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Thank you for publishing a thought provoking news piece by Scott
Gottlieb (BMJ 2001;323:1025(b))on drug related deaths among geriatric
patients in hospitals.
Medicine is an ever changing science which needs constant upgradation
incorporating ideas from new research and clinical experiences. It should
be interpreted in a zero state of mind without any bias for the past or
the future. One of the primary features of the new millenium is the
progresive acceptence of the fact of "global graying". In response to this
added responsibility of the twenty-first century, doctors with the finest
and best talents should take the leadership in gerontology or geriatrics
in coordination with leading thinkers, social workers, scientists, health
administrators, etc., in order to help the society to adapt to its own
progressive aging. If nothing is done, there will be senescence of the
society at large.
The clientele of geriatric medicine has traditionally been defined by
demographers, insurers, employers, as those over the age of 65. But, in
many countries where geriatric medicine has become a distinct speciality,
the age of 75 is often considered to be the limit. The problem lies in the
treatment, because there is a lack of functional reserve of all the organs
resulting in multiple disabilities, covert as well as overt. In this age
group a typical example would be that of a very old, sick and frail
patient with multiple complications coming for treatment to the youngest
medical officer on emergency duty with, for instance, severe broncho-
pneumonia without fever or acute myocardial infarction without pain, or
hyper-thyroidism without features of hyper-metabolism. The coincidence of
multiple problems in elderly patients often results in a blurring of the
diagnostic criteria, which, in turn, may produce non-specific presentation
and clinical response. This is what creates mischief leading to multiple
drug application resulting in increased morbidity and mortality due to
drug interaction.
I have a suggestion for my learned colleagues who may appreciate the
problem I have mentioned and wish to do something by way of meeting the
challenge.
In case of geriatric patients, there is a generalized loss of
cellular immunity; however, humoral immunity remains reasonably
intact.(1). My suggestion is that we can draw a chart under the WHO or a
BMJ entrusted group leadership, who can map out a schedule of vaccination
for geriatrics against common organisms like influenza virus,
pneumococcus, diptheria, tetanus bacteria, to name a few, as is done in
the case of children. Another important thing which can be done is to
establish a scoring system for each vital organ of the geriatric patient,
similar to the Unified Parkinson's Disease Rating Scale or the Montreal
Pain Rating Scale. It is widely known that there is a 1 percent loss of
cells from the age of 40. We can think also in terms of rejuvenating the
functional failing organs with hypoantigenic fetal cell/ tissue
transplantation,(2,3,4) collected from aborted fetal material with
specifications drawn out by internationally respected scientists. Further,
we can think in terms of umbilical cord blood stem cell transplantation,
with its multi-potential growth promoting factors. We can even transfuse
umbilical cord whole blood to geriatrics after removing the stem cell
content (.01 percent of the nucleated cells of the cord blood), to combat
geriatric anaemia. This cord blood is rich in fetal haemoglobin (which
carries 60 percent more oxygen than adult haemoglobin), growth factors and
cytokines, etc.,(5) and therefore has a potential growth promoting role.
In the light of recent developments in molecular biology, it has been
observed that fetal stem cells and germiline cells, which express
telomerase reverse transcriptase, can divide indefinitely and thus have
the potentiality to rejuvenate a failing geriatric organ after fetal cell
transplantion and its homing effect on the hosts' organ.
Sincerely yours,
Dr. Niranjan Bhattacharya,MBBS,MD,MS,FACS(USA),Principal
Investigator, Project on Fetal Cell Transplant, Dr.T.S.Bandopadhyay,Ph.D.,
Dr. Mahua Bhattacharya,MBBS,DGO,DA, Dr.Sanjukta Bhattacharya,Ph.D.
References:
(1)Fox Roy A, "Immunology and Aging",in Evans JG, Williams TF,
eds.,OXFORD TEXTBOOK OF GERIATRIC MEDICINE, OUP,1992 : 51-60.
(2)Bhattacharya N, Mukherjee Kl, Chettri MK et al,"A Unique
Experience with Human Pre-immune (12 Weeks) and Hypo-immune (16 Weeks)
Fetal Thymus Transplant in a Vascular Subcutaneous Axillary Fold in
Patients with Advanced Cancer: A Report of Two Cases", European Journal of
Gynecological Oncology, 2001;22(4):273-7.
(3)Bhattacharya N, "Fetal Tissue Organ Transplant in HLA Randomized
Adults' Vascular Subcutaneous Axillary Fold: A Preliminary Report of 14
Cases", Clinical & Experimental Obstetrics and Gynecology,
2001;28(4):233-9.
(4)Bhattacharya N, Bandopadhyay T, Bhattacharya M et al,"Do not
discard 99.99% of the human placental umbilical cord blood for the sake of
stem cells only" BMJ.com, 6 Oct.2001, Rapid Response to Proctor SJ et al,
"Umbilical Cord Blood Bank in UK", Editorial, BMJ,2001;323:61.
(5)Bhattacharya N, Mukherjee KL, Chettri MK et al,"A Study Report of
174 Units of Placental Umbilical Cord Whole Blood Transfusion in 62
Patients as A Rich Source of Fetal Hemoglobin Supply in Different
Indications of Blood Transfusion", Clinical & Experimental Obstetrics
and Gynecology, 2001;28(1):47-52.
Competing interests:
No competing interests
06 April 2002
Dr. Niranjan Bhattacharya, MBBS, MD, MS, FACS(USA)
Immunization and Fetal Cell/Tissue Transplant: A New Strategy for Geriatric Treatment
Dear Sir,
Thank you for publishing a thought provoking news piece by Scott
Gottlieb (BMJ 2001;323:1025(b))on drug related deaths among geriatric
patients in hospitals.
Medicine is an ever changing science which needs constant upgradation
incorporating ideas from new research and clinical experiences. It should
be interpreted in a zero state of mind without any bias for the past or
the future. One of the primary features of the new millenium is the
progresive acceptence of the fact of "global graying". In response to this
added responsibility of the twenty-first century, doctors with the finest
and best talents should take the leadership in gerontology or geriatrics
in coordination with leading thinkers, social workers, scientists, health
administrators, etc., in order to help the society to adapt to its own
progressive aging. If nothing is done, there will be senescence of the
society at large.
The clientele of geriatric medicine has traditionally been defined by
demographers, insurers, employers, as those over the age of 65. But, in
many countries where geriatric medicine has become a distinct speciality,
the age of 75 is often considered to be the limit. The problem lies in the
treatment, because there is a lack of functional reserve of all the organs
resulting in multiple disabilities, covert as well as overt. In this age
group a typical example would be that of a very old, sick and frail
patient with multiple complications coming for treatment to the youngest
medical officer on emergency duty with, for instance, severe broncho-
pneumonia without fever or acute myocardial infarction without pain, or
hyper-thyroidism without features of hyper-metabolism. The coincidence of
multiple problems in elderly patients often results in a blurring of the
diagnostic criteria, which, in turn, may produce non-specific presentation
and clinical response. This is what creates mischief leading to multiple
drug application resulting in increased morbidity and mortality due to
drug interaction.
I have a suggestion for my learned colleagues who may appreciate the
problem I have mentioned and wish to do something by way of meeting the
challenge.
In case of geriatric patients, there is a generalized loss of
cellular immunity; however, humoral immunity remains reasonably
intact.(1). My suggestion is that we can draw a chart under the WHO or a
BMJ entrusted group leadership, who can map out a schedule of vaccination
for geriatrics against common organisms like influenza virus,
pneumococcus, diptheria, tetanus bacteria, to name a few, as is done in
the case of children. Another important thing which can be done is to
establish a scoring system for each vital organ of the geriatric patient,
similar to the Unified Parkinson's Disease Rating Scale or the Montreal
Pain Rating Scale. It is widely known that there is a 1 percent loss of
cells from the age of 40. We can think also in terms of rejuvenating the
functional failing organs with hypoantigenic fetal cell/ tissue
transplantation,(2,3,4) collected from aborted fetal material with
specifications drawn out by internationally respected scientists. Further,
we can think in terms of umbilical cord blood stem cell transplantation,
with its multi-potential growth promoting factors. We can even transfuse
umbilical cord whole blood to geriatrics after removing the stem cell
content (.01 percent of the nucleated cells of the cord blood), to combat
geriatric anaemia. This cord blood is rich in fetal haemoglobin (which
carries 60 percent more oxygen than adult haemoglobin), growth factors and
cytokines, etc.,(5) and therefore has a potential growth promoting role.
In the light of recent developments in molecular biology, it has been
observed that fetal stem cells and germiline cells, which express
telomerase reverse transcriptase, can divide indefinitely and thus have
the potentiality to rejuvenate a failing geriatric organ after fetal cell
transplantion and its homing effect on the hosts' organ.
Sincerely yours,
Dr. Niranjan Bhattacharya,MBBS,MD,MS,FACS(USA),Principal
Investigator, Project on Fetal Cell Transplant, Dr.T.S.Bandopadhyay,Ph.D.,
Dr. Mahua Bhattacharya,MBBS,DGO,DA, Dr.Sanjukta Bhattacharya,Ph.D.
References:
(1)Fox Roy A, "Immunology and Aging",in Evans JG, Williams TF,
eds.,OXFORD TEXTBOOK OF GERIATRIC MEDICINE, OUP,1992 : 51-60.
(2)Bhattacharya N, Mukherjee Kl, Chettri MK et al,"A Unique
Experience with Human Pre-immune (12 Weeks) and Hypo-immune (16 Weeks)
Fetal Thymus Transplant in a Vascular Subcutaneous Axillary Fold in
Patients with Advanced Cancer: A Report of Two Cases", European Journal of
Gynecological Oncology, 2001;22(4):273-7.
(3)Bhattacharya N, "Fetal Tissue Organ Transplant in HLA Randomized
Adults' Vascular Subcutaneous Axillary Fold: A Preliminary Report of 14
Cases", Clinical & Experimental Obstetrics and Gynecology,
2001;28(4):233-9.
(4)Bhattacharya N, Bandopadhyay T, Bhattacharya M et al,"Do not
discard 99.99% of the human placental umbilical cord blood for the sake of
stem cells only" BMJ.com, 6 Oct.2001, Rapid Response to Proctor SJ et al,
"Umbilical Cord Blood Bank in UK", Editorial, BMJ,2001;323:61.
(5)Bhattacharya N, Mukherjee KL, Chettri MK et al,"A Study Report of
174 Units of Placental Umbilical Cord Whole Blood Transfusion in 62
Patients as A Rich Source of Fetal Hemoglobin Supply in Different
Indications of Blood Transfusion", Clinical & Experimental Obstetrics
and Gynecology, 2001;28(1):47-52.
Competing interests: No competing interests