Wednesday, July 27, 2011

Incois prepares multi-hazard vulnerability maps for Indian coasts

Syed Akbar
Hyderabad, July 25: Coastal belt will now be more protected from tsunamis and cyclonic floods as the city-based Indian National Centre for Ocean Information Services (Incois) is all set to come out with multi-hazard vulnerability maps that pinpoint the exact areas to be submerged in case of natural calamities.
"We know that coastal areas are vulnerable to tsunamis, cyclonic floods and storm surges. But we do not know what are the areas that will be submerged. Using the latest digital technology we are now 
mapping the entire coastal belt. This will help us know the exact localities that will be affected in case a natural 
disaster hits the coast. Using the maps, we can take precautionary and safety measures to prevent loss of life," said Incois  scientist Dr RS Mahendra.
He said Incois is now ready with maps of Tamil Nadu and Andhra coasts. Incois is now busy securing data on the coastline of other States and once the process is completed, the high digital elevation model maps will be available for use. The maps will be on a resolution of 1:1,00,000 scale and will focus on all 
vulnerable areas.
In case of highly vulnerable areas along the coast with high population density, Incois will come out with special 3-D GIS maps, which will be even more accurate and highly informative. The mapping will consider all coastal hazards arising from seal level rise, coastal erosion, wave action, storm surges and tsunamis.
In Andhra Pradesh the highly vulnerable areas are the Krishna and the Godavari delta. Coastline between
Machilipatnam and Nellore is mostly low-lying and  is vulnerable to oceanogenic hazards. In case of Machilipatnam town there's no elevated areas. "The exact area and the population to be affected on the 
coastline will be known once the maps are ready. For instance, in case of Nellore district 1708.36 sq km area fall under multi-hazard zone," he said.
The Incois team used parameters like historical storm surge heights, future sea level, future shoreline and high resolution coastal topography to identify vulnerable areas. The coastal population is under threat due to future storms, erosion and accelerated sea level rise. "The Incois maps will become vital tools 
for coastal disaster management during an event and to take suitable decision on the future developments," Dr Mahendra added.

Epidemiology of suicides: Watch out for definite traits to prevent suicides, say psychiatrists

Syed Akbar
Hyderabad: Suicides and suicidal tendencies leave behind definite traits, which can be of great help to curb the increasing menace in young population, point out city researchers. Andhra Pradesh accounts for 11 per
cent of suicide deaths in the country.
Those who should be watched for suicidal tendencies are people with psychiatric disorders including depression and schizophrenia, mood disorders, personality disorders particularly of anti-social or narcissistic type, alcohol abuse, and painful or chronic medical conditions. People on certain medicines, which create suicidal tendencies, should also be kept under observation and should not be left alone.
"Watch out for warnings or clues such as giving property away," suggests senior psychiatrist Dr MS Reddy of Asha Hospital. According to him, there's no single cause for suicide. One should observe for casual factors. "Those with feelings of hopelessness, definite suicide plan, a recent suicide attempt
and severe depression should not be left alone as it is unsafe for the patient," he warns.
People with suicidal tendencies not only give out warning signs but also follow a definite pattern in the methods they adopt to end their lives. Men, for instance, prefer hanging and insecticide poisoning, while women go in for self-immolation and hanging in case they want to end their life. Two-thirds of people in the State, both men and women, who commit suicide prefer hanging and insecticide poisoning.
Dr Reddy and his team from Asha Hospital carried out a research study on the epidemiology of suicide in India, with focus on Andhra Pradesh. The study pointed out that earlier, older men formed the largest chunk of suicide cases but now the trend has reversed with more young people ending lives.
With the number of suicidal deaths increasing, Andhra Pradesh is now responsible for more than 11 per cent of suicides reported in the country. The researchers used patient care record forms of all medical emergencies in Hyderabad and other parts of the State, and found that 72 per cent of men, who committed suicide, either hanged themselves or consumed insect poisons. A little over 40 per cent of women committed suicide by self- immolation or hanging.
"Around 37.8 per cent of people, who commit suicide, are below 30 years of age. The percentage of suicides committed by those below 44 years is 71 per cent. About 60 per cent of suicides may not have occurred if proper intervention was undertaken," Dr Reddy said.
According to the study published in the latest issue of Indian Journal of Psychological Medicine, a majority of those committing suicide suffer from depression or other emotional disorders. Over 7.5 per cent of Indians face some sort of emotional disorder. Out of every three cases of suicide reported every 15 minutes in India, one is committed by a youth in  the age group of 15-29 years.
"Suicide is complex with psychological, social, biological, cultural and environmental factors involved. The largest number of victims were found in the age group of 21-30 years. Majority of the victims were mentally sound, married and were from rural background," he told this correspondent.
He said suicidal note was detected in five per cent of cases. Suicidal tendency and alcohol intake could not be encountered in most of the cases. Financial burden in 37 per cent and marital disharmony in 35 per cent were some of the main reasons for the suicide.
Long-term follow-up of people who have been hospitalised for severe depression show a suicide risk of up to 13 per cent. People with severe depression are 20 times more likely and people with bipolar disorder are 15 times more likely to die from suicide than members of the general population.
The data on suicide cases collected by Dr Reddy revealed that a majority of the victims were mentally sound, married and were from rural background. Victims were mostly drawn from low socio-economic status (48 per cent). Less educated or illiterates were usually the victims.
Stating that all major psychiatric disorders carry an increased risk of suicide, he said 90 per cent of suicides can be traced to depression linked either to bipolar disorder, major depressive disorder, schizophrenia or personality disorders, particularly borderline personality disorder.
Around five per cent of schizophrenics will commit suicide during their lifetimes, usually near the illness onset. Risk factors for suicide among people with schizophrenia include a history of previous suicide attempts, the degree of illness severity, post-psychotic depression, social isolation, and male gender.
Referring to mood disorders, Dr Reddy said depressed people with agitation, severe insomnia, anxiety symptoms, and anxiety disorders are particularly at risk. Eating disorder like anorexia nervosa is also linked to suicide as such people are 40 times more prone to suicides than normal people.
Alcohol abuse has also emerged as one of the important factors for suicidal tendencies. It has been observed that many of the suicide victims were under influence of alcohol.
Box item

* Suicides are no longer the domain of the elderly. More youngsters are
ending their lives for a number of reasons.

* Methods of suicide differ from gender to gender and region to region. But
the common factors or warning signs remain mostly the same. Psychiatrists
suggest that people should watch out for suicidal tendencies or warning signs
in their near and dear ones, so that timely intervention can save their lives.

* Some common methods of suicide are cutting wrist, hanging, electrocution,
jumping from buildings, jumping into water bodies, sleeping across railway
tracks, burning and poisoning.

* If you notice your close one with suicidal ideation, take him to a

* Be careful with certain anti-depressant drugs. They may create or increase
suicidal tendencies. When such drugs are prescribed by doctor, ensure that
the patient is not left alone in the room. Keep a watch on him or her.

Indians add four more years to their life in the first decade of the new millennium: Average life expectancy at birth for Indians goes up

Syed Akbar
Hyderabad: The first decade of the new millennium may have been marred by largescale corruption, scams, emergence of new pathogens and diseases, and incidents of violence, but what many have not noticed is that Indians have silently added four more years to their life. A child born in 2010 in India has an average life expectancy at birth of 65 years. This is in contrast to the average life expectancy at birth of 61 years in 2000.
This is good news particularly for city scientists, who are searching for clues to longevity and checking the process of ageing. A team of researchers at the University of Hyderabad led by Prof Kalluri Subba Rao has been doing research on the process of ageing, at genetic, molecular, clinical, biochemical
and behavioural levels.
While the Centre for Research and Education in Ageing (CREA) in the University of Hyderabad may take a few more years to unravel the mystery behind ageing and discovering the road to longevity, the Centers for Disease Control and Prevention (CDC) of the United States in its latest report on 10 major global achievements on the health front during 2000-2010 states that if the past trends continue, the average life expectancy at birth may rise to 73 years by 2025.
"Worldwide, a child born in 1955 had an average life expectancy at birth of only 48 years. By 2000, the average life expectancy at birth had increased to 66 years and 68 by 2010," it points out, adding that these improvements in longevity have resulted from improved living conditions overall, advances in medical science, and a number of population-level interventions.
But health experts here feel that much need to be done on the health and sanitation front if India has to equal the world average. The global average life expectancy at birth is 68 years while it just 65 years for Indians. Though Indians have added four more years to their life span on an average, they are still three years behind the world average.
Interestingly, India is fast catching up with the world if the trends in the last 10 years are any indication. While the global average life expectancy at birth went up by two years from 66 to 68 years between 2000 and 2010, in India it increased by four years from 61 to 65 years.
While Indian women have added four years to their life span in the first decade of the new millennium, Indian men had to be content with just three years. Thus an Indian boy born in 2010 has now an average life expectancy at birth of 63 years, up from 60 years in 2000. For an Indian girl, it is 66 years, up from 62 years.
That the average life span in India has increased to 65 years is a reflection of improvement in health care services in the country, says Dr Aftab Ahmed, senior physician, Apollo Hospitals, Secunderabad. "Today we have good and accessible medical care which is very effective in preventing as well as controlling and curing diseases. Individually, good lifestyle, healthy food habits, exercise, avoiding smoking, safe sex and preventive health checks had
helped Indians to lead a healthier and longer life," he adds.
The reduction in neonatal mortality rate has also helped Indians to move towards longevity. The neonatal mortality rate per 1000 live births was 43 in 2000 and it came down to 34 in 2010. A reduction of nine neonatal deaths per 1000 live births will make a huge impact on the over all health scenario in the country, points out social activist VS Narayana, but emphasises the need for further reduction in the neonatal mortality rate.
Stating that the search to extend the life and live longer or to live forever is one of the dreams of man, Suneetha Sapur, nutritionist and director of Akshaya Foundation, says better health care, immunisation and improved nutrition have helped to reduce the child mortality and morbidity in the population there by extending the life span in India.
"We no longer see the severe malnutrition like Kwashiorkor and marasmas except in very rare incidence. Also severe deficiencies of vitamin A like karatomalcia and pellagra have more or less disappeared. But the major challenge before us now is the new epidemic of lifestyle ailments like heart diseases, hypertension, cancers and diabetes, which are expected to account for 75 per cent of all deaths by 2030," she warns.
According to Prof Subba Rao, when India became free the life expectancy at birth was around 40 years. Then, old age was not a problem. The average life expectancy of an Indian today is 65 years and this figure is fast improving. "Never before have so many people lived for so many years, thanks to the amazing progress made in medical and biological research. Today India has nearly 117 million people over 60 years," he says emphasising the need for full-fledged research on the process of ageing.
Health experts in the city are also digging into the old Ayurveda texts to find out if there's any secret health formula that could improve the health of people and make them live longer. Since Ayurveda is considered as a medical science of rejuvenation, further research on herbs and formulations is expected to provide clues on longevity.
One of the herbs, for instance, attributed to long life is amla (goose berry). "This could be due to the vitamin C content and flavonoids, which are important antioxidants. A diet rich in antioxidants prevent the damage of the cell by free radicals and also provide protection against age-related cell degeneration. Low calorie and high antioxidant diet is the key for healthy and long life," said Suneetha.

Some Facts

* Hyderabad is one of the centres involved in research on longevity and the
process of ageing.

* The average life expectancy at birth in India at Independence was about 40
years. In the last six decades, Indian have added 26 years to their life span,
including four years in the last 10 years. In 1990 the average life span for men was 57 
and women was 58. By 2000, it went up to 60 years for men and 62 for women. Today, it is 
63 for men and 66 years for women. The average works out to 65 years.

* Revalidation of Rasayana therapy in Ayurveda may hold the key to long
and healthier life.

* Experts feel that the process of ageing can be stopped and reversed if
studies at molecular and cellular level prove successful.

* Factors like checking use of tobacco and improving road safety will add to
the average life expectancy.

* According to Centers for Disease Control and Prevention, reduction in
child mortality and vaccine preventable diseases, access to safe water and
sanitation and prevention and control of malaria, HIV/AIDS, tuberculosis and
neglected tropical diseases are major health achievements in the last 10 years.

* India still has quite a high maternal mortality ratio, infant and child
mortality rate and high number of road accidental deaths. If they are brought
down further, the quality of life in the country will improve a lot.

Contract Research Organisations: CROs turn into human trafficking racket for drug trials

Syed Akbar
Hyderabad, July 23: Clinical research in the city has turned into a sort of human trafficking racket with Contract Research Organisations (CROs), which conduct drug trials on behalf of pharmaceutical companies, vying with one another in boasting of "large base of volunteers" ranging from 3,000 to
45,000 and offering "special population" for research.
The city has a little over 50 CROs and their combined "volunteers" registration is estimated at five lakh, mostly from socially and economically weaker sections. The CROs also take pride in their "control access" systems and ability to undertake studies for special population like the elderly, the obese, surgically sterile women, post-menopausal women, healthy women with child-bearing potential, and people suffering from defects in reproductive system. This in other words means practically every section of population, both healthy and suffering from diseases are readily available for quick research.
Some of them claim that they can keep the "volunteers" in their laboratories for as long as 28 days with strong checks on their movement. Some others offer trials on patient population too ranging from diabetics to those suffering from cancers. Interestingly, one CRO boasts of "readily available" diabetics as it has contacts with a leading hospital.
A website of a CRO claims that recently when a biotechnology company from the US needed 400 diabetics for a study, it began by heading to a nearby hospital specialising in diabetes, where a dozen new patients arrive every day and more than 40,000 are in its records.
"Our huge database of more than 27,000 volunteers which include 80 female volunteers and our ability to undertake studies for special population and unconventional molecules sets us apart from the competition," says a city-based CRO to its prospective clientele around the world.
Senior scientist Dr K Babu Rao said it's unethical to recruit volunteers on permanent basis and maintain a database of special population for quick enrolment whenever a pharmaceutical company comes up with a demand for exclusive research. "How can a CRO recruit volunteers in advance? It is ethically wrong and the drug administration should conduct raids on unscrupulous CROs and seize the database of volunteers for effective follow-up in case something goes wrong," he pointed out.
Another CRO proudly declares that it has a "volunteer mobilisation team" for clinical trials. "Vigilant screening and volunteer assessment methodology have created an extensive database of 47000 plus volunteers for studies," it says. Yet another CRO speaks of its volunteer database of  20000, that include healthy male and female, and post-menopausal women volunteers. 
"With an extremely large female volunteer database of about 500 we currently conduct a large number of female studies. Our large female volunteer database with our unique facility design enables us to conduct
mixed gender studies," says another CRO.
With the CROs resorting to unethical practices, the Indian Council of Medical Research has suggested compulsory registration of volunteers with the district authorities. "We will consider the proposal of compulsory registration of volunteers so that there's constant vigilance and if something goes wrong the volunteers can be traced," said ICMR director-general Dr VM Katoch.
Most of the CROs do not report adverse reactions to the Clinical Trials Registry of India and this makes the tracking of volunteers difficult. The government has acted only when volunteers lodged complaint with the police.
Hyderabad has been attracting multinational clinical trials as, phase I trials are about 50 per cent cheaper than western equivalents, while Phase II and Phase III are 60 per cent less expensive in the city.

Monday, July 25, 2011

Chaos science: Novel device to detect damage to nerves in diabetic neuropathy

By Syed Akbar
Hyderabad, July 21: In a major technological breakthrough that could prevent amputation of legs in
diabetics, a city doctor has successfully patented a medical device that helps doctors to monitor and treat
nerve damage or neuropathy in patients.
At present there's no perfect medical device that could tell doctors the quantum of nerve damage (diabetic
neuropathy) in the feet of diabetics.Though glucometers tell the sugar levels in the blood, they do not inform physicians about the damage
diabetes has caused to nerves. It is the damage to the nerves that causes diabetic sores, gangrene, or diabeticfoot, which may ultimately result in amputation.
Senior chronobiologist Dr C Jairaj Kumar, who is currently a visiting faculty in Ludwig-Maximilians
University, Germany, developed the medical device based on "chaos science". Dr Jairaj's technology was
one of the seven indigenous technologies selected by the Central government for presentation before US
Secretary of State Hillary Clinton in New Delhi earlier this week.
"As high salt content in water corrodes water pipes, high glucose levels in the blood damage the blood
vessels. The first to be affected are small blood vessels. Medium and large blood vessels are affected
gradually. The damage to small blood vessels impacts the eyes and feet, while damage to medium size
blood vessels hurts kidneys and heart. In case of heart it even causes myocardial infarction. Our device
helps in knowing the extent of damage caused to such nerves. The problem can be treated at initial stages,
preventing amputation in case of diabetic foot, and death in case of heart muscle damage," Dr Jairaj said.
The device works on the concept of chaos science and neuropathy. It measures the progression of diabetic neuropathy and predicts foot ulcer development. "It is a novel concept based on the theory of chaoticmovement of the foci in the sole of the foot," he added.
All that a diabetes patient has to do is to stand on the device for a few minutes. The report is generated
within five minutes. The equipment studies the feet of the patient in detail and identify areas which are
prone to ulcers. It will pinpoint high risk ulcer prone zones in the feet, thus allowing the doctor to take
preventive measures. Nerve damage as less as seven per cent can be found out through this device.
Dr Jairaj said every year about 25 per cent of diabetics develop ulcer-related complications. Of them 50 per
cent become infected and 20 per cent of those require amputation. "Regular screening enables a physician
to assess and benchmark progression of neuropathy, then initiate preventative measures to proactively
prevent formation of foot ulcers, gangrene development or amputation," he said.