Monday, November 30, 2009

Kaiga sabotage of trinium pollution: Hyderabad relatively safe from nuclear radiation, despite NFC

2009
By Syed Akbar
Hyderabad, Nov 29: Hyderabad, which meets the uranium needs of all nuclear power plants in the country, is relatively safe from radiation hazards.
Though most of the city-based Nuclear Fuel Complex is not under International Atomic Energy Agency safeguards, it has developed its own safety mechanism over the years to prevent radiation hazards to its employees and people living in the vicinity.
There have been quite a few instances of mishaps in the NFC since it was set up in 1971, but there's no evidence about the leakage of radiation into the environment. NFC witnessed accidents in the past. The recent one was on November 17, 2002 at its uranium oxide plant. Environmentalists then warned that large dosage of radioactive material was released into Hyderabad air then.
The DAE was quick to obtain a safety certification for NFC to "clear all doubts" in the minds of people about radiation hazard from the plant.
Moreover, a nuclear fuel processing unit like NFC is not as hazardous in terms of radiation leakage as a nuclear power plant. NFC enriches uranium from ore before it supplies to nuclear fuel plants in India.
Currently only a part of NFC is under IAEA safeguards. Now that it has been receiving uranium supplies from other countries, the department of atomic energy is bound to open some more parts of the plant
under safeguards for processing and fabricating the nuclear fuel, according to official sources.
"The adverse effect of sudden exposure to radiation on health is solely decided by the duration of the exposure. If a person is exposed for a brief period, it can cause skin irritation or skin cancer in the worst scenario. However if they are exposed for a longer duration, it can even cause blood cancer, genetic mutations and birth defects in the offspring," warns senior consultant radiologist Dr B Murali.
NFC officials claim that those who had designed NFC took enough care to prevent damage to human health and environment through radiation exposure. To ensure that enough safety mechanism is always in place, the Baba Atomic Research Centre has set up a health physics unit at NFC. It carries out in plant radiation and industrial hygiene survey, besides monitoring the health of workers at regular intervals.
NFC workers posted in the controlled area are monitored through thermo luminescent dosimeters for external exposure. Other employees in NFC are also monitored for lung 'uranium' burden.
"Studies conducted by Institute of Genetics and Hospital for Genetic Diseases could not detect any adverse work environment at NFC," a senior official said.
The safeguards notwithstanding, a plant dealing with radioactive substances always stand as a threat to human and animal life as well as environment. There have been complaints from NFC employees that they are exposed to radiation.
Radiation effect is felt more on pregnant women, says Dr Murali adding "women pregnant for less than three months are the most vulnerable as the child growing in the womb will get affected by radiation exposure. Depending on the stage of its development, the foetal growth gets stunted. She is very likely to give birth to an abnormal baby".

Tuesday, November 17, 2009

National Epilepsy Day November 17: Myths, misconceptions, stigma still continue with epilepsy or seizures

By Syed Akbar
Hyderabad, Nov 15: Epilepsy shrouds in myths. No other disease is as enigmatic as epilepsy and despite so much advancement in science, people continue to hold their myths about this neurological disorder. The common myth is that it is a mental illness and affects one's intellectual functioning.
As India observes the national epilepsy day on Tuesday, health researchers and medical experts clarify that epilepsy is not a psychological condition and it is not contagious. It is a common problem with four to 10 out of every 1000 people suffering from it. There's no cure for epilepsy and yet it could be controlled effectively.
"Seizures are caused by a transient, excessive and abnormal discharge of nerve cells. It can be treated. Any person can develop epilepsy at any time and there's no age restriction," says senior neurologist Dr M
Tripathi.
A disease surrounded by myths, people try to "lessen" the problem by putting an object, mainly made of iron, in the mouth of the patient. This many feel will prevent the patient from biting the tongue. Iron objects are also thrust into the hands of the person under seizure. This, doctors say, will only aggravate the problem, exposing the person to the risk of injury.
"The patient should be placed on his side so the tongue falls away and to the side. Do not try to restrain the person. Though there's no known cure for epilepsy, the problem can be fully or partially controlled through proper medication," he points out.
Though the brain is involved in epilepsy, it does not affect the intellect of an individual. It is not a mental illness. Historical records show that several world leaders including Alexander the Great, Russian writer Leo Tolstoy, dynamite discoverer Alfred Nobel, eminent physicist Sir Isaac Newton and ancient mathematical genius Pythagorus experienced seizures.
According to neurologist and medical author Dr S Jain, one in every 10 people may experience a seizure in their lifetime. However, the seizure may not necessarily be due to epilepsy. "There are several myths that
surround the disorder. The problem could be tackled quite easily if we create awareness among people. This is because epilepsy has become common all over the world," he points out.
Even as the disease is surrounded by misconceptions, a team of scientists at Cardiff University discovered that studying the way a person's brain ''sings" could shed light on epilepsy and schizophrenia. Further studies on this aspect will help scientists understand the reason behind neurological problems like epilepsy and find a possible cure.
According to them, a person's brain produces a unique electrical oscillation at a particular frequency when he or she looks at a visual pattern. The frequency of this oscillation appears to be determined by the concentration of the neurotransmitter called GABA or gamma-aminobutyric-acid.
The more GABA is present, the higher the frequency or "note" of the oscillation. GABA is a key inhibitory neurotransmitter and is essential for the normal operation of the brain.

National Epilepsy Day November 17: What triggers epilepsy, do's and don'ts in case of seizure

=====================
Do's & Don'ts

=====================
1. Follow doctor's prescription. Do not change the medicine or alter the dose
2. Do not change regular food habits or regular sleep time
3. Do not get excited
4. Do not take alcohol and avoid smoking
5. Avoid swimming or driving without a companion.
6. In case of a seizure, turn the patient to the side and loosen any tight clothing
7. Do not restrain convulsive movements
8. Allow free breathing without crowding.

=================================
What triggers epilepsy?
=================================
Epilepsy is triggered by several factors.

In case of children the factors include fever, birth or brain defects, infections like meningitis and head injuries.

In the case of adults the causative factors may be reaction by drugs, excessive consumption of alcohol, head injuries, brain tumours and lack of sleep.

National Epilepsy Day November 17: Common symptoms of Epilepsy, seizures or fits

============================
Common symptoms
============================

1. Attack of "fits" may be brief or long. There many be simple muscle jerks or severe and prolonged contractions of the muscles.
2. There may be temporary loss of awareness and disturbances of movement.
3. The person may appear to cry out or make some sound, stiffen for a few seconds, followed by rhythmic movements of hands and legs.
4. The person under seizure may not appear to be breathing.
5. In some cases, the patients appear to be confused after the attack ends.
6. The person may pass urine or stools.

Mild malaria parasite Plasmodium vivax may turn potent, cause health complications of Plasmodium falciparum

By Syed Akbar
Hyderabad, Nov 13: The generally mild malarial parasite, Plasmodium vivax, has turned potent with about a dozen complicated cases reported in recent times. The parasite has been found to attack lungs and cause severe respiratory complications.
Malaria is caused mainly by four species of Plamodium. Of these, Plasmodium falciparum has been known for its dangerous health complications including damage to brain and death. The type of malaria caused by common Plasmodium species, vivax, is generally mild and does not cause death.
But of late, cases of potent malaria caused by Plasmodium vivax have been reported from different malaria endemic regions of the country, raising concerns among medical experts and health planners. One such P. vivax complicated case has been reported in a corporate hospital in the city.
"Acute renal failure, acute respiratory distress syndrome, hypoglycemia, coma, or epileptic seizures are manifestations of severe Plasmodium falciparum malaria. On the other hand, Plasmodium vivax malaria seldom results in pulmonary damage, and pulmonary complications are exceedingly rare," says critical care specialist Dr Manimala S Rao.
Dr Manimala and her team treated one such patient. The 42-year-old man had developed acute respiratory distress syndrome. He had been diagnosed as having Plasmodium vivax malaria.
Though P. vivax has symptoms common to other types of malaria, it does not generally exhibit more severe complications like acute renal failure, ARDS and epileptic seizures. The patient was admitted with fever, chills, dry cough, headache, and body pain. He developed respiratory problem and was shifted to intensive care unit.
The team of doctors attending on the patient concluded that malaria caused by Plasmodium vivax can lead to acute respiratory distress syndrome.

Sunday, November 8, 2009

Indian doctors: Hall of fame - India regains supremacy in the world of medicine

By Syed Akbar
The Indian tradition of medical excellence pre-dates the advent of writing. Dhanwantari, Sushruta and Charaka gave the knowledge of Ayurveda to the world. Ancient Indian medical theses include those on
internal medicine, ophthalmology, otorhinolaryngology, surgery, toxicology, psychiatry, paediatrics and the science of rejuvenation and fertility.
In ancient India, two main schools emerged - Atreya - of physicians and Dhanwantari - of surgeons. The earliest international scholars of medicine came to Indian Ayurvedic schools: Chinese, Greeks, Romans,
Egyptians, Afghanis Ayurvedic texts were translated into Arabic.
Paracelsus, the father of modern Western medicine, practised a system of medicine in 16th century Europe, which borrowed heavily from Ayurveda.
Such was the development and the trust of people in the efficacy of Indian system of medicine that a doctor is considered a divine incarnate. - Viadyo Narayano Hari.
It is an Indian legacy that flourishes till today with medicine men of Indian origin leading the field in innovation, public health and teaching.

Indian doctors: Hall of fame - Part 1: Dr Chittaranjan S Ranawat, knee surgeon

By Syed Akbar
Remember the orthopaedic surgeon, who had come down all the way from the USA in 2000 to operate upon then prime minister Atal Bihari Vajpayee? Meet Dr Chittaranjan S Ranawat, the world renowned orthopaedic surgeon, researcher, developer and inventor. He holds half a dozen patents for his technological inventions that had made knee replacement surgeries quite an easy task for surgeons everywhere.
Dr Ranawat hails from Sarwania in Madhya Pradesh. Last year he developed rotating platform flexion, which has been hailed as a major technological advancement in knee replacement surgeries. The product, made
from superior plastics, is ideal for non-obese people. It does not wear out easily and ensures implant stability.
"I am dedicated to research and development of new methods to diagnose and treat arthritis from all causes. My goal has been to improve existing total joint technology and the knowledge of the disease process," points out Dr Ranawat.

A clinical professor of orthopaedic surgery at Weill Medical College of Cornell University, Dr Ranawat also doubles up as the director of Ranawat Orthopaedic Center at Lenox Hill Hospital. His focus areas have
been total hip and knee replacement and primary and revision total joint surgery.
He established Ranawat Foundation in 1986 to carry on his research activity. He has punished 92 research works on hip, 89 works on knee and more than 90 research publications on other topics including hand, wrist, shoulder and cervical spine.
Explaining how his research has been helping patients relieve themselves of the knee pain, he says "one of our most recent projects involves pain reduction after joint replacement surgery using a series of intra-operative
injections into the soft tissue with selected medications to control post-operative pain."
Dr Ranawat also focuses on the use of MRI scans as a non-invasive tool to detect wear-induced implant failure. At present patients are exposed to the risk of radiation using X-rays and CT scans to detect the failure. "By studying the implants themselves, we hope to design the best possible hip and knee implant for maximum mobility, function and durability," he adds.

Indian doctors: Hall of fame - Part 2: Dr Manjit S Bains, mesothelioma expert

By Syed Akbar
Millions of people all over the world suffer from a form of cancer called mesothelioma, and many of them look towards Dr Manjit S Bains as their Messiah. Mesothelioma is caused by exposure to asbestos and Dr Manjit Bains is a world authority from Memorial Sloan-Kettering Cancer Centre in New York, on this form of cancer.
A thoracic surgeon par excellence, Dr Manjit Bains is also famous for his clinical expertise in thoracic surgical oncology, lung cancer, oesophageal cancer, mediastinal tumours, pulmonary metastases, video-assisted thoracic surgery, pulmonary and upper gastrointestinal endoscopy, including laser endoscopy, and tracheobronchial and oesophageal stents.

"I am a medical graduate from All India Institute of Medical Sciences, New Delhi," he says with a bit of pride. After he settled down in the USA, he took up studies, surgeries and research on mesothelioma. Today he is credited with dozens of mesothelioma resources around the world. He has authored several books on cancer and successfully dealt with severely complicated kinds of thoracic cancers, earning accolades from leading research institutions and patients alike.
Dr Manjit Bains, who has completed four decades in the profession, has been included in the panel of about two dozen professional societies around the world. He has to his credit 150 research publications and books on cancers.
He has mastered the art of lung cancers, some of which requires removal of the entire lung along with partial removal of other organs. "We have been studying the resection and reconstruction of the chest wall," in cases of mesothelioma.
The pioneering research work carried out by him revealed that the use of a rigid prosthesis is possibly better but should only be done to patients who have gone through a rigorous selection process. He is also credited with research on the survival rate of cancer patients who are treated with pleurectomy (removal of outermost layer around the lung) rather than extrapleural pneumonectomy (removal of portions of lungs and outermost lung layer).

Indian doctors: Hall of fame - Part 3: Dr V Shanta, cancer specialist, Adyar Cancer Institute

By Syed Akbar
Magsaysay awardee Dr V Shanta is hope personified for millions of cancer patients in the country. In the last five decades, this untiring crusader against cancer rekindled hope, joy and the will to live in patients.
As chairperson of the famous Adyar Cancer Institute in Chennai, Dr Shanta is credited for her pioneering research in oncology, and prevention and cure of cancer.
She is also a leader in popularising early cancer detection programme and has set up India's first hereditary cancer clinic. She also opened tobacco cessation clinic, after her research studies revealed that cancers of the mouth, throat, oesophagus, and lungs are quite high among men and those of the breast and cervix among women. One in five women in the world who suffer from cervical cancer is an Indian.

Noticing her specialisation in cancer, the World Health Organisation nominated her to its advisory committee. Inspired by her maternal uncle Dr Subrahmanyam Chandrasekhar and her grandfather’s brother Sir CV Raman, both Nobel laureates, Dr Shanta too up cancer research. A profound believer in "Supreme Power", she attributes her success and service to the "grace of God" and "faith in her mission".
Dr Shanta is known for her groundbreaking research on oral, cervical, and breast cancer and paediatric leukaemia. At 78, Dr Shanta is quite active and treats cancer patients, performing surgeries and carrying on the research. "There is much more to do," she says, even as she attends to her patients.

Indian doctors: Hall of fame - Part 4: Dr Mani Lal Bhaumik, excimer laser surgery

By Syed Akbar
If you are suffering from short- or long-sightedness and yet do not want to wear glasses or contact lenses, your eye doctor will suggest that you undergo excimer laser surgery. It is an innovative technology that eliminates the need for wearing external eye aids to correct vision defects.
Excimer laser is used the world over and millions of people have benefited from it. They no longer wear glasses or contact lenses. And the credit goes to our own Indian Dr Mani Lal Bhaumik, researcher,
physicist, philanthropist and author.

His excimer invention won him 15 patents and made him a billionaire. He is one of the few Indians listed in the Who’s Who in America and in the Who’s who in the World, as also in the American Men and Women in
Science.
He believes that the recipe of success lies in the indomitable will to do something. Dr Mani Lal discovered the world's first efficient excimer laser, which takes less than a minute to correct vision defects like short or
long sight. Reaching the summit of glory was not an easy task for this young Bengali, who had to walk six km barefoot to the nearest school.
Inventor Mani Lal has an author in him too. His book, "The Cosmic Detective" is the best-seller in its class. He believes that science and spirituality are just two faces of the same coin. "This coin is the unique human consciousness that allows us to perceive both ourselves and objective reality," he argues.
His latest book, Code Name God, also a best-seller, emphasizes that the chasm between science and spirituality can be bridged.

Indian doctors: Hall of fame - Part 5: Dr Naresh Kumar Trehan, cardiologist

By Syed Akbar
A pioneer in the field of coronary artery bypass surgery, Dr Naresh Kumar Trehan has performed about 50,000 open heart surgeries. Today he is regarded as the king of open heart surgeries, including end stages
cases, in India. His reputation extends beyond national boundaries to the United States of America and the United Kingdom.
Soft spoken and simple-looking Dr Naresh Trehan held important academic and clinical positions in the New York University Medical Centre, Bellevue Hospital, New York, and Veterans Administration Hospital, Manhattan, USA.

He is famous world-wide for perfecting the art of minimally invasive robotically controlled cardiac surgery. Dr Naresh Trehan has operated upon thousands of VVIPs and business tycoons. To him also goes the credit of performing more than 10,000 beating heart surgeries, which even expert doctors in the USA and the UK, think twice before doing it.
Hailing from Punjab, Dr Naresh Trehan feels that Punjabis are perhaps the best suited for cardiac operations. "We Punjabis have the power to withstand the trauma of heart surgery. It is a risky proposition," he says. Incidentally, Punjab is one of the three States in the country with high risk of heart ailments.
While many Indian doctors prefer to stay abroad for professional reasons, Dr Naresh Trehan returned to India in 1988, despite a successful career in United States. He started Escorts Heart Institute  and Research Centre, which in a short span of time became an important landmark the world over in cardiac surgery and cardiology.
Dr Naresh Trehan shows keen interest in research and education. He has to his credit a number of research works presented at international medical meets in about a dozen countries.

Indian doctors: Hall of fame - Part 6: Dr KM Cherian, cardiologist and transplant surgeon

By Syed Akbar
Dr KM Cherian is the first and only Indian doctor, whose name is engraved in one of the stones in Kos Island, Greece, the birth place of Hippocrates, the Father of Medicine. Dr Cherian’s life is a saga dedicated to the world of cardiology and he has several firsts to his credit.
"My entry into the profession is purely providential," he says and his achievements have been "ordained". Like all those who are at the summit, he does not think he is on the top of the field "except that I had the opportunity to perform several first cardiac surgeries and transplants in the country".

Always busy with his patients and surgeries, Dr Cherian wishes he had free time for other activities. This affable doctor from Chennai has to his credit the first successful coronary artery graft, mitral valve replacement for endomyocardial fibrosis, introduction of profound hypothermia and circulatory arrest for correction of cardiac defects in infants, and first internal mammary artery graft, in India.
Dr Cherian, who studied medicine in India, Australia, New Zealand and the US, also introduced cardioplegia for myocardial preservation in India and undertook transatrial repair of tetralogy of fallot, transatrial and repair of double outlet right ventricle. He also performed the first heart transplant, first bilateral lung transplant, first pediatric heart transplant, first auto transplant and first heart and lung transplant, in India after the Central government introduced legislation on brain death cases.
He disagrees that all Indians do brilliantly. "Unless those Indians, who have achieved are motivated, hard working and committed". Brilliance is not a birth right or a national asset as Einstein once said "Brilliance is 99 per cent perspiration and 1 per cent inspiration".

Indian doctors: Hall of fame - Part 7: Dr Pradip Kumar Datta, FRCS teacher of doctors



By Syed Akbar
If thousands of doctors the world over have taken their first step on the career ladder of medicine, it’s thanks to Dr Pradip Kumar Datta. He is famous for his world renowned course in medicine which he launched in 1981. In recognition of his services to medical teaching, he has been awarded the Farquharson Award by the Royal College of Surgeons.
He conducts postgraduate surgical courses in the UK and India. And when he gets some spare time he goes salmon and trout fishing. Dr Pradip Datta was appointed as Consultant Surgeon, the top position that one can reach in National Health Service, UK.
Hailing from Visakhapatnam, he left India in 1967 to discover that it was difficult for Indian doctors to pass the Fellowship of the Royal College of Surgeons. He then decided to set up training for FRCS course and gained an international reputation for supporting students to develop the confidence they needed to impress examiners at the FRCS.
A humble Dr Pradip Datta, however, does not accept the fact that he has attained the highest pinnacle in the medical teaching profession. "I would never dream of ever saying or even thinking that I am the
best doctor in the field. That would be very arrogant, not to mention conceited".
Dr Pradip Datta, a general surgeon by profession, served as the honorary secretary of the Royal College of Surgeons of Edinburgh. Dr Datta does not benefit financially from his teaching as he gives donations and fees to charities. "I chose general surgery as my speciality as it gave me an opportunity to see patients with very
different conditions and to treat and operate on a wide range of surgical cases".
This doctor-teacher from Andhra Medical College in Visakhapatnam feels that Indians are doing so well because they are in general very hardworking and motivated. "This is not only in the field of medicine
but also in other spheres. This is true abroad as it is in India as well".

Indian doctors: Hall of fame - Part 8: Prof K Srinath Reddy, cardiologist and public health expert



By Syed Akbar
A clinical cardiologist and epidemiologist by training, Prof K Srinath Reddy is internationally renowned for his unstinting services to public health and rare career commitment to preventive cardiology.
Prof Srinath Reddy has several outstanding feats to his credit as a cardiologist and public health expert, but argues that unlike in competitive sports, one cannot ever claim to be on the top, in the field of medicine. Nevertheless, he agrees that "my work has won national and international recognition in the past 16 years".
Inspired by Dr Norman Bethune, a Canadian doctor who served in China, he decided to contribute lifelong, as a health professional, "to improve the lives of people and help to create a healthier India".
Prof Srinath Reddy graduated from Osmania Medical College, Hyderabad and later trained at AIIMS, Delhi. Before he took up the present task of presidentship of the Public Health Foundation of India, he headed
the cardiology department at AIIMS.
He has been involved in several major international and national research studies including the INTERSALT global study of blood pressure and electrolytes, on epidemiology of coronary heart disease and community control of rheumatic heart disease and on risk factors of myocardial infarction.
"A good doctor needs competence, commitment and conscientiousness in professional work while combining care, courtesy and compassion in dealing with patients and their families. I have tried to imbibe and apply these attributes in my work," says simple-looking Prof Srinath Reddy.
Always busy with his profession, he reads books, listen to music and watch old English and Hindi films whenever he gets "free" time. He has served on many WHO expert panels. He has also served as chair of the
scientific council on epidemiology of the World Heart Federation. He has more than 210 scientific publications. He was conferred Padma Bhushan. The Royal Society for the Promotion of Health, UK, conferred on him the award of the Queen Elizabeth Medal.
"Indians are quick learners usually," he says adding "but not always, apply themselves diligently to the completion of any task they take up". They also have the capacity for lateral thinking, which helps them to become effective problem solvers.

Indian doctors: Hall of fame - Part 9: Dr D Nageshwar Reddy, gastroenterologist



By Syed Akbar
When one thinks of gastroenterology, the first name that pops to mind is Dr D Nageshwar Reddy. From being just one of the many professors of gastroenterology two decades ago, Dr Nageshwar Reddy carved out a niche, through research, utmost patient care and dedication, in this area of medicine.
Today he is the best Indian doctor in gastroenterology and the most sought-after worldwide. When he gets free time, he reads books on philosophy, science and evolution.
"The centre of my universe is the patient," he says and it’s this single principle that has earned him name and fame, both at national and international level. "Only when we constantly think of ways to improve care of our patients and work hard at it, can we reach the top of any branch of medicine," he adds.
Being at the top in this select field, Dr Nageshwar Reddy feels that humility and compassion are two other characteristics that doctors require to excel in medicine. "Team work is very important," he points out.
Stating that it took about 15 years to reach the top in the field, Dr Nageshwar Reddy says he selected gastroenterology as the incidence of gastrointestinal diseases is very high in India.
He graduated from Kurnool Medical College in 1978 and obtained a PG degree in medicine from Madras Medical College in 1982 and specialisation in gastroenterology in 1984 from Post Graduate Institute of Medical Education and Research, Chandigarh.
A busy doctor he is, Dr Nageshwar Reddy and his team see over 200 outpatients and 250 inpatients. He is credited with a breakthrough in endoscopic treatment of gastrointestinal cancers, gallstones and pancreatitis.
He bagged a number of national and international awards which include Dr BC Roy Award for development of specialities, Padmasri, and the Master Endoscopist Award, the highest award in endoscopy, equivalent
to Nobel Prize in endoscopy.
He feels that Indians are doing so brilliantly because Indians are innately intelligent and willing to work hard, much harder than an average westerner.

Indian doctors: Hall of fame - Part 10: Dr Rangaswamy Srinivasan, Lasik co-inventor

By Syed Akbar
Dr Rangaswamy Srinivasan co-invented the process of LASIK surgery, a laser process that allows the removal of soft tissue from anywhere in the human body with a precision that was unknown before. He developed a technique called "Ablative Photo Decomposition " in 1981, not in a hospital, but at the IBM Research Centre.
He is a research physician who works on inventing techniques to improve not only surgical methods but also processes used in the making of computer chips. This inventor loves reading books on history, particularly
Indian history, and listens to music.

"When the potential of APD in surgery was announced by IBM in 1983, surgeons came to my lab to see what I could do to help their speciality. One of the first was an ophthalmic surgeon from Columbia University. Together we developed the surgical procedure which is today known as LASIK."
Dr Srinivasan, who obtained his early education in Chennai, is the first person of Indian origin to be inducted into the inventors hall of fame in Akron, USA for discovery of Lasik and yet he says, "it will be just a boast to
say I am the best doctor in this field".
"Indians are doing brilliantly everywhere in the world whenever and wherever they get the opportunity. The tragedy is that these people (including me) have to emigrate in order to find that opportunity. After my Ph. D., I did return to India and I did find a job at one of the leading government research centres.
But the pace of the work there and the red-tape not to mention the hierarchical arrangements were so discouraging that I left after just eight months in order to seek my opportunities abroad".

Indian doctors: Hall of fame - Part 11: Dr Santosh G Honavar, retinoblastoma specialist

By Syed Akbar
Retinoblastoma is a major eye cancer, which leads to blindness. Managing the problem requires a lot of expertise, patience and dedication. Dr Santosh GHonavar is a rare blend of a clinician and a scientist. The comprehensive multispecialty children’s eye cancer centre, which he established, is now recognised as one of the best in the world. He has contributed more than 125 research papers to various national and international magazines.
His outstanding work on retinoblastoma notwithstanding, Dr Honavar does not feel that he is on the top of the field. "The moment one assumes this, he has lost it!," he says, adding "like a duck in water, one has to
paddle hard to even stay at the same place in the field of medicine".

Dr Honavar loves music but says he has chosen ophthalmic plastic surgery and ocular oncology, because it provides all the excitement of being a surgeon, and also the sense of fulfilment of being able to restore the
patient’s appearance as in ophthalmic plastic surgery; and salvage life, eye and vision as in ocular oncology.
Simple looking Dr Honavar has made a mark of his own in the fields of tumours of the ocular surface, orbit, retinoblastoma, and paediatric lachrymal disorders. The worth of Dr Honavar’s scientific work can be gauged by his cumulative citation index of 617, H Index of 16 and G Index of 22. He is a recipient of Shanti Swarup Bhatnagar award.
He feels that Indians, specifically those who have received their initial medical education in India are doing well in medical specialities probably because of their extensive training background and exposure to a vast range of pathology. "We Indians fancy gadgets and techniques and tend to do very well in performing surgical procedures that the others have invented, may be even much better than the inventor, because of the vast volume that we have to hone our skills with."

Indian doctors: Hall of fame - Part 12: Prof Jatin P Shah, head and neck surgery expert

By Syed Akbar
Head and neck surgery is a highly specialised art of medicine. Given the most important and sensitive organs they contain, many doctors shudder at the very thought of specialising in it. But Professor Jatin P Shah feels quite at ease as he scalpels through the head and neck of his patients with 100 per cent success.
Today he is arguably the best Indian doctor and authority in the field of head and neck surgery in the West. But Prof Jatin Shah is full of humility when he refuses to accept it. "One should never consider as being on "top of the field" since it implies that further growth has stopped. I believe one should continue to strive to be at the top of the field throughout one’s active life" he points out.
That Prof Jatin Shah takes head and neck surgery with a passion is evident when he confides, "it is not work for me but it is simply joy and pleasure and it is my means of recreation and relaxation. Thus, it is my life and soul."

Prof Jatin Shah graduated from the medical college of MS University in Vadodara, and received his training in surgical oncology and head and neck surgery at Memorial Sloan Kettering Cancer Center. He is a national and international leader in the field of head and neck surgery. Ask him why he has chosen oncology (cancer), he says "I had also a personal reason for getting attracted to this field since I lost my father to lung cancer".
He founded The International Federation of Head and Neck Oncologic Societies, in 1986. He received many international awards including honorary fellowships from The Royal College of Surgeons of Edinburgh,
London and Australia. But he likes to share credit with his vast team, which includes expert cancer surgeons, specialist-scientists and paramedical staff.
Explaining why Indians excel outside, Prof Jatin Shah observes, "when we move to the more affluent western world, which offers an environment conducive to productivity, and creates a milieu for one to be creative and
productive, we seize the opportunity and excel". The combination of excellent education, outstanding work ethics and sheer hard work has led numerous Indians to perform brilliantly.
Prof Jatin Shah is a much sought-after speaker with visiting professorships in 32 countries including the United States, Canada, the United Kingdom, Japan and China. In recognition of his outstanding contributions, and world leadership in head and neck surgery, Memorial Sloan Kettering Cancer Center, has established "Jatin Shah Chair in Head and Neck Surgery and Oncology".
And what the Professor does when he is free? "Head and neck surgery is my pride and passion. Thus, it occupies my mind and my body."

Thursday, November 5, 2009

Toxicity of GM Foods: Is Bt brinjal safe for human consumption?

2009
By Syed Akbar
Four thousand years after it entered the Indian kitchen, all time favourite brinjal may soon shed its traditional flavour. With the Genetic Engineering Approval Committee giving its nod for the genetically modified or Bt brinjal for human consumption, doubts are being expressed about the very survival of the native brinjal varieties.
India is the home to about 2500 varieties of brinjal, all native to the land. Unlike tomato and potato, which
entered the Indian soil in the last 100 years, brinjal has been under cultivation for about four millennia. When the Bt brinjal enters the mass cultivation phase in India, it will become the first GM food crop approved for human consumption.
"The mouth-watering bagara baigan or baigan ka bharta may not be the same again. Once the genetically modified or Bt brinjal is introduced, the centuries old Indian cuisine may undergo a change. GM crops, though give better yields, will rob off taste. There are other environmental concerns too," cautions senior geneticist Dr MM Khaja.Though the USA and other Western countries have approved GM foods like Bt soya and Bt maize, they are primarily meant for animal feed. Those who are against GM crops argue that since GM crops are a new phenomenon, the long time side effects on human health are yet to be understood.
"Tinkering with Nature does have catastrophic effects not only on environment but also on the health of man and animals. The injection of Bt gene from a soil bacteria into food stuff may lead to mutations in human body, may be at a later date. The GEAC should have conducted safety studies for at least a decade before declaring Bt brinjal safe for human use," points out Ch Venkatasubbaiah, who runs an environmental group against GM foods.
Thanks to its ubiquitous use in the Indian kitchen, brinjal has the distinction of being the second highest
consumed vegetable in the country, after potato. The crop is grown over 5.50 lakh hectares providing
livelihood to a little over 15 lakh farmers and about 50 lakh vegetable vendors. Indians consume about one
crore tonnes of brinjal, 25 per cent of the world's total consumption. At stake is about Rs 10,000 crore
worth of native brinjal production and priceless biodiversity.
Those in favour of Bt technology argue that GM brinjal will become a boon for the average Indian farmer,
since it will improve the overall production, quality and taste of the vegetable by preventing it from its
common pest. There's no need of spraying of pesticide and this will enhance the quality of the product,
besides improving its taste.
Infants are always considered as a high-risk group and the effects of such novel food items like Bt brinjal needs to be checked for their effects on infants. No such study was done in the case of Bt brinjal. The Royal Society of London has in the past expressed concern in this regard - Greenpeace.
The private seed company that is coming out with Bt brinjal has selected some mammals and birds for poison studies and claims that no toxicity was found in the lab animals. It is yet to be used on humans and only time will tell whether it will prove toxic on human beings.
Internationally renowned biotechnologist Prof DR Krishna calls for proper checks on GM crops. "If proper
checks and balances are not evolved to regulate the developments in the bio-technology sector, it will lead
to more problems and complications resulting in the loss of our rich bio-diversity and threatening the public
health."
Another concern about GM crops is the Bt toxin from bacteria, which some scientists argue, is about a
thousand times more potent when injected into food stuff. Greenpeace, which has been spearheading world-
wide campaign against genetic modification of food items, expresses concern that if Bt brinjal was allowed,
other food crops like lady's finger and cabbage will be genetically tinkered. Studies on these crops are
already in progress. There's a talk of even GM rice.



Toxicity of GM foods - Part two: Arguments for and against Bt brinjal

By Syed Akbar

There has been a lot of debate on the safety aspects of genetically modified crops. Those in favour of GM crops say they help farmers by reducing the costs on pesticides, while increasing the yields to feed the
ever-growing population. But those who oppose GM crops, express doubts over their environmental safety and fitness for human or animal consumption.

In India the only GM crop that has been in mass cultivation for at least five years is Bt cotton. But cotton is a commercial and not a food crop. In the USA and other countries Bt maize and Bt Soya are in cultivation
and most of the produce goes for animal feed.
Bt brinjal will be the first GM food crop to be permitted for human consumption.
=====================
Arguments against Bt brinjal
=====================

1. Those who eat Bt brinjal will develop resistance to antibiotics like neomycin and streptomycin.
2. The bacterial gene inserted in Bt brinjal releases crystal proteins, which are dangerous for human consumption.
3. Since Bt brinjal is a new product, it is now clear how it will react with human body over a long period of time.
4. Bt brinjal will upset the natural biodiversity, posing a major threat to ecological balance.

=========================
Arguments in favour of Bt brinjal
=========================
1. Bt brinjal will do away with the need for pesticide spraying.
2. It will increase productivity, thus helping farmers monetarily.
3. Bt brinjal is safe for human consumption.

Toxicity of GM foods - Part three: What is Bt brinjal?

2009
By Syed Akbar

What is a Bt or genetically modified brinjal? India has thousands of varieties of brinjal. All of them are native to sub-continent. But they are prone to pests, so much so that by the time farmers harvest the crop, half of the produce or even more is lost to insects and worms. What farmers get is hardly half or one-third of the total produce.

To reduce the losses to insects or worms, farmers keep on spraying pesticides, spending huge amounts.
So a local private seed company with international links has genetically modified one of the varieties of brinjal to make it pest-resistant.

To achieve this, it has inserted a toxic gene from a soil-thriving bacteria called Bacillus thuringenesis, or Bt for short. This gene makes the brinjal plant poisonous for its common pest. In other words, farmers need not spray pesticides. Studies have shown that the Bt toxin gains in potency about a thousand times when used in GM crops.

Sounds good. But farmers stand to benefit for a short time. The Bt seeds are not cultivable, unlike those of traditional brinjal varieties. Every season, farmers will have to look to the seed company for supplies. In other words, farmers will be at the mercy of the seed firms.

Friday, October 30, 2009

Nosocomial infection caused Nellore blindness: All about the hospital bane called pseudomonas

2009
By Syed Akbar
Hyderabad, Oct 27: It was not a wrong incision that caused infection leading to blindness at a mass surgical camp in Nellore. Health experts feel that there could have been inadequate sterilisation of the equipment used and indequate care exercised against infections during the operation.
According to Dr CR Sundaresan from Singapore, "perhaps since it was a camp setting, asepsis would not have been adequate". The improper follow up could also have contributed.
======
About two dozen people, who underwent surgeries for cataract at a free camp organised by Bollineni Foundation in Nellore, were infected. Half a dozen of them turned blind. Improper disinfection is said to be the cause.
======

Pseudomonas, which is blamed as the causative agent of infection in 16 of the people who underwent cataract surgery, is a highly dangerous organism that is capable of living even in antiseptic lotions. The doctors should have exercised utmost caution on the asepsis aspect, instead of just depending on the brand of the aseptic material used during the surgeries.
==============
Being Gram-negative bacteria, most Pseudomonas spp. are naturally resistant to penicillin and the majority of related beta-lactam antibiotics, but a number are sensitive to piperacillin, imipenem, tobramycin, or ciprofloxacin.This ability to thrive in harsh conditions is a result of their hardy cell wall that contains porins. Their resistance to most antibiotics is attributed to efflux pumps which pump out some antibiotics before they are able to act.
=============
Dr Sundaresan pointed out that Pseudomonas is the bane of hospital or medical procedure acquired infection (nosocomial infection). This notorious organism is hard to eliminate except with the most diligent measures, as it can even thrive in antiseptic lotions.
"Also a 'work up' before surgery is mandatory, which means that certain conditions such as diabetes mellitus, which could potentially cause this turn of events, must be excluded. Except for a single measurement of blood sugar, which in and of itself may not be an adequate measure to identify diabetes, a few investigations would have been performed," he argues.

Meanwhile, the Andhra Pradesh Opthalmological Society on Tuesday argued that the complication is not related to surgery "but to factors outside the control of the surgeon". According to Dr K Sivarama Krishna, association president, clustering or grouping of cases specially means some material or fulid used during surgery, such as irrigating fluid bottle, intraocular lens, viscoelastics, gloves etc were contaminated with bacteria.
"A surgeon uses these items of the brands he trusts, and it is not possible to check the sterility of each item before use. He has to trust the brand," he points out adding that this complication cannot be eliminated despite all efforts and "this risk has to be accepted as long as surgery happens. Otherwise surgery cannot happen".
The association said doctors had obtained consent of the patients for possible infection following eye surgery.

Neem Extracts - NeemAzal T/S: Azadirachta indica as larvicide of harmful, disease-causing mosquitoes

2009
By Syed Akbar
Hyderabad, Oct 27: Indian vector control experts have now found that extracts from the common neem can
fight the spread of dangerous diseases like malaria, dengue and chikungunya, by killing the mosquitoes that
harbour the causative organisms.

Mosquito species like Aedes, Anopheles and Culex carry harmful organisms that cause chikungunya,
dengue, malaria and elephantiasis. The spread of mosquitoes is controlled world-wide by spraying synthetic pyrethroids like permethrin, deltamethrin and alpha-cypermethrin.These chemical insecticides kill mosquitoes but cause untold damage to environment and human health. Moreover, many species of mosquitoes have developed resistance to chemical pesticides.
A team of researchers from the Vector Control Research Centre has found that Azadirachta indica (Indian neem) to be a potential resource for the development of new insecticides for arresting the spread of mosquitoes. The neem extracts can also be used for the treatment of netting or housing.
Though neem products have been used world over in agriculture and gardening to control pests, they have
never been tested on human pathogens and mosquitoes or disease vectors. According to the researchers, Dr
K Gunasekaran and Dr T Vijaykumar, the neem extracts effectively control adult mosquitoes as well as
their larvae.

"Antiviral activity of neem leaf extracts has been evidenced against dengue virus, HIV and several important parasitic protozoa, including Trypanosoma, Leishmania and Plasmodium. The neem product, NeemAzal T/S 1.2 per cent EC, has successfully controlled mosquitoes like Anopheles stephensi, Culex quinquefasciatus and Aedes aegypti," the study pointed out.
The produce, when used even in minute quantities (less than 1 ppm), kills 50 per cent of larvae before they become adult mosquitoes. NeemAzal T/S 1.2 per cent EC is a promising insecticide to complement currently used biological larvae control agents including larvivourous fish, the researchers said.

Tuesday, October 27, 2009

Blinding at an eye camp: Inadequate sterilisation of equipment caused infection

2009
Syed Akbar
Hyderabad, Oct 27: It was not a wrong incision that caused infection leading to blindness at a mass surgical camp in Nellore. Health experts feel that there could have been inadequate sterilisation of the equipment used and indequate care exercised against infections during the operation.

According to Dr CR Sundaresan from Singapore, "perhaps since it was a camp setting, asepsis would not have been adequate". The improper follow up could also have contributed.

Pseudomonas, which is blamed as the causative agent of infection in 16 of the people who underwent cataract surgery, is a highly dangerous organism that is capable of living even in antiseptic lotions. The doctors should have exercised utmost caution on the asepsis aspect, instead of just depending on the brand of the aseptic material used during the surgeries.

Dr Sundaresan pointed out that Pseudonomas is the bane of hospital or medical procedure acquired infection (nosocomial infection). This notorious organism is hard to eliminate except with the most diligent measures, as it can even thrive in antiseptic lotions.

"Also a 'work up' before surgery is mandatory, which means that certain conditions such as diabetes mellitus, which could potentially cause this turn of events, must be excluded. Except for a single measurement of blood sugar, which in and of itself may not be an adequate measure to identify diabetes, a few investigations would have been performed," he argues.

Meanwhile, the Andhra Pradesh Opthalmological Society on Tuesday argued that the complication is not related to surgery "but to factors outside the control of the surgeon". According to Dr K Sivarama Krishna, association president, clustering or grouping of cases specially means some material or fulid used during surgery, such as irrigating fluid bottle, intraocular lens, viscoelastics, gloves etc were contaminated with bacteria.

"A surgeon uses these items of the brands he trusts, and it is not possible to check the sterility of each item before use. He has to trust the brand," he points out adding that this complication cannot be eliminated despite all efforts and "this risk has to be accepted as long as surgery happens. Othersise surgery cannot happen".

The association said doctors had obtained consent of the patients for possible infection following eye surgery.

Monday, October 26, 2009

Oral cholera vaccine has been found to be safe in India

2009
By Syed Akbar
Hyderabad, Oct 25: Oral cholera vaccine has been found to be safe in India and is likely to be introduced for inoculation in cholera endemic areas in the country including Hyderabad.

Though oral cholera vaccine consisting of killed whole cells has been present in the market for many years,
it is never prescribed by health authorities fearing its safety.


Vietnam is the only country where it is prescribed, though in a limited way. With India and several other countries showing bouts of cholera epidemic at regular intervals, the Seoul-based International Vaccine Institute took up its safety and efficacy studies on Indian populations.

The IVI modified the vaccine to suit World Health Organisation standards and inoculated over a lakh people in Kolkata. A leading pharmaceutical research company from Hyderabad collaborated the project and prepared the vaccine. It is inexpensive and has been found to be highly useful in preventing cholera.

IVI advocacy officer Tae Kyung Byun told this correspondent that the vaccine protected individuals in age-groups one to 4.9 years, 5·0 to 14·9 years, and 15 years and older, and protective efficacy did not differ significantly between age-groups.

This modified killed-whole-cell oral vaccine, compliant with WHO standards, is safe, provides protection
against clinically significant cholera in an endemic setting, and can be used in children aged one to 4·9
years, who are at the highest risk of developing cholera in endemic settings like Hyderabad.

According to WHO statistics, cholera accounts for an estimated 1,20,000 deaths every year world-wide.
"WHO has recommended the use of oral cholera vaccine for control of the disease since 2001, and one such
vaccine, containing recombinant cholera toxin B subunit and killed whole cells is internationally licensed,"
he said.


The Kolkata trial has revealed that the vaccine is safe and confers 66 per cent protection in all individuals older than one year of age, eight to 10 months after vaccination, and 50 per cent protection, three to five
years after vaccination. The vaccine has been found to be safe and immunogenic in India.

Over all, the vaccine provides about 70 per cent protection against clinically significant cholera for at least two years after vaccination, equally in children and older people.

Sunday, October 25, 2009

Genetic history of Muslims in India: Islam spread through cultural conversion, and not through human invasion

2009
By Syed Akbar
Hyderabad, Oct 23: The spread of Islam in India was predominantly a cultural conversion associated with minor but detectable levels of gene flow primarily from Iran and Central Asia, and not directly from the
Arabian peninsula, according to a new research study collaborated by the city-based Centre for Cellular and Molecular Biology.

The study also found that most of the Indian Muslim populations received their major genetic input from geographically close non-Muslim populations. "However, we have also observed low levels of likely sub-Saharan African, Arabian and West Asian admixture among Indian Muslims. We rule out significant gene flow from Arabia," CCMB senior scientist Dr K Thangaraj told this correspondent.

==========================
According to historical evidence, the Indian Subcontinent has been exposed to several waves of human migrations from the Arabian Peninsula and Iran, the homelands of Indian Muslim rulers Arabian Peninsula (where Islam was propagated) served as a hub for human migrations, hence the merged genetic signatures of Eurasian and African origin, which has been detected in both maternal and paternal lineages from the region. Besides Arabia, Iran is a second plausible genetic source for Indian Muslims. It is positioned in the tricontinental nexus and its populations genetically show close proximity to those from the Near East, lthough with a lesser genetic input from Africa than from the populations of the Arabian Peninsula.Besides mtDNA and the Y chromosome, which show relatively low levels of differentiation between these two potential sources, recentstudies of lactose tolerance have revealed that Iranian and Arabian populations differ significantly in genetic patterns at this locus.
=====================
The CCMB took up the study in collaboration with the National DNA Analysis Centre of the Central Forensic Science Laboratory, Kolkata, State Forensic Laboratory, Lucknow, Leverhulme Centre for Human
Evolutionary Studies of University of Cambridge, UK, Department of Evolutionary Biology of Estonian Biocentre and Tartu University, Estonia, and the Wellcome Trust Sanger Institute, UK.

To estimate the contribution of West Asian and Arabian admixture to Indian Muslims, the team assessed genetic variation in mitochondrial DNA (mother's lineage), Y-chromosomal (father's lineage) and genetic
markers representing six Muslim communities from different geographical regions of the country.

"Most Indian Muslims are closely related to their neighbouring non-Muslim populations and this suggests that they descend primarily from local Hindu converts. The exception to this are some northern and north-western Indian Muslims, who differ from indigenous Hindu populations, likely because of a higher proportion of genetic lineages of external origin," the study pointed out.

The researchers used as many as 472 Indian Muslim mitochondrial DNAs, 431 Indian Muslim Y chromosomes and 747 Indian Muslim and non-Muslim gene (MCM6) profiles for the study. "There is a notable variation between different Indian Muslim populations, some being highly similar to local Indian populations and others having similarities with external populations, so that when they are all grouped
together as ‘Indian Muslims’, the group difference is statistically insignificant from that of non-Muslims," Dr Thangaraj said.
Shia, Sunni, Dawoodi Bohras from Gujarat and Mappla from Kerala are found to cluster together with Indian non-Muslim populations, whereas Dawoodi Bohras from Tamil Nadu seem to be an outlier. In the Y-chromosomal plot too, Shia, Sunni, Dawoodi Bohras from Gujarat and Mappla form a group with their neighbouring Indian non-Muslim populations and Europeans, whereas the Dawoodi Bohras from Tamil Nadu, again found as an outlier.


Thursday, October 8, 2009

Scientists baffled at sudden swine flu deaths in India

2009
Syed Akbar
Hyderabad, Aug 10: Scientists and health experts are baffled over the sudden swine flu deaths in the country, even as the National Institute of Virology has clarified that the novel H1N1 virus that causes human influenza has not mutated in India to become more aggressive.

Swine flu has been in existence in the country for the past five months without any fatalities. But in the last one week there have been six deaths, forcing scientists and health experts to think whether the virus had mutated in the country to take a virulent form. Some believe that the novel H1N1 virus is now in the second phase of manifestation as the human influenza viruses normally do. The Spanish flu virus did the same in early 19th century killing millions of people worldwide.

"We have been monitoring the virus from different human samples. But so far we have not found any mutation or change in the virus. The virus currently present in the country is the same as found in Mexico, USA and other parts of the world," Dr Akhilesh C Mishra, director of NIV, Pune, told this correspondent.

Asked about the sudden swine flu deaths in the last one week, Dr Mishra attributed it to the "wide profiling system" now adopted by health authorities. "Earlier, we used to screen only those coming from other countries. Now we are screening the local public too. This has led to a sudden spurt in the number of cases. And this explains the deaths too," he clarified.

But senior geneticist Dr M Khaja emphasises the need for a relook at the virus. "All through the history the influenza virus has been mutating. Even the present novel H1N1 virus is a mutant one. There are chances of it mutating further in a country like India with vast population. Swine flu virus is capable of leading to secondary infection, both viral and bacterial," he said.

Even as local scientists differ on whether the virus has mutated or turned aggressive since temperatures have gone down because of monsoon, American researchers have unravelled the mechanism the human influenza virus adopts to kill its host.

Swine flu virus is capable of binding deeper into the cells of lungs and stomach, unlike other influenza viruses. "There are slight differences in the way different flu proteins bind to receptors in lungs. Since the swine flu virus binds deeper in the lung's trachea, bronchi and bronchioles, it causes breathing problems, which ultimately lead to death. The virus is also capable of replicating faster and causing more damage than other influenza viruses. Different patients react differently to the virus. This explains the death of some swine flu patients and survival by others," said US-based senior researcher Dr G R Reddy.

While other influenza virus do not touch the stomach, the novel human influenza virus binds with the stomach lining and intestines. This causes diarrhoea, vomiting and nausea in some patients suffering from swine flu.

Wednesday, October 7, 2009

Acupuncture regaining popularity


---------------------------------------------
The doctor can be contacted on mobile No. +91-9949699469 and his address is flat No. 11, Manohar Enclave, Krishnapuri Colony, West Marredpally, Secunderabad - 500026 Hyderabad India
---------------------------------------------

By Syed Akbar

Middle-aged T Amarnath had a slip disc. Doctors suggested that he undergo
surgery. After being on bed for 29 days, he felt that surgery only would solve his
problem. But before he joined a hospital, one of his friends suggested that he
consult an acupuncture expert. Within a week, he was back to work with no signs
of slip disc.

Surendra Paul Singh (51) had been diagnosed with a kidney problem with urea
and serum creatinine levels of 140 and 7.8 respectively. A fortnight after he
underwent acupuncture therapy, the kidneys had started returning to normalcy.
The present readings are 80 (urea) and 5.2 (creatinine).

Scores of patients like Amarnath and Surendra Paul, who have benefited from
acupuncture after allopathic treatment failed, stand testimony that this ancient
Chinese medical system is gaining popularity in Andhra Pradesh. With the cost of
acupuncture treatment being affordable, more and more patients are turning
towards it. The success rate too is quite high, claim patients, who benefited from
acupuncture.

And popularising acupuncture in Hyderabad is Dr N Arun Kumar, who treats his
patients employing a sort of holistic approach, combining acupuncture with Yoga
postures, Pranayama and Ayurveda. He underwent specialised training in
acupuncture in Sri Lanka.

That acupuncture is becoming popular even among doctors practising modern
medicine is also evident from the medical history records maintained at the clinics
run by Dr Arun. Some of his clients include senior surgeons, physicians and
specialist doctors. And they all vouchsafe that acupuncture is not only safe, but
also effective.
Says housewife Aruna, who has been suffering from severe back pain, "a doctor
gave me an imported injection which costs Rs 20,000. And when it failed to
provide relief, he suggested surgery. I have been undergoing acupuncture sessions
for the past 28 days and I am much relieved now. A week more of acupuncture
sessions will, I am sure, solve this nagging problem".

According to Dr Arun, acupuncture had its birth in India but developed in China.
"It's a 5000 year old system and the cost involved in this method of treatment is
hardly five per cent of the money one has to spend if one follows allopathy. I also
prescribe simple Yoga exercises and Pranayama. In some cases a few Ayurvedic
medicines are also prescribed. There's no diet restriction except like avoiding
tamarind. I also teach them a few mudras," he points out, explaining how
acupuncture works.

"It's virtually painless. I just feel the ##### of a needle. It gives immediate relief
from pain," says one of the patients Abkari Meena. A few days ago she could not
walk because of the back pain. "It's OK now. I can stand and walk without
support. I am able to climb stairs."

As Dr Arun says acupuncture gives effective results in problems related to
orthopaedics and neurology, particularly in cases like rheumatic pains,
spondylosis, back pain, leg pain and slip disc. Also beneficial in knee pain,
cervical spondylosis, shoulder pain, frozen shoulder, tennis elbow, foot drop,
sciatica, arthritis (rheumatoid), osteo arthritis of the cervical spine, migraine,
insomnia, paralysis, bell's palsy, trigeminal neuralgia, peripheral neuropathy,
asthma, skin diseases and vertigo. The gastric and urinary systems responds well
to this form of treatment. It effectively controls diabetes.

Dr Arun, a student of noted acupuncturist Dr Lohia, uses specialised needles with
automated vibrating system to treat patients. "In early days doctors used to move
the needles manually. It was quite painful. Now it is automated and the level of
vibration can be adjusted according to the patient's requirement".

Acupuncture works on the Chinese medical principle of good and bad energy. It
removes imbalances and creates a striking balance between these two energies,
thus improving the immune system.

--------------------
Doctors testify
---------------------


I had severe back pain and I was treated by Arun Kumar (acupuncturist). Now I
am totally pain free and thankful to him for his technique and skill.
Dr. D Ramchandra Reddy, consultant anaesthetist and intensive care specialist

-------

I had severe pain in my legs even after I underwent a total knee replacement four
years ago. I sought the help of Arun to treat me. Now, I am able to wait, without
pain, comfortably.
Dr. Mangutha Narsing Rao

--------

It gives me great pleasure to state that Arun has treated my wife Dr SG Mudaliar
(retd. chief medical superintendent), South Central Railway, for back pain, which
she had been suffering for the past one year. Now she is relieved of that pain.
Dr ASG Mudaliar (retd. prof of surgery and civil surgeon, superintendent of
Gandhi Hospital)

-------

I was suffering from serious back pain. Then I got acupuncture treatment from
Arun and now I'm relieved of the pain.
Dr MV Mukteshwar (consultant anaesthetist (retd) Gandhi Hospital)

Monday, October 5, 2009

Avian Influenza: The disease in humans


History and epidemiology. Influenza viruses are normally highly species-specific, meaning that viruses that infect an individual species (humans, certain species of birds, pigs, horses, and seals) stay “true” to that species, and only rarely spill over to cause infection in other species. Since 1959, instances of human infection with an avian influenza virus have been documented on only 10 occasions. Of the hundreds of strains of avian influenza A viruses, only four are known to have caused human infections: H5N1, H7N3, H7N7, and H9N2. In general, human infection with these viruses has resulted in mild symptoms and very little severe illness, with one notable exception: the highly pathogenic H5N1 virus.

Of all influenza viruses that circulate in birds, the H5N1 virus is of greatest present concern for human health for two main reasons. First, the H5N1 virus has caused by far the greatest number of human cases of very severe disease and the greatest number of deaths. It has crossed the species barrier to infect humans on at least three occasions in recent years: in Hong Kong in 1997 (18 cases with six deaths), in Hong Kong in 2003 (two cases with one death) and in the current outbreaks that began in December 2003 and were first recognized in January 2004.

A second implication for human health, of far greater concern, is the risk that the H5N1 virus – if given enough opportunities – will develop the characteristics it needs to start another influenza pandemic. The virus has met all prerequisites for the start of a pandemic save one: an ability to spread efficiently and sustainably among humans. While H5N1 is presently the virus of greatest concern, the possibility that other avian influenza viruses, known to infect humans, might cause a pandemic cannot be ruled out.

The virus can improve its transmissibility among humans via two principal mechanisms. The first is a “reassortment” event, in which genetic material is exchanged between human and avian viruses during co-infection of a human or pig. Reassortment could result in a fully transmissible pandemic virus, announced by a sudden surge of cases with explosive spread.

The second mechanism is a more gradual process of adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Adaptive mutation, expressed initially as small clusters of human cases with some evidence of human-to-human transmission, would probably give the world some time to take defensive action, if detected sufficiently early.


During the first documented outbreak of human infections with H5N1, which occurred in Hong Kong in 1997, the 18 human cases coincided with an outbreak of highly pathogenic avian influenza, caused by a virtually identical virus, in poultry farms and live markets. Extensive studies of the human cases determined that direct contact with diseased poultry was the source of infection. Studies carried out in family members and social contacts of patients, health workers engaged in their care, and poultry cullers found very limited, if any, evidence of spread of the virus from one person to another. Human infections ceased following the rapid destruction – within three days – of Hong Kong’s entire poultry population, estimated at around 1.5 million birds. Some experts believe that that drastic action may have averted an influenza pandemic.

All evidence to date indicates that close contact with dead or sick birds is the principal source of human infection with the H5N1 virus. Especially risky behaviours identified include the slaughtering, defeathering, butchering and preparation for consumption of infected birds. In a few cases, exposure to chicken faeces when children played in an area frequented by free-ranging poultry is thought to have been the source of infection. Swimming in water bodies where the carcasses of dead infected birds have been discarded or which may have been contaminated by faeces from infected ducks or other birds might be another source of exposure. In some cases, investigations have been unable to identify a plausible exposure source, suggesting that some as yet unknown environmental factor, involving contamination with the virus, may be implicated in a small number of cases. Some explanations that have been put forward include a possible role of peri-domestic birds, such as pigeons, or the use of untreated bird faeces as fertilizer. At present, H5N1 avian influenza remains largely a disease of birds. The species barrier is significant: the virus does not easily cross from birds to infect humans. Despite the infection of tens of millions of poultry over large geographical areas since mid-2003, fewer than 200 human cases have been laboratory confirmed.

For unknown reasons, most cases have occurred in rural and periurban households where small flocks of poultry are kept. Again for unknown reasons, very few cases have been detected in presumed high-risk groups, such as commercial poultry workers, workers at live poultry markets, cullers, veterinarians, and health staff caring for patients without adequate protective equipment. Also lacking is an explanation for the puzzling concentration of cases in previously healthy children and young adults. Research is urgently needed to better define the exposure circumstances, behaviours, and possible genetic or immunological factors that might enhance the likelihood of human infection.

Assessment of possible cases. Investigations of all the most recently confirmed human cases, in China, Indonesia, and Turkey, have identified direct contact with infected birds as the most likely source of exposure. When assessing possible cases, the level of clinical suspicion should be heightened for persons showing influenza-like illness, especially with fever and symptoms in the lower respiratory tract, who have a history of close contact with birds in an area where confirmed outbreaks of highly pathogenic H5N1 avian influenza are occurring. Exposure to an environment that may have been contaminated by faeces from infected birds is a second, though less common, source of human infection. To date, not all human cases have arisen from exposure to dead or visibly ill domestic birds. Research published in 2005 has shown that domestic ducks can excrete large quantities of highly pathogenic virus without showing signs of illness.

A history of poultry consumption in an affected country is not a risk factor, provided the food was thoroughly cooked and the person was not involved in food preparation. As no efficient human-to-human transmission of the virus is known to be occurring anywhere, simply travelling to a country with ongoing outbreaks in poultry or sporadic human cases does not place a traveller at enhanced risk of infection, provided the person did not visit live or “wet” poultry markets, farms, or other environments where exposure to diseased birds may have occurred.

Clinical features 1. In many patients, the disease caused by the H5N1 virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, H5N1 influenza in humans is poorly understood. Clinical data from cases in 1997 and the current outbreak are beginning to provide a picture of the clinical features of disease, but much remains to be learned. Moreover, the current picture could change given the propensity of this virus to mutate rapidly and unpredictably.

The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around two to three days. Current data for H5N1 infection indicate an incubation period ranging from two to eight days and possibly as long as 17 days. However, the possibility of multiple exposure to the virus makes it difficult to define the incubation period precisely. WHO currently recommends that an incubation period of seven days be used for field investigations and the monitoring of patient contacts.

Initial symptoms include a high fever, usually with a temperature higher than 38oC, and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. Watery diarrhoea without blood appears to be more common in H5N1 avian influenza than in normal seasonal influenza.

The spectrum of clinical symptoms may, however, be broader, and not all confirmed patients have presented with respiratory symptoms. In two patients from southern Viet Nam, the clinical diagnosis was acute encephalitis; neither patient had respiratory symptoms at presentation. In another case, from Thailand, the patient presented with fever and diarrhoea, but no respiratory symptoms. All three patients had a recent history of direct exposure to infected poultry.

One feature seen in many patients is the development of manifestations in the lower respiratory tract early in the illness. Many patients have symptoms in the lower respiratory tract when they first seek treatment. On present evidence, difficulty in breathing develops around five days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody. Most recently, blood-tinted respiratory secretions have been observed in Turkey. Almost all patients develop pneumonia. During the Hong Kong outbreak, all severely ill patients had primary viral pneumonia, which did not respond to antibiotics. Limited data on patients in the current outbreak indicate the presence of a primary viral pneumonia in H5N1, usually without microbiological evidence of bacterial supra-infection at presentation. Turkish clinicians have also reported pneumonia as a consistent feature in severe cases; as elsewhere, these patients did not respond to treatment with antibiotics.

In patients infected with the H5N1 virus, clinical deterioration is rapid. In Thailand, the time between onset of illness to the development of acute respiratory distress was around six days, with a range of four to 13 days. In severe cases in Turkey, clinicians have observed respiratory failure three to five days after symptom onset. Another common feature is multiorgan dysfunction. Common laboratory abnormalities, include leukopenia (mainly lymphopenia), mild-to-moderate thrombocytopenia, elevated aminotransferases, and with some instances of disseminated intravascular coagulation.

Limited evidence suggests that some antiviral drugs, notably oseltamivir (commercially known as Tamiflu), can reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset. However, prior to the outbreak in Turkey, most patients have been detected and treated late in the course of illness. For this reason, clinical data on the effectiveness of oseltamivir are limited. Moreover, oseltamivir and other antiviral drugs were developed for the treatment and prophylaxis of seasonal influenza, which is a less severe disease associated with less prolonged viral replication. Recommendations on the optimum dose and duration of treatment for H5N1 avian influenza, also in children, need to undergo urgent review, and this is being undertaken by WHO.

In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize its therapeutic benefits. However, given the significant mortality currently associated with H5N1 infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered in patients presenting later in the course of illness.

Currently recommended doses of oseltamivir for the treatment of influenza are contained in the product information at the manufacturer’s web site. The recommended dose of oseltamivir for the treatment of influenza, in adults and adolescents 13 years of age and older, is 150 mg per day, given as 75 mg twice a day for five days. Oseltamivir is not indicated for the treatment of children younger than one year of age.

As the duration of viral replication may be prolonged in cases of H5N1 infection, clinicians should consider increasing the duration of treatment to seven to ten days in patients who are not showing a clinical response. In cases of severe infection with the H5N1 virus, clinicians may need to consider increasing the recommended daily dose or the duration of treatment, keeping in mind that doses above 300 mg per day are associated with increased side effects. For all treated patients, consideration should be given to taking serial clinical samples for later assay to monitor changes in viral load, to assess drug susceptibility, and to assess drug levels. These samples should be taken only in the presence of appropriate measures for infection control.

In severely ill H5N1 patients or in H5N1 patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing these patients.

Avian Influenza: The disease in birds


Avian influenza is an infectious disease of birds caused by type A strains of the influenza virus. The disease occurs worldwide. While all birds are thought to be susceptible to infection with avian influenza viruses, many wild bird species carry these viruses with no apparent signs of harm.

Other bird species, including domestic poultry, develop disease when infected with avian influenza viruses. In poultry, the viruses cause two distinctly different forms of disease – one common and mild, the other rare and highly lethal. In the mild form, signs of illness may be expressed only as ruffled feathers, reduced egg production, or mild effects on the respiratory system. Outbreaks can be so mild they escape detection unless regular testing for viruses is in place.

In contrast, the second and far less common highly pathogenic form is difficult to miss. First identified in Italy in 1878, highly pathogenic avian influenza is characterized by sudden onset of severe disease, rapid contagion, and a mortality rate that can approach 100% within 48 hours. In this form of the disease, the virus not only affects the respiratory tract, as in the mild form, but also invades multiple organs and tissues. The resulting massive internal haemorrhaging has earned it the lay name of “chicken Ebola”.

All 16 HA (haemagluttinin) and 9 NA (neuraminidase) subtypes of influenza viruses are known to infect wild waterfowl, thus providing an extensive reservoir of influenza viruses perpetually circulating in bird populations. In wild birds, routine testing will nearly always find some influenza viruses. The vast majority of these viruses cause no harm.

To date, all outbreaks of the highly pathogenic form of avian influenza have been caused by viruses of the H5 and H7 subtypes. Highly pathogenic viruses possess a tell-tale genetic “trade mark” or signature – a distinctive set of basic amino acids in the cleavage site of the HA – that distinguishes them from all other avian influenza viruses and is associated with their exceptional virulence.

Not all virus strains of the H5 and H7 subtypes are highly pathogenic, but most are thought to have the potential to become so. Recent research has shown that H5 and H7 viruses of low pathogenicity can, after circulation for sometimes short periods in a poultry population, mutate into highly pathogenic viruses. Considerable circumstantial evidence has long suggested that wild waterfowl introduce avian influenza viruses, in their low pathogenic form, to poultry flocks, but do not carry or directly spread highly pathogenic viruses. This role may, however, have changed very recently: at least some species of migratory waterfowl are now thought to be carrying the H5N1 virus in its highly pathogenic form and introducing it to new geographical areas located along their flight routes.

Apart from being highly contagious among poultry, avian influenza viruses are readily transmitted from farm to farm by the movement of live birds, people (especially when shoes and other clothing are contaminated), and contaminated vehicles, equipment, feed, and cages. Highly pathogenic viruses can survive for long periods in the environment, especially when temperatures are low. For example, the highly pathogenic H5N1 virus can survive in bird faeces for at least 35 days at low temperature (4oC). At a much higher temperature (37oC), H5N1 viruses have been shown to survive, in faecal samples, for six days.

For highly pathogenic disease, the most important control measures are rapid culling of all infected or exposed birds, proper disposal of carcasses, the quarantining and rigorous disinfection of farms, and the implementation of strict sanitary, or “biosecurity”, measures. Restrictions on the movement of live poultry, both within and between countries, are another important control measure. The logistics of recommended control measures are most straightforward when applied to large commercial farms, where birds are housed indoors, usually under strictly controlled sanitary conditions, in large numbers. Control is far more difficult under poultry production systems in which most birds are raised in small backyard flocks scattered throughout rural or periurban areas.

When culling – the first line of defence for containing outbreaks – fails or proves impracticable, vaccination of poultry in a high-risk area can be used as a supplementary emergency measure, provided quality-assured vaccines are used and recommendations from the World Organisation for Animal Health (OIE) are strictly followed. The use of poor quality vaccines or vaccines that poorly match the circulating virus strain may accelerate mutation of the virus. Poor quality animal vaccines may also pose a risk for human health, as they may allow infected birds to shed virus while still appearing to be disease-free.

Apart from being difficult to control, outbreaks in backyard flocks are associated with a heightened risk of human exposure and infection. These birds usually roam freely as they scavenge for food and often mingle with wild birds or share water sources with them. Such situations create abundant opportunities for human exposure to the virus, especially when birds enter households or are brought into households during adverse weather, or when they share areas where children play or sleep. Poverty exacerbates the problem: in situations where a prime source of food and income cannot be wasted, households frequently consume poultry when deaths or signs of illness appear in flocks.

This practice carries a high risk of exposure to the virus during slaughtering, defeathering, butchering, and preparation of poultry meat for cooking, but has proved difficult to change. Moreover, as deaths of birds in backyard flocks are common, especially under adverse weather conditions, owners may not interpret deaths or signs of illness in a flock as a signal of avian influenza and a reason to alert the authorities. This tendency may help explain why outbreaks in some rural areas have smouldered undetected for months. The frequent absence of compensation to farmers for destroyed birds further works against the spontaneous reporting of outbreaks and may encourage owners to hide their birds during culling operations.

THE ROLE OF MIGRATORY BIRDS

During 2005, an additional and significant source of international spread of the virus in birds became apparent for the first time, but remains poorly understood. Scientists are increasingly convinced that at least some migratory waterfowl are now carrying the H5N1 virus in its highly pathogenic form, sometimes over long distances, and introducing the virus to poultry flocks in areas that lie along their migratory routes. Should this new role of migratory birds be scientifically confirmed, it will mark a change in a long-standing stable relationship between the H5N1 virus and its natural wild-bird reservoir.

Evidence supporting this altered role began to emerge in mid-2005 and has since been strengthened. The die-off of more than 6000 migratory birds, infected with the highly pathogenic H5N1 virus, that began at the Qinghai Lake nature reserve in central China in late April 2005, was highly unusual and probably unprecedented. Prior to that event, wild bird deaths from highly pathogenic avian influenza viruses were rare, usually occurring as isolated cases found within the flight distance of a poultry outbreak. Scientific studies comparing viruses from different outbreaks in birds have found that viruses from the most recently affected countries, all of which lie along migratory routes, are almost identical to viruses recovered from dead migratory birds at Qinghai Lake. Viruses from Turkey’s first two human cases, which were fatal, were also virtually identical to viruses from Qinghai Lake.

COUNTRIES AFFECTED BY OUTBREAKS IN BIRDS

The outbreaks of highly pathogenic H5N1 avian influenza that began in south-east Asia in mid-2003 and have now spread to a few parts of Europe, are the largest and most severe on record. To date, nine Asian countries have reported outbreaks (listed in order of reporting): the Republic of Korea, Viet Nam, Japan, Thailand, Cambodia, the Lao People’s Democratic Republic, Indonesia, China, and Malaysia. Of these, Japan, the Republic of Korea, and Malaysia have controlled their outbreaks and are now considered free of the disease. Elsewhere in Asia, the virus has become endemic in several of the initially affected countries.

In late July 2005, the virus spread geographically beyond its original focus in Asia to affect poultry and wild birds in the Russian Federation and adjacent parts of Kazakhstan. Almost simultaneously, Mongolia reported detection of the highly pathogenic virus in wild birds. In October 2005, the virus was reported in Turkey, Romania, and Croatia. In early December 2005, Ukraine reported its first outbreak in domestic birds. Most of these newer outbreaks were detected and reported quickly. Further spread of the virus along the migratory routes of wild waterfowl is, however, anticipated. Moreover, bird migration is a recurring event. Countries that lie along the flight pathways of birds migrating from central Asia may face a persistent risk of introduction or re-introduction of the virus to domestic poultry flocks.

Prior to the present situation, outbreaks of highly pathogenic avian influenza in poultry were considered rare. Excluding the current outbreaks caused by the H5N1 virus, only 24 outbreaks of highly pathogenic avian influenza have been recorded worldwide since 1959. Of these, 14 occurred in the past decade. The majority have shown limited geographical spread, a few remained confined to a single farm or flock, and only one spread internationally. All of the larger outbreaks were costly for the agricultural sector and difficult to control.