INDIAN COUNCIL OF MEDICAL RESEARCH
 

6.27.1. The Indian Council of Medical Research (ICMR) established in 1911 has a network of 21 permanent research institutes and six regional medical research centres distributed throughout the country . During 1997-98 the Council continued research on a wide spectrum of subjects through intramural and extramural projects including various multicentric collaborative projects.

6.27.2. The Council is administered by a Governing Body chaired by the Minister for Health & family Welfare. The Council receives grant in aid from the Ministry under Plan & Non-Plan for meeting its normal expenditure as well as for plan activities. The following provision existed during 1997-98 in the budget for payment as grants-in-aid to the Council.

Plan : Rs. 54 Crore Non-Plan : Rs. 36 Crore

6.27.3. The Council also awards prizes to Indian scientists (young as well as established ones), in recognition of significant contributions to biomedical research.

6.27.4. Communicable Diseases: India like many other advanced developing countries bears the burden of existing communicable diseases, while having to tackle newly emerging and re-emerging infectious diseases. The Tuberculosis Research Centre (TRC), Chennai has assisted the Ministry of Health & Family Welfare to restructure National Tuberculosis Control Programme (NTCP) to Revised National Tuberculosis Control Programme(RNTCP) by providing training and operational research inputs. Tuberculosis Research Centre(TRC) has also undertaken surveillance of drug resistance in tuberculosis in Tamil Nadu as a part of WHO/International Union Against Tuberculosis and Lung Diseases IUATLD global project. The BACTEC system was compared with conventional method culture and found to be superior to conventional method. The Centre has also developed simple direct drug sensitivity test and shortened its duration. Molecular epidemiological studies have shown endogenous reactivation to be the most likely cause of relapse of tuberculosis in adults. A novel probe TRC 4 which promises to have diagnostic potential has been developed.

6.27.5. The Central Jalma Institute for Leprosy (CJIL), Agra has developed ribosomal RNA probe and RNA-PCR technique to correlate with viability of the bacilli and diagnosis of active disease. The CJIL, Agra has also developed a Mycobacterial Repository Centre for collection, characterisation and supply of reference and well-characterized Indian strains. The Institute is serving as a Referral Centre for Mycobacterial Diseases for purpose of validation of immunodiagnostic as well as biotechnology products developed in India. A comparative trial of various candidate leprosy vaccines viz. ICRC, N.W.,BCG and a combination of BCG and armadillo derived killed M.leprae (alongwith normal saline used as control) is in its final stages at CJIL's Field Unit, Avadi. The results are expected by end of 1998.

6.27.6. Leptospirosis has been recognized as a major public health problem in some parts of India. Regional Medical Research Centre (RMRC), Port Blair has initiated studies to assess the magnitude of leptospirosis and to understand the relationship between seroprevalence and the attack rate of the disease, and environmental risk factors associated with seropositivity.

6.27.7. Outbreaks of viral encephalitis in Maharashtra, Karnataka, Andhra Pradesh and Tamil Nadu were investigated by National Institute of Virology, (NIV),Pune and found to be due to Japanese encephalitis virus. The disturbing finding is that the infection is now spreading to the rural areas. Simultaneously entomological studies were carried out to know the mosquitoes responsible for the spread of these outbreaks and suggest control measures. Proactive surveillance of vectors of dengue in rural and urban areas has been undertaken by Centre for Research in Medical Entomology (CRME), Madurai to develop reliable surveillance tools and control strategies. A simple inexpensive and effective ovitnap has been developed to measure the density of adult Ae.aegypti. It can also be used as a mosquito control device.

6.27.8. The Enterovirus Research Centre (EVRC),Mumbai and NIV's field station at Bangalore is actively participating in Polio Surveillance activity as a part of WHO SEAR Polio Network in the WHO's Global Polio Eradication Programme. NIV Field Station detected wild polio virus 1 & 3 from states of Karnataka and Andhra Pradesh during 1997. Genetic relationship among poliovirus isolates was studied by sequencing specific regions of viral RNA. A decrease in bio-diversity of virus was seen during 96-97. This finding along with absence of wild polio virus type 2 are evidences of significant impact of Government of India's polio eradication programme.

6.27.9. In first longitudinal study of HIV transmission in India in seronegatives, the sero-prevalence in male STD patients, female STD patients and female sex workers screened in Pune by National AIDS Research Institute (NARI) was 19.7%, 17.6% and 54.7% respectively. The HIV sero-incidence in these groups was 6,7 and 18 respectively. The overall sero- prevalence and incidence was 23% and 7.6%. These findings suggest that the HIV epidemic is persistent and extensive in high-risk groups screened at the clinic sites. Sentinel surveillance for HIV among TB patients in Pune have shown that seroprevalence of HIV increased from 10.75% in 1995 to 21.5% in 1997 indicating increasing trend of HIV infection in TB patients. In view of the spread of HIV among drug users in the eastern part of the country ICMR undertook research activities. It was found that one fifth of IDUs in Calcutta (mostly using buprenophine) were positive for HbsAg while 4% were VDRL reactive. Condom use was insignificant while 74% had had sex with female sex workers and 15% of male IDUs also report being homosexual. The results underscore the urgent need to initiate interventions to control the spread of HIV. An ICMR-WHO project in Manipur has highlighted the need for intensification of the intervention among the sex partners of the IDUs in addition to continued intervention among the IDUs themselves. The results of the project have shown that HIV risk reduction among the IDUs in developing country setting is feasible by means of outreach. A pilot analysis of clades of HIV-I has identified clade C, clade Thai-B and clade North American B. Further studies on immunological, virological and molecular epidemiological aspects and clinical pathology and social studies are underway.

6.27.10. The Rajendra Memorial Research Institute,, (RMRI), Patna has continued to carry out epidemiological, immunological and other basic studies on Leishmania. Feasibility of application of remote sensing technology by GIS for information and mapping of sandfly distribution and evaluation of its role as an epidemic predictor is being investigated at RMRI,Patna. The work has been initiated to establish a leishmania parasite bank at RMRI to provide different species/strains of leishmania for research work. Development of a nucleic acid probe against leishmania has been started.

6.27.11. The Council's Malaria Research Centre applied bioenvironmental methods at 13 different geo ecological sites of the country for control of malaria. The methods are low cost, indigenous and simple and provide long term impact on malaria control and in reduction in mosquito menace. These techniques are being applied through PHCs. The MRC,Delhi has also established a Malaria Parasite Bank which is functioning as a national resource. It supplies different species and strains of parasites, sera/plasma from malaria infected blood of different species, chloroquine resistant and sensitive P.falciparum parasites, specific stages of Pfalciparum produced in vitro to various institutes as per their demand.

6.27.12. In a study conducted by ICMR's Vector Control Research Centre at Pondicherry traditional healers (Dasari) were motivated to participate as village level link workers in Malkangiri district of Orissa state for treatment of uncomplicated malaria cases and for referring malaria cases to Anganwadi workers, ANMs, MPWs or PHC Medical officers. The results demonstrated the feasibility of using Disaris for treatment of malaria

6.27.13. The Council's National Institute of Cholera & Enteric Diseases at Calcutta intensified its research on the major enteropathogens such as Vibrio cholerae, Shigella species, diarrhoeagenic E. Coli and Rotaviruses. The Institute prepared V.cholerae 01 monoclonal and polyclonal antisera and V.cholerae 0139 antiserum which were distributed to different organizations/investigators and through WHO South East Asia Regional Office to different countries in the region.

6.27.14. Reproductive Health: In the field of reproductive health and nutrition basic, clinical as well as operational studies were carried out during 1998-99. The major objective of operational studies has been on developing and implementing intervention strategies aiming to improve the quality and coverage of services for fertility regulation, maternal and child health, safe abortion procedures, reproductive tract infections/ sexually transmitted diseases (RTI/STDs) and adolescent health.

6.27.15. At the Institute for Research in Reproduction, (IRR), Mumbai studies were undertaken to identify endometrial functional markers to predict receptivity of the endometrium to blastocyst implantation. Studies in normally cycling female marmosets and bonnet monkeys showed maximum localization of leukemia inhibitory factor (LIF) in the endornetrial gland during mid-luteal phase of the cycle. Resazurin test to assess sperm function was standardized and validated to assess the quality of the sperm in men. Rez. test and sperm function tests (sperm mitochondrial index, hypo-osmotic swelling test, chromatin decondensation test and gelatin test) were performed simultaneously on semen samples obtained from 50 subfertile men to evaluate the functional ability of the sperm. Rez. test results correlated with the sperm functions tests.

6.27.16. Underthe'IntegratedReproductive Health Care Services' project ongoing through the network of Human Reproduction Research Centres, re-orientation training was provided to PHC medical officers and paramedical workers covering various components of reproductive health. The emphasis of the training was on updating their skills and knowledge for better services and participating in planning, monitoring and evaluation of services using Target Free Approach. The training was provided jointly by the faculty from medical colleges and district hospitals. Altogether 1574 medical officers and 7,683 ANMs/LHVs from 23 districts of the country have been provided this training.

6.27.17. A total of 9,985, including 2,942 pregnant women have been tested under the 'Collaborative Study on Prevalence of RTI/STDs'. Among the pregnant women 1. 8 % were found to be VDRL positive, 3.3 % were positive for hepatitis B, 1.6% for HIV(ELISA) and 2.1% had chlamydial infection.

6.27.18. A study on intramuscular iron therapy for management of anaernia during pregnancy is ongoing. Preliminary data analysis on 300 pregnant women enrolled so far, indicated improvement in haemoglobin level by 1.5 to 2 gm./dI. Under another hospital based study information on indications for Caesarean section in tertiary hospitals has been obtained on about 7,000 cases. The data is under analysis.

6.27.19. 'Feasibility study of using pregnancy detection kits at PHC/SC level' has been initiated to assess the demand for early detection of pregnancy (within 30 days of missed period) in rural and urban slum areas. This study also aims to evaluate the sensitivity and specificity of four pregnancy detection kits (i) Preg Color-Tube test, (ii)Preg Color-Card test (iii) Easy preg-Strip test and (iv) Pregnosis-strip test.

6.27.20. Genetic Medical Research Centre, Mumbai has been offering genetic counselling, genetic screening and antenatal diagnosis. Centre has also been participating in the task force studies. A study on,'Control Programme for Thalassernia by Antenatal Screening' is ongoing at 5 centres. An interim analysis of data on 6,500 pregnant women showed that 3.3 per cent were carriers-of beta thalassernia. The centre is in the process of developing a simple test for carrier detection of thalassemia by ELISA. The aim is to produce a user friendly kit, which can be used at the primary health centre level.

6.27.21. Nutrition: The District Nutrition Project ongoing in 16 districts of the country aims to study the prevalence of micronutrient deficiency disorders and evolve a need based service delivery intervention model through the existing district health system. Analysis of baseline data from 6 districts has shown prevalence of anaernia among 60-96% of pregnant women, prevalence of bitot spots in 0.4 to 4.7 per cent, prevalence of goitre in 0.2 to 8.5% and prevalence of cretinism in 0.06 to 0.5%. Information collected on knowledge, attitude and practices of mothers and paramedical and medical staff is being studied for developing appropriate intervention package.

6.27.22. National Institute of Nutrition, Hyderabad is carrying out studies related to nutrient composition of foods and management of diet and nutrition related diseases. Different types of foods including cereals, millets, pulses, oils, vegetables, milk and milk products etc. have been analysed for their energy, protein, vitamin and mineral contents.

6.27.23. Environmental & Occupational Health: Studies conducted at the National Institute of Occupational Health, Ahmedabad, have concentrated on the occupational hazards to people involved in manufacturing insecticides like methonyl, cotton mills, salt manufacturing workers and tobacco harvesters in addition to the study of the environmental effects of lead in children and noise pollution. This Institute has also developed microbial and aquatic systems for testing toxicity of individual effluents. The Poison Information Centre of the Institute provides information on antidotes and management of poisoning to the medical practitioners round the clock.

6.27.24. Non-communicable Diseases: Operational research and epidemiological studies in areas of national interest i.e. cancer, cardiovascular diseases, blindness and mental health received priority through the task force approach. Field and laboratory based research was encouraged through support provided to individual scientists. Multidisciplinary studies on cervical and breast cancer and reproductive tract infections conducted by the Institute of Cytology & Preventive Oncology, New Delhi focussed on search for preventable factors. The study on cervical cancer has identified age at consummation of marriage, promiscuity, sexual.hygiene and education as important risk factor in aetiology of cervical dysplasia. National Cancer Registry Programme continued providing authentic data on cancer occurrence through its network of seven population-based and five hospital-based cancer registries. Case control studies in cancers of gall bladder and prostate concentrated on identification of aetiological factors. Projects on operational feasibility of early detection of cervical cancer through visual inspection of cervix by paramedical workers and on cost of management of tobacco related diseases have been completed. Studies are also being carried out through environmental carcinogen testing units.

6.27.25. Coronary heart disease, a multifactorial disease, is reported to be increasing amongst the urban population. A multicenteric study to identify the risk factors for acute myocardial infarction in Indian population has been initiated. Multicentric projects on epidemiology and management of glaucoma are continuing to provide data on the prevalence of various types of glaucoma in different parts of the country. In a project on Chlamydial infections four clones producing monoclonal antibodies against chlarnydia have been developed. These antibodies have been used to develop ELISA kits for antigen detection in clinical specimens. Further work on validation of these kits is being pursued. This project has also facilitated establishment of a centre equipped for advanced research on chlamydia at Dr. R.P.Centre, ARMS, New Delhi.

6.27.26. In the area of otorhinolaryngology a task force project on epidemiology, culture and immunological study of rhinosporidiosis was initiated to identify the pathogen causing disease in man. Steps to initiate task force project on role of nutrition in head and neck cancers were also undertaken.

6.27.27. A task force project on parenteral glycyrrhizin (SNMC) therapy of subacute hepatic failure, chronic hepatitis and cirrhosis with activity has been completed. Work on a heat attenuated hepatitis E virus was also undertaken.

6.27.28. Basic Medical Sciences:

6.27.28.(i) Haematology. Prenatal diagnosis and counselling for hemoglobinopathies is being offered to the high risk women for diseases like thalassaernia and sickle cell anaernia. The awareness programme related to this area is simultaneously also taken up with NGOs in the high risk communities. The carrier detection as well as intervention programme in relation to sickle cell anaernia has been carried out in Gadchiroli district of Maharashtra. The PHC doctors were trained for the management of vaso-occlusive crisis in sickle cell anaernia by simple measures like oral electrolyte reconstitution therapy, administration of folic acid, etc.

6.27.28.(ii) The prenatal diagnosis and carrier detection in haemophilia A and B families have been established successfully. The task force on HLA cell tray for Indian population was successfully carried out and three sera were found to be unique to the Indian population which will be very useful for HLA stereotyping in Indians.

6.27.28.(ii)(a) The multicentric task force on lymphocyte subpopulation in Indian subjects revealed that the CD4 count in Indians is low as compared to the western population. However, CD8 values are comparable. The screening of 147 multitransfused haemophiliacs for hepatitis B, hepatitis C and HIV revealed that 15 % were reactive for HBsAg, 23% for HCV and 6% for HIV. This study therefore, stresses the importance of screening the donors for hepatitis C.

6.27.28.(ii)(b) The Centre for Advanced Research in Bone Marrow Transplantation (BMT) for thalassemia major established at the Christian Medical College, Vellore carried out both clinical as well as laboratory studies on BMT. 'Ibis Centre has become a comprehensive centre for management of thalassemia in India and has carried out bone marrow transplantation in about 90 thalassemia major cases.

6.27.28.(iii) Pathology: Studies are in progress to understand the pathogenesis of post Kala-azar dermal leishmaniasis and to develop better diagnostic methods for this condition.

6.27.28.(iii)(a) Breast cancer cells cultured in vitro are being studied to understand the regulation of senescence in this cell line. In addition, neural tumours such as medullo and neuro blastomas have been studied for their differentiation patterns and alterations in adhesion molecules.

6.27.28.(iii)(b) Teaching atlases on pathology are being revised and updated.

6.27.28.(iv) Traditional Medicine Research: In the area of traditional medicine research, the ICMR continued its multidisciplinary centrally coordinated task force strategy following the disease oriented approach in the evaluation of selected traditional remedies/techniques in refractory disease conditions. In the area of diabetes mellitus, a multicentric flexible dose double blind randornised clinical trial on an Ayurvedic drug has been in progress. Multicentric clinical trials are also in progress on an Ayurvedic drug for the treatment of bronchial asthma.

6.27.28.(iv)(a) In an attempt to develop/strengthen human resources, a national training course-cum-workshop was organ- ised on "biostatistical techniques in controlled clinical trials on traditional remedies".

6.27.28.(v) Publication, Information & Communication: The Council's periodical publications, the ICMR Patrika, the ICMR Bulletin and the Indian Journal of Medical Research (IJMR) continued to be published during the year 1998-99. The IJMR brought out a special issue on Nutrition Research to commemorate 80 years of the National Institute of Nutrition, Hyderabad (1918-1998) in November, 1998. As part of the Hindi Day Celebrations, a popular lecture in Hindi on "Paralytic Stroke and its Prevention" was organised. The preparation of the III volume and updation of the 11 volume of the Monograph on Medicinal Plants of India is in progress.

6.27.28.(v)(a) The Council participated in a S&T exhibition to. commemorate the 50th Anniversary of India's Independence organ- ized by the Department of Science & Technology at the India Gate lawns New Delhi in August', 1998.

6.27.28.(v)(b) The Council's Institute for Research in Reproduction, Mumbai, celebrated the World Population Day on July 11, 1998 by organizing discussions on the effects of overpopulation; reproductive health care in the community; and available methods of contraception. The National Institute of Nutrition, Hyderabad celebrated the "Nutrition Week" during September 1-7, 1998 by organizing various events including open house, popular lectures, exhibitions, etc.

6.27.28.(v)(c) The Council's ICMR-NIC Centre for Biomedical Information, started in 1986, has been designated as the 17th International MEDLARS Centre by the National Library of Medicine(NML), USA. The Centre has progressed well in its objectives viz. dissemination of the latest information on biomedical research throughout the country; developing bibliographic database of Indian biomedical research and its dissemination on the Internet; and training of medical/library professionals on searching the databases. A total of 154 institutions across the country are accessing MEDLARS services using NICNET facilities. A large number of individual users avail search services by visiting the Centre. Seventy four State and District Centres of NIC have been equipped to provide MEDLARS services to the local professionals. The exhaustive compilations prepared by the Centre on diseases like malaria, plague, dengue, buffalo-pox and epidemic dropsy have been widely acclaimed by various agencies. With arrangements from ADONIS and the NLM, USA, the Centre provides full text of articles requested by the users in the shortest possible time. Top priority is accorded to the patient care searches, which are conducted free of charge. Comprehensive information on drugs and the compilation of the Union Catalogue are some of the invaluable services, which have been appreciated by the medical community.