Indian Council of Medical Research's National Ethical Guidelines for biomedical and health research involving human participants: The way forward from 2006 to 2017

A comprehensive review on the current status of CRISPR based clinical trials for rare diseases

A considerable fraction of population in the world suffers from rare diseases. Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and its related Cas proteins offer a modern form of curative gene therapy for treating the rare diseases. Hereditary transthyretin amyloidosis, hereditary angioedema, duchenne muscular dystrophy and Rett syndrome are a few examples of such rare diseases. CRISPR/Cas9, for example, has been used in the treatment of β-thalassemia and sickle cell disease (Frangoul et al., 2021; Pavani et al., 2021) [1,2]. Neurological diseases such as Huntington's have also been focused in some studies involving CRISPR/Cas (Yang et al., 2017; Yan et al., 2023) [3,4]. Delivery of these biologicals via vector and non vector mediated methods depends on the type of target cells, characteristics of expression, time duration of expression, size of foreign genetic material etc. For instance, retroviruses find their applicability in case of ex vivo delivery in somatic cells due to their ability to integrate in the host genome. These have been successfully used in gene therapy involving X-SCID patients although, incidence of inappropriate activation has been reported. On the other hand, ex vivo gene therapy for β-thalassemia involved use of BB305 lentiviral vector for high level expression of CRISPR biological in HSCs. The efficacy and safety of these biologicals will decide their future application as efficient genome editing tools as they go forward in further stages of human clinical trials. This review focuses on CRISPR/Cas based therapies which are at various stages of clinical trials for treatment of rare diseases and the constraints and ethical issues associated with them.

Mannose-Binding Lectin Gene Variants as Disease Susceptibility Biomarkers in Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease characterized by progressive destruction of peripheral joints. About 1% of the human population worldwide is suffering from this disease. The pathophysiology of RA is largely being influenced by immune dysregulation. Mannose-binding lectin (MBL), an acute-phase protein, has been reported to play an important role in pathogenesis of RA by the activation of complement pathway. Various studies documented the established the role of MBL in pathogenesis of various autoimmune diseases, including RA. MBL protein is encoded by gene MBL2, mapped on chromosome 10q11.2-q21. Objective: Both MBL serum levels and activity are mainly determined genetically by its variants. So considering the putative clinical role of MBL2, this case-control association study was designed to assess its six functional variants in a northwestern Indian cohort. Methods: Genetic typing of six MBL2 variants was done by amplification refractory mutation system-polymerase chain reaction. Data were analyzed using suitable statistical tools. Results: Significant difference has been observed in genotypic and allelic distribution between cases and controls for rs11003125. Comparison of allelic distribution for rs1800450 showed significantly high prevalence of A allele in cases than controls. Conclusion: These results indicate that MBL2 variants may act as plausible marker for susceptibility toward RA. Keeping this in view, it is pertinent to screen these variants in other population groups of India.

A Brief Review on Good Clinical Practice and its Training Methods

The field of clinical research continues to advance, and for ethical conduct of research, researchers need to have a strong foundation in good clinical practice (GCP). GCP guidelines are internationally recognized standards that govern the conduct of clinical trials, ensuring the protection of human subjects and the generation of reliable data. However, novice researchers or postgraduate medical students who would delve into research activities may face difficulty getting avenues for GCP training. Hence, in this brief review article, we discuss the significance of GCP in the field of clinical research with a glimpse of its history, development, and key principles. We provide a list of online courses, benefits, and disadvantages of those courses, and a list of organizations that conduct GCP workshops or continued medical education programs in India.

Design and implementation of multicenter pediatric and congenital studies with cardiovascular magnetic resonance: Big data in smaller bodies

Cardiovascular magnetic resonance (CMR) has become the reference standard for quantitative and qualitative assessment of ventricular function, blood flow, and myocardial tissue characterization. There is a preponderance of large CMR studies and registries in adults; However, similarly powered studies are lacking for the pediatric and congenital heart disease (PCHD) population. To date, most CMR studies in children are limited to small single or multicenter studies, thereby limiting the conclusions that can be drawn. Within the PCHD CMR community, a collaborative effort has been successfully employed to recognize knowledge gaps with the aim to embolden the development and initiation of high-quality, large-scale multicenter research. In this publication, we highlight the underlying challenges and provide a practical guide toward the development of larger, multicenter initiatives focusing on PCHD populations, which can serve as a model for future multicenter efforts.

A cross-sectional audit of informed consent of online survey: Characteristics and adherence to prevalent guidelines

Background

Research on human participants requires formal approval from a competent ethics committee. During the recruitment of the research participants, obtaining informed consent is a prerequisite. The online survey method is used by many researchers as it can collect the data from a diverse population in a short time.

Aim

This study aimed to observe the characteristics and adherence to prevalent guidelines (set by the Indian Council of Medical Research [ICMR]) of informed consent coupled with online surveys.

Methods

We collected the informed consent text from online survey links obtained from a network of colleagues who got a request to participate in a survey. Data were collected from July 2020 to June 2022. The text was anonymized for further analysis. The word count, sentences, and Flesch reading ease score were calculated. The adherence to ICMR guidelines where checked by two authors individually and a consensus was reached to prepare the final result.

Results

A total of 44 online surveys in English were audited and among them, 10 did not have informed consent. The informed consent in 34 surveys had a median of 6 sentences and 84 words. The median reading ease score was 45.7 (college level). The majority of the consent states the purpose of the research (91.18%), the voluntary nature of the participation (85.29%), and mentioned that it is research (64.71%). However, the rest of the components are ignored by the majority of the survey consent form.

Conclusion

Informed consent form with online surveys lacks adherence to the components suggested by ICMR. Hence, the forms should be made carefully by the researchers so that the vigor of informed consent is maintained in the online surveys.

Uncovering Caregiver Concerns: 5 key issues that still remain unresolved in administration of oral medicines for children in India

INTRODUCTION

Administration devices play a very crucial role in achieving a drug's therapeutic effect. Children are often dosed with oral liquids, but dosing devices don't have the accuracy needed, putting them at risk of inaccurate and suboptimal dosing. The availability and use of administration devices may vary throughout the world. Multiple surveys in UK, Europe and Japan have shown diverging practices by parents/caregivers. The aim of the present investigation was to conduct a larger Pan-India study through a series of workshops to understand the use and challenges of traditional devices and assess the need of innovative administration devices for liquid orals in India.

METHODS

The methodology used for the workshop was contextual inquiry and survey questionnaire were used to record the responses. Parents for the workshop were recruited by advertising the survey on various social media platforms. Informed consent was taken from the parents or caregivers for their participation in the survey. Workshops were conducted pan India and both middle class and urban worker families in the occupational category were included in the study. During the workshop, the parents were briefed about the background and purpose of the study. Certain global innovative devices such as oral syringes, syringes with pacifiers were shown to the parents. Their views and opinions were taken through survey questionnaire and via interactive sessions. The questions were themed for the interactive session on 1) challenges faced, 2) willingness to use innovative devices and 3) the factors influencing their decision on the use of innovative devices.

RESULTS

Across the four regions (4 metro cities) involved in the study, 271 caregivers agreed to participate in the workshops. 17.7% administered solid dosage forms, 81.2% administered liquid dosage form and the remaining 1.1% opted for others. Traditional devices: Caregivers reported the use of measuring cups (41.4%) followed by household spoons (25.8%), droppers (15.3%), measuring spoons (2.6%), and other dosing devices (5.5%) for measuring oral liquids. 8.0% did not use any of the dosing devices as they were administrating tablets and/or capsules. The ease-of-use score was the highest for the dropper (2.67 ± 0.68) and the lowest for the measuring spoon (2.00 ± 1.00). The reported challenges were categorised into five categories which also influences the preference of using administration devices. This includes device design, user experience and usability, sociocultural factors, such as beliefs, knowledge and education, regulatory, and market/distribution. Innovative devices: The majority of the caregivers (86.7%) were not aware of any of the innovative devices shown to them. 58.7% were willing to use it if was recommended by the doctor, 1.5% of caregivers would use it on pharmacists' recommendation and 37.6% parents would use it if came along with the medicine. The criteria considered by the parents for use of the innovative devices in the descending order were Doctor's recommendation> Quality> Cost> Packed in medicine> Ease of use > Availability/accessibility. There were no differences observed among the low and high socioeconomic status of caregviers regarding the use of traditional devices, challenges faced and awareness about innovative devices. Overall, the study revealed heterogeneity in the SES for the use of administration devices in the four zones. The association of SES and opinion on the use of administration devices was demonstrated with no statistically significant interaction between caregiver SES and the use of administration devices.

CONCLUSION

The workshop revealed the prevalence of traditional dosing devices like measuring cups, household spoons among the caregivers. It highlighted key issues with the use of appropriate administration devices for correct and accurate dosing in children that remain unresolved and prevalent in India. This study reflects on the needs of the target community; thus hope will help facilitate the development of locally sustainable solutions to improve the administration of medicines in children in India.

Simple determination of dichlorvos in cases of fatal intoxication by gas Chromatography-Mass spectrometry

Dichlorvos (DDVP) is an organophosphorous insecticide which is classified as "highly hazardous" Class 1B chemical by World Health Organization (WHO) and largely misused for the purpose of self-poisoning in developing countries. Forensic toxicology laboratories are routinely encountering cases of pesticide poisoning due to their fatal intoxication. Herein; a method is described based on vortex-assisted dispersive liquid-liquid microextraction (VA-DLLME) coupled with Gas Chromatography-Mass Spectrometry (GC-MS) for the determination of an organophosphorous insecticide; dichlorvos (DDVP) in human autopsy samples (blood, stomach content and liver). Under the optimum conditions, the method was found to be linear in the range of 0.5-10 µg mL^-1 and 1.5-10 µg g^-1 for blood and tissue samples, respectively. Limit of quantification was set at 0.55 µg mL^-1 and 1.1 µg g^-1 for blood and tissue samples, respectively. Intraday and inter-day precisions were less than 8 and 12 %, respectively. Good recoveries in the range of 86-95 % were obtained for the proposed procedure. The method has been satisfactorily applied for the determination of DDVP in autopsy samples from two different cases received in our laboratory. In comparison to previous methods; the proposed method is relatively short, high sample throughput, inexpensive and adheres to the principles of green analytical chemistry (GAC) for determination of DDVP in human autopsy samples. The method can be adopted in forensic toxicological laboratories for analysis of DDVP in autopsy samples. In addition, the green character of the proposed method was evaluated using ComplexGAPI procedure.

The First Wave of the COVID-19 Pandemic Strengthened the "Strong" and Weakened the "Weak" Ones

The aim of this study was to explore how the first wave of the COVID-19 pandemic, during which contact communication was severely restricted, changed psychological health indicators, such as subjective assessment of health and depression, impulsivity, stress and emotional intelligence (EI) and how that depended on age, gender, physical activity (PA), sports specificity and body mass index (BMI).We surveyed 6369 before and 2392 people during the first wave of the COVID-19 pandemic. The participants were aged 18-74 years. Participants completed the Danish Physical Activity Questionnaire (DPAQ), the 10-item Perceived Stress Scale (PSS-10), the Schutte Self-Report Emotional Intelligence Test (SSREIT), Barratt Impulsiveness Scale Version 11 (BIS-11), subjective depression and health self-assessments. One-way and two-way analyses of variance (ANOVA) were performed to assess the effect of independent variables on the dependent variables of MVPA (METs). Statistical analysis showed that restrictions during the first wave of the COVID-19 pandemic did not alter moderate-to-vigorous physical activity (MVPA), except for a significant decrease in MVPA in women aged 18-25 years, or body mass index in women and men of different ages. An increase in depression and impulsivity was observed, especially an increase in unplanned or spontaneous activity. The restrictions during the first wave increased stress in women of all ages and, rather unexpectedly, improved health self-assessment in men.The study showed that the first wave of the COVID-19 pandemic affected people's subjective assessment of health, depression, stress and impulsivity in two ways: it "weakened the weak ones" and "strengthened the strong ones".

Do Physical Activity, BMI, and Wellbeing Affect Logical Thinking?

We studied 6368 people (4544 women and 1824 men; aged 18–74 years). The research goal was to determine whether the Cognitive Reflection Test score (logical thinking compared with intuitive thinking) depends—and in what way it depends—on the healthy lifestyle components and emotional health-related components as well as age (18–74 years) and gender. We established that analytical vs. intuitive thinking depended on components of a healthy lifestyle, physical activity, sleep, eating habits, smoking and alcohol consumption, specificity of sporting activity, body mass index, and emotional health-related components (stress, depression, impulsivity, subjective health, emotional intelligence), as well as age and gender. We found that logical thinking was not associated with sleep, moderate-to-vigorous PA, impulsivity, subjective health, and components of a healthy lifestyle. However, logical thinking decreases with age, gender (higher in men than in women), BMI (decreases in both genders over the second degree of obesity), depression (the more severe depression in women, the worse their logical thinking), sedentary behavior (people who sat for longer periods had more difficulty solving problems), and in professional sportswomen (logical thinking is worse in professional sportswomen than in sedentary women, amateur sportswomen, or women who use gyms). Finally, we determined inverse correlations between logical thinking, emotional intelligence, and stress.

Physical Activity, Stress, Depression, Emotional Intelligence, Logical Thinking, and Overall Health in a Large Lithuanian from October 2019 to June 2020: Age and Gender Differences Adult Sample

This study aimed to examine relationships and group differences among adult people’s (aged 18–74) physical activity (PA), expression of stress, depression, emotional intelligence (EI), logical thinking (LT), and overall health assessment. Two hypotheses were formulated before the study. The first hypothesis is that overweight and obesity in young adults (18 to 34 years) females and males, in particular, should increase sharply and this should be associated with decreased PA, abruptly deteriorating subject health, increased stress, depression, and poorer emotion management and EI. Second hypothesis: We further thought that the better people’s reflective thinking, the more they should live a healthier life (e.g., exercise more and eat healthier), their overweight and obesity should be small or none. We aimed to confirm or reject these two hypotheses. We applied a quantitative cross-sectional study design. The study results revealed that during the lifespan of 18–24 and 25–34 years (young adults) there was a sharp increase in overweight and obesity, a decrease in PA (and especially vigorous physical activity (VPA)) (and this was particularly evident in the male), while research participants felt less stress and depression, subjective assessment of health did not change, and EI increased steadily with age (18–24 to 65–74 years). The higher the EI of the research participants from 18–24 to 65–74 years of age the higher their moderate-to-vigorous physical activity (MVPA), the less stress and depression they felt. Based on the results, it can be said that both females and males prefer PA “with a hot heart rather than a cold mind.” We base this conclusion on the fact that females and males who have the highest EI also have the highest MVPA while LT is not associated with MVPA.

Assessment of ASHA for knowledge, diagnosis and treatment on malaria in Mandla district of Madhya Pradesh as part of the malaria elimination demonstration project

Background

The role of Accredited Social Health Activist (ASHA) in the health care delivery services at the periphery level is crucial for achieving disease prevention, control and elimination goals. The objective of the study was to assess the knowledge, attitude, practices, priorities and capability of ASHA related to malaria diagnosis and treatment as part of the Malaria Elimination Demonstration Project in 1233 villages of district Mandla, Madhya Pradesh.

Methods

A cross sectional study was conducted using a fully structured, pre-tested interview schedule during June and July 2017 (before the field operations of MEDP were started). Two hundred twenty (17%) of the total ASHAs were selected for the interview from the 9 developmental blocks of Mandla district.

Results

Knowledge, Attitude and Practices (KAP) study revealed that most ASHAs knew that mosquitoes are the main agent for spread of malaria (97.7%). They mostly used Rapid Diagnostic Test (RDT) for diagnosis (91.8%). The majority (87.3%) correctly identified negative RDT result while only 15% and 10.5%, respectively, identified Plasmodium vivax and Plasmodium falciparum positive cases correctly. Further analysis showed that 85% ASHAs used chloroquine, 44.5% used artemisinin-based combination therapy (ACT), and 55.5% used primaquine for treatment of malaria. It was also found that only 38.2% ASHA gave PQ for 14 days in cases of P. vivax. At the time of the interview, 19.1% ASHAs did not have any RDTs for diagnosis and 47.7% reported not having ACT for treatment of P. falciparum malaria.

Conclusions

This study has revealed that ASHAs in the test district were not adequately trained or stocked for malaria parasite species identification and treatment, which are the major components of malaria elimination programme. This study has, therefore, revealed a need for training ASHAs on testing by RDT and proper treatment regimen for P. vivax and P. falciparum.

Managing conflict of interest in Ethics Committee

The article discusses conflict of interest (COI) situations and how to manage COI in ethics committee (EC).