Tobacco facts

Tobacco use is one of the biggest public health threats the world has ever faced.

There are more than one billion smokers in the world. Globally, use of tobacco products is increasing, although it is decreasing in high-income countries.
Almost half of the world's children breathe air polluted by tobacco smoke.

The epidemic is shifting to the developing world. More than 80% of the world's smokers live in low- and middle-income countries. Tobacco use kills 5.4 million people a year - an average of one person every six seconds - and accounts for one in 10 adult deaths worldwide. Tobacco kills up to half of all users.

It is a risk factor for six of the eight leading causes of deaths in the world.
Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of disease and death has just begun.

100 million deaths were caused by tobacco in the 20th century. If current trends continue, there will be up to one billion deaths in the 21st century. Unchecked, tobacco-related deaths will increase to more than eight million a year by 2030, and 80% of those deaths will occur in the developing world.

Loose motions major cause of death among Indians

Syed Akbar
Hyderabad: "Loose motions" have now emerged as the major cause of death among Indians overtaking respiratory infections, cardiovascular diseases and road traffic injuries.
According to the World Health Organisation's first-ever country profiles of environmental burden of disease, the simple-appearing loose motions kill three times more people in India than the complicated cardiovascular diseases do. Loose motions are responsible for the death of 28 people for every 2000 population in the country every year as against nine people killed by complicated heart diseases.
Incidentally, the increasing number of vehicles on roads have not increased the number of accidental deaths. But they have contributed to lung cancers, asthma and other types of cancers. Only five people in India die in road accidents for 2000 people every year as against 20 people killed due to respiratory diseases caused by vehicular pollutants.
Loose motions or diarrhoeal diseases are linked to bad sanitation and poor quality of drinking water. And Andhra Pradesh is no exception to diarrhoeal deaths. Doctors in the State attribute the spurt in complaints of loose motions and respiratory diseases to pollution. They say the number of patients with bowel problems has increased of late.
Dr SC Samal, senior gastroenterologist of Apollo Health City, points out that 99 per cent of deaths due to diarrhoea are in children. "It’s rarely a cause of death in adults. Poverty is an indirect index of diarrhoea. The socio economic status and level of literacy determine the incidence of the problem. Better economic status and being literate makes one to afford better housing with sanitation, safe drinking water and maintain hygienic conditions. These can prevent incidents of diarrhoeal deaths," he says.
The WHO's environmental burden of disease lists as many as 14 "risk factors" that are responsible for the death of people. While diarrhoea tops the list with 14 deaths for every 1000 people every year, respiratory infections occupy the second slot with 10 deaths for the same number of people. Unintentional injuries that are responsible for the death of 9.5 people for 1000 population are the third major killer.
Incidentally malaria, though linked to environment and sanitation, is the least cause of death in India. Only 0.3 people per 1000 population die because of malaria.
Chest specialist Dr Pradyut Waghray says of late the number of asthma and other respiratory problems has increased in Hyderabad. "Breathing problems are on the increase. Small particles from dust and emissions get deposited in the lungs and cause a number of breathing problems. Many of these pollutants are carcinogenic in nature and cause cancers," he says.

Pollution leading to hearing disability in new born babies

Syed Akbar
Hyderabad: Environmental factors including increasing pollution levels are contributing to hearing disability in new born babies.
A study by a group of city researchers reveals that while genetic factors contribute to 50 per cent of deaf cases in new born babies, 40 per cent of the cases are related to environmental factors like pollution.
The incidence of hearing disability is two to three per 1000 live births in India and one per 1000 babies is profoundly deaf at birth or in the prelingual (stage of learning language) childhood period.
As against these pre-natal (before birth) factors, post-natal (after birth) infection of the ear (otitis media) is responsible for 11.71 per cent cases of deafness in children while head injuries contribute to just 4.83 per of the cases. The study was conducted by the Institute of Genetics and Hospital for Genetic Diseases and the Department of ENT, Osmania Medical College, Hyderabad.
The factors responsible for infection of the middle ear include poor hygiene, lack of breast feeding, poor nutrition and inadequate healthcare. "Proper care during birth and proper monitoring after birth of the child is required to prevent adverse postnatal conditions leading to direct hearing loss or indirect disease related sensorineural hearing loss that can cause permanent disability in survivors of adverse perinatal conditions," the study pointed out.
As many as 1076 children below 14 years of age with congenital hearing impairment formed the study group.

Junk DNA that's not a junk at all, says CCMB

Syed Akbar
Hyderabad: In a major scientific breakthrough the city-based Centre for Cellular and Molecular Biology has found that the so-called "Junk DNA" present on the human Y-chromosome is not at all "junk" but contains properties that could control cell division in testes.
The study, first of its kind in the world, gives an insight on male sterility factors and might give vital information on what prevents cancer of testes in a majority of male populations.
"This is the first demonstration that junk DNA interacts and controls the function of a gene located on another chromosome, which is not limited to a sex. This study opens up a new approach to unravel the function of the non-coding DNA in our genome. New discoveries of RNA world and its role in gene expression are considered to be a great revolution in modern biology, which is over-shadowing the importance of DNA. It is suggested that protein-coding genes may not be the movers and shakers of human evolution, as scientists once thought. Perhaps we should stop looking at proteins and start looking at non-coding DNA," CCMB director Dr Lalji Singh said.
More than 98.8 per cent of human genome is made up of non-coding DNA generally referred to as "junk". Less than 1.2 per cent of human DNA codes for protein. One of the biggest challenges in the field of modern biology is to find out the function of junk DNA. The Y chromosome is of interest to man because it carries genes for maleness.
This chromosome contains DNA specifically present in male. Two-thirds of Y chromosome is made up of repetitive DNA, which has been thought of as junk. The present study at CCMB presents unequivocal evidence that 40 mega base repeat block of the Y-chromosome, which was earlier perceived as junk DNA, is transcribed into RNA but not translated into protein as it does not have the required features to be translated.
However, the CCMB study clearly demonstrates that the Y-chromosomal junk DNA is transcribed into two novel RNAs in a developmental-state-specific and testis-specific manner, one of which controls the expression of a protein by a mechanism described as trans-splicing wherein RNAs from different chromosomes/genes recombine to produce chemeric RNAs, Dr Singh observed.
The results of the study released to media on Friday has been published in Genome Research.

Heart Diseases: Aping the West proves costly for people in Andhra Pradesh

By Syed Akbar
Hyderabad: Aping the West in food and lifestyle is proving to be dear to people in Andhra Pradesh with heart diseases linked to food habits emerging as the leading cause of death.
According to a recent survey published by the Central Bureau of Health Intelligence, ischemic heart disease characterised by reduced blood supply to the heart has been killing 13.21 per cent of people in Andhra Pradesh. It is the cause of death in 12.2 per cent of women and 14.08 per cent of men.
Incidentally ischemic heart disease tops the 10 important causes of death in people of the State.
Doctors link the disease to smoking, diabetes, hypertension, obesity, excessive use of hydrogenated fats (vanaspathi) and foods containing high cholesterol levels. So far, ischemic heart disease has been the major cause of death in the US and Europe. That it has emerged as the top killer in Andhra Pradesh is a cause for concern, says senior cardiologist Dr PC Rath.
In patients suffering from ischemic heart disease the flow of blood to the heart is obstructed and thus the heart is deprived of oxygen. This leads to death if not attended to immediately. According to Dr Rath, a little change in lifestyle and food habits will help in controlling cardiovascular diseases.
Cerebrovascular disease (bleeding in brain or cutting supply of blood or oxygen to the brain) is the second leading cause of death in Andhra Pradesh, though it is the third leading cause of death in the West. Cancer or malignancy, which is the second leading cause of death in the West, is incidentally the 10th cause of death in Andhra Pradesh.
While lower respiratory (lung) infections is the third over all leading killer in the State, diarrhoeal diseases occupy the third position in case of women and tuberculosis in case of men. Self-inflected injury is the seventh leading killer both among men and women while asthma and stomach cancer is the eighth major cause of death among men and women respectively, according to the CBHI report.
Road accidents occupy the 10th slot in case of men and dementia (group of disorders relating to brain) is the 10th cause of deaths among women. Cirrhosis of the liver is the cause of 2.19 per cent of deaths among men but incidentally it is absent among women. Cirrhosis is linked to alcohol.
Women tend to be more prone to unintentional injuries than men. Statistics show that 4.09 per cent of deaths in women and 3.81 per cent of deaths in men are attributed to unintentional injuries.

Diabetes: Some startling facts and figures

Startling facts and figures about diabetes in India
1. India currently has the world's largest diabetic population with an estimated four crore people

2. Every sixth person is a diabetic in Hyderabad and other metropolitan cities including Delhi, Mumbai and Chennai.

3. Every 15 minutes a legis lost to diabetes in India

4. In India 40,000 legs are amputed per year, most of them as a result of an infection in the foot of someone with diabetes.

5. It is estimated that 1000 amputations take place in a year in Hyderabad, 3000 in Delhi and 4000 in Mumbai.

6. Eightyfive per cent of amputations can be prevented with early detection and early interventions

Renewed fight against TB pays rich dividends

Syed Akbar
Hyderabad: The renewed fight against tuberculosis in the country has paid rich dividends with the incidence of the killer disease coming down by appreciable levels.
But what is worrying health experts and planners is the explosion of drug-resistant tuberculosis fuelled by HIV/AIDS. Andhra Pradesh, with the largest number of HIV/AIDS cases in the country, is now more vulnerable to drug-resistant TB. Incidentally, the State too has a large number of TB patients.
India has one of the largest number of TB patients accounting for one-fifth of all the TB cases in the world and the emergence of drug-resistant TB strains has become a major challenge to medical doctors and scientists alike.
Strains of extremely drug-resistant tuberculosis or XDR-TB have now been found in 28 countries including India. The death rate for people co-infected with HIV and XDR-TB is around 85 per cent while for normal TB patients is less than 10 per cent.
According to World Health Organisation, India continues to be a global TB hot spot, despite reduction in the incidence in the country. In India every one minute a person afflicted by TB dies. The WHO observes that HIV and drug-resistant TB are threatening to reverse the gains made in TB control over the last few years, particularly during 2006. A majority of newly diagnosed TB patients have developed resistance to first-line anti-TB drugs.
The Central government launched last year a new strategy to stop TB and achieve reversal of the epidemic by 2015. "The new strategy while building on the previous DOTS strategy to control TB, includes additional interventions to meet evolving challenges such as HIV associated TB, emerging drug resistance and enhance the uptake of services by the community at large," a senior health official pointed out.
The death rates due to tuberculosis have come down to just four per cent
because of strict implementation of DOTS in different parts of India including Andhra Pradesh where TB is largely prevalent. While the death rate in patients who do not undergo DOTS is a whopping 29 per cent, those who are treated by DOTS are less susceptible with just four per cent mortality. Where DOTS is not used, infectious patients are seven times more likely to die from the disease.
Union Ministry of Health and Family Welfare records point out that more than three lakh children are forced to leave school every year because their parents are TB patients. More than a lakh women with TB are rejected by their families due to social stigma attached to the disease. The economic cost of tuberculosis in the country is about Rs 8,000 crore a year, i.e. had the disease been controlled, India would have saved that much amount.

XX maleness a rare syndrome

By Syed Akbar

It is a common knowledge that a person with XX chromosomes is a woman and the one with XY chromosomes is a man. The sex chromosomes XX determine the female sex of a foetus while XY determine the male sex of the unborn in the womb.
There are men with XX chromosomes but they do not have fully developed male genital organs. However, a team of scientists in Hyderabad recently came across with a XX man with normal genitals and complete masculinity. This is a very rare medical phenomenon.
The scientists' team at the Centre for Cellular and Molecular Biology conducted a research on this XX man with gene SRY-negative and 46 chromosomes.
According to CCMB senior scientist Kumarasamy Thangaraj, XX maleness is a rare syndrome with a frequency of one in 20,000-25,000 males. XX males exist in different clinical categories with ambiguous genitalia or partially to fully mature male genitalia, in combination with complete or incomplete masculinisation. But in the present study the team reported a case of SRY-negative XX male with complete masculinisation. The "man", however, was infertility and unable to conceive.
The patient had fully mature male genitalia with descended but small testes and no signs of undervirilisation. Polymerase chain reaction analysis for SRY (sex determining region Y gene) and other sex determination genes ZFY, amelogenin, AZFa, AZFb and AZFc as also other tests showed the absence of any Y-chromosome-derived material.
Genotyping with X-STR (short tandem repeat) of the chromosome ruled out the possibility of any deletion on X chromosome. "Development of the male phenotype in the absence of SRY probably resulted from the loss of function mutation in some unknown sex-determining gene, which normally inhibits the male pathway, or from a gain of function mutation in a gene downstream to SRY in male pathway," Dr Thangaraj points out.
We all know that the presence or absence of Y chromosome, SRY gene in particular, determines the sex in human beings and other mammals. SRY is thought to direct the sex-determination pathway towards male development. The fortuitous finding of chromosomal rearrangements in association with a sex-reversed phenotype has led to the isolation of SRY gene. Careful genetic analysis of cases with abnormal sexual
development, presented with chromosomal translocations or deletions/
duplications, has resulted in the identification of many genes playing role in sex determination, Dr Thangaraj says.
"Despite the identification of SRY almost 15 years ago, the pathway downstream to SRY remains largely unknown, although SOX9 and DAX1 have recently been proposed to function downstream to SRY gene in male sex-determination pathway," he adds.
According to the CCMB study, an increasing number of reports suggest that the male phenotype can develop even in the absence of SRY gene. Till date, many cases of XX males with or without SRY and apparently with no other Y-chromosome sequences have been reported.
Such persons exist in three clinical categories: XX males with normal genitalia; XX males with ambiguous genitalia; and XX true hermaphrodites with ovarian and testicular tissues.
"Based on the presence or absence of the Y-chromosome sequences, XX males can be divided into two categories. Approximately 90 per cent of the cases carry varying amount of the Y sequences due to an illegitimate recombination between X and Y chromosomes, whereas 10 per cent do not have any Y-chromosome sequences. Most of the XX males with SRY have normal genitalia, whereas most SRY-negative cases have ambiguous genitalia," says Dr Thangaraj.
The cause (aetiology) of development of male phenotype in most of the SRY-negative 46,XX males (like the present case study) remains unexplained.
He points out that development of the testis and normal male genitals in a significant number of SRY-negative 46,XX males gives clue to the existence of other autosomal or X-linked genes in the sex-determining pathway. Comprehensive genetic analysis of these cases may help to decipher new gene(s) involved in the sex-determining pathway.
A 34-year-old man attended the genetic clinic of the Institute of Reproductive Medicine, Kolkata, with complaints of infertility. His height was 156 cm and weight 64 kg. The patient had fully mature normal male genitalia with no symptom of undervirilisation.
The testicles were descended in the scrotum but small in size with volumes 4.8 ml and 5.1 ml (normal range 18–30 ml). Axillary (under arm) and pubic hairs were of normal pattern and density. Serum concentrations of reproductive hormones (LH and FSH) were elevated at 15.8 mIU/ml (normal range 2.0–14.0 mIU/ml) and 25.8 mIU/ml (normal range 1.5–12.0 mIU/ml), respectively. Testosterone hormones level was normal at 580 ng/dl (normal adult male range, 437–707 ng/dl).
DNA was extracted from peripheral blood leukocytes of the patient, a normal fertile male and a female for analysis. Absence of PCR amplification of Y-STR markers further confirmed the lack of Y-chromosome sequences in the patient DNA. X-STR analysis showed heterozygous alleles for 42 of 53 markers, suggesting the presence of two X chromosomes.
According to him, majority of the XX males carry SRY gene translocated to the X chromosome due to an illegitimate recombination between X and Y chromosomes. These patients are sterile males and usually have normal male genitalia.
Dr Thangaraj says XX males without SRY gene have ambiguous to normal genitalia, show incomplete to complete masculinisation and are infertile. The existence of SRY-negative males ruled out the prevailing notion that the mere presence of SRY determines maleness. The most common observation that the individuals with SRY are male shows that it is the presence or absence of a normal SRY gene which determines maleness, provided all downstream genes are functionally intact.
In majority of the cases, XX maleness should result either from the loss of function mutations in a gene normally inhibiting testes formation in genotypic females or from the gain of function mutations in a gene downstream to SRY in testis determining pathway. The hypothetical gene may be X-linked or autosomal. If the gene is autosomal, the degree of the male phenotype will be dependent on the extent of the loss or gain of function in the mutant gene, he says.
"Because the present case had normal male phenotype, it should
either be homozygous mutant for this hypothetical autosomal gene or
a result of preferential inactivation of the normal copy of the X-linked
heterozygous mutant gene," Dr Thangaraj concludes.

Exclusive atlas for tribal areas in India

Syed Akbar
Hyderabad: The city-based National Institute of Rural Development has developed a GIS-based atlas of all the tribal areas in the country which closely monitor the living standards of tribal populations besides checking encroachments in forest lands.
The tribal atlas, the first of its kind in the country, covers the Schedule V areas spread across Andhra Pradesh, Maharashtra, Madhya Pradesh, Rajasthan, Jharkhand, Orissa, Himachal Pradesh, Chattisgarh and Himachal Pradesh. The tribal map is based on satellite imagery which will be constantly updated for real time status of the tribal and forest lands.
Vast tracks of forest and tribal lands have been under encroachment in the all important Schedule V areas of the country. Moreover, there is no updated data on the status and living standards of many tribal communities despite the Central and the State governments taking up several welfare measures.
Since the tribal atlas is based on satellite imageries, it can be updated anytime for a first hand information on the condition of tribal lands and the people living there.
"This will help the Integrated Tribal Development Agency and the Integrated Tribal Development Project to have a better understanding of the needs of the tribals living in forest areas. This will also give boost the present administrative set-up catering to the development of tribal areas," says a report of the NIRD.
Experts at NIRD have utilised socio-economic and demographic data along with the natural resources information and infrastructure data for generation of the tribal atlas. The GIS map covers areas ranging from regional to micro levels which will serve as a proven effective administrative and management tool for decision making for developing the tribal areas and their people.
The atlas is based on the demographic profile of Scheduled-V areas and has a spatial spread. It will have wide use among organisations working for tribal development.

UV Index very high: Hyderabad fast turning into a "radiation city"

Syed Akbar
Hyderabad: 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". WHO standards specify that in places where the UV radiation is "extreme", people should better keep indoors and move out only when necessary.
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 this week 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.

Second-hand tobacco smoke has become major cause of lung diseases and reproductive problems

Syed Akbar
Hyderabad: Second-hand tobacco smoke in closed environs has emerged as the major cause of lung diseases and reproductive problems in twin cities.
Records on patients reported at various hospitals in the city in the last six years show that there has been an increase in cancer and infertility cases by at least five per cent every year. About 15 per cent of these patients are victims of second-hand tobacco smoke, a term referred to people who do not smoke themselves but involuntarily inhale harmful elements from regular smokers.
According to estimates by health experts, as many as 15,000 cancer cases were reported last year in Hyderabad as against 10,000 cases in 2000. Infertility cases too went up considerably from 6,000 to 10,000 a year during the same period. Most of the cancer and infertility cases in non-smokers is due to second-hand tobacco smoke. Health experts point out that the victims are non-smokers who frequent bars, pubs and restaurants where smoking is allowed in closed doors.
"Neither ventilation nor filtration will reduce the impact of tobacco smoke in closed door environments. There is nothing like safe limits for second-hand tobacco smoke in areas which are closed. About 300 cases of cancer are reported to about 200 chest specialists in Hyderabad every week and about 50 patients are non-smokers. What is troubling is that the incidence has gone up drastically among women, who are mostly non-smokers," says senior lung specialist Dr Pradyut Waghray.
The problem of second-hand tobacco increased to such alarming levels that the World Health Organisation was forced to issue policy recommendations to member countries recommending compulsory smoke-free environments to protect public health.
A majority of the patients reporting at city hospitals and clinics are as young as 35 years and doctors link it to smoking in colleges.
Fertility expert Dr Roya Rozati, who has done considerable research on second-hand tobacco smoke and infertility, points out that tobacco pollutants will affect both men and women. "While it reduces sperm count and the quality of the semen in men, it leads to infertility in women," she says.
According to Dr SVSN Prasad, senior medical oncologist at Apollo Cancer Hospital, changing lifestyle among the youth, especially women, can be a cause of further increase in lung cancers in future. "Women from the IT and ITES sectors are taking to smoking. This is further contributing to passive smoking or second-hand tobacco smoke. The increase in pub culture can also increase the number of cancer patients in Hyderabad," he warns.
Incidence of acute myeloid leukaemia in mothers is also on the increase in twin cities because of second-hand tobacco smoke.

Cholera in Hyderabad: WHO norms on disinfection thrown to the winds

2009
Syed Akbar
Hyderabad, May 10: State health officials have flouted all medical safety norms by not isolating cholera patients and disinfecting the bodies of victims before funeral.

Officials did not bother to invoke the cholera prevention and control guidelines for the simple reason that they do not want to admit the diarrhoeal deaths at Bholakpur here as those of cholera. While they await reconfirmatory reports from the National Institute of Cholera and Enteric Diseases, the death roll has gone up to 12 and dozens of fresh cases continue to pour in at various city hospitals.

Andhra Pradesh has been listed as a State endemic to cholera and yet it does not have the mandatory cholera monitoring committee. A week has passed since the acute diarrhoeal disease broke out and the authorities concerned do not bother to constitute the panel to oversee the control and preventive measures. Joint director (communicable diseases) Ram Swarup admitted that there's no separate panel for cholera but the subject is covered by a state level surveillance committee.

Patients are admitted in a common ward in Fever and Gandhi Hospitals endangering the lives of others. Cholera is highly contagious and those suffering from it have to be kept in isolation or quarantined. The World Health Organisation's global task force on cholera control suggests that severe cases should be isolated from rest of the population. It also suggests that gatherings should be avoided as stool and vomit are highly contagious and spreads fast. Cholera patients have to be in a
special ward, isolated from other patients.

The authorities also failed in their duty to disinfect corpses with chlorine solution. Health guidelines stipulate that mouth and anus of the bodies should be filled with cotton wool soaked with chlorine solution. Officials said they did not disinfect the bodies as only one death was reported in hospital while others died at home.

They also ignored the WHO's standard warning that a place might be facing an outbreak very soon if there are an unusual number of acute diarrhoeal cases in a week and patients from the same area have similar clinical symptoms. Dozens of cases were reported from Bholakpur locality but the authorities failed to sound a general public alert on cholera.

The Greater Hyderabad Municipal Corporation equally shares the blame. Its sanitation supervisors are supposed to test water quality on daily basis, but they did not. They acted only on May 4 after several cases of diarrhoea were reported from Bholakpur.

GHMC chief medical officer Dr M Jayaram washed off his hands arguing that private hospitals do not send data to them. But he had no answer asked about the data from government hospitals. The authorities waited for half a dozen deaths to swing into action by distributing chlorine tablets and ORS packets and setting up medical screening camps.

Cholera in Hyderabad: It's official failure

2009
Syed Akbar
Hyderabad, May 10: Twelve deaths and about 600 cases of hospitalisation.
And yet Andhra Pradesh State government officials do not know what caused the havoc.

A week after death stared at poor residents of Bholakpur in the State
capital, officials continue to fight over the causative agent. Preliminary
laboratory reports here indicate cholera, but health authorities still
await a reconfirmation by the National Institute of Cholera and Enteric
Diseases, Kolkata, to swing into action. For them, it's still the mild and
less harmful gastroenteritis.

As officials attempt to take shelter behind technicalities on the
causative bacteria to hide their inefficiency and lethargy, 70 more new
cases of diarrhoea and vomiting were reported from different parts of
the city on Sunday. Two more persons succumbed to the disease
taking the death roll to 12.

Cholera is caused by the bacteria Vibrio cholerae while gastroenteritis
is caused by Escheresia coli, which is relatively less harmful.
Whenever cases of diarrhoea and vomiting break out in largescale,
officials take shelter behind E coli to escape the wrath of people, while
actually some or all the cases are of Vibrio cholerae. Since the
symptoms in both the cases are almost similar, officials often side with
gastoenteritis to save their skin.

As many as 40 samples collected from various parts of the State
including 24 from Hyderabad have tested positive for cholera. Had
officials acted immediately the tragedy could have been minimised, if
not averted, feel Bholakpur residents. It will take another week for the
NICED to give its report and untill then there will be no cholera cases,
officially. A team from NICED is arriving on Sunday to study the
samples.

That officials still believe there's no cholera in the city can be summed
up from what Principal Secretary (Health) Dr LV Subrahmanyam says:
"it is premature to point fingers at the existence of cholera bacteria
when the confirmatory test reports are awaited from National Institute
of Cholera and Enteric Diseases".

He, however, agreed that 12 cases were identified at Fever Hospital and
four at Gandhi Hospital and they were awaiting reconfirmation from
Kolkata. "All these patients have been discharged after providing the
required treatment at the respective hospitals and taking their contact
address. The test results are expected soon," Dr Subrahmanyam said.

Fever Hospital Superintendent Dr P Prasad sides with Dr
Subrahmanyam when he said cases of cholera were quite common
round the year. "Though vibrio cholera bacteria was identified in the
preliminary tests for 12 cases this month, there were around 10 cases
identified last month and during summer almost every week around
three cholera cases are identified."

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

Syed Akbar
Hyderabad: 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.

Link between infertility and female genital tuberculosis

Syed Akbar
Hyderabad: A team of city doctors has established a link between infertility and female genital tuberculosis, which is fast spreading in South India after lying low for many years.
The team has also found easy diagnostic methods to detect genital tuberculosis in women with 100 per cent accuracy. Currently diagnosing female genital tuberculosis is nothing short of a Herculean task. In many countries diagnosis is mainly limited to clinical suspicion based on symptoms. The problem is further compounded as abdominal and vaginal examinations reveal nothing.
Dr Roya Rozati, Dr Sreenivasagari Roopa and Dr Cheruvu Naga Rajashwari of the department of reproductive medicine at Mahavir Hospital and Research Centre have not only solved the diagnosis problem by identifying mycobacterial DNA tests through polymerase chain reaction but also established a link between the disease and infertility.
Genital tuberculosis is an important cause of infertility, more so in endemic zones such as South India. The proportion of extra-pulmonary TB is increasing down the Vindhyas and currently stands slightly higher than smear-positive pulmonary TB. Effective chemotherapy had reduced all forms of TB including FGTB until the HIV epidemic reversed the trend over the last decade.
However, the true epidemiology of this disease remains unknown due to lack of highly sensitive and specific tests. Genital tuberculosis not only causes tubal obstruction and dysfunction but also impairs implantation due to endometrial involvement and ovulatory failure from ovarian involvement.
The prevalence of FGTB in infertility clinics shows marked variations in different countries ranging between 15 and 25 per cent. In India in 80 to 90 per cent of cases, FGTB affects young women between 18 and 38 years of age, besides being an important cause of infertility.
"A high erythrocyte sedimentation rate and a positive mantoux test are non-specific. AFB staining is not sensitive enough and both culdoscopy and laparascopy carry a significant risk of bowel injury. Surgery is disadvantageous as it is highly invasive and carries a risk of activating silent infection. Only histopathological evidence in biopsy of premenstrual endometrial tissue or demonstration of tubercle bacilli in culture of menstrual blood or endometrial curetting can provide diagnosis with certainty," says Dr Roya Rozati.
The doctors investigated biopsy or curettage samples from 65 women clinically suspected to have genital tuberculosis for mycobacterium.
Genital tuberculosis is often a secondary complication as a result of reactivation of a silent bacillemia, primarily from lungs, affecting most commonly the fallopian tubes, ovaries, cervix, endometrium and vagina and vulva, and in some instances also from kidney and intestines.
"Direct inoculation of tubercle bacilli can also take place over vulva or vagina during sexual intercourse with a partner suffering from tuberculous lesions of genitalia," she said.

When stones speak history: GSI lists exotic geological monuments

Syed Akbar
Hyderabad: The exotic geological monuments that dot the country giving a peep into the prehistoric past will now bustle with international tourists thanks to a grand plan to resurrect these natural structures.
The Geological Survey of India has now drawn up an ambitious plan to develop natural rock and other formations into attractive tourist spots. India has several imprints of varied geological processes through ages and is a storehouse of interesting geological features.
To tap these geological formations into international tourist destinations, the GSI has declared some of these natural locales as national geological monuments. The tourists visiting these places will have an insight in the real past like the formation of the subcontinent, the orogeny (mountain formation), the palaeoenvironment and the exotic collection of paleoflora and paleofauna.
According to GSI sources, one of the the geo-tourism destination identified by GSI is the "Natural Arch" near Tirupati, a unique geological marvel in the country. The arch, measuring eight metres in width and three metres in height, has been curved out of quartzite of Cuddapah Supergroup of Middle to Upper Proterozoic (1600 to 570 million aeons) by collective action of weathering agents like water and wind over a long period of several thousands of years.
Natural arches of this kind are a rarity. The Rainbow Arch of Utah in the USA and the one in the Dalradian Quartzite are the other examples.
Even the serene Tirumala Hills are of geo-tourism destination because of their "Eparchaean Unconformity" (precambrian era), which separates the proterozoic Nagari quartzite from the oldest archaean granite representing a time gap of over 800 million aeons. "The unconformity is supposed to be a period of remarkable quiescence without much structural disturbance and igneous activity in the history of earth," GSI sources point out.
The Kadapa district has one of the largest baryte deposits of the world and is considered to have formed through precipitation from volcanic vapours under submarine conditions and sub aerial showering of ash and molten baryte lapilli (volcanic hail). The deposit occurs in the Pullampet Formation of the Nallamalai Group of the Cuddapah Supergroup. The lower beds of Mangampeta Barytes are of the highest grade and often occur as pure barium sulphate.
Other geological sites selected by the GSI are Marine Gondwana Fossil Park at Manendragarh in Chattisgarh, Akal Fossil Wood Park in Jaisalmer of Rajastan, National Fossil Wood Park in Villupuram district of Tamil Nadu, Siwalik Fossil Park in Sirmur district of Himachal Pradesh, Stromatolite Park (structures produced by blue-green algae) in Chittaurgarh district of Rajasthan and Columnar Basaltic Lava in Coconut Island of Udupi district in Karnataka.

Global warming hits mango production, taste

2009
Syed Akbar
Hyderabad: For the first time the "king of fruits" has lost its sheen, both in terms of colour and taste and overall output. Mango production is expected to be down by about 20 per cent over last year's yield across the country.

Though there's no full-fledged scientific study as yet, environmentalists and those in mango production blame global warming for mango woes. Like many fruits, mango is a seasonal crop, which in other words means dependent on optimum temperatures for yield. Any major change in the optimum temperature, which in the case of mango is between 15 and 18 degrees Celsius, will affect flowering (inflorescence)
and thus the total production.

According to Insram Ali, president of All-India Mango Growers' Association, global
warming has affected mango production this time. "The inflorescence was hit by increase in temperature during the flowering period in November-December. This explains a considerable fall in the overall production this season," he said. The temperature has also affected the texture, sugar content and taste of the fruit
in many parts of the country, including Andhra Pradesh.

AP has the highest per acreage mango production in India, though Uttar Pradesh leads the country in terms of total acreage under mango cultivation. In Krishna district, the epicentre of mango crop in Andhra Pradesh, production is expected at 5000 tons this season, as against 6,000 tons last season.

B Suhasini, deputy director of horticulture, Vijayawada, said though good quality mangoes are expected this season due to no pests and untimely rains, there will be a fall in the overall production by 20 per cent. Agrees senior entomologist Dr NBV Chalapathi Rao of Mango Research Centre, Nuzvid. He said the fall was due to
global warming and sudden change or fluctuation in temperatures.

Though global warming is blamed for fall in production, principal scientist Dr Y
Satyanarayana Reddy of Fruit Research Centre, Sangareddy, finds fault with growers and traders for lack of sweetness in the fruit. "It takes between 116 to 120 days for the mango fruit to ripe. The best and tasty fruit is expected only in the
fourth week of April or the first week of May. The fruit should have nine per cent sugar content to tastegood," he said.

The total acreage under mango in the State is 2.76 lakhs hectares with an annual
production of 3.25 lakhs tonnes.

Asian Institute of Gastroenterology: Doctors keep themselves fit through exercise

2009
Syed Akbar
Hyderabad: It's six in the morning. A group of people in track suits enters a gymnasium, complete with state-of-the-art equipment including the mandatory thread mills, weight benches and height adjusters.

After a hectic 30 minutes of exercise, they check their weight on the nearby portable weighing scale. Having lost some weight and calories, they disperse, allowing others to continue with the exercise.

This is a general routine at any hitech gymnasium in the city. But what makes this gym stand apart is that it is attached to a hospital. And those trimming their bodies and losing calories are physicians, surgeons and medical experts. All of them believe that a good body gives a good mind and when both combines the results are wonderful. Patients get good attention, proper treatment and care. It's a win-win situation for both.

The modern gymnasium attached to the Asian Institute of Gastroenterology in Hyderabad stands
testimony to the latest fad among doctors to stay fit, eat fit and serve patients well. The AIG is perhaps one of the few medical institutions of repute to provide gym facility to its medical staff. Almost every doctor in the institute makes it a point to shed a few calories to ensure that they are attentive to the needs of patients.

"It all began with the concept that a fit doctor is the best doctor. A few minutes of exercise regularly keeps us healthy. Many doctors because of their busy and untimely schedules do not find enough time to do exercise. So we have opened a gym in the hospital premises. Doctors come here and burn their calories without disturbing their tight schedule. Those on morning surgeries exercise in the evening and vice versa," says Dr D Nageshwar Reddy, chairman and chief of gastroenterology, Asian Institute of Gastroenterology.

Many doctors in the city have now included exercise in their daily routine. While those not so busy prefer to burn calories every day, seven days a week, the busybees make it a point to exercise at least for 35 minutes, four days a week.

"I have been in favour of optimum exercise, not too long or too short. But I do vigorous exercise as it is the best form of shedding weight. What is important is quantification of exercise. This keeps the circulation of blood in good condition," observes surgeon Dr GV Rao.

There are some in the medical fraternity who believe that regular exercise will prevent major health risks like cardio vascular strokes, cerebro vascular strokes, diabetes and fatty liver. Argues Dr Manu Tandon "those in the top position should show the way to the juniors. If the seniors are not healthy, they set a bad trend. So our war is against obesity".

Dr Rupa, a regular at the gym, suggests isometric exercises for people, particularly those in the medical profession. "It is a sort of strength training," she says.

Traffic cops losing their fertility levels due to pollution

By Syed Akbar
Hyderabad: Traffic cops beware! An increasing number of policemen on traffic duty are losing their fertility levels thanks to their prolonged exposure to vehicular pollutants everyday.
According to a research study conducted by a team of city-based fertility experts in association with the All-India Institute of Medical Sciences, Hyderabadi traffic cops have significantly lower total sperm motility and high extent of damage to sperm DNA. The fertility levels in traffic policemen are almost 20 to 30 per cent lower than that of people from other occupations.
Even the volume of semen ejaculated by traffic cops (2.35 ml) is lower than the men in the control group (2.41 ml). The total progressive motility is 57.64 and 65.28 per cent respectively in traffic police personnel and those from other occupations that do not require constant exposure to vehicular pollutants.
Traffic policemen also showed significantly lower forward progression of sperm. There was a significant increase in basal DNA damage in the cops as compared with that of the control group. This increase is due to the presence of lead, nitric oxide and toxic substances present in environment.
The study was carried out by fertility experts R Rozati, K Shankarappa, Sugana Reddy and Satyanarayana Reddy in collaboration with Prof A Kriplani of AIIMS. Fifteen traffic policemen and 15 people from other occupations were selected for the study. They were screened for their fertility levels. A detailed semen analysis was carried out for any genotoxic effect of traffic pollutants on sperm DNA through single cell gell electrophoresis method.
In traffic police personnel, the result showed 50 cells per treatment with comet tail length, which in other words means damage to the sperm DNA. A significant increase in basal DNA damage and deranged in sperm count and its morphology was observed in cops.
Says Dr Rozati, "pollutants have adverse effect on male reproductive function. Occupational exposure to traffic pollution reduces the semen quality. Traffic policemen, street sweepers, postal workers, salespersons, taxi drivers, city bus drivers and newspaper vendors experience the highest exposure to airborne pollutants. Traffic cops in big cities like Hyderabad are at a high risk".
Policing is among the top three occupations most commonly reported by both occupational physicians and psychiatrists in the Occupational disease Intelligence Network (ODIN) system for Surveillance of Occupational Stress and mental Illness (SOSMI).

Swine flu and HIV/AIDS: Influenza A may make HIV patients an easy target

2009
Syed Akbar
Hyderabad, May 2: The Andhra Pradesh State government has been sitting on the
proposal to set up a specialised virology laboratory in Hyderabad, even
as the World Health Organisation said people suffering from
HIV/AIDS are at high risk of contacting swine flu or Influenza A.

Andhra Pradesh ranks high in HIV/AIDS cases with a large number of
persons carrying the immuno-deficiency virus and the present threat of
Influenza A makes them vulnerable to the new problem. With no
specialised testing facility for viral diseases in the State, health
authorities are forced to send the samples to the National Institute of
Virology in Pune.

The State government proposed to set up a virology lab two years ago
after the outbreak of bird flu in parts of the country. Since then the
proposal has been gathering dust and health officials point out that they
are awaiting the specialised equipment. "We are expecting the
equipment in a couple of months. Once it arrives, the lab will be
operational. It may be set up at Sir Ronald Ross Institute of Tropical
and Communicable Diseases," said principal secretary (health) LV
Subrahmanyam.

"The need for a specialised lab to test viral cases is now felt more than
ever. The State has a large population of pigs and birds. There are also
large number of HIV/AIDS cases. This makes the State vulnerable to
cases of bird and swine flu, though such cases have not been reported
earlier. The WHO's assertion that HIV/AIDS carriers are more
susceptible to influenza A should force the government to hurry up
with the lab," said senior zoologist D Srinivas.

According to a WHO report, age and other groups with increased risk
for complications of seasonal influenza include persons with
immunodeficiency diseases, including HIV infection. The risk of
mortality from seasonal influenza is increased among HIV-infected
individuals compared with the general population.

Studies have shown an increased risk for heart- and lung-related
hospitalisations in people infected with HIV during influenza seasons
as opposed to other times of the year, and a higher risk of influenza-
related death in HIV-infected people.

A strange eye problem called cone dystrophy: Can't tolerate glare

Syed Akbar
Five-year-old Asma Sultana has a pathetic tale to tell. Like her two elder sisters Rehana Sultana (6) and Najma Sultana (7), she can't tolerate light. Bright light makes her virtually blind. The three girls were diagnosed by doctors at LV Prasad Eye Institute in Hyderabad as suffering from a strange eye problem called cone dystrophy.
Their father, a daily labourer, deserted the girls after he noticed that the eye defect could not be rectified. The girls' mother took care of them and admitted in a local government school. But soon the problems began for the girls as they could not see the black board or move freely in the open.
The mother then took the girls to LV Prasad Eye Institute where doctors prescribed some simple techniques to reduce the problem. The girls now have an improved vision and play with other children. The doctors helped the girls overcome the defect by advising sunglasses. The girls were given absorptive or tinted lenses that reduce glare. They were also advised to wear hat for shade from sunlight.
"There is no permanent treatment or cure to photophobia but better eye management and eye care techniques will reduce the trouble. Lubricant eye drops will also help. Patients find it difficult to drive during night because of headlights glare. Even during the day time they feel uncomfortable in the sunlight," says senior ophthalmologist Dr Sreekumar Reddy.
The problem with these three girls was that they are extremely sensitive to light and lower their gaze while walking. They squint and blink at the slightest glare. Cone dystrophy in their eyes has led to this rare condition called photophobia or hyper sensitivity to light.
Andhra Pradesh has thousands of children and adults with photophobia and the number is increasing with the each passing year. Neglect of ophthalmic care by parents in case of young children is said to be one of the causes for low vision coupled with sensitivity of light. As many as five crore people suffer from the low vision problem in the country and quite a considerable number of them complains of photophobia.
Though there are no official statistics on the number of photophobia patients in the country, the problem is quite common in albinos or "moon-children" and those with low vision. People who suffer from various eye diseases like ocular albinism, cataract, retinitis pigmentosa and diabetic retinopathy also complain of sensitivity to light like these girls. "For a clear image to appear on the retina a clear medium is needed. In case of opacity in the eye the intraocular light gets scattered bringing down the vision levels. Such eyes become extremely sensitive to light and glare. People with photophobia see glare in light that appears normal for healthy people," says ophthalmologist Dr Altaf Akbar.
Eyecare specialists suggest that coloured lenses with specific tints to restrict different wavelengths of light will do wonders. The patient may choose from a wide range of colours that suit his or her eyes.
Filters, that come in different tints at various levels of absorption and different cut-off points, provide contrast enhancement and help in light adaptation. Corning photochromic filters are also useful since short wavelength light has been shown to cause hazy vision, reduced contrast and discomfort. The photochromic filters filtering out blue light in the visible portion of the spectrum, at the wavelengths that create problems for the photophobic patients. They are specially designed to filter short wavelength light.
Some ophthalmologists are of the view that ultra violet shields (of blue spectrum) provide protection for 100 per cent UV and visible light. The filter in the shields eliminates near infrared 100 per cent UV and provides visible light protection.
For those who find it a problem while reading because of reflection from white pages may go in for typoscope (a black, non-reflective plastic card with a rectangle cut out of it).
A hat with a wide brim or a sun visor can help cut down glare and facilitate mobility outdoors.
When photophobic patients move between places of different lighting levels (say from sunlight to a closed room or vice versa), doctors suggest that they pause a while, take off or put on the sunglasses depending whether they are moving in or out of sunlight. This allows their eyes to adjust without causing any visual discomfort.

Indian children are capable of registering a high growth rate

Syed Akbar
Hyderabad: Indian children are capable of registering a high growth rate provided they get a well-balanced nutritional diet during the schooling years.
A study conducted by the city-based National Institute of Nutrition showed micronutrient-rich supplement would increase tissue growth and skeletal shell in apparently normal children. School-children who received micronutrient-rich food recorded growths up to three cm in height and four kgs in weight during the 14 months of study as compared with children fed with regular normal diet.
The NIN carried out the study among residential school-children, between six and 16 years of age, in Hyderabad. As many as 268 children were selected randomly from two classes of each grade (1 to 9) and were provided a micronutrient-enriched beverage. While 146 got the micronutrient-rich beverage, 122 children received a placebo drink.
Bone parametres and bone area at various sites and the entire body were measured with dual-energy X-ray absorptiometry at the beginning and end of the study.
After 14 months, increments for height, weight, fat-free mass, percentage of fat, whole-body bone mineral content, whole-body bone area and bone mass density at the neck of the femur were significantly greater in the supplemented group than in the placebo group.
NIN deputy director Veena Shatrugna, who conducted the research study, told this correspondent that diets in the boarding school provided 745 mg/d of calcium, including the calcium from milk used to reconstitute the respective supplements.
This is the first time that data on bone parametres in children between the ages six and 16 years is reported from India. The baseline values appear to correspond to reported values from the West. In addition, the beneficial effects of an additional calcium intake of 224 mg with other micronutrients in the supplemented group compared with the placebo group have been demonstrated, she pointed out.
The children in this study belonged to middle-income group from the semi-urban areas of Hyderabad with apparent adequate intake of energy and protein, but intakes of vitamin A, iron, folate, thiamin, and niacin were less than 60 per cent of recommended dietary allowance and calcium intakes were only 700 mg/d which is much below the Western RDAs.

WHO increases swine flu threat level to "phase 5"

Syed Akbar
Hyderabad, April 30: India is safe from swine flu thanks to the preparedness measures it had undertaken during the outbreak of bird flu a year ago, even as the World Health Organisation has increased the threat perception of the epidemic from "phase 4" to "phase 5".

As the Central government had initiated a number of preventive steps after bird flu cases were reported in the neighbourhood, monitoring of swine flu has become quite easier for health authorities. The preparedness measures in the last two years are now benefiting the country in the form of increased awareness and action plan to tackle swine flu, should there be an outbreak here.

The WHO's classification of present outbreak of swine flu as "phase 5" indicates that the disease is now transmitting from human to human. The highest level of threat perception for any disease, as per WHO standards, is "phase 6".

"Health experts, for the first time, could track the evolution of swine flu in real time. This is mainly because the government has been awake on the avian flu problem," said Dr MN Khaja, senior scientist.

Thousands of health workers have been on high alert ever since a few cases of bird flu were reported two years ago. They had undergone specialised training. Since the nature of bird flu and swine flu is similar, health workers may not find it difficult to meet any challenge posed by swine flu.

Influenza viruses, whether bird flu or swine flu, are notorious for fast mutation and unpredictable behaviour. The WHO's change to a higher phase of alert is a signal that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

According to a WHO report, in nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

"In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. In Phase 3, an animal or human-animal influenza virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks".

When a disease takes the "community level outbreaks", it is declared as having "phase 4" threat. Swine flu was declared as phase 4 till Wednesday. WHO updated the threat to phase 5 on Thursday because the virus is now characterised by human-to-human spread into at least two countries in one WHO region.

"While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalise the organisation, communication, and implementation of the planned mitigation measures is short," the WHO report said. When it takes the pandemic phase with
community level outbreaks it is classified as phase 6.