrative autonomy, MAHE has implemented sweep-ing improvements in student admissions, faculty selections and theexamination system. Freed from the stifling affiliated college sys-tem, MAHE has introduced faculties of allied health, communica-tion, management and information sciences which offer undergradu-ate and postgraduate degree courses, several of which are unique inIndia, such as a bachelor's degree in respiratory therapy and amaster's degree in medical software systems.

23 April 2000 G. G. ChristoManipal Academy of Higher Education

University BuildingManipal

REFERENCE1 Mani MK. Letter from Chennai. Natl Med J India 2000;13:37-8.

Vanishing polio and emerging acute flaccid paralysisin India

In a recent communication, Jain et al:' pointed to the reported declinein cases of paralytic poliomyelitis in India from 24 257 in 1988 to3556 in 1998. Concurrently, there was a nation-wide rise in con-firmed cases of acute flaccid paralysis (AFP), from 1005 in 1996 to3556 in 1998. Extended immunization of the susceptible populationin future, during primary coverage and national immunization cam-paigns or door-to-door mopping up, would drastically reduce oreliminate poliovirus-induced cases of AFP. This would not guaran-tee a simultaneous reduction in AFP attributable to neurotropicviruses other than polioviruses. Episodes of AFP with a clinicalpicture similar to paralytic poliomyelitis have been described glo-

bally with other neurotropic viruses including Japanese encephali-tis," enterovirus 7P and Coxsackie virus AIO infection.' Whileeradication of polio from India is necessary, any residual disabilityassociated with AFP should also be addressed.

The neuronal damage should be picked up early and accompaniedby an antiviral therapeutic intervention immediately. Specific in-volvement by different neurotropic viruses can at present be detectedfairly early during the course of illness by magnetic resonanceimaging (MRI).5 There is intense hyper-resonance during T2 imag-ing in MRI in the afflicted neurons. Future episodes of AFP in Indiashould be diagnosed early by MRI and the patient offered specificantiviral therapy.

Interferon-a therapy halted progression of poliovirus-induceddisease in two patients within 24 hours of treatment. A 16-monthinfant and a 34-year-old man with bulbar paralysis due to type 1 wildpoliovirus and type-2 attenuated vaccine strain were given 1 or 3million units of interferon-a, respectively, for 10 days. Clinicalimprovement was apparent within a day or SO.6

The national strategy to combat poliomyelitis would be compre-hensive only through strengthened facilities. These would include anearly indication by MRl regarding involvement of the target neuronsin the brain and spinal cord in all episodes of AFP. Therapeuticintervention with interferon and pleocarnil,? an effective agent againstenteroviruses, should halve the neuronal damage and prevent re-siduallong-term disability. Health care professionals in India, irre-spective of the magnitude of poliovirus-induced AFP,' are obliged toeliminate long term disability associated with increasing episodes ofAFP by neurotropic viruses.

2 April 2000 Subhash C. AryaCentre for Logistical Research and Innovation

New Delhi

REFERENCESJain R, Kumar TA, Singh S. Polio eradication in India: Are we on the correct path?

Natl Med J India 1999;12:299-300.2 Solomon T, Kneen R. Dung NM, et al. Poliomyelitis-like illness due to Japanese

encephalitis virus. Lancet 1998;351:1094-7.3 Wang SM, Liu CC, Tsemg HW, et al. Clinical spectrum of enterovirus 71 infection

in children in southern Taiwan, with emphasis on neurological complications. ClinInfect Dis 1999;29: 184-90.

4 Yoshikamura K, Kurashige T. A case of poliomyelitis-like illness. Brain Dev1998;20:540-2.

5 Malzberg MS, Rogg JM, TateCA, Zayas Y, Easton ID. Poliomyelitis: Hyperintensityof the anterior horn cells on MR images of the spinal cord. AJR 1993;161:863-5.

6 Levin S. Interferon treatment of poliomyelitis. J Infect Vis 1985;151:'745-6.7 McConnell J. Enteroviruses succumb to new drug. Lancet 1999;154:1185.

Disclosure of affiliation between journal editor andmanuscript author

As a Canadian physician and past editorial fellow at the Annals ofInternal Medicine, I have come to value, and critically question, thescientific, moral, and financial role of the editor in the world ofmedical journalism. Medical journal editors remain dedicated todefining fair authorship' and full disclosure of potential competingfinancial or ethical interests on the part of both its authors and the

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editors themselves.>' This, in turn, may lead to the publication ofbetter science,' while also protecting the interests of the patient. 4

At times, a friend or relative of the journal editor may submit amanuscript to that journal for consideration. In this situation, thateditor typically removes himlherself from the review process of thatmanuscript. However, this can be difficult at times, especially whenthe journal is a small one, with only one editor. And even whenanother editor is available to decide on the worthiness of that manu-script, I wonder whether there remains an unconscious or unseeninfluence in the manuscript selection process. It is the editor of amedical journal who ultimately decides whether a paper is publishedtherein.'

Accordingly, I would think it sensible that any affiliation betweenthe journal editor(s) and manuscript author(s) be another point fordisclosure. By doing so, we can maintain the spirit of fairness andimpartiality that is so vital in the peer review, editorial and publica-tion process.

23 May 2000 Joel RayMcMaster University

TorontoOntarioCanada

REFERENCESRennie D, Flanagin A. Authorship! Authorship! Guests, ghosts, grafters, and thetwo-sided coin. lAMA 1994;271:469-71.

2 Southgate MT. Conflict of interest and the peer review process. lAMA 1987;258: 1375.3 Rennie D, Flanagin A, Glass RM. Conflicts of interest in the publication of science.

lAMA 1991;266:266-7.4 Rennie D, Yank V. Disclosure to the reader of institutional review board approval

and informed consent. lAMA 1997;277:922-3.5 Stehbens WE. Basic philosophy and concepts underlying scientific peer review. Med

Hypotheses 1999;S2:31...{j.

Emergence of Salmonella typhi Vi antigen-negativestrains in an epidemic of multidrug-resistant typhoid

fever cases in Calcutta, India

Typhoid fever continues to be a global health problem, especially inthe tropics and sub-tropics. During 1990-91, a total of 740 blood,stool or both samples were collected from children with clinicallysuspected enteric fever admitted to the Dr B.C. Roy MemorialChildren's Hospital, Calcutta. These were processed for the isolationof S. typhi by standard methods. I S. typhi was isolated from 261(35.3%) samples. Of these, 70 (26.8%) S. typhi strains did notagglutinate with Vi antiserum (Wellcome Reagents Limited, En-gland). All the 261 strains were sent for phage typing to the NationalSalmonella Phage Typing Reference Centre, Lady Hardinge MedicalCollege, New Delhi. All the 70 Vi-negative strains were phageuntypable. From May to December 1999, 50 blood culture samplesfrom clinically suspected patients of typhoid fever of the samehospital were again screened. S. typhi was isolated in 90 of these. Byslide agglutination test using Vi antiserum (Denka Seiken, Japan), 5(55.6%) were Vi-positive and 4 (44.4%) were Vi-negative. All theseVi-negative strains were also phage untypable.

To detect the presence of Vi antigen encoding gene in thechromosome, we tested all the 74 Vi-negative strains by polymerasechain reaction (PCR) based on the ViaB sequence.' Interestingly, 72(97.3%) out of the 74 S. typhi strains that did not agglutinate with theVi antiserum were found to harbour the Vi encoding gene.

THE NATIONALMEDICAL JOURNAL OF INDIA VOL. 13, NO.3, 2000

Vi-negative strains of S. typhi that are devoid of the Vi antigen andthat cannot be typed with Vi phages occur globally. They werereported worldwide in the 1960s.3 In the 1970s, Vi-negative isolateswere encountered in Jamaica,' Indonesia,' New Zealand" and Malay-sia.'

Our findings suggest that ViaB PCR can reinforce the clinicaldiagnosis of typhoid fever in Vi agglutination-negative S. typhistrains. The upsurge of agglutination negative S. typhi strains to theVi-specific antiserum perhaps indicates the existence of geneticchanges among these strains which mask the expression of Viantigen. These may cause a challenge to the typhoid vaccine.

3 May 2000 M. R. SahaT. Ramamurthy

Department of MicrobiologyP. DuttaU. Mitra

Department of Clinical MedicineNational Institute of Cholera and Enteric Diseases

BeliaghataCalcutta

West Bengal

REFERENCESManual for laboratory investigation of acute enteric infection. World HealthOrganization Programme for Control of Diarrhoeal Diseases Geneva:World HealthOrganization, 1983: 23 (CDD/83.3).

2 Hashimoto Y, Itho Y, Fujinaga Y, et al. Development of nested PeR based on theViaB sequence to detect Salmonella typhi. 1 Clin Microbiol 1995;33:775-7.

3 International Committee for Enteric Phage Typing. The geographical distribution ofSalmonella typhi and Salmonella paratyphi A and B types during the periodI January 1966 to 31 December 1969. 1 Hyg Camb 1973;71:59-84.

4 French GL, King SD, Louis PS. Salmonella serotypes, Salmonella typhi phage typesand antimicrobial resistance at the University Hospital of the West Indies, Jamaica.1 Hyg Camb 1977;79:5-16.

5 Sanborn WR, Vieu JF, Kombalarini VS, et al. Salmonellosis in Indonesia: Phagetype distribution of Salmonella typhi. 1 Hyg Camb 1979;82:143-52.

6 International Federation for Enteric Phage Typing. The geographical distribution ofSalmonella typhi and Salmonella paratyphi A and B phage types during the period1 January 1970 to 31 December 1973. 1 Hyg Camb 1982;88:231-54.

7 Jegathesan M. Phage types of Salmonella typhi isolated in Malaysia over the 10-yearperiod 1970-79. 1 Hyg Camb 1983;90:91-7.

Disposable syringes of 1 ml

A significant number of patients coming to a diagnostic pathologylaboratory require estimation of blood glucose. Only 1 mI of bloodis sufficient for the investigation. The disposable syringes availablein the market come in 2 mI, 5 ml and 10 ml sizes. The syringeavailable in 1 mI size is of the tuberculin type and is comparativelyexpensive.

We appeal to manufacturers of syringes to seriously considermanufacture of ordinary 1 mI disposable syringes. These will notonly use less plastic, but will probably be less expensive and(comparatively) environment-friendly.

23 May 2000 Dilipkumar C. VoraA. M. Pai

PathologistsAmbika Darshan

Mahatma Gandhi RoadMumbai

Maharashtra

CORRESPONDENCE

Withdrawing drugs: Need for global uniformity

I wish to share with your readers a news item that I saw on the worldwide web. I understand that the Janssen company, which is manufac-turing the hugely popular drug cisapride (over 34 brands available inthe Indian market), is voluntarily withdrawing the drug from themarket in USA. Prior to its withdrawal this drug was approved foruse, only for severe night-time heartburn experienced by adultpatients with gastro-oesophageal reflux disease (GER)) not re-sponding adequately to other therapies. However, this drug is used inIndia for diverse conditions of the upper gastrointestinal tract whichcause vague symptoms of pain, distension and discomfort. Thus, itfinds widespread use in general medical practice, surgery, gastroen-terology and in almost all other specialties for the treatment of suchsymptoms.

As of 31 December 1999, the use of cisapride has been associatedwith 341 reports of abnormalities in heart rhythm including 80deaths. Most of these adverse events occurred in patients who weretaking other medications or suffering from underlying conditionsknown to increase the risk of cardiac arrhythmia associated withcisapride. The company will continue to make the drug available topatients who meet specific clinical eligibility criteria for a limited-

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access protocol. Since the drug's approval in 1993, cisapride'slabelling has been revised several times (most recently in January2000, see FDA Talk paper TOO-6) to inform health care profession-als and patients about the drug's risks. Despite these risk manage-ment efforts, the firm decided-in consultation with the Food andDrug Administration, USA-that continued general prescriptionaccess to the drug in the USA poses unacceptable risks [http://primarycare.medscape.coml21175.rhtml].

I give the details of the medscape's communication to me so thatphysicians in India will be cautious in prescribing this drug. I feel thatdrug companies in India will not voluntarily withdraw the drug(considering the wide market it has), as has been done in the USA,unless the drugs controller takes notice and acts. Even then I suspectit will continue to be available in the market.

In this era of globalization, drug companies should follow uni-form policies globally, especially in relation to withdrawing possiblydangerous drugs. One man's poison should certainly not be another'smeat.

15 May 2000 B. C. Rao874, 2nd Cross, 7th Main

H.A.L. 2nd stageBangaloreKarnataka

SJ Bhatia, BYL Nair Hospital, MumbaiR Pandey, Pathology, SGPGI

VA Saraswat, Gastroenterology, SGPGISK Yachha, Gastroenterology, SGPGI

S Baijal, Radiology, SGPGISR Naik, Gastroenterology, SGPGI

R Aggarwal, Gastroenterology, SGPGI

Postgraduate Clinics in Gastroenterology 2000 (Focus: Investigative Modalities in Gastroenterology)Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India

8-10 September 2000

Course contentsThe course is directed at imparting knowledge about various investigative techniques used in the diagnosis and treatment of patientswith diseases of the gastrointestinal tract and liver. Effort will be made to cover theoretical aspects of these techniques, demonstrate theseprocedures and teach interpretation of these tests. It is proposed to follow an interactive format, wherever possible. In particular, it isproposed to cover the following techniques. .

1. GI radiology: Conventional contrast studies, CT, MR!, angiographic techniques and interventional procedures2. GI physiology: Oesophageal and rectal manometry; 24-h pH monitoring3. GI biochemistry: Tests for malabsorption, breath tests, etc., bile analysis and GI pathology5. GI serology and molecular biology: ELISAs, immunofluorescence, PCR, RT-PCR, DNA sequencing, etc.

Course FacultyB Nagi, PGIMER, ChandigarhS Naik, Immunology, SGPGIG Choudhuri, Gastroenterology, SGPGI

Target audienceDM (Gastroenterology) students MD (MedicinelPediatrics) students Young faculty members in these specialties

Number of participantsTo ensure close interaction between the faculty and participants, total number of participants will be limited to 30. Participants will beselected on a first-come, first-served basis.

Registration feeRs 600 (including attendance at scientific sessions, twin-sharing accommodation and food for 3 days) as a bank draft payable to SGPGIPostgraduate Clinics at Lucknow. Last date for registration is July 31, 2000.

Travel supportEfforts are being made to arrange travel bursaries for students. To be considered for these, kindly write to us with your CV.

Contact information:Rakesh Aggarwal, Associate Professor, Department of Gastroenterology, SGPGI, Lucknow 226014, Uttar Pradesh, IndiaEmail: rakesh@sgpgi.ac.in FAX: (522) 440017 Phone: (522) 440700/440800, Extn. 2431, 2400

•••.Clinics website: http://www.sgpgi.ac.in/conf/gastro2000.html ~