Satvik Food: Ancient Indian Diet Keeps Heart Problems Away

October 30, 2006
By Syed Akbar
Hyderabad, Oct 30: Intake of Vedic diet comprising fresh uncooked vegetables and raw sprouts will stabilise the heart beat and prevent arrhythmias, which often lead to death.
Arrhythmia is a health problem affecting the electrical system of the cardiac muscle and causes the heart to beat slowly or pump blood less effectively. A research study on various diets mentioned in the ancient Indian texts revealed that those who take a diet comprising vegetables, grains, sprouts, minimum quantity of oil and raw foods showed a rhythmic heart beat.
The study, conducted by Dr P Ravi Shankar and others at the Russian Medical Academy, showed that cells of the same tissue would exist with different resting potentials depending on the dietary intake as prescribed in the Indian system of medicine.
As many as 75 male Wistar rats were used in the study. They were divided into five groups each comprising 15 rats. Three groups of rats were fed with different types of diets referred to in the ancient Indian Scriptures. The other two groups were taken as control groups. The researchers used the action potentials in the heart muscle as a reference parameter. The action potentials showed an average resting potential of about - 84.5 milli volts. At the end of the study, the rats were killed and action potentials were measured from their intact hearts.
The values of action potentials in the rats fed with a diet made up of raw vegetables and grains were very close to the resting potential. The action potentials of those fed with spicy foods had varied between 86.5 milli volts and 93.5 milli volts. The third group which received cooked foods with lot of oil and sweets had action potentials between 105.28 milli volts and 112.28 milli volts.
"The findings prove that the more the resting potential, the lesser the external
stimulus needed to excite and generate an action potential which gives a greater understanding of arrhythmias in cardiac muscles and various nervous and other disorders," the study pointed out

Hepatitis C virus -- the new time bomb

By Syed Akbar
Published in The Asian Age/Deccan Chronicle on October 26, 2006
Hyderabad, Oct 25: As scientists and health experts rededicated themselves on World Hepatitis Day on October 1 fighting the disease, latest health data reveals that a highly asymptomatic liver disease caused by the Hepatitis C virus (HCV) is fast spreading in India.
A World Health Organisation report says that HCV, often described as a "viral time bomb", has recouped vigorously to strike at rates up to two times more than that of the human immuno-deficiency virus or HIV.
WHO lists India along with Egypt, Italy and Japan where HCV is rampant. The number of HCV patients in India equals if not exceeds the total number of HCV patients in Europe and the USA.
WHO reports that as against 5.1 million Indians suffering from HIV/AIDS, around 12 million carry HCV. About 30 per cent of HIV patients simultaneously suffer from HCV.
The Indian Journal of Gastroenterology reports that about three per cent of people in Andhra Pradesh carry the HCV. The number could be higher as the data was collected based on medical screening at laboratories.
The undetected HCV population might be large because the virus does not show symptoms straightaway.
There is no vaccine to prevent HCV unlike the other Hepatitis varieties; vaccination for other types of Hepatitis may slow or prevent HCV infection. The best way to avoid HCV infection is to follow prevention and precaution steps.
"Did you receive a blood transfusion, haemodialysis, angiogram, tatooing, prolong injections or syringes? If yes, get tested for HCV. The cure rate is high if it is detected early," says senior gastroenterologist Dr Dharmesh Kapoor.
The HCV does not spread by air. Transmission is through skin or mucous membrane and one has to be careful while sharing tooth brushes, nail cutters, razors, syringes and tattoo needles.
Those who have multiple sex partners are at high risk of contacting the disease.
The efficacy of latex condoms in preventing infection with HCV is unknown. Doctors feel that proper use of condoms may reduce the transmission risk, though it will not totally eliminate it.
According to Dr Dinesh Kini, consultant gastroenterologist of Manipal Hospital, Bangalore, "HCV has a tendency to develop into long term liver disease and can cause liver cirrhosis and even cancer of the liver. The infection has an initial phase which is often asymptomatic and lasts up to six months".
Like HIV, the HCV virus remains in the infected patients for years together. Unlike HIV, it does not invade the immune system but replicates using the liver's resource cells.
The patient does not know that he is carrying the virus; he experiences fatigue and discomfort in the upper abdominal area. HCV can remain undetected for as long as 10 years.
In up to 85 per cent cases, the virus fights the body immune system. Patients develop long term or chronic infection and transmit the disease.
About half the HCV cases do not show symptoms even though the virus is fairly active.
While 20 per cent of patients recover fully the remaining develop some form of chronicity.
Five per cent of chronic patients develop liver cell cancer and an equal number suffer from decompensated cirrhosis.
"If untreated the liver will be damaged. The only treatment then remains is to replace the damaged liver by a new one. Early detection and prompt treatment can save lives," observes Dr Samir R Shah, specialist in hepatobiliary diseases, Jaslok Hospital and Research Centre and Breach Candy Hospital, Mumbai.
"PEGylated interferon can effect a cure in a good number of patients," says gastroenterologist Dr Kapoor. PEGylation is the coupling a polyethylene glycol structure to a larger molecule, for example, a therapeutic protein. Interferons are a class of natural proteins produced by the cells of the immune systems in response to challenges by viruses, bacteria, parasites and tumour cells.
The PEGylation of the interferon slows down the body's ability to break down the interferon molecule.
The interferon gets absorbed more slowly and constant amounts of interferon are present in the body which constantly attacks the virus.
Pegylated interferon alfa-2a (40KD) suppresses the virus in more than 50 per cent of patients. Ribavirin is also found effective against this disease.
Eleven Hepatitis C virus genotypes with several distinct subtypes have been identified throughout the world.
The WHO report notes that "Although different strains have not been shown to differ dramatically in their virulence or pathogenicity, different genotypes vary in their responsiveness to interferon/ribavirin combination therapy."
"Such heterogeneity hinders the development of vaccines, since vaccine antigens from multiple serotypes will probably be necessary for global protection," the report states.

Targeted therapy to treat cancer

October 25, 2006
By Syed Akbar
As October, the national breast cancer awareness month, draws to a close, oncologists and health experts suggest “targeted therapy” to treat the fast increasing menace. Of late, the incidence of breast cancer in India has been going up on par with developed countries mainly because of lifestyle changes including early menarche, lack of exercises and fatty diet.
Breast cancer has now become the commonest cancer in women in urban areas in India. It has emerged as the leading cause of death in women aged 35–55 years and the second leading cause of death in women of all ages. According to the International Agency for Research on Cancer, a World Health Organisation unit, about a lakh new breast cancer cases are reported every year in India.
Oncologists, doctors who deal with cancers, observe that breast cancer has certain patterns in its incidence. That it depends on the lifestyle of people. The incidence is higher in urban areas than in rural areas with National Capital Delhi leading the Indian chart. Delhi is followed by Mumbai, Chennai, Bangalore, Hyderabad and Kolkata.
An increasing number of cancer specialists are now prescribing targeted therapy or therapies to control breast cancer. Targeted therapy is nothing but a therapy with a specific molecular target. This method of treating cancer is efficient in more than one ways.
“In targeted therapy the biological processes that drive the cancer are understood and treatment is targeted at the biological process. In this process only cancer cells are targeted and the normal cells are spared,” says senior medical oncologist Dr SVSN Prasad. Targeted therapy is better than other traditional therapies. In chemotherapy or radiotherapy the normal tissue is also affected. Moreover, side-effects are minimal in the case of targeted therapy or therapies.
Targeted therapy is now increasingly being used for treatment of breast cancer, particularly in fighting HER2 or human epidermal growth factor receptor 2. HER2 is a gene that helps control how cells grow, divide and repair themselves. It directs the production of special proteins called HER2 receptors. Each healthy breast cell contains two copies of the HER2 gene, which helps normal cells grow. Sometimes a cell may have too many copies of the HER2 gene, which may lead to too much HER2 protein. This may play an important role in turning a normal cell into a cancer cell. The targeted therapy helps in prevention of recurrence and spread of the disease. Dr Prasad suggests that for more effective results targeted therapy can be combined with chemotherapy.
Dr Vijay Anand Reddy, radiation oncologist at Apollo Cancer Hospital, relates alarming increase in breast cancer to fast changing lifestyle of people, particularly in urban areas. Lifestyle changes like early menarche, lack of exercises and fatty diet are also the contributory factors.
“Today, breast cancer is the commonest cancer in women in urban population. India is fast catching up developed countries in terms of number breast cancer patients. Molecular therapies are referred as anti-bodies against HER2 antigens have really made a significant impact on the management of breast cancer patients,” he points out. One out of five women in advanced stage of breast cancer is HER2 positive.
Around nine per cent of women develop breast cancer during their lifetime, making it the second most common cancer in the world. In India, breast cancer accounts for 20 per cent of the total cancer-related diseases. According to WHO health statistics, breast cancer occurs at a younger age in India as compared to developed countries. HER2 type of breast cancer has greater risk of spread with faster growth of tumor. There are greater chances of the tumor coming back.
“Targeted therapies have emerged as the latest treatment option for people suffering from cancers. The therapy terminates the cancerous cells without affecting the quality of life of the patient. Indian oncologists prefer Herceptin, a unique biologic targeted therapy, for women with HER2-positive breast cancer,” says Dr Vijay Anand.
Since Herceptin targets mostly tumor cells that over-express the HER2 protein, it does not affect normal healthy cells. Patients on this therapy alone may be less likely to experience the side effects typical of other types of treatments, such as hair loss, fatigue, or a decline in certain blood counts.
Doctors observe that the best protection against cancer is awareness. Timely detection of cancer helps towards early treatment and prevents further progression of the disease.
The World Cancer Report states that action on smoking, diet and infections can prevent one third of cancers while another one third can be cured.
The World Health Organisation is of the view that cancer rates could further increase by 50 per cent to 15 million new cases in the next 14 years.
India has one of the high cancer mortality rates. There has been an increase in the incidence of breast cancer cases in Indian cities, points out Dr J Bandana, consultant gynaecologist.
“Lifestyle changes, smoking, usage of oral contraceptives, hormone replacement therapy, postponement of childbirth, obesity etc increase the risk of breast cancer,” she says. Dr Bandana suggests regular self breast examination for women and those over 40 should also undergo mammography once a year to nip breast cancer at an early stage.
Women with a history of first-degree relatives (mother, sister) suffering from breast cancer should be more cautious and regularly self examine their breasts, undergo mammography once a year, she observes.

Ramadan crescent: State to have moon panel

October 2006
By Syed Akbar
Hyderabad, Oct 24: With Muslim religious scholars divided once again on the
‘sighting’ of the Id moon, the Jamiat Ulema-e-Hind, an umbrella body of Imams of
mosques, has decided to set up a State-level moon-sighting panel to ensure that the
major Muslim festival is celebrated uniformly all over the country.
While Muslims in the entire country on Tuesday celebrated the Id-ul-Fitr (the
festival of alms-giving which marks the end of the month-long fasting during
Ramazan), those in Maharashtra and Andhra Pradesh will celebrate it on Wednesday.
Even within Andhra Pradesh, Muslims in Nalgonda, Guntur and other districts
celebrated the Id on Tuesday.
‘The problem is mainly because of lack of coordination among our moon-sighting
panels in different States. In Andhra Pradesh there is only one moon-sighting or
Ruhiyat Hilal committee and its operations are limited to twin cities of Hyderabad
and Secunderabad. We do not have a panel at the State level to coordinate with
Muslims scholars in various districts of Andhra Pradesh on one hand and with Hilal
committees of other States on the other,” Jamiat Ulema State president Hafiz Peer
Shabbir Ahmad told this correspondent.
The Hyderabad Hilal committee on Monday evening wound up its sitting quite early
without waiting for reports from other States. It simply announced that the Id would
be celebrated on Wednesday but as reports of moon sighting poured in from other
States including national Capital Delhi, the Hyderabad panel met once again late in
the night. The meeting which lasted till 12.20 am on Tuesday decided against
following observations of Hilal committees of other States. “Several Muslim families
all over the State had to remain awake till late in the night to know the fate of
the new moon. This is something not good. We have modern technology and gadgets. The
Hyderabad panel should have utilized them to take the decision fast without having
to wait for that long. By 9.00 pm the Shahi Imams of Delhi and Fatehpuri mosques
have announced their decisions,” senior religious scholar Hafiz Syed Shujath Hussain
said.
Muslim scholars blame the Hyderabad Hilal committee for the “paux pas”. The city
panel is controlled by a group of Muslim scholars following a particular school of
Islamic jurisprudence. There is no representation to Muslim scholars of other sects
or religious schools of thought. The decision on Id for Wednesday was taken
reportedly on the insistence of 135-year-old Islamic institution Jamia Nizamia’s
chief Mufti Khaleel Ahmad. Sources said the decision on Id for Wednesday was taken
to avoid confusion in the community at the eleventh hour.
“Our new State-level Hilal committee will have representation to all sects including
Shias. We will have the committee with Muslim scholars of different schools of
Islamic jurisprudence. Henceforth, the new panel will ensure that the Id is
celebrated uniformly throughout the country or at least in the State,” Jamiat State
secretary Sabir Ahmad pointed out.

Drugs under watch list

2006
By Syed Akbar
Hyderabad, Oct 16: The Central government has put 11 drugs under watch for their reported side-effects as part of its pharmacovigilance programme.
According to Rajesh Bhushan, director, Union Ministry of Health and Family Welfare, the government will take a decision on banning or otherwise of these drugs after gathering feedback from stake-holders. He said these drugs include pain-killers, cardio-muscular and anti-pyretic.
"We have already banned Rofecoxib and Valdecoxib after it was established that the are not good for the health of our people," he said.
Rajesh Bhushan told reporters at the National Institute of Nutrition here that the MHFW had sought the cooperation of healthcare professionals
in collecting data of adverse events related to drugs marketed in India. The submitted data will be collated and evaluated by the National Pharmacovigilance Centre operating at the department of pharmacology,
All-India Institute of Medical Sciences, New Delhi.
Referring to the drug sector scenario in the country, Rajesh Bhushan said laboratories required urgent upgradation for increasing capacity and competency. He regretted that all imported drug batches were not tested. A large number of vacancies in Central Drugs Standard Control Organisation and Central and State laboratories were coming in the way of effective implementation.
He agreed that there were constraints in existing testing capabilities and capacities especially for contaminants and microbiological parameters.

Ultra violet radiation: Hyderabad fast turning into a radiation city

Syed Akbar
Hyderabad, Oct 13: Hyderabad is fast turning into a "radiation city" 
with harmful ultraviolet (UV) rays hitting the city at "extreme" levels.
UV forecasts for Hyderabad show that the radiation falling down on the 
city from the sun for most part of the year is on the higher side, which 
is an indication that all is not well with the ozone layer above and the 
city's atmosphere.
Hyderabad is bracketed with concrete jungles like Mumbai, Kolkata, 
Bangalore and Chennai as these cities record "extreme" UV radiation 
for more than three days a week. However, Delhi appears to be slightly 
better as the UV radiation levels there are generally "high" to "very 
high" but rarely "extreme".
Ultraviolet rays falling on the earth are classified into various 
categories based on the intensity of the radiation and the harm they 
cause to human beings and animals. The World Meteorological 
Organisation, a WHO body, has standardised the UV radiation levels 
with its "UV Index" which is a simple measure of the UV radiation 
level at the earth's surface. Hyderabad's UV Index shows a measure of 
11, the highest point in the UV scale.
No wonder then that there has been a spurt in skin diseases in 
Hyderabad may be because of extreme levels of UV radiation. "Most of 
the cases relate to photo-ageing and skin cancer due to penetration of 
the rays into the skin. Even if one is in a car the rays can penetrate the 
glass and impact the skin. The most common skin allergy cases that 
come to us are related to  UV radiation called polymorphic light 
eruption," senior dermatologist Dr Anup Lahari pointed out.
The values of the UV Index range from zero to 11 and the higher the 
Index value, the greater the potential for damage to the human body 
and the less time it takes for harm to occur. On the higher side is the 
"extreme" and on the lower side is the "very low". In between UV 
Index is categorised as "low", "medium", "high" and "very high".
The WMO and the World Climate Research Programme as also the 
India Meteorological Department regularly issue UV forecasts for 
different cities around the world and in India respectively. The IMD 
monitors UV levels at its 45 radiation observatories spread across the 
country.
The UV Index up to October 18 is 11 i.e. "extreme" for Hyderabad, 
Chennai and Mumbai, while it is 8 (very high) for Delhi, 7 (high) for 
Chandigarh and 10 (very high) for Kolkata. The Index last week was 
also "extreme" for most part of the week for Hyderabad and other cities 
except Delhi.
The main reason given for the high intensity of UV radiation in 
Hyderabad is rapid urbanisation and high levels of pollution.
"As UV radiation can neither be seen nor felt, the UV Index is an 
important tool to raise awareness of the problem and alert people on a 
daily basis to take prompt, appropriate and protective action. That 
Hyderabad has high UV Index is an indication that the ozone layer is 
not properly filtering the sunlight. If the ozone does its job properly, 
the harmful radiation are filtered out. The high UV Index shows that 
the ozone layer has become thin," says Prof OSRU Bhanu Kumar, head 
of the department of environmental sciences, Andhra University.
Health experts and environmentalists warn that damage from the 
exposure to the UV rays is cumulative and over a period of time it will 
lead to serious diseases of the eye, including cataract and macular 
degeneration.
Consultant radiologist of Care Hospital Dr B Murali suggested that one 
should go in for massive tree plantation and keep off the sun to the 
extent possible to avoid UV radiation. "UV radiation exposures are 
largely preventable. The best protection is achieved by practising a 
combination of recommended safe behaviours. Limit exposures to sun 
rays when they are the strongest i.e. between 10 am and 4 pm. Seek 
shades such as trees or umbrella whenever possible. Use a broad-
spectrum sunscreen with sun protection factor of at least 15. Sunglasses 
can provide 100 per cent protection," he said.
Children are at high risk as on an average they get three times more sun 
exposure and thus are subject to damaging cumulative effects of UV. It 
is estimated that 80 per cent of lifetime sun exposure occurs before 18 
years of age.
"With the UV rays being equally extreme even in a "garden city" like 
Bangalore, there has been an increase in eye related problems there. Dr 
NM Sudha, senior ophthalmologist from Bangalore, pointed out that 
ultra violet light is as a causative factor in several eye problems such as 
cataract, retinal degeneration and surface problems such as pterigyum. 

Andhra Pradesh government new initiative: Screening for children with heart ailments

2006
By Syed Akbar
Andhra Pradesh is going to add yet another feather in its cap. This time for taking up the gigantic task of providing medicare and conducting heart surgeries free of cost to around 5000 children, mostly from the lower strata of society.
The second phase screening of heart diseases in children, under an innovative scheme launched by the State government in August 2004, is currently on in the State. Already 3,200 children have been identified for surgery in medical camps held in September. Another round of medical camps is scheduled for October 8 at 44 centres across the State. Once the screening process is completed, heart surgeries will be performed on these children in about 50 corporate, private and government hospitals.
In the first phase screening held in 2004, over 5500 children were identified for surgeries and of them 4700 underwent heart operations. The remaining 700 children could not make their way to the operation theatre for want of infrastructure. These children will now be included in the list of fresh beneficiaries in the second phase.
Andhra Pradesh is the first and so far the only State in the country where children under 12 years of age are provided free heart treatment in the state-of-the-art corporate hospitals. They are also provided with free follow up treatment. Only the neighbouring Karnataka State has a health insurance scheme for children belonging to below the poverty families. Unlike the cardiac programme in Andhra Pradesh, the scheme in Karnataka provides for general health problems. A CM’s Children Relief Fund was exclusively set up for the purpose.

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How the Scheme Began:
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It was August 7, 2004. The new Congress government was just settling down. Hundreds of children suffering from heart diseases gathered in Hyderabad to press for their demand for free medical treatment. The Mahajana Sangarshna Samithi had organised the demonstration by mobilising poor children and their parents from all most all the rural areas of the State.
Tragedy struck the demonstration. One of the children, T Sobhan (12), of Shanigaram of Karimnagar district, collapsed on the Lower Tank Bund road apparently unable to bear the stress of walking and standing for long under the hot sun. A couple of days later, two more children, Rajasekhar from Prakasam district and Konda Saidulu from Nalgonda district succumbed to heart ailments. Incidentally, these two children too had participated in the demonstration.
This moved the new Congress government and Chief Minister YS Rajasekhar Reddy announced a special package for children suffering from cardiac ailments which includes free heart surgery. Andhra Pradesh thus became the first State in the country to introduce free heart treatment for children below 12 years of age.
In the first year the government conducted screening tests for 5500 children and of them about 2000 children underwent surgeries. Another 2700 children were operated upon in 2005. The government has initially allocated Rs 8 crore for the project and announced that it would be a continuous programme. Keeping its assurance, the government has now called for the second phase of screening tests in all the 23 districts to identify new patients.
The government has also taken up an ambitious programme to strengthen facilities in government hospitals so that state-of-the-art medicare is provided to poor children. The government has also roped in children specialists to perform surgeries.
Now buoyed by the success of the cardiac programme, the government has decided to introduce a universal health insurance scheme to take care of the health needs of children suffering from various ailments. Children below 12 years and belonging to below poverty line families will be covered under the proposed scheme. According to a rough estimate, two lakh children under 12 years are suffering from heart problems in the State and about 20,000 children add to this number every year.

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How It Works:
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Unlike in other States where free treatment is provided to the poor only in government hospitals, the Andhra Pradesh government has made a provision for treatment of poor children even in corporate and top class hospitals. The provides financial aid to corporate hospitals towards these surgeries and other follow up treatment if any.
These private hospitals charge 20 per cent less than the rates fixed by the State-controlled Nizam’s Institute of Medical Sciences. The payment is made by the Director of Medical Education to the hospital concerned after getting scrutiny of bills by a committee constituted for the purpose.
The State government has divided heart diseases into various categories for purpose of treatment. The category I covers PDA interruption pericardiectomy, closed mitral valvotomy and PA banding, while category II covers BT shunt coarctaion of aorta repair. Under category II, surgeries like ASD closure, VSD closure and AP window repair.
The other categories are: category IV: Intracardiac repair of TOF, intracardiac repair of TAPVC; Category V: Intracardiac repair of TGA, DORV, tricuspid atresia, trunkus arteriosus etc., and other surgeries needing special conduits like pulmonary atresia; Category VI: Valve repair, mitrial valve repair, tricuspid valve repair; Category VII: Mitral valve replacements,
aortic valve replacements, tricuspid valve replacements; Category VIII: double valve replacements (mitral valve replacement and aotric valve replacement); Category IX: Interventional procedures like percutaneous
balloon valvuloplasties, balloon septostomy including cardiac catheterization and cine angiograms.
Initially there was no provision for permanent pacemaker implantation (PPI) but now the government has included this category also. A new category - Category X - has been included to provide for permanent pacemaker implantation. Other cardiac problems not included in the above categories, whenever they come up would be examined and put in appropriate category on a case to case basis by the central cell at Gandhi Hospital in consultation with the Director of Medical Education.

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Special Cardiac Cells
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Moreover, special cardiac cells have been created in seven government teaching hospitals, which will treat, operate or refer patients to other hospitals. These cells are located at Osmania General Hospital, Hyderabad, King George Hospital, Visakhapatnam, Mahatma Gandhi Memorial Hospital, Warangal, Gandhi Hospital, Secunderabad, Government General Hospital, Kurnool, Government General Hospital, Guntur and Government General Hospital, Kakinada.
On being approached by a child cardiac patient, the cardiac cell in the Teaching Hospital will conduct necessary screening and render advice to the child patients and his/her parents/attendants. The cardiac cell will undertake treatment of the paediatric cardiac ailments at the same teaching hospital including surgeries.
If the surgeries for which facilities are not available or the required expert cardiac surgeon personnel are not available in the teaching hospital, then the cardiac cell of the teaching hospital will first enquire with the other government teaching hospitals as to whether they can handle the required type of surgeries.
If any of the other teaching hospitals in the State have such spare capacity, the case will be referred to there. If not, it will be referred to the nearest private hospital that can perform such surgery. An identification card is issued to the patient for this purpose, by the government cardiac cell of the teaching hospital.
In case, the patient comes back to the hospital concerned at a later date, where surgery is performed, the hospital should have to take proper care of the patient. It should not insist reference from the cardiac cell.
Congress MP V Hanumantha Rao demands that the Central government bear the cost of operations. "Thousands of children are in a critical condition for lack of medical facilities. The State government does not have the resources to fund the critical heart operations of children who are waiting for months for heart operations. Many children are also dying while they wait for heart operations in Andhra Pradesh. The Central government should pay attention to this critical problem," he pointed out.

Hepatitis C strike rate double that of HIV incidence in India

2006
By Syed Akbar
As scientists and health experts the world over rededicated themselves on the World Hepatitis Day on October 1 to the complex research on finding a vaccine for Hepatitis C, latest health reports reveal that this highly asymptomatic liver disease is fast spreading in India.
A World Health Organisation report points out that Hepatitis C virus, often described as a "viral time bomb", has recouped with strength to strike vigorously, two times more than that of the human immuno-deficiency virus or HIV. It has emerged as a silent killer in the country. The WHO lists India along with Egypt, Italy and Japan, where the HCV cases is rampant. The number of Hepatitis C patients in India equals if not exceeds the total number of HCV patients in Europe and the USA.
What worries health planners in developing countries, particularly India, is that there is no vaccine as yet to prevent Hepatitis C. Other Hepatitis virus like A and B have vaccines to prevent the spread of the disease. In the absence of a vaccine, the best way to keep off Hepatitis C virus, is by simply following certain "prevention and precaution" steps.
Another worrying factor that came to light during the World Hepatitis Day on October 1 was that the Hepatitis C virus could not be prevented totally through the use of condom. This virus can be spread by sex. But the efficacy of latex condoms in preventing infection with Hepatitis C virus is unknown. Doctors, however, feel that proper use of condoms may reduce the transmission risk, though it will not totally eliminate it.
Vaccination against Hepatitis A and Hepatitis B may help in prevention of Hepatitis C to a large extent.
"Did you receive a blood transfusion, hemodialysis, angiogram, tatooing, prolong injections or syringes? If yes, get tested for Hepatitis C. Remember the cure rate is high if the infection is detected early. Pegylated interferon can affect a cure in good number of patients," says senior gastroenterologist Dr Dharmesh Kapoor.
WHO health reports indicated that as against 5.1 million Indians suffering from HIV/AIDS, around 12 million Indians are suffering from Hepatitis C. That the disease is poised to spread fast in developing countries is evident from the fact that eight out of 10 people do not have access to safe blood. Moreover, about 30 per cent of HIV patients also simultaneously suffer from Hepatitis C.
The Indian Journal of Gastroenterology reports that about three per cent of people in Andhra Pradesh are infected by Hepatitis C. The number could actually be higher than reported as the data was collected based on medical screenings at laboratories. The undetected Hepatitis C population might be large for the simple reason that the disease is not manifested by any symptoms.
According to Dr Dinesh Kini, consultant gastroenterologist of Manipal Hospital, Bangalore, "Hepatitis C has a tendency to develop into long term liver disease and can cause liver cirrhosis and even cancer of the liver. The infection involves an initial phase of infection, which is often asymptomatic and lasts up to six months".
In a majority of patients (up to 85 per cent cases), the virus successfully fights the body immune system. The patients develop long term or chronic infection. They are now ready to transmit the disease to healthy people.
Like the HIV, the Hepatitis C virus remains in the infected patients for years together undetected. But unlike HIV, it does not invade the immune system but replicates successfully using the liver's resource cells.
Many times the patient does not know that he is carrying the virus except for some troubles like fatigue and discomfort in the upper abdominal area. It remains undetected for as long as 10 years and this is the main reason why scientists have so far failed in their attempts to develop a vaccine for this virus.
The WHO report on Epidemic and Pandemic Alert and Response refers to Hepatitis C virus as "highly heterogeneous". Eleven Hepatitis C virus genotypes with several distinct subtypes have been identified throughout the world.
The only good thing about Hepatitis C is that the virus does not spread by air. Since the mode of transmission is through skin or mucous membrane, one has to be careful while using tooth brushes, nail cutters, razors, injections and drug and tattoo needles. Those who are sexually active with multiple partners are at high risk of contacting the disease.
"If untreated the liver will be damaged. The only treatment then remains is to replace the damaged liver by a new one. Early detection and prompt treatment can save life," observes Dr Samir R Shah, specialist in Hepatobiliary diseases, Jaslok Hospital and Research Centre and Breach Candy Hospital, Mumbai.
Pegylated interferon alfa-2a (40KD) is a new generation Hepatitis C therapy and it offers sustained improvement in liver function and suppresses the virus in more than 50 per cent of patients. Ribavirin is the other drug found effective against this disease.
The pegylation of the interferon slows down the body’s ability to break down the interferon molecule. The interferon gets absorbed more slowly in the body and over a longer period of time. Thus constant amounts of the interferon are present in the body and because of this, the virus is under constant attack.
The WHO report, however, notes that "The diversities in the genotype of the virus have distinct consequences. Although different strains have not been shown to differ dramatically in their virulence or pathogenicity, different genotypes vary in their responsiveness to interferon/ribavirin combination therapy. Moreover, such heterogeneity hinders the development of vaccines, since vaccine antigens from multiple serotypes will probably be necessary for global protection".
About half of the Hepatitis C cases do not have any symptoms of the disease even though the virus is fairly active in the body. While 20 per cent of patients recover fully the remaining develop some form of chronicity. Five per cent of chronic patients develop liver cell cancer and an equal number suffer from decompensated cirrhosis.

Heart diseases are responsible for about one-third of all deaths in rural India

2006
By Syed Akbar
Hyderabad, Oct 3: Heart diseases are responsible for about one-third of all deaths in rural India while only 13 per cent of deaths are related to accidents including suicide.
An international research study conducted jointly by the George Institute for International Health and the University of Queensland revealed that heart related problems constituted the "major killer" of human beings in the countryside. The findings were published in the International Journal of Epidemiology and the research was carried out in East and West Godavari districts of Andhra Pradesh. The study emphasised the need for India to improve its health services besides creating new health avenues to fight against chronic ailments.
While the incidence of diseases related to heart are on the rise in the country, interestingly enough cases of infectious diseases are on the decline. This, according to the study, is the result of change in social and economic scenario in villages.
The study pointed out that death from injury, both accidents and self-inflicted as in suicide, was the second most common cause of death in rural India contributing to 13 per cent of total deaths. Infectious diseases, including tuberculosis, intestinal infections and HIV/AIDS, are responsible for 12 per cent of deaths, while cancer is contributing to 7 per cent of deaths.
According to Dr Rohina Joshi, the data on the causes of death is an indicator of the health problems now facing the rural India. The spurt in heart related diseases is linked to high rate of smoking, diabetes and high blood pressure among villagers.
The study was conducted in 45 villages spread over East and West Godavari districts covering a total population of 1.80 lakh.