Hepatitis C strike rate double that of HIV incidence in India

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

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

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

Prophet's Medicine: Herbal And Spiritual Cure For All Problems

September 27, 2006
By Syed Akbar
Hyderabad, Sept 16: Young Rubina is on a diet regulation eating figs and dates to shed that extra fat in her body. Middle-aged Abdul Kareem takes black cumin seeds to keep his blood cholesterol under check. Septuagenarian Zaheeruddin gulps a syrup of pure honey to fight his abdominal trouble while his daughter-in-law Fathima gives vapours of incense to her son to beat throat infection.
All these Hyderabadis are on a prescription of Tibbe Nabawi or the Prophet's Medicine, which is fast taking its roots in the city as an alternative system of curative and preventive medical practice. People suffering from common ailments and patients with chronic diseases including those with obesity are increasingly turning to Tibbe Nabawi. Giving a modern touch to this 1500-year-old Islamic system of medicine, some pharmaceutical companies are marketing facial masks, beauty creams, hail oil, massage oil and ointments based on the Prophet's prescriptions. And they are in good demand.
At least a dozen Tibbe Nabawi clinics have been opened in Hyderabad and other parts of the State to cater to the vast clientele. As many as eight different books on the Prophet's Medicine are now available in city book shops.
Says eminent physician Dr Fakhruddin Muhammad, "the efficacy of the pharmacopoeia of the Prophet's Medicine is scientifically proved by dozens of research organisations including the Food and Drugs Administration. It is based on natural herbs and food products without any addition of chemicals. It is a lifestyle management system to prevent health problems and cure diseases".
Practitioners of the Prophet's Medicine prescribe commonly available herbs and fruits (raw or extracts) like grapes, pomegranates, citrus, honey, henna, dates (specially of the ajwa variety), olive, methi (fenugreek), aloe vera, rosewater, hibiscus, miswak, black cumin (kalonji), sweet basil (myrtle), ginger, Indian incense (Ud-al-Hind), truffles, watercress, squash, melons and figs.
The treatment ranges from cardiac problems to pleurisy, obesity to malnourishment, respiratory troubles to anaemia and renal obstructions, improvement of eyesight and mental agility to toning up skin texture and deworming to healing of wounds, both internal and external. As many as 30 products are available in the city market based on Kalonji combinations alone. People who have had a heart attack and have survived are prescribed the combination of honey, sana maki and ajwaa dates to speed up recovery.
Dr Fatemeh Mojtahedi, an MBBS doctor, has switched over to the Prophet's Medicine in her Avicenna Clinic to treat obesity. She has formulated "slim capsules" based on the herbs and fruits mentioned in ancient Islamic medical literature inspired by Tibbe Nabawi.
"The important thing we can learn from prophetic nutrition is moderation. Treatment of obesity is quite simple in the Prophet's medicine: eating simple and wholesome natural foods and herbs, and drinking plenty of water. Since the Prophet's Medicine normalises the metabolism and curbs the appetite, patients, who shed excess weight, continue to maintain their slim and trim figure even after the treatment is over," explains Dr Fatemeh. She has treated about 8000 patients and one of them has reportedly lost 58.5 kgs in nine months and 15 days. Dr Fatemeh is approaching the Guinness Book of World Records with a claim of reducing obesity in the shortest time.
The interest in Prophet's Medicine increased in the local populace after the International Institute of Islamic Medicine and the Islamic Medical Association of North America jointly held a conference a few years ago on the scientific validity of the medical prescriptions given by the Holy Prophet.
Following the conference, many have abandoned their toothpaste and toothbrushes in favour of Miswak stick, which the practitioners of the Prophet's Medicine point out strengthens the gums and prevents tooth decay, improves the sense of taste and assists in digestion.
Dr Qudratullah Hussami, whose Islamic Research Academy has done pioneering research in the Prophet's Medicine, points out that "Tibbe Nabawi is a nothing but a collection of Hadith that instruct Muslims on the subject of sickness or medical treatment. Most of the products used in this system of medicine are prescribed by the Prophet himself or utilised by him. Over 200 university research papers have proved the efficacy of the medicine, particularly the black cumin seeds".
Hakeem Muhammad Zaheer Ahmad prescribes black cumin (Kalonji or
Nigella sativa) to his patients to treat asthma, control of sugar in blood and urine, psoriasis, hypertension, hypotension and skin diseases. He is also working on the efficacy of black cumin seeds in the treatment of cancer.
Dr Syed Jaleel Hussain, former director of the Central Research Institute in Unani Medicine, says the Prophet has prescribed olive oil for treatment of haemorrhoids (piles). Kalonji extract removes obstructions in body, expels gases and strengthens the stomach.
"Kalonji oil has improved my hair growth. It has successfully controlled falling of hair due to alopecia. The drug has also improved my skin texture," says Rafique Ahmad, a resident of Charminar. According to inter student Zareena Almas, the facial mask and beauty cream prepared from Kalonji has been quite effective in controlling pimples and blackheads. "Unlike common creams which are heavily loaded with chemicals, the Tibbe Nabawi creams do not cause any skin rashes or irritants. There's no need for even a skin patch test," she observes.
Dr Ghousuddin, consultant pharmacologist, refers to medical reports in support of his claim that the Prophet's Medicine has been useful in paralysis, facial palsy, migraine, amnesia and palpitation.
Islamic scholar Moulana Hasanul Hashmi is of the view that Tibbe Nabawi is not only a curative and preventive system of medicine but it also gives a "rewarding experience". The Prophet's Medicine is based on Sunnah and it is a good thing (Nek Kaam) for Muslims to follow it, he says.

Majority of people in India suffer from common nutrition problems

September 24, 2006

Syed Akbar

A majority of Indians are malnourished. Even those who consume sufficient quantity of food suffer from malnutrition because they don not get well-balanced food. Nationwide surveys by Central government agencies over the years reveal that Indians, including those living in urban areas, suffer from common nutrition problems like protein energy malnutrition and micronutrient deficiencies (vitamin A, iron, iodine and vitamin B-complex).
Keeping this in view, the Hyderabad-based National Institute of Nutrition has come out with a Nutrition Manual containing dietary guidelines for Indians, particularly adolescent girls and pregnant women. The guidelines give a broad perspective on the present nutritional scenario in the country, besides suggesting the type of food one should take for healthy, long and happy life. The nutrition quota differs from person to person depending on the amount and type of work he or she undertakes. It also varies depending on age and sex.
The nutrition guidelines assume importance in the backdrop of the poor health scenario in several parts of the country. About one-third of infants born are low in weight i.e. less than 2.5 kgs. This is as against less than 10 per cent of low birth weights recorded in developed countries including small nations like Israel. It was also noticed that two per cent of nursery school children in the country suffer from severe and florid forms of protein energy malnutrition leading to health problems like Kwashiorkor and marasmus.
Health surveys reveal that children below five years suffer from sub-clinical under-nutrition resulting in low weight for age. This is less than 75 per cent of median weight for age as fixed by the National Centre for Health Statistics. About 65 per cent of these children are stunted (low height for age). Under-nutrition if continued throughout the growing phase of childhood leads to short stature in adults. Half of the adults in the country have body mass index below 18.5, which in other words means chronic energy deficiency.
The dietary goals as envisaged by the NIN include maintenance of a state of positive health and optimal performance in populations at large, ensuring adequate nutritional status for pregnant women and lactating mothers, improving birth weights and promoting growth of infants, children and adolescents to achieve their full genetic potential and preventing chronic diet-related disorders.
The dietary guidelines are: consuming nutritionally adequate diet through a wise choice from a variety of foods; additional food and extra care during pregnancy and lactation; food supplements for infants by four to six months; consumption of green leafy vegetables, other vegetables and fruits in large quantities; moderate use of oils, sugar and salt; avoidance of processed and ready-to-eat foods; and adequate amounts of water.
According to NIN, a balanced diet should provide around 60 to 70 per cent of total calories from carbohydrates, preferably starch, about 10-12 per cent from proteins and 20-25 per cent from fat.
Nutrient dense low fat foods are recommended for old people for being physically active and healthy. Nutritionally adequate diet with extra food for child bearing/rearing women for maintenance of health productivity and prevention of diet-related disease and to support pregnancy/lactation.
Body-building and protective foods are recommended for adolescents for growth spurt, maturation and bone development. For children's growth, development and to fight infections, energy, body-building and protective food (milk, vegetables and fruits) are recommended. And for infants, breast milk and energy rich foods (fats and sugar) are needed for growth and appropriate milestones.
The balanced diet recommended for an adult man (sedentary) per day is: 20 grams of oil/fats; 25 grams of sugar, 300 grams of milk and milk products, 60 grams of pulses (for vegetarians), 30 grams of pulses, egg/meat/chicken/fish (for non vegetarians), 400 grams of vegetables, 100 grams of fruits and 420 grams of cereals and millets. Elderly people may reduce 90 grams of cereals and millets and add an extra serving of fruit.
In case of women, 300 grams of vegetables, 300 grams of cereals and millets and 20 grams of sugar, besides the other dosage recommended for men.
Half of the people suffer from nutritional anaemia and this is more pronounced in women as 70 to 90 per cent of them are found to be anaemic. Health statistics indicate that anaemia caused due to malnutrition kills over a lakh pregnant women. Coming to iodine deficiency, about 300 million people live in areas where iodine is in short supply. Iodine deficiency leads to problems like goitre, neonatal hypothyroidism, mental retardation, delayed motor development, stunting, deaf-mutism and neuromuscular disorders. Around one lakh still-birth and neonatal deaths occur every year because of deficiency of iodine in mothers.
Studies by the National Nutrition Monitoring Bureau show that the daily intake of most foods, except cereals and millets (470 grams) is much below the recommended dietary allowances. The diets provide negligible amounts of protective foods like pulses (29 grams) and vegetables.
Consumption of green leafy vegetables and other vegetables (70-80 grams), which are rich sources of micronutrients like beta-carotene, folate, calcium, riboflavin and iron, is woefully inadequate. Intake of visible fat is less than 60 per cent of the RDA.
"The proportion of households with energy inadequacy is 48 per cent while that with protein inadequacy is 20 per cent. Thus, in the cereal/millet-based Indian dietaries, the primary bottleneck is energy and not protein, as was earlier believed. This dietary energy gap can be easily overcome by increasing the quantities of habitually eaten foods by the poor," the study points out.

OTC drugs may open Pandora's Box

2006
By Syed Akbar
Hyderabad, Sept 23: The Central government's decision to allow sale of certain medicines through ordinary grocery stores is likely to open the Pandora's Box.
Health and medical experts are divided over the feasibility of the government's move as a majority of people in the country are illiterate and there's every possibility of the over the counter drugs being misused. Doctors fear that even seemingly harmless medicine like iron tablets will cause severe health complications if it is not stored properly. While those in favour of the government's move argue that over the counter sales would help the poor as they generally do not have access to a general physician.
The Central government has given time till September 26 for people to send in their suggestions and objections on the draft notification for sale of drugs in grocery stores. After September 26, the government will issue a notification after which it becomes law.
"Most of the medical stores in the country do not have proper storage facilities. We can least expect facilities in ordinary grocery stores. In medical shops at least shopkeepers have the knowledge of pharmacy. Unless the government ensures that shopkeepers are properly trained in pharmacy, the over the counter sale of medicines will prove to be harmful than beneficial," argues Dr Bhaktiyar Chowdhury of Hyderabad Spine Clinic.
Even the Indian Drug Manufacturers' Association has objected to the government's decision saying that only a few medicines should be sold through grocery stores. It argued that India did not have sufficient number of qualified pharmacists and infrastructure to preserve the drugs well.
At present only grocery stores in villages with less than 1000 population are permitted to sell select medicines. Once the Act comes through, grocery stores all over the country will be able to sell medicines which do not require prescription of a qualified registered medical practitioner.
According to industry sources, despite strict restrictions medicines worth over Rs 5000 crore are sold through over the counter process every year. The segment has been recording an annual growth rate of 12 to 15 per cent and this is precisely the reason why multinational companies are bringing pressure on the Centre to amend Schedule K of Indian Drugs and Pharmaceutical Act to permit sale of medicines through grocery stores.
"Bad storage facilities, wrong prescription and failure to comply with the expiry date can be extremely harmful to patients. The problem does not relate to just serious side effects including death but also to meeting specified bioavailability and bioequivalence criteria of drugs," points out Dr B Murali of Care Hospital.
Ironically, some of the drugs which the government wants to permit through OTC sales are known to cause side effects or have drug interactions and disease interactions. Permission for sale of non-steroidal anti-inflammatory drugs, gastrointestinal medicines and prochlorperazine will be dangerous to the health of people.
Senior physician Dr S Ramachandra Rao suggests that drastic changes in the labelling practices of over the counter medicines should have to be strictly enforced. OTC drugs should be labelled in local regional and local languages with clear instructions to patients. "It has to be ensured that all OTC drugs specify the correct prescription particularly in case of children like quantity, frequency and duration of the intake," he said.
Non-steroidal anti-inflammatory drugs like ibuprofen, mefenamic acid, ketoprofen and dictlofenac, gastrointestinal drugs like domperidone and loperamide and prochlopreazine may damage kidneys in case of overdose, warns Dr Murali.
Health experts also warn over sale of potentially dangerous drugs like iodochlorohydroxy quinoline, which is banned in many countries but sold in India. This drug is likely to cause blindness. Even anti-malarial drugs and ophthalmic solutions have been proposed for sale through grocery stores.

Indians suffer from cardiac ailments 10 years earlier

2006
By Syed Akbar
Hyderabad, Sept 22: Indians suffer from cardiac ailments 10 years before people of other countries develop them. And if the World Health Organisation report is any indication, about 60 per cent of all heart patients in the world will be in India in the next six years.
A research study has now been taken up to find out the reasons for the high prevalence of heart diseases in Asian countries, particularly India. Scientists and researchers have thus far been baffled by the mystery behind heart attacks in people who are not bracketed under high risk groups and who do not have "social vices" like smoking and drinking.
Apollo Hospitals have tied up with John Hopkins to identify the causes responsible for cardiac risk among Indians. The study will find out whether a particular gene is behind heart attacks.
Apollo Hospitals chairman Dr Pratap C Reddy told reporters here on Friday said there was possibly a genetic predisposition to heart diseases among Indian, but the precise cause was still elusive.
"Risk factors that are often associated with heart diseases like hypertension, smoking, high total serum cholesterol and high fat diet do not seem to fully account for the high incidence of the disease in Indians. The disease process also differs in Indians as the coronary vessels are diffusely affected while in other ethnic groups the coronary arteries are more discretely affected. High incidence of diabetes and low levels of good cholesterol with high levels of triglycerides may partially address the high risk of heart diseases in Indians but there is something beyond," Dr Reddy pointed out.