AIIMS Bhopal

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Prof. Sarman Singh
Director & CEO, AIIMS, Bhopal

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The establishment of the All India Institute of Medical Sciences (AIIMS) at New Delhi in 1956 was a dream project of first Prime Minister of India, Shri Jawahar Lal Nehru and this was executed by first health Minister of India Mrs. Raj Kumari Amrit Kaur through an act of Parliament known as AIIMS Act. However, in last 50 years it was realised that there was huge regional imbalance with respect to the availability of tertiary healthcare services that are affordable as well as reliable, ameliorating available facilities for quality medical education by establishing a vital figure of doctors and conducting research activities, with peculiar relevance to the area, in the country. In 2003, Shri Atal Bihari Vajpayee, the then Prime Minister of India, envisaged to establish 6 AIIMS like Institutes in various parts of the country on the lines of AIIMS, New Delhi. In 2006, the foundation of AIIMS, Bhopal, an Institute of National Importance, was laid by an initiative launched by the Government of India, known as ...

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The present Director of All India Institute of Medical Sciences, Bhopal, Prof. Sarman Singh was born to the inerudite parents hailing from a very small village of Aligarh, Uttar Pradesh. He did his MBBS from prestigious King George’s Medical College, Lucknow, MD from Post Graduate Institute of Medical Research (PGIMER), Chandigarh, and Postgraduate course in Epidemiology of Infectious Diseases from world famous University of Michigan at Ann-Arbor, USA and a course on International Research Ethics from Harvard University, USA and Natal University, South Africa. He has been working at the All India Institute of Medical Sciences, New Delhi since 1988 at various positions.

Dr. Singh is an able administrator and hard task master and has good administrative and constitutional knowledge. He is now internationally acclaimed medical scientist with outstanding research and academic achievements.

He has guided more than 20 PhD and MD students. Of the 15 PhD students, all are pursuing their career successfully – 7 in the USA, 2 in South Korea, 2 in the UK, 1 in Germany and 8 in India. All have received accolades in the form of best poster or best oral presentations in various national and international conferences and most of them have received travel awards from DST, DBT, ICMR, BMGF or from conference organisers. One student was selected by HIV trust fund (Geneva) to work at NIH for 6 months.

His team received several research grants from Department of Biotechnology, Indian Council of Medical Research, Department of Science, and Technology, Council for Scientific and Industrial Research, NIH (USA), DFID, European Commission, Bill & Melinda Gates Foundation, WHO etc.
Dr. Singh is voracious writer, dedicated researcher, loved teacher by his students, an able administrator, and a visionary. This is evident from his high citation index of 7400, i10 index of 143 and h-index of 42.

The main focus of Prof. Sarman Singh’s research has been on developing more sensitive and cost-effective diagnostic methods for infectious diseases, particularly those that are difficult to diagnose and treat. Towards this goal, he has made several ground breaking discoveries in the field of pathophysiology of visceral Leishmaniasis or kala-azar. He was the first to develop and patenting a rapid and highly cost-effective diagnostic test for this disease. A novel recombinant antigen (Ld-KE16) was prepared from an Indian strain of L. donovani (Singh & Sivakumar 2003; Sivakumar et al, 2006) ((PCT/IN2003/000400) and the commercial rights of the test were transferred to the M/s Span Diagnostic Pvt Ltd through the Department of Biotechnology, Govt. of India. The company has made rapid diagnostic test (RDT) kits in various test formats, which were dedicated to the nation by the Honourable Minister of Science & technology, Government of India Shri Kapil Sibal on February 6, 2006 in a glittering ceremony at the Press Club of India. These RDTs have made the invasive and hazardous methods like bone marrow and splenic aspiration dispensable at a very affordable price (Singh 2006). It is a matter of pride that the diagnosis of kala-azar can now be made at a cost of less than Rs. 50 per patient in India using these trailblazing “Made in India” kits. These test kits are exceptionally accurate with 100% specificity and 98% sensitivity.

The disease kala-azar mainly affects the poor and down-trodden section of our society (Singh et al, 2000). Till rapid tests were made available, thousands of poor in the states of Bihar, W Bengal and Uttar Pradesh were dying due to this disease because of non-availability of sensitive, cost-effective and point-of-care diagnostic methods. It may be mentioned that with the availability of this revolutionary test, the number of kala-azar deaths has come down significantly - thanks to the Government of India for their active surveillance, and free treatment combined with the RDT kit developed by Dr. Singh that played a pivotal role in the national kala-azar elimination program. This cutting edge technology is also saving of millions of dollars of the Indian Government every year on foreign exchange. This is the first ever-indigenous invention by a medical scientist, which has become an integral part of any national disease elimination programme. This invention received high appreciation and applauds from the WHO (WR-India, as chair of the award selection committee) in the BMJ Research and Innovation excellence award distribution ceremony while announcing the award to Dr. Sarman Singh.

Beside the above, this work has been recognised by the prominent science agencies of India, notably the Department of Biotechnology (Product, process and Commercialisation award); Indian Council of Medical Research (Dr. BK Aikat Award); Medical Council of India (Dr. BC Roy Award); Government of Uttar Pradesh (Vigyan Ratna Award); Indian Medical Association (Med-Achiever Award); Delhi Medical Association (Chikitsa Ratna Award); Indian Society of Parasitology (Dr. BP Pandey Oration Award); Indian Association of Tropical Parasitology (Outstanding Researcher in Parasitology); Indus Foundation (Innovation Excellence Award); Society for Immunology and Immunopathology (Life Time achievement Award) and many more.

The issue of reservoirs of visceral leishmaniasis in India has remained dogmatic. The dictum has been that only post-kala-azar dermal leishmaniasis (PKDL) patients serve as reservoirs and there are no animal reservoirs in India, in contrast to the well-known animal reservoirs worldwide. In a spearheading study Dr. Singh working on the premise that in several areas where there are no PKDL cases (Dey et al, 2007), the outbreaks or sporadic cases of VL do occur (Singh et a, 2011). Furthermore, using novel PCR primers (PCT/IN2004/000395) his team also found that VL and PKDL strains are genetically different and both strains have differences in the anti-leishmanial drug susceptibility pattern (Mishra et al 2011). Therefore, in a radical approach, his team investigated thousands of animals in endemic areas as well as in non-endemic areas and found that goats are very potent animal reservoirs of VL in India (Singh et al 2013). These findings are bound to make drastic deviation in the kala-azar elimination programme of India.

The whole genome sequence (WGS) of several isolates of Leishmania donovani from VL patients has been sequenced, but it is a matter of pride that Dr. Sarman Singh became the first in the world to carry out the WGS of the PKDL strain of Leishmania. The sequence alignment data showed significant differences in the genome of PKDL strain as compared to VL strains (Gupta et al, 2015). The WGS also revealed a revolutionary finding that a major portion of a saprophytic bacterial (Parvibaculum lavamentivorans DS-1) genome gets integrated into the genome of PKDL strain. On the basis of this discovery new biological phenomenon has been postulated, thereby this integration could be the triggering factor to manifest the two strains differently (the viscerotropic form becoming dermotropic). This landmark discovery also proved his old hypothesis, that Leishmania donovani undergoes in-vivo hybridization to manifest as PKDL. These findings will go a long way in the eradication of old dogma about PKDL.

India has distinction of having maximum cases of HIV, TB, and Leishmaniasis. In an in-depth invited review in International Journal of Infectious Diseases Dr. Singh discusses the current scenario of HIV-leishmania co-infection and factors that contributed to help quell this duo, in contrast to the other co-endemic countries (Singh, 2014). However, the Leishmania and TB both are co-endemic in several parts of eastern India. It is also known that approximately 20% VL patients will have concomitant or subsequent Tuberculosis but there is no effective vaccine for these infections. Considering this as a major research challenge, for the first time his team prepared a self-cleaving chimeric DNA vaccine which can be used against both TB and visceral leishmaniasis (Dey et al, 2008). This cutting edge innovation has been patented globally (PCT/IN2009/000093). The department of Biotechnology who funded and licensed this work, observed this invention as of high commercial value. The reputed journal Vaccine invited him to publish this innovative research to publish in their special issue (Dey & Singh, 2009) and again another reputed journal (Parasites and Vectors) invited him to write a systemic review on Leishmania vaccines (Srivastava et al 2015).
Miltefosine is a new drug approved for the treatment of VL in 2004 only but within few years of its introduction, the efficacy has gone down. To understand the mechanism of resistance, in an avant-garde study his team has discovered novel mutations in the genes of Leishmania; which impart resistance to miltefosine. These mutations can now be used as molecular markers to diagnose and predict miltefosine resistance in circulating strains at an initial stage (Srivastava et al, 2016).

Tuberculosis is the main killer infectious disease in India. On the top of that multi-drug resistant (MDR) and extensively drug resistant (XDR) forms have emerged forcing WHO to announce MDR-TB as health emergency. Dr. Singh for the first time reported high incidence of XDR-TB in Indian AIDS patients (Singh et al 2007). Though this publication created lot of discussion in Government, but finally it was accepted as realty and based on these findings Government of India implemented programmatic management of DR-TB (PMTD). Unfortunately early and accurate diagnosis of TB has remained a major challenge for researchers and programme managers. In last 20 years several serological test kits were dumped in the Indian market for the diagnosis of PTB and EPTB. But these kits gave highly inaccurate results, leading to unnecessary treatment to hundreds of thousands of patients, and leaving several thousands TB patients untreated. Dr. Singh played crucial role in getting these serological kits banned for import, manufacture and use in India (The Independent, UK; Times of India; The Hindu; Deccan Herald; Spectrum; etc.) and live discussion on the all India Radio. The Editorial published in the IJMR (Singh & Katoch, 2011) played the key role in this decision taken by the Government of India in May 2012.

However, the ban on serology has created a complete gap in the TB diagnostic field. Dr. Singh worked untiringly to find out novel molecular tools and biomarkers for the diagnosis and differentiation of drug susceptible and drug resistant Mycobacterium tuberculosis. His laboratory has recently made a revolutionary discovery in this field. After screening hundreds of proteins of MTB, his team identified 5 novel proteins/antigens, which are over-expressed only during the in-vivo drug resistance development. The genes were cloned and proteins expressed, purified and used on various categories of patients showing the sensitivity and specificity of these proteins between 98.2% -100% and 89.1 - 98.2%, respectively (Singh et al, 2015, Singh et al, 2016*). Using these novel proteins development of a point-of-care (POC) rapid test is underway. This innovation will be a game changer in the area of TB diagnostics not only for India but globally. The Foundation for Newer Innovative Diagnostics (FIND) has shown interest in this innovation and very soon this innovation will make India proud of innovative research. He has also used his epidemiological skills acquired during his training at University of Michigan (USA) and has done various field studies. He has formed a network of scientists working on Tuberculosis in India. In a spearheading study his team screened 628 isolates of MTB collected from various parts of the country, genotyped these and did drug susceptibility testing to uncover how the socio-geographical factors influence the prevalence of various genotypes of MTB. This was unique and first study of its kind. The Beijing genotype of MTB, which is most prevalent in NER-India is having highest vulnerability for drug resistance while EAI genotype (found mainly in South India) having least preponderance for drug resistance (Singh et al, 2015). In this study he for the first time successfully documented the impact of population migration on the prevalence of various mycobacterial genotypes in different. This study was judged as the best study of 2015-16 carried out at the AIIMS and Dr. Singh was awarded First Prize in Research Excellence by the hon’ble Minister of Health and Family welfare, Government of India, Sri JP Nadda. The study has got wide coverage in the print media and Department of Biotechnology (NER-BPMC) has announced a special call for proposals to deal with this menace. Recently his team proposed to make use of phantom drones to control drug resistant tuberculosis in North-East Region of India. The proposal is being actively considered by the central TB division of Ministry of Health & Family elfare, Government of India.
Dr. Singh has also done pioneering work in the field of non-tuberculous mycobacteria (NTM) often neglected by clinicians and medical microbiologists as contaminants. In AIDS era these NTM have gained much importance but the conventional methods of identification are neither reproducible nor very specific. His team has developed novel sets of multiplex-PCR primers for the diagnosis and differentiation of Mycobacterium tuberculosis, M. avium, M. kansasii, and other NTM, directly from the clinical samples in a single tube (PCT/IN2004/000396). These PCR primers and the process have been found highly sensitive and specific and are being routinely used at AIIMS and many other laboratory settings throughout the country (Singh et al, 2006, Gopinath et al, 2009, Kumar et al 2014a). The PLoS Neglected Tropical Disease published Dr. Singh’s “Personal Opinion: on this subject, which is highly cited. This has made a paradigm shift in the understanding of NTM disease in India. Using the same gene targets, a new technology known as loop mediated isothermal amplification (LAMP) assay has also been developed by him with a commercial partner (Kumar et al, 2014b). The technology is being evaluated across the country and soon may be taken up by the Government of India. Currently molecular tools have become essential to understand the pathophysiology and drug targets. Dr. Singh has moved with the time. His laboratory is equipped with all modern tools including 6-laser flow cytometer and New Generation Sequencer (NGS), beside all routine diagnostic tools and services. His laboratory caters diagnostic (routine and specialised) tests with precision and accuracy. For his quality services his laboratory is recognised as training centre for whole Asia region for new TB diagnostics by the Stop-TB division of WHO (Geneva) and also by the central TB division of Government of India.
Prof. Singh is the sole authority in the field of Toxoplasmosis in India for both medical and veterinary fraternity. His Toxoplasma reference laboratory is the only centre in entire India, which is maintaining and distributing the Toxoplasma gondii strains to other researchers for the last 26 years continuously. Because of his spearheading teachings through webinars, print media and on other platforms including the FOGSI, ISP, IATP, IAMM, etc he has been able to convince the majority of Gynaecologists, Obstetricians, Paediatricians and Medical /veterinary microbiologists of India, that bad obstetric history (BOH) is a misnomer and that Toxoplasma causes multiple abortions is only a myth (Singh 2003; Singh & Pandit 2004; Singh et al, 2014). He is now the last word for Gynaecologists and Obstetricians of India regarding the diagnosis and management of congenital/antenatal toxoplasmosis. He has saved several unwarranted terminations of precious pregnancies suspected to have intrauterine toxoplasmosis on the basis of inaccurate test methods. His work has been cited in several reputed reference and text books-notably, the Infectious Diseases of foetus and neonates (Remington & Klein), Practical Obstetric Problem (Ian Donald); Toxoplasmosis: A comprehensive Clinical Guide (David et al), International Encyclopaedia of Public Health (Academic Press); Practical Guide to high-risk Pregnancy and delivery (Arias); Internal Medicine: an Illustrated Radiological Guide (Tubaikh) to name a few. It is worth mentioning that for his work on Toxoplasmosis he has been honoured by the Indian Academy of Tropical Parasitology as well as by the Indian Society of Parasitology. Beside TORCH infections his original work on mother-to-child transmission of Hepatitis E virus has been cited in almost all text books of paediatrics and Obstetrics, for examples – Principles and Practice of Infectious Diseases (Bennett et al); Infectious Diseases of foetus and neonates (Remington & Klein); Practical Obstetric Problem (Ian Donald); Viral Infections of Humans (Kaslow et al) and Avery’s Neonatology.

He was the first to document first case of HIV-Leishmania co-infection in India (Singh et al 2000a) and also high incidence rates of hepatitis B and Hepatitis C virus infections in Kala-azar patients of Bihar who were receiving multiple injections of sodium antimony gluconate (Singh et al, 2000b). He for the first time documented that circumcised patients had lower incidence of Hepatitis C and HIV virus infections in India. The WHO noticed these findings and its Safe Injection Global Network (SIGN) division organised a special meeting with Government of India (in 2001) and highlighted the need for safe injection practices in India. Dr. Singh was special invitee in this meeting to present his findings. This advisory issued by the WHO to India based on his findings changed the scenario of injection practices in India.

As a physician also he has contributed immensely in the Clinical Practice. For the first time from India, he reported mucosal involvement by Leishmania donovani in an AIDS patient and Prof. Singh coined a new clinical condition- post-kala-azar mucosal leishmaniasis (PKML) and published in the Lancet (Singh, 2004). Other authors are now using this clinical term also (Singh 2014). He has treated rare clinical conditions like genitourinary enterobiasis (Singh et al, 1989), Scalp Phthiriasis (Singh et al, 1990), Hookworm granuloma of Gastric Os (Singh 1999), Toxoplasmosis in an immunocompetent surgeon, and many more. He has successfully carried out clinical trials of herbal immunomodulators in AIDS patients. He is running a pre- and post-test counselling clinic for HIV/AIDS and TORCH infections for the last 20 years and supervises more than 5 lakh investigations each year.

Indeed Dr. Singh has several firsts to his credit, whether it pertains to new discoveries, novel innovations, finding new pathogens, clinical conditions, or disease manifestations. His keen interest in new discoveries and scientific dissemination started from his early residency days at PGIMER, Chandigarh. Dr. Singh was the first to report fungal contamination (Trichosporon beigelli) of UGI endoscopes instead of routine decontamination procedures (Singh et al 1989). This work has been cited in almost all textbooks of Gastroenterology. He also reported new species of Trichuris (vulpis) in Onges tribes of Nicobar (Singh et al 1993) and new genotypes of Mycobacterium tuberculosis in India.

In addition to research, teaching and patient care he is helping various Government organizations like UPSC, DBT, ICMR, ICAR in the academic and administrative processes, and on being on their task forces. Dr. Singh has been member of Peer Team of NAC and Inspector of the MCI. Dr. Singh has also been on the research advisory committees/examiner of more than 25 central and state universities. He is also member of scientific advisory committees of JIMPER, Pondicherry; RMRC, Jodhpur and National JALMA Institute for Tuberculosis. He is grant reviewer for DST, DBT, DHR, ICMR, CSIR, BIRAC/IKP, BCIL of India. His research is also recognised outside India and he is grant reviewer for Medical Research Council, Government of South Africa; Ministry of Science and Technology, Life Sciences Division, Government of Israel and Ministry of Health (General Director for Scientific Research and Health Innovation), Italy. He is also abstract reviewer for World AIDS conference (IAS, Geneva) consecutively for 9th year and also for CROI (USA) and ICASA (South Africa) for last 3 years.

He is one of the upper 10% peer reviewers of publications from topmost publishers like Elsevier (including Lancet), NPG, Bentham, Springer, ASM, JAMA, BMA and others. Overall he is manuscript reviewer for 41 reputed journals while refusing review requests from hundreds of online journals.

When I joined the Institute on 4th June, 2018 as the Director, I aimed to excel the Institute in all three fields namely Academics, Research and, Patient care. I also intended to enhance the patient care services and establish transparency in the process of recruitment, procurement and, other services. I am very pleased to share that we have succeeded to a great extent in fulfilling our commitments. This could have not been possible without the support of our faculty, officers, resident doctors, nursing officers, administrative, finance, engineering and other staff, the students and, most importantly my secretariat. We have achieved many milestones that are small in number, though vital in figure.

The AIIMS, Bhopal is a huge establishment sprawling in 150 acres having a large hospital complex, residential complex, hostels, Medical College, Nursing College (Centre of Excellence in Nursing Education) and other essential services. At present the bed strength of the hospital services is 793 with 24 modular operation theatres, 42 functional departments that include 22 speciality, 14 super-speciality and 6 other departments, catering to an average footfall of around 46264 OPD per month and 1609 IPD patients per month. The speciality services available at AIIMS, Bhopal include Anaesthesiology, Biochemistry, Community & Family Medicine, Dentistry, Dermatology, Dietetics, Emergency Medicine, General Medicine, General Surgery, Microbiology, Obstetrics and Gynaecology, Ophthalmology, Orthopaedics, Otorhinolaryngology (ENT-Head & Neck Surgery), Paediatrics, Pathology, Physical Medicine & Rehabilitation, Psychiatry, Radio-diagnosis & Imaging, Radiotherapy, Trauma & Emergency Medicine, Transfusion Medicine & Blood Bank, and AYUSH. The super-speciality services include Burns & Plastic Surgery, Cardiology, Cardiothoracic Surgery, Endocrinology & Metabolism, Nephrology, Neurology, Neurosurgery, Neonatology, Nuclear Medicine, Paediatric Surgery, Pulmonary Medicine & TB, Surgical Gastroenterology, Surgical Oncology, Urology and teaching departments of Anatomy, Forensic Medicine & Toxicology, Pharmacology, Physiology, Hospital Administration, and Nursing College. Recently a new and Department of Translational Medicine has also been created, which is unique in the country. The AIIMS, Bhopal also has a Department of AYUSH to include Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy. On the construction front, AIIMS, Bhopal has 135 blocks.

The AIIMS, Bhopal is expected to accommodate distinct talents, deliver highly trained medical and paramedical human resources in the interests of the country and conduct research of national and regional health interest. The institute allows experimenting with innovations in medical education. AIIMS, Bhopal is imparting a total of 9 courses through its Medical College and Nursing College. These courses include MBBS, MD, MS, DM, MCH, PDCC, PhD and BSc Nursing (Hons) and MSc (Nursing).

AIIMS, Bhopal is one of the partners of National Knowledge Network (NKN) connecting 52 Medical Colleges all over the country to share updated knowledge in the field. The prestigious scheme of Government of India ‘Ayushman Bharat’ under Pradhan Mantri Jan Arogya Yojana for the people who are in need of quality health care facility has also been initiated in AIIMS, Bhopal.

For the first time for any AIIMS, the AIIMS, Bhopal has established a Centre for the Translational Medicine. This center will have dedicated faculty and state of the art infrastructure and equipment like Whole Genome Sequencer, automated Nucleic Acid extractor, Flow cytometer, Atomic absorption system, and the In-vivo image analyzer to conduct the drug and vaccine trial in animals. The faculty of this center will also be mandated to develop new diagnostic and human devices, drugs, vaccines, and systems based on artificial intelligence. It is also important to mention that the Institute has started the Regional Virology Diagnostic Laboratory (RVDL) along with C& DST-TB Laboratory which is of first of its kind in the State. A 16 bedded MDR ward is also in the offing. The Institute has also established a Cancer Treatment Centre with a holistic approach in association with AIIMS, New Delhi. Recently, AIIMS, Bhopal has also set up a Cancer Registry Center and a Poison Information Centre (PIC).

The Institute has surpassed all other newly established AIIMS in the field of Research and has a dedicated Research Cell for coordinating the research activities in the Institute. A total of 233 Publications were made in the last two years. The Faculty of AIIMS, Bhopal is carrying out cutting-edge research mainly in the field of tuberculosis, cancer diagnostics, infectious diseases, chronic kidney diseases & environmental toxins, health care delivery system, severe acute malnutrition, effects of yoga on health and meditation and, antimicrobial stewardship, etc. The Ministry of Health and Family Welfare, Government of India and the Madhya Pradesh Government have designated the AIIMS, Bhopal as centre of Excellence for COVID-19 Research. This Institute was first to start clinical trial of Mycobacterium w (Mw) for COVID-19 treatment. A total of 180 research proposals for extramural funding were submitted by the Faculty of AIIMS, Bhopal to different funding agencies in last one year and 45 projects have been approved for funding. The premier funding agencies include ICMR, DST, DBT, BIRAC, DHR, UNICEF, MP Govt. and the total grant outlay of projects sanctioned in this period is Rs 25.11 crores. Centre of Excellence in Labour, Delivery and Recovery (LDR), and Medical Device Adverse Event Monitoring Centre in Department of Pharmacology under the aegis of Indian Pharmacopia Commission, Ghaziabad have been established with Government funding. Institute has also started providing its laboratory facilities on short term basis for encouraging research activities.

Further, through untiring efforts of the Institute, AIIMS, Bhopal is able to get huge CSR funding from PSUs as well as from private organizations, which is being utilized for establishing an instrumentation of state-of-art, high-end central facility at AIIMS, Bhopal.

Lastly, as we ring in a new decade, 2020 is time for us to put our words into action and likewise, AIIMS, Bhopal envisages a lot more development in terms of extension of Medical College Building, development of for 200 to 250 Bedded Vishram Sadan type of patient care facility through CS ; development of Indoor sports complex with multipurpose hall; construction of Phase II Residential Complex of various accommodation categories; development of entertainment Park, herbal garden, more green campus ; to increase the self-dependency of the institute in terms of water resource capacity; for optimum energy conservation; a Rural Health Center at Chiklod with School of Public Health ; an International Vaccine Sciences centre with CSR funding; beside many other development works.

The future looks bright as I imagine all the endless possibilities for AIIMS, Bhopal. I am confident that we will continue to put our dedication and constant toil for steering our commitments towards the patients, humanity and the nation.

Prof. Sarman Singh

Director & CEO

AIIMS, Bhopal

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