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Annual Report 1999-2000
Autonomous Institutions
Sree Chitra Tirunal Institute for Medical
Sciences & Technology, Thiruvananthapuram
The concept and achievement of uniting technology
and medical sciences within a single institutional framework
was regarded sufficiently important by the Government of India
to declare it as an Institute of National Importance by an
Act of Parliament in 1980. The Act lays down the objectives
of the Institute to be the promotion of biomedical engineering
and technology, demonstration of high standards of patient
care and the development of post-graduate training programmes
of the highest quality in advanced medical specialities and
biomedical engineering and technology. The Institute achieved
significant progress in these fields.
The R & D activities of the Institute were reorganised
in project mode to ensure that identification and development
of appropriate health care technologies will meet the requirements
of the profession and the industry in a globally competitive
environment. Mechanisms for effective collaboration with medical
devices industry and technology transfer were streamlined
even as commercialization of the technologies continued at
a satisfactory pace. Establishment of a Laboratory for molecular
medicine, modification and consolidation of the facilities
for the evaluation of biomaterials and devices were accomplished.
The commencement of the Indo-French R & D project on diamond-like
carbon coating heralded the beginning of the era of global
co-operation in biomedical technology development.
The Achutha Menon Centre acquired international status with
overseas students and scholars flocking to it for formal training
and collaborative research in public health, as well as the
work of our MPH graduates being recognised by international
organisations. An international seminar organised by the Centre
attracted public health experts from India and abroad. The
Centre was also recruited as an active member of the global
programme - Public Health Schools Without Walls. In the short
span of its existence - barely 3 years - Achutha Menon Centre
became an internationally acclaimed Centre for training, research
and consultancy in public health.
Biomedical Technology Wing
The Biomedical Technology Wing continued to
focus on the development of Biomaterials and Biomedical Devices,
which can be converted into commercialisable technologies
in collaboration with industries. The establishment of laboratory
for Molecular Medicine was nearly complete. PCR work station,
Gradient Robocycler for PCR and DNA synthesizer were procured
and commissioned. PCR based diagnosis for Tuberculous meningitis
was standardized.
The research activities were being consolidated to address
problems related to material-tissue interactions pertaining
to the biomaterials and devices mentioned below, with the
objective of achieving improved biocompatibility and biofunctionality.
The research also encompassed toxicological evaluation of
materials, design of experiments (both invitro and invivo
animal models) for functional evaluation prior to clinical
studies.
Development of Biomedical Technology
The Biomedical Science and Technology programmes
are being developed with the following overall objectives:
- Product development with emphasis on innovativeness
- Competence builds up through Team Effort and training/exposure
in relevant institutions.
- Scientific studies to initiate new areas and answer specific
questions arising the developmental programmes.
In order to achieve the above, the following
activities are being intensified:
- Design and prototyping
- Materials and Processing
- Biological Evaluation
The laboratories are being expanded with additional
facilities like Thermal Analyser, X-ray Diffraction, Gas permeability
tester etc., for material characterisation. Hematology Analyser,
Epifluorescence microscope and Image Analyser have been added
for evaluation of biochemical and pathological parameters
of blood and soft and hard tissues. All the facilities and
expertise are also being extended to industries and other
R&D laboratories on a collaborative/chargeable basis.
A laboratory for Molecular Medicine with the objective of
developing DNA based diagnostic methods for genetic and infectious
diseases is being set up.
Besides the above, Laboratories are adopting the Good Laboratory
Quality Assurance
Programmes with a view to receive ISO certification for testing
and evaluation of biomaterials and medical devices.
The following table summarizes the R & D status of selected
programmes:
Product/Process Status
1. Dental Composite (Restorative * Discussions
with companies are Materials) going-on for technology transfer.
* Radio-opaque dental composites and Dentine-bonding agent
are being developed.
2. Hydroxyapatite (Bone graft Clinical evaluation for dental
application material) continued. Transfer of technology is
being arranged.
3. Membrane Oxygenator Design Validation completed.
(Artificial lung for open heart Development of Injection moulding
dies & surgery) centrifugal potting machines were in progress.
Final Product evaluation is in progress.
4. Fibrin Glue (surgical Clinical trial continued in the Institute
hemostatic agent) (Cardiac & Nuerosurgeries).
Identification of industrial partner for technology transfer
and commercialisation is going-on.
5. Coating on Urinary Catheter Antimicrobial silver oxide
coated urinary cathetar showed
(Infection resistance) reduced bacterial adhesion and was
non-toxic. Further in- vitro evaluation was in progress .
6. Coating on Heart Valve An Indo-French project was started.
Evaluation of theComponents (Improved coating by the industry
in France is in progress.Blood compatibility)
7. Vascular Graft (Artificial Clinical trial completed. Identification
of industrial large diameter blood vessel) partner for further
development is on going.
8. Hydrogel (Therapeutic Identification of industrial partner
is on going.Embolization agent)
9. Needle Electrode Pilot production of 1800 nos. of CNE completed.
Technology transferred to M/s. South Indian Drugs & Devices
Pvt. Ltd., Chennai. Commercial production started.
In addition to the above, we have made 1800 Concentric Needle
Electrodes as part of the Joint Technology Development with
SIDD/SPIC, Chennai and the licensing process for technology
transfer has been initiated.
During this period, four patents and one design registration
have been filed reflecting one aspect of technology development.
Efforts are also on-going to bring together the industry and
the medical personnel to identify and address all technical
issues for selection and execution of proje3cts that can blossom
into affordable and relevant technologies.
Patents Filed
1. A process for the preparation of Anti-Snake
Venom in Hens and Isolation of Immunoglobulins from Chicken
Egg-Yolk.
Inventors: Lossy K. Krishnan, Mary
Vasantha Bai.
2.A Biodegradable and Haemostatic Fibrin Sheet for Wound Care
Application.
Inventors: Lissy K. Krishnan, Mira
Mohanty, Arthur Vijayan Lal.
3. A process for the Preparation of a photopolymerisable Dentine
Bonding Agent.
Inventors: V. Kalliyanakrishnan, P.P.
Lizymol.
4. A process for the preparation of Urethane Teramethacrylate
Resin Marix (UTMA).
Inventors: V. Kalliyanakrishnan, P.P.
Lizymol
5. Design application for the Assembly Fixture for Production
of Concentric Needle Electrode.
Inventors: Niranjan D. Khambete, V.
Ramesh Babu, E.B. Mohan Raj,O.S. Neelakantan Nair.
R & D Programmes
Research efforts on molecular imprinting and
metal containing polymers were continued. Molecularly imprinted
polymers based on metal containing monomers were synthesised
and the preliminary results indicated the feasibility of optimising
these polymers as selective adsorbents for proteins.
Spectropghotometric methods base on cyclodextrin
polymer were developed to detect clinically relevant molecules
like heparin.
Clinical evaluation of Porous Hydroxyapatite
granules was on in a few Dental Colleges for periodontal applications.
The granules were prepared in various size ranges to suit
different applications. The technology profile document on
HA granules was prepared. The preparation of bioactive glasses
and Hydroxyapatite bioactive glass composites granules were
standardised. Animal bone implantation study is going-on.
- Oral Insulin Delivery System
Oral insulin delivery system based on chitosan
/ calcium alginate matrix having different release kinetics
for a variety of diabetic conditions was attempted. It was
found that insulin complexed with B-cyclodextrin for different
periods has different release kinetics in vitro. In vivo experiments
in diabetes induced rabbits, using one of these complexes
encapsulated in a chitopsan/calcium alginate matrix, yielded
promising results. Studies on optimization of the size of
microspheres for improved loading and efficiency in anti-diabetic
activity were in progress.
- Molecular defects in Epilepsy
Surgically resected hippocampal tissues from
the anterior temporal lobe of epilepsy patients were studied
for gene defects by candidate gene approach. This approach
is based on the working hypothesis that neurotransmitter release
machinery in epileptic neurons is defective. Genes of two
functionally important proteins in the neurons were studied.
The tissues were also analyzed for ultra structural changes
to identify secondary molecular defects in the diseases. Additionally,
differential display technique to analyze gene expression
variations in epileptic hippocampus was being standardised.
An ideal matrix was developed for growing human
umbilical cord endothelial cells on tissue culture plastic
and PTEE grafts. By incorporating growth hormones with the
matrix components, confluent EC layer could be obtained in
2-3 days after seeding the cells. The EC monolayer formed
was non-thrombogenic compared to the bare graft surface or
the gelatin coated graft.
The Indo-French Centre for Promotion of Advanced
Research, New Delhi, sanctioned an industrial research project
"Development of Diamond like coatings for Biomedical
and other applications". This project is a joint collaborative
venture involving a French industry, University of Paris-Sud
and the Division of Internal Organs of the Institute. After
setting up the required research equipments, research work
has been initiated.
Academic Programmes
As a University, the Institute continues to
offer regular Academic Programmes for Post-doctoral Degrees
(DM, M.Ch), Diplomas, and certificates, Ph.D. and certificate/diploma
courses in specialised nursing as well as bloodbanking, radiology,
operation theatre technology etc. With the addition of Master
of Public Health Programme , the Institute is offering a total
of 19 academic programmes. The student strength for DM/MCh.
Degrees and Post Doctoral Certificate Courses during the year
was 50. The Master of Public Health Degree programme had 15
scholars including two from Bangladesh. The Institute has
12 scholars for the Ph.D. Programme, 20 Scholars enrolled
for the Post Basic Nursing Certificate Programme and 24 scholars
for the various Diploma programmes. The national response
to various academic courses remained impressive and confirmed
the nationwide acceptance of the educational programmes of
the Institute. All candidates registered in 1998-99 for postdoctoral
certificate courses and Diploma & certificate courses
have completed their training satisfactorily. The demand for
short-term training/observership in procedures, techniques
and management was again on the increase. More than 100 scientific
papers were published and presented in national & international
conferences.
Hospital Services
The Hospital continued to provide high quality
patient care at an affordable cost. The hospital has 217 beds
and serves as tertiary referral centre for cardio-vascular,
thoracic and neurologic diseases. The cardiac and neurologic
departments are fully supported in their programmes by sister
departments such as anesthesiology, biochemistry, blood transfusion,
microbiology, pathology and radiology. Apart from their direct
responsibility for patient services, all these departments
carry out clinical and experimental research of their own.
Patient care services were maintained at a high standard,
while several new initiatives were begun during the year.
In tune with the recent trends in evolving non-surgical
management of patients with cardiovascular diseases, several
interventional management protocols were established for the
treatment of heart ailments. A comprehensive care service
for movement disorders and the inauguration of the Centre
for Epilepsy Care in the country were some of the important
achievements. The Department of Cardiology continued to introduce
several interventional techniques for the treatment of various
heart diseases. Three workshops conducted by the Cardiology
Dept. gave tremendous boost to the already active interventional
programmes. In the Cardio Vascular & Thoracic Surgery
Dept., more than 1400 open-heart/closed/vascular surgeries
were successfully performed. Chitra Vascular Graft Prostheses
were successfully implanted in six patients as part of the
limited trial, preceding multicentric clinical trials.
There was steady increase in the services offered
through the general Neurology OPD as well as the specialty
clinics. Two Epilepsy Clinics being conducted weekly at the
Neurology Department have large number of attendance’s
and an average of 1500 patients attends the Epilepsy Clinics
per annum. The outreach epilepsy clinics conducted in Malapuram
and Thrissur districts of Kerala twice a month had an attendance
of approximately 100 every month. More than hundred patients
underwent epilepsy surgery for medically refractory seizures.
The R. Madhavan Nayar Centre for Comprehensive Epilepsy Care
started recently with external donation, houses a state-of-the-art
3-patient video EEG monitoring facility, a 6-bedded ward,
2-bedded ICU and an operation theatre.
The comprehensive care programme for Movement
Disorders, established out of external donations in 1997,
expanded its existing activities in collaboration with the
Department of Neurosurgery & Radiology by including stereotatics
and functional neurosurgery for various movement disorders.
Medically intractable cases of Parkinson’s disease and
various tremor disorders selected from the Movement Disorder
Clinics were extensively evaluated and subjected to surgery
under close intra-operative neurological monitoring. Intra-operative
microelectrode guidance will be available for the first time
in Asia in this programme by early 2000. The highly advanced
technique of Deep Brain Stimulation for the management of
Movement Disorders is going to be performed. Besides the above,
Speech and Behavioural Neurology Services, Neuromuscular Services
and Strokes Services are functioning in the hospital and hundreds
of patients attend to these special clinics.
There is substantial increase in the volume
of operative work compared to the previous years in the Department
of Neurosurgery. This Department continued to cater to more
and more complex intracranial and intraspinal lesions. Surgery
for intracranial aneurysms, other vascular malformations,
tumors of base of skull, CV junction anomalies, intramedullary
spinal cord tumours and temporal lobe epilepsy formed major
bulk of the total surgical procedures. Streostatics surgery
for movement disorders and surgery of peripheral nerve injuries
and craniofacial anomalies also got underway for the first
time. Clinical trials of indigenously prepared Fibrin Glue
at the BMT Wing of the Institute was undertaken.
The emphasis was on providing services not easily
available in other hospitals, particularly for the low socio-economic
sections of the society. However, all these efforts have led
to an exponential increase in the demands on hospital services
from the public. The Institute maintained its momentum of
progress in all its major spheres of activities thereby the
concept of uniting technology and medical sciences within
a single institutional frame-work is being achieved. While
seeking to provide treatment facilities that are not readily
available to the socio-economically weaker sections of the
society, the Institute’s primary responsibility is to
ensure continuous development of biomedical technology to
support and foster a growing and credible medical device industry
in India. In the light of the emerging economic scenario,
indigenous technology development must aim at producing innovative
and globally competitive technologies in order to maintain
its continued relevance and viability. The Institute thus
remained committed to the objectives for which it was established
and constantly strove to justify the trust reposed on it by
the nation.
The activities and accomplishments of the Institute
in the penultimate year of the 20th century are a reflection
of the Institute’s capability to fulfill its mandate.
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Introduction
Introduction
