EPIT with Viaskin milk viable therapeutic option for immunoglobulin E-mediated cow’s milk allergy: JAMA

Cow’s milk allergy (CMA) is a common childhood food allergy with no approved treatment. However, a recent clinical trial investigated the efficacy and safety of epicutaneous immunotherapy using Viaskin milk in children with IgE-mediated CMA.

IgE-mediated CMA poses significant challenges for affected children and their families, as it can lead to severe allergic reactions and impact quality of life. This study was published in the journal JAMA Pediatrics by Daniel P. and colleagues.

This phase 1/2 clinical trial enrolled 198 children aged 2 to 17 years with confirmed IgE-mediated CMA. The study evaluated the safety and efficacy of Viaskin milk at doses of 150 μg, 300 μg, and 500 μg compared to placebo over a 12-month treatment period. The primary outcome measure was the proportion of treatment responders based on the cumulative reactive dose of cow’s milk protein at the month 12 food challenge.

  • Among the participants, 95.5% completed the treatment regimen.

  • The highest treatment response rate (49.0%) was observed in children who received Viaskin milk at the 300-μg dose, compared to 30.2% in the placebo group.

  • This response was particularly notable in children aged 2 to 11 years, with a response rate of 57.9% in the 300-μg dose group compared to 32.5% in the placebo group.

  • Most adverse events were mild or moderate application-site reactions, with low rates of treatment-related anaphylaxis.

The findings of this trial suggest that 12 months of daily epicutaneous immunotherapy with Viaskin milk at a dose of 300 μg is associated with a statistically significant treatment response in children with IgE-mediated CMA. Treatment-related adverse events were generally mild, and discontinuation rates were low. Further research is warranted to confirm these findings and explore Viaskin milk as a potential treatment option for children with CMA.

Epicutaneous immunotherapy using Viaskin milk shows promise as a novel approach to treating cow’s milk allergy in children. The study’s findings underscore the need for additional research to validate these results and assess the long-term efficacy and safety of this therapeutic approach.

Reference:

Petroni, D., Bégin, P., Bird, J. A., Brown-Whitehorn, T., Chong, H. J., Fleischer, D. M., Gagnon, R., Jones, S. M., Leonard, S., Makhija, M. M., Oriel, R. C., Shreffler, W. G., Sindher, S. B., Sussman, G. L., Yang, W. H., Bee, K. J., Bois, T., Campbell, D. E., Green, T. D., … Wood, R. A. Varying doses of epicutaneous immunotherapy with Viaskin milk vs placebo in children with cow’s milk allergy: A randomized clinical trial. JAMA Pediatrics,2024. https://doi.org/10.1001/jamapediatrics.2023.6630

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Oocytes outsmart toxic proteins to preserve long-term female fertility

Oocytes are immature egg cells that develop in almost all female mammals before birth. The propagation of future generations depends on this finite reserve of cells surviving for many years without incurring damage. In mice, this can be a period of up to eighteen months, while in humans it can last almost half a century, the average time between birth and menopause. How the cells accomplish this remarkable feat of longevity has been a longstanding question.

Researchers at the Centre for Genomic Regulation (CRG) in Barcelona have discovered a new mechanism which explains how oocytes remain in pristine conditions for decades without succumbing to the wear and tear that would cause other cell types to fail. The findings, reported today in the journal Cell, represent a new frontier to explore unexplained causes of infertility.

The researchers looked at protein aggregates, which are clumps of misfolded or damaged proteins. If left unchecked, these harmful substances accumulate in the cytoplasm and have highly toxic effects. Protein aggregates are known to accumulate in neurons and their effects have been linked to several neurodegenerative diseases. Cells usually manage aggregates by breaking them down with specialized enzymes. They can also divide into two new cells, concentrating aggregates in one of the cells and sparing the other.

But oocytes are not like the other cells. Their long life means they cannot dissipate toxic substances through cell division. Constantly breaking down protein aggregates is an inviable strategy, as it requires using a high amount of energy that may not be available. Oocytes also have the job of donating their entire cytoplasm to an embryo after fusing with a sperm, and so prefer to reduce their metabolic activity, a strategy which avoids generating by-products which can damage the maternal DNA and compromise future reproductive success. This makes oocytes particularly sensitive to the effects of misfolded or damaged proteins.

However, “in contrast to the tens of thousands of papers on protein aggregation in neurons, how mammalian oocytes cope with protein aggregation is essentially unstudied, despite having the same problem of being long-lived and non-dividing”, explains Dr. Elvan Böke, Group Leader of the Oocyte Biology & Cellular Dormancy programme at the Centre for Genomic Regulation and author of the study. “We wanted to explore how oocytes deal with these misfolded or damaged proteins”, adds Dr. Böke.

Patrolling ‘clean-up crews’

Dr. Böke’s team, led by Dr. Gabriele Zaffagnini, started by collecting thousands of immature oocytes, mature eggs, and early embryos from adult mice. Using special dyes, they observed how the protein aggregates behave in real-time using a technique called live-cell imaging. They also used electron microscopy to get a closer look and see nanoscopic details inside cells, work that took five and a half years to complete.

The researchers discovered special structures in the oocytes which they named EndoLysosomal Vesicular Assemblies-or ELVAs for short. These structures -there are about 50 per each oocyte – roam the cytoplasm, where they capture and hold onto protein aggregates, rendering them harmless. Cells have many subcellular structures known as organelles, which perform jobs much like an organ does in the body. The researchers conceptualise ELVAs as a “superorganelle” because it is a network of many different types of cellular components working together as a single unit.

The study revealed a crucial moment during the oocyte maturation stage, which is when an oocyte converts into a mature egg, preparing for ovulation and possible fertilisation. During this stage, the researchers observed ELVAs moving towards the cell’s surface and breaking down the protein aggregates, essentially deep-cleaning the cytoplasm. This is the first observation of the unique strategy oocytes employ to get rid of protein aggregates.

“An oocyte must donate all its cytoplasm to the embryo at fertilisation, so it cannot afford for garbage to accumulate, which would pose an existential risk for its function. In that sense, ELVAs are like a sophisticated waste disposal network or clean-up crew, patrolling the cytoplasm to ensure no aggregates are freely floating. ELVAs keep these aggregates in a confined environment until the oocyte is ready to dispose of them in one fell swoop. It’s an effective and energy-efficient strategy,” says Dr. Zaffagnini, postdoctoral researcher at the Centre for Genomic Regulation.

Protein aggregates may contribute to infertility

Fertility declines with age, and poor oocyte quality is the major cause of female infertility. Global infertility rates are also on the rise, with delayed motherhood being one of the contributing factors. Understanding how oocytes remain healthy, and what causes these strategies to fail with age, is critical for understanding unexplained causes of infertility and open up new avenues for treatment.

The findings of the study suggest that the presence of protein aggregates could interfere with both egg and embryo quality. When the researchers experimentally prevented the ability of ELVAs to degrade protein aggregates during the oocyte maturation process, it led to the formation of defective eggs. When the researchers intervened and “forced” the embryos to inherit aggregated proteins, 3 in 5 (60%) failed to complete very early stages of development.

“A lot of studies have historically focused on one small aspect of why oocyte quality declines, which are meiosis and euploidy. However, a recent review of eleven thousand embryo transfers has shown that the decline in female fertility with age are heavily influenced by other, yet unknown factors. Our research opens a fascinating future direction to explore whether protein degradation, and problems with how they are regulated in oocytes, could explain the age-related decline in embryo health,” concludes Dr. Böke.

Another type of long-lived cell which do not divide yet have to deal with protein aggregates are neurons. The accumulation of the harmful substances in these cells is linked to the development of several types of neurodegenerative diseases including Alzheimer’s. Could ELVA-like compartments also exist in neurons and other cell types? The study opens the door for future research avenues beyond the field of reproduction. 

Reference:

Gabriele Zaffagnini, Shiya Cheng, Marion C. Salzer, Manuel Irimia, Melina Schuh, Elvan Böke, Mouse oocytes sequester aggregated proteins in degradative super-organelles, Cell, DOI:https://doi.org/10.1016/j.cell.2024.01.031.

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Long-Term Ozone Exposure Linked to Increased Risk of Chronic Kidney Disease Mortality, reveals study

Chronic kidney disease (CKD) is a significant public health concern worldwide, with mortality rates continuing to rise. While the adverse effects of environmental pollutants on respiratory and cardiovascular health are well-documented, the impact on renal outcomes remains unclear.

Ozone, a major component of air pollution, is known to induce oxidative stress and inflammation, which may contribute to the progression of CKD. A recent study aimed to investigate the association between long-term ozone (O3) exposure and mortality in individuals with CKD. This study was published in the journal of BMC Nephrology by Ejin Kim and colleagues.

A cohort of 61,073 participants was included in this study, with researchers employing Cox proportional hazards models to analyze the association between ozone exposure and the risk of end-stage renal disease (ESRD) and mortality. Ozone concentrations were calculated based on exposure one year before enrollment using inverse distance weighting (IDW) for interpolation. Models were adjusted for socioeconomic status and other measured pollutants.

The key findings of the study were:

  • In both single and two-pollutant models, long-term ozone exposure was significantly associated with an increased risk of ESRD and all-cause mortality.

  • The hazard ratios (HR) for ozone exposure varied depending on the assessment method, with HR values of 1.025 (95% CI: 1.014–1.035) at the district level and 1.04 (95% CI: 1.035–1.045) at the individual address level for ESRD risk.

  • Similarly, HR values for all-cause mortality were 1.012 (95% CI: 1.008–1.017) at the district level and 1.04 (95% CI: 1.031–1.05) at the individual address level.

This study provides compelling evidence that long-term ambient ozone exposure increases the risk of end-stage renal disease and mortality in individuals with chronic kidney disease. The findings underscore the importance of implementing strategies to reduce ozone emissions, which would not only benefit public health but also contribute to environmental preservation. Efforts to mitigate ozone pollution are essential in safeguarding the health of vulnerable populations and promoting overall well-being.

Reference:

Kim, E., Huh, H., Mo, Y., Park, J. Y., Jung, J., Lee, H., Kim, S., Kim, D. K., Kim, Y. S., Lim, C. S., Lee, J. P., Kim, Y. C., & Kim, H. Long-term ozone exposure and mortality in patients with chronic kidney disease: a large cohort study. BMC Nephrology,2024;25(1). https://doi.org/10.1186/s12882-024-03500-6

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H. pylori Infection Linked to Increased Dementia Risk in Older Adults

Chronic infectious diseases are increasingly recognized as potential contributors to dementia risk, prompting researchers to explore the role of infections such as H. pylori in cognitive decline. The association between chronic infectious diseases and dementia risk, including Alzheimer’s disease, has gained attention in recent years. Helicobacter pylori, a common bacterial infection affecting the stomach lining, has been suggested as a potential contributor to dementia risk.

A recent study aimed to investigate the association between H. pylori infection and incident dementia in older adults. This study was published in the Journal Of The American Geriatrics Society by Virgilio H. and colleagues. Conducted on a prospective cohort of 689 older agricultural workers aged 65 years and above from Southwest France, this study assessed the association between H. pylori infection and incident dementia over a 7-year follow-up period.

Participants were categorized based on H. pylori status determined by serology at baseline, and cognitive performance was evaluated. Survival analyses, including Kaplan–Meier curves and Cox proportional hazards models, were used to explore the risk of incident dementia according to H. pylori status.

  • Among the participants, 29.0% were H. pylori-positive at baseline.

  • These individuals exhibited worse cognitive performance compared to H. pylori-negative participants at baseline.

  • Over the follow-up period, 85 incident dementia cases were diagnosed.

  • After adjusting for confounding factors such as age, sex, education, and cardiovascular risk factors, H. pylori infection remained significantly associated with an increased risk of dementia (HR 1.70, 95% CI 1.05–2.74).

  • The risk was particularly pronounced for Alzheimer’s disease (HR 2.85, 95% CI 1.58–5.12).

Despite a decrease in the prevalence of H. pylori infection, this study provides compelling evidence for the association between H. pylori infection and dementia, particularly Alzheimer’s disease, in older adults. These findings underscore the importance of further research to elucidate the mechanisms linking infectious diseases, gut inflammation, and pathological brain aging. Understanding these mechanisms could pave the way for novel preventive and therapeutic strategies to mitigate dementia risk in older populations.

Reference:

Hernández-Ruiz, V., Roubaud-Baudron, C., Von Campe, H., Retuerto, N., Mégraud, F., Helmer, C., Amieva, H., & Pérès, K. Association between Helicobacter pylori infection and incident risk of dementia: The AMI cohort. Journal of the American Geriatrics Society,2024. https://doi.org/10.1111/jgs.18748

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Swapping meat for Quorn lowers bad cholesterol by 10-percent

Regularly substituting meat for mycoprotein such as Quorn could help to lower bad cholesterol by 10-percent, which is comparable to switching to a Mediterranean or vegan diet.

New research by the University of Exeter, published in Clinical Nutrition, also found substituting meat for Quorn reduces blood glucose and c-peptide concentrations associated with diabetes, cardiovascular disease and all-cause mortality.

With one in six UK adults suffering from raised cholesterol, the findings indicate that mycoprotein – the high protein, high-fibre food source that’s the main ingredient in Quorn – could play a key role in cholesterol management and improving heart health.

Dr George Pavis, of University of Exeter, led the study and said: “We’re really excited about these results and what they mean for public health. Previous laboratory studies, where all food eaten is controlled and alcohol and caffeine consumption regulated, have clearly shown that daily consumption of mycoprotein reduces bad cholesterol. But this is the first study of its kind to explore the impact of such a dietary intervention in a real-world, home-based setting where participants were not restricted in terms of what else they consumed or did.

“The findings demonstrate that introducing Quorn foods into a diet on a regular basis helps to significantly lower bad cholesterol, blood glucose and c-peptide concentrations, which is important for boosting heart health and reducing the risk of cardiovascular disease.

“It was particularly interesting to see the scale of the impact that Quorn consumption had in terms of reducing harmful cholesterol, with its performance over four weeks comparable to what we might expect to see from well-established approaches, such as following a Mediterranean diet.”

The remotely delivered study involved 72 overweight adults with high cholesterol levels. Researchers found that participants who ate 180g of Quorn products on a daily basis – equivalent to two servings of Quorn mince – saw a 10-percent reduction in ‘bad’ LDL cholesterol over the four-week study period. This equates to a 0.3 millimole per litre (mmol/l) decrease in bad cholesterol levels in less than one month.

Research has shown how more wholesale healthy dietary changes, such as switching to a Mediterranean or vegan diet, will typically deliver a 0.2 – O.3 mmol/l reduction in bad cholesterol levels after 12 weeks. Researchers at the University of Exeter also noted that typical doses of atorvastatin, the most popular statin prescribed by the NHS to treat high cholesterol, commonly yield a 0.3 – 1.3 mmol/l reduction after 12 months.

According to medical research, a decrease of 0.39 mmol/l in bad cholesterol levels is associated with a 25% lower lifetime risk of heart and circulatory disease. With pharmaceutical trials suggesting that reductions increase in a linear way over time, the researchers suggested further studies should be undertaken to see if the results improve even further when Quorn is eaten over a longer period.

The study – which saw half of the participants (39) given meat and fish products to eat on a daily basis as part of their regular diet, while the other half (33) were provided with Quorn products – also revealed further heart health benefits.

High blood sugar levels and c-peptide concentrations are commonly associated with diabetes and an increased risk of cardiovascular disease and all-cause mortality. The researchers found that study participants who ate Quorn products experienced, on average, a 13-percent drop in blood glucose levels and a 27-percent fall in c-peptide concentrations, compared with the control group. With current data showing that 2.4 million people are at an increased risk of type 2 diabetes in the UK based on high blood sugar levels, these findings demonstrate how mycoprotein could also play a key role in tackling a disease that currently costs an estimated £14 billion a year to treat.

The findings come after the latest annual Health Survey for England estimated that well over half (59-percent) of adults suffer from raised cholesterol and one in ten from diabetes, with both conditions known to cause cardiovascular disease – meaning millions of people could be at risk of a potentially fatal heart attack or stroke.

Sam Blunt, Quorn’s director of sustainability and corporate affairs, said: “The potential cholesterol-lowering effects of Quorn’s mycoprotein were first identified nearly four decades ago and, since then, numerous studies have helped us to understand more about the extent of its cholesterol management capabilities, with its high-fibre content thought to play a key role in this.

“While the benefits of adopting a Mediterranean diet are clear, it’s not always easy to do and this study highlights how, by simply introducing Quorn products into their diet on a regular basis, people may be able to quickly reduce their cholesterol levels and improve their heart health with minimal effort.”

Reference:

George F. Pavis, Raquel Revuelta Iniesta, Holly Roper, Tim J.A. Finnigan, Francis B. Stephens, Benjamin T. Wall, A four-week dietary intervention with mycoprotein-containing food products reduces serum cholesterol concentrations in community-dwelling, overweight adults: A randomised controlled trial, Clinical Nutrition, DOI:https://doi.org/10.1016/j.clnu.2024.01.023.

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FDA Approves Clobetasol Propionate Ophthalmic Suspension for Post-Operative Ocular Care

The FDA has approved clobetasol propionate ophthalmic suspension 0.05% (APP13007) for managing post-operative inflammation and pain following ocular surgery. This approval marks a significant advancement in ocular care, offering a novel treatment option for patients undergoing various eye procedures.

Ocular surgery is commonly associated with inflammation and discomfort post-procedure, necessitating effective management strategies. The approval of clobetasol propionate ophthalmic suspension addresses this need by providing a potent corticosteroid formulation for alleviating post-operative symptoms.

Formosa Pharmaceuticals and AimMax Therapeutics collaborated to develop and obtain FDA approval for clobetasol propionate ophthalmic suspension. Eyenovia is poised to lead commercialization efforts in the US, facilitating access to this innovative treatment option for ophthalmologists and patients.

Clobetasol propionate ophthalmic suspension 0.05% is formulated using Formosa’s APNT nanoparticle platform, delivering a potent corticosteroid directly to the affected area. Notably, this is the first FDA-approved ophthalmic clobetasol propionate product and the first new steroid introduced to the ophthalmic market in over 15 years.

The approval was based on robust evidence from two randomized, double-masked phase 3 clinical trials involving over 750 subjects undergoing cataract surgery. The trials demonstrated that the suspension provided rapid and sustained clearance of inflammation, surpassing placebo with statistical and clinical superiority (P <.001).

With approximately seven million ocular surgeries performed annually in the US, there exists a substantial market for post-surgical ocular care products. Clobetasol propionate ophthalmic suspension presents a promising opportunity, with its favorable dosing regimen and efficacy profile positioning it to capture a significant share of the $1.3 billion annual market.

The approval of clobetasol propionate ophthalmic suspension represents a significant advancement in ocular care, offering clinicians and patients an effective solution for managing post-operative inflammation and pain. This milestone underscores the importance of innovation in addressing unmet needs in ophthalmology and improving patient outcomes.

Reference:

Inc. FP. Formosa Pharmaceuticals and Aimmax Therapeutics announce the NDA submission to the US FDA for APP13007 for the treatment of post-operative inflammation and pain following ocular surgery. PR Newswire: press release distribution, targeting, monitoring and marketing. May 5, 2023. Accessed March 4, 2024. https://www.prnewswire.com/news-releases/formosa-pharmaceuticals-and-aimmax-therapeutics-announce-the-nda-submission-to-the-us-fda-for-app13007-for-the-treatment-of-post-operative-inflammation-and-pain-following-ocular-surgery-301815496.html.

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Yogurt consumption can reduce type 2 diabetes risk: FDA makes qualified health claim

USA: The U.S. Food and Drug Administration (FDA) announced in a letter of enforcement discretion that it will not object to using certain qualified health claims regarding yogurt consumption and reduced type 2 diabetes (T2D) risk.

The FDA, however, adds, “Yogurts that meet the FDA’s standard of identity will be allowed to carry qualified health claims provided that they are worded so as not to mislead consumers, and that other factors for the use of the claim are met.”

Following a review of the evidence, albeit limited evidence, the FDA said, “There is some credible evidence supporting a relationship between yogurt intake and reduced risk of type 2 diabetes.”

A health claim characterizes the relationship between a substance and a disease or health-related condition. A qualified health claim is supported by scientific evidence but does not meet the more rigorous “significant scientific agreement” standard required for an authorized health claim, the FDA stated. The agency has allowed such qualified health claims for dietary supplements since 2000 and food since 2002.

The FDA responded to a qualified health claim petition submitted on behalf of Danone North America requesting the agency to review the use of a qualified health claim concerning the relationship between yogurt consumption and reduced T2D risk for all types of yogurts that meet the FDA’s standard of identity.

The petition also noted that the evidence supports the health effects of yogurt as a food rather than related to any single nutrient or compound and thus is independent of sugar or fat content.

One study published in BMC Medicine in 2014, which supported this claim, showed that everyone serving yogurt per day was incrementally linked with a 17% lower risk for the development of type 2 diabetes (HR 0.83). The same study failed to find a significant association between total dairy consumption and type 2 diabetes risk.

The FDA considers two cups (3 servings) per week of yogurt to be the minimum amount for this qualified health claim.

The letter discusses the factors that the FDA intends to consider in the exercise of its enforcement discretion for the use of a qualified health claim on yogurt and the relationship between the consumption of yogurt and a reduced risk of type 2 diabetes.

The FDA intends to consider exercising its enforcement discretion for the following qualified health claims regarding the relationship between yogurt and reduced risk of type 2 diabetes:

  • “Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes. FDA has concluded that there is limited information supporting this claim.”
  • “Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes according to limited scientific evidence.”

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Include Robotic Surgery training in MCh Curriculum through NMC: Surgeons urge Govt

New Delhi: Highlighting the lack of proper training for robotic surgery in the country, the India Chapter of the Clinical Robotic Surgery Association (CRSA) recently submitted a representation urging the Director General of Health Services (DGHS) to include robotic surgery in the medical curriculum through the National Medical Commission (NMC).

Commenting on the matter, the President of CRSA, Vivek Bindal pointed out that there is currently no training curriculum for robotic surgery in India. He said, “We are looking to provide a guideline document to the Health Ministry to make robotic surgery a part of training for resident doctors and MCh (higher degree in surgical sciences) candidates.”

The popularity of Robotic Surgery is increasing in India because of its precision and minimal pain score when compared to Open Surgery and Laparoscopy.

Also Read: Doctors at Indraprastha Apollo Hospital perform robotic surgery to treat multiple uterine fibroids in 37 year old patient

Referring to this, CRSA President Bindal told Business Standard, “Robotic-assisted surgeries (RAS) have many benefits for patients such as early discharge, short hospital stay, fewer painkillers, fewer antibiotics, fewer complications, and less ICU stay.”

“RAS has come up in a big way in specialties such as gynaecology, oncology, and gastrointestinal surgeries. However, to make this technology available for all eligible patients, more surgeons need to get trained in robotic-assisted surgery,” he added.

Meanwhile, the senior consultant and Head of the Department (HoD) of Manipal Hospital, Dwarka, Randeep Wadhawan also highlighted the need for developing training pathways for such surgeries. 

He said that despite the increase in the number of robotic surgeries in India, the number of surgeons who can do such operations, compared to the number of population, is still much lesser.

“Currently, RAS training is given at certain centers of excellence, supported by private entities. There are 35 such centers as of today, which train surgeons in several specialties,” he added.

The National Board of Examinations in Medical Sciences (NBEMS) runs two-year fellowship programmes for minimum access surgeries to doctors after completion of their postgraduate degree course. Currently, robotic surgeons tend to opt for a fellowship course followed by clinical practice.

“During the advent of robotic surgery, this was acceptable. However, as robotic surgery continues to develop, it is imperative that robust training and credentialing systems are in place to ensure that patient safety and surgical outcomes are not compromised,” Wadhawan mentioned.

Also Read: Sharda Hospital organises India’s first International Robotic Workshop

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AI will always be a slave to us, we will remain the masters: AIIMS Director

Artificial Intelligence is always going to be artificial and the humans will remain the masters, Director AIIMS Delhi, Dr M Srinivas said on Thursday while outlining how the premier medical institute in the national capital is harnessing AI for the benefit of patients, including in cancer treatment.

Participating in ‘ANI Dialogues – Navigating India’s Health Sector’ here, Dr Srinivas said AI complements and supplements efforts and allows scalability and filtering at a faster pace.

For more information click on the link below:

Artificial Intelligence Will Always Be A Slave To Us, We Will Remain The Masters: AIIMS Director

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Former Union Health Minister Dr Harsh Vardhan quits politics

After a long political career of 30 years, the former Union Health Minister Dr. Harsh Vardhan has announced his decision to quit electoral politics.

In an X post, Dr Harsh Vardhan mentioned that he has promises to keep and announced his decision to go back to his ENT Clinic at Krishna Nagar. He further mentioned that he would continue to pursue his work against tobacco and substance abuse, against climate change as well as teaching simple and sustainable lifestyles.

For more information click on the link below:

Dr Harsh Vardhan Retiring From Politics And Going Back To His Roots- ENT

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