NIMHANS: Tsunami trauma still haunts victims

June 1, 2008
By Syed Akbar
Hyderabad: The Tsunami that hit the Indian Ocean in December 2004 is now history. But
four years after the devastation, people affected by Tsunami are still in trauma. Their psychiatric morbidity is quite high and children are the worst-hit. The Bangalore-based National Institute of Mental Health and Neuro Sciences conducted a study on people affected by Tsunami and compared the data with those of normal
population. About 12,000 victims were interviewed as part of the study to establish psychiatric morbidity and the extent of mental trauma they had undergone.
"People are still traumatised. The effect will continue for some more time. In case of children, it may continue for life," NIMHANS assistant professor of psychiatry Dr
Suresh Bada Math, told this correspondent. A meta-analysis of 160 studies of disaster victims found that post-traumatic stress disorder, major depressive disorder, generalised anxiety disorders, and panic disorders were identified.
The factors that most consistently increased the risk for adverse outcome were severity of the exposure to the disaster; living in a highly disrupted or traumatised community; lack of social support; belonging to an ethnic minority group; post-traumatic stress; and being female.
Psychiatric morbidity was 5.2 per cent in the displaced population and 2.8 per cent in the non-displaced population. The overall psychiatric morbidity was 3.7 per cent. The displaced survivors had significantly higher psychiatric morbidity than did the non-displaced population. The disorders included panic disorder, anxiety disorders not otherwise specified, and somatic complaints. The existence of an adjustment disorder was significantly higher in the non-displaced survivors. Depression and post-traumatic stress disorder were distributed equally in both groups.
According to Dr Suresh, one of the study team members, psychiatric morbidity was found to be the highest in the displaced population. However, the incidence of
depression and PTSD were distributed equally in both groups. Involvement of community leaders and survivors in shared decision-making processes and culturally
acceptable interventions improved the community participation.
"Cohesive community, family systems, social support, altruistic behaviour of the community leaders, and religious faith and spirituality were factors that helped survivors cope during the early phase of the disaster," he said.
The NIMHANS study suggested that in a developing country like India there is a high need for psychosocial rehabilitation from day one of the disaster. "Our observations
clearly depicts that the presence of a mental health team in the early phase of disaster is definitely required for treating the immediate needs of the patients and planning long-term psychosocial rehabilitation as per the local need. The ‘mental health/psychiatric’ label needs to be avoided in the country".
The initial assessment by the team revealed that five to eight per cent of the population were suffering from mental health issues following the disaster. This may increase as time passes. Psychiatric morbidity is expected be around 25 to 30 per cent in the disillusionment phase. A notable feature was the high resilience
observed in the joint family system during the early phase of the disaster.
The NIMHANS experiences emphasised the point that in the formulation of any psychosocial rehabilitation plan, due consideration should be given to the local
culture, traditions, language, belief systems and local livelihood patterns. Any rehabilitation programmes need to be flexible, locally adaptable and acceptable. Utilisation of local community resources and community participation should be emphasised, leading towards community empowerment.
The team found that 475 survivors had at least one psychiatric diagnosis. Of these, 244 were displaced survivors residing in the Port Blair relief camps, and 231 were in the Non-Displaced Survivors Group from Car-Nicobar Island. The most common psychiatric problems observed in the survivors’ group were adjustment disorder in 178 (37.5 per cent), depression in 102 (21.5 per cent), panic disorder in 57 (12 per cent), PTSD in 53 (11.2 per cent), anxiety disorder not otherwise specified (NOS) in 26 (5.5 per cent), and other disorders in 16 (3.4 per cent). The "other" disorders were noted in children and adolescents by their parents, and included dizziness, vertigo, startle response, sleep-wake cycle disturbance.

Cola and Health: ICMR to study health problems of soft drinks

May 27, 2008
By Syed Akbar
Hyderabad, May 26: The Union Ministry of Health and Family Welfare is gathering information from scientists and research institutions across the country on the
ill-effects of consumption of soft drinks, carbonated water and beverages on the health of people.
This is the first-ever major exercise taken up by the MoHFW on soft drinks in the backdrop of research reports by various laboratories that consumption of soft drinks
and carbonated water is deleterious to the health of people, particularly children. The MoHFW has entrusted the task to the Indian Council of Medical Research. Research laboratories and scientists, who have done work on soft drinks, may send in their data to ICMR by this month-end.
"Since, this issue is of national importance and in the public interest, scientists from all over the country are requested to share their, if any, published/unpublished
data/study with us (the reference of the published paper). If you are currently carrying out any study in the related field, you may send us the same," says Dr GS Toteja, senior scientist at ICMR.
Dr Toteja told this correspondent that the ICMR had already received 120 research papers and they are looking for more such studies so that ICMR could prepare a
comprehensive report. "This is a major exercise. Based on the papers and data presented to us, we will come out with a comprehensive report. A committee of experts will go through the papers," he said.
The MoHFW/ICMR move comes in the wake of publications in different parts of the world including India that soft drinks provide more than the recommended dietary allowance of refined sugar. Some of the soft drinks contain aspartame as sugar substitute, which lowers the seizure threshold in the brain inducing depression, rage and paranoia.
Since phosphoric acid forms a major component in soft drinks, regular consumption of drinks laced with this chemical may affect the body's function to utilise calcium, thus leading to osteoporosis.
Another component caffeine is known to cause jitters, insomnia, hypertension and beast lumps among others.
Based on a similar exercise in the USA, the National Institute of Diabetes and Digestive and Kidney Diseases included soft drinks on the list of foods, which doctors may advise patients to avoid.
Surveys show that children and adolescents are the heaviest consumers of soft drinks and carbonated beverages. They are known to contribute nine per cent of calories in boys and eight per cent in girls.
The ICMR study will take all these medical facts into consideration before arriving at a final report.

Chennai, Bangalore, Hyderabad to get lead maps

May 26, 2008
By Syed Akbar
With lead poisoning threatening people in big cities, a group of scientists in Bangalore has decided to develop specialised lead maps for Chennai, Hyderabad and Bangalore to enable citizens know which areas are affected by lead.
The lead maps will tell people the landscapes and water bodies they should avoid if they want to keep themselves in good health. Once lead maps are developed for these cities, the project will be extended gradually to all districts. Specialised lead maps have become necessary for a country like India where people do not know much about the ill-effects of lead, which is present in most of the items people use in their daily life. Even a simple fancy item like Kajal/Surma (khol) is loaded with lead.
The maps will have “dangerous spots” highlighting the areas where lead contamination is considerable. “We are planning to create such maps for all the districts in the country. The lead maps will also inform citizens about the precautionary measures they should take whenever they happen to visit such areas,” says Bangalore-based Dr Venkatesh Thuppil, who is recognised as the “lead man of India”, for his pioneering research in the field.
The National Referral Centre for Lead Poisoning in India, Bangalore, of which Dr Venkatesh is the director, has taken up lead poisoning as a major health concern. Because of the untiring efforts supported by research studies by the Centre, the Government of India introduced the concept of lead-free petrol eight years ago.
Dr Venkatesh told this correspondent that they thought of lead maps after they came across several people with cases of lead poisoning. “We know that people are visiting us with cases related to lead poisoning. We then thought of identifying the areas which contribute to the problem. This took us to the proposal of creating lead maps for important cities,” he points out.
The national centre took up monitoring of air, water and soil in Bangalore as a pilot study. The scientists also studied the levels of lead in human blood to understand the gravity of the situation. “In our studies it came to our notice that people with high levels of lead in their blood were from areas where the concentration of lead in environment was high. The areas near battery repair units were the worst hit. The lead levels in blood samples of children from the vicinity were as high as 75 micrograms per decilitre as against the universally permissible limit of 10 micrograms per deciliter,” he said.
Lead maps for specific areas are important for they will not only tell people about the concentration levels of lead in a given locality, but also prevent lead-related health problems including retarded growth in children due to damage to the central nervous system.
Presently, the scientists of the national referral centre are busy collecting data from a number of places in Karnataka, besides Chennai and Coimbatore in Tamil Nadu and Hyderabad in Andhra Pradesh.
For accurate results, the scientists want to take lead concentration levels in a given locality during May-June, July-Oct and Nov-Dec, so that they could have exact information on the lead concentration just before the start of rainy season, during the rainy season and the months that follow.
The NRCLPI in collaboration with the Harvard University and Boston Medical Centre in USA is currently working on the abatement of lead and other heavy metals in Ayurvedic and other traditional medicines.
“Women have to be very careful about lead poisoning. The cosmetics are the utility products used extensively worldwide for maintaining and improving general appearance of face and other parts of the body. Women are frequently using Kajal/Surma and Kumkum without knowing the health hazards of these utility products,” he says.

Lead toxicity and herbal medication

May 26, 2008
By Syed Akbar
Many people believe that herbal medicines are a safe bet. They think that allopathic drugs cause side-effects while herbal medication is good for the body and the mind.
But a team of researchers from Bangalore has come out with a scientific study which points out that many herbal medicines contains poisonous heavy metals, particularly lead. Injudicious use of herbal medicines will result in accumulation of lead in the blood causing severe health complications.
A study by T Venkatesh, A Ravi Raja, GN Vishal Babu and Geraldine Menezes of the department of biochemistry and biophysics, St John’s Medical College, Bangalore, some of the herbal medicines prepared from certain roots and leaves contain lead at alarming levels.
“Awareness about the toxic effects of non-essential metals is still lacking in developing countries. Lead is one among them, which ranks second in the Agency for Toxic Substances and Disease Registry’ s top 20 list of toxic metals. Some of the herbal medicines prepared from certain roots and leaves are known to contain this toxic metal at alarming levels.
We came across a person, who suffered from the toxic effects of lead such as vomiting and colicky abdominal pain after consuming an herbal remedy for jaundice treatment. This went unrecognised initially because of the presence of multiple problems like malaria and renal calculi. Lead poisoning as causative factor for anemia, vomiting and colic were confirmed only when blood lead concentration was estimated. A combination of chelation therapy and nutritional supplementation was found to be useful in reducing the body lead burden,” Venkatesh told this
correspondent from Bangalore.
Lead enters the body by routes such as inhalation, ingestion or by dermal contact, undergoes cumulative storage and it has no known biological functions. Major organs and systems like nervous system, hematopoietic system, digestive system, cardiovascular system, reproductive system, skeletal system, immunological system and renal system are affected by lead. People are exposed to lead from different environmental sources such as air, soil, food, drinking water or from different occupational and recreational sources and also occasionally from sources like folk
remedies, cosmetics, moonshine whisky and gasoline huffing. Folk and herbal remedies from the Indian subcontinent are a significant unrecognised source of lead toxicity.
A 39year old male patient from a village in Goa was referred to National Referral Centre for Lead Poisoning in India, Bangalore, for the evaluation of lead poisoning. History revealed his habitual consumption of herbal medicines for any kind of illness. This time he had consulted a traditional practitioner for the treatment of jaundice in his village, who gave him syrup known in local language as Kadda.
After consuming 10 to 15 ml of Kadda everyday morning on empty stomach, for a period of 10 days, the patient experienced vomiting and severe abdominal pain. As the syrup did not cure jaundice he was admitted to Government Hospital for the treatment twice, on two occasions within a short period of two weeks.
All possible investigations including HbSAg and HIV were carried out. Results of biochemical investigations showed all normal except for mild elevation of total serum bilirubin -1.6 mg/dl (normal-0.2 to 1.0mg/dl) and Unconjugated bilirubin –1.3mg/dl (normal-0.2 to 0.6 mg/dl) suggestive of hemolytic jaundice. An abdominal CT scan revealed the presence of a 3mm calculus on the left kidney.
With persisting vomiting and severe abdominal pain, he was referred to a superspeciality private hospital in his place. At the time of admission - blood pressure was 130/90 mm of Hg; pulse rate was 76/minute and had no history of diabetes mellitus and hypertension.
Laboratory investigations showed a decrease in hemoglobin 7.8 grams. Repeat CT scan confirmed the presence of left renal calculus. Endoscopy was normal. A barium meal and follow through study did not reveal any abnormality in the small bowel. Two days later after the admission the patient suffered from fever with chills. So test for malaria along with ICT, WIDAL, tests for Leptospira, Brucella, and dengue were carried out. All tests were negative.
A surgical opinion was sought because of the persistent abdominal pain and fever. Urine examination, which was normal initially, had shown 10-12 WBCs on repeat examination. During this time as a work up for anemia, a rectic count was done which was raised and suspected a possibility of hemolytic anemia; the entire work up for hemolytic anemia included sickle test, hemoglobin variant analysis.
As the fever was not coming down, the smear for malaria was repeated including the indirect Coomb’s test that was positive this time and Chloroquine was given. It was also noted that the W.B.C count was progressively coming down and showed leucopenia on the blood picture and a possibility of drug-induced cause was found out.
The fever and vomiting gradually subsided but not the abdominal pain. A bone marrow examination revealed microcytic blood picture. Finally doctors suspected lead poisoning and the patient was sent for blood lead analysis to the NRCLPI. He presented with extreme weakness of both lower limbs and abdominal pain. His blood pressure was 132/86 mm Hg, Heart rate 84/min.
Most significant findings were elevated blood lead level and elevated systolic and diastolic blood pressure.

Lifestyle diseases to beat viral threat

May 23, 2008
By Syed Akbar
Hyderabad, May 22: Bacteria, viruses, germs and worms will play a low profile in the next two decades as lifestyle diseases overtake infectious and communicable diseases.
The global burden of disease is fast shifting from infectious diseases to non-communicable diseases, with chronic conditions such as heart disease and stroke now being the chief causes of death globally, including India.
While the World Health Organisation warns that shifting health trends will push lifestyle diseases up the chart, health experts in India point out that the trend has already started in the country with the number of heart diseases and diabetes going up considerably.
According to a WHO report, leading infectious diseases like diarrhoea, HIV, tuberculosis, neonatal infections and malaria will become less important causes of death world-wide over the next 20 years. The WHO has arrived at this projection based on data on 73 health indicators.
Senior interventionist cardiologist Dr DK Barua says the chief causes of death are non-communicable diseases like heart attack, diabetes and hypertension. "The incidence of non-infectious diseases has gone up considerably. We are on the ascending stage now and 20 years from now, India could over take China in diabetic cases," he says.
The WHO statistics show risk factors like smoking and alcohol consumption will push the number of non-communicable diseases including maternal mortality, which is currently as high as 450 per lakh live births in India and other developing countries.
King George Hospital superintendent Dr T Ravi Raju supports WHO data saying India will become a leading county in terms of number of cases of diabetes and heart and kidney ailments. The average life span of an Indian was 37 years before Independence and now it has gone up to 65. "Continents were wiped due to cholera, malaria, tetanus and other communicable diseases but India could control them. Polio, cholera and small pox has been eradicated from the country. Before they could get heart and other non-infectious diseases, Indians were dying of communicable diseases. In heart diseases, the cases in India are nine times higher than that of Japan and six times more than that of US," he says.
Health experts say that the change in pattern of diseases is not necessarily due to the change in lifestyle or stress but Indians are genetically more prone to heart diseases than those living in any other developing country. About 15 per
cent of Indians are suffering from diabetes and in another 20 years, the percentage could go up to 20 per cent.

India Defence: Electronic warfare to move to satellites

By Syed Akbar
May 19, 2008
Hyderabad, May 18: India is planning to move its electronic warfare systems to satellites to make it difficult for most of its enemies to shoot down. Currently, electronic warfare systems (EWS) are mounted on ground vehicles or on pilotless aircraft. Though they are highly advanced, they are limited by range and have shortcomings apart from the fact that they are vulnerable to enemy attack.
The satellite-based EWS are more attack-proof because just about three countries have jealously-guarded capability to shoot down satellites. EWS are used to monitor enemy communication systems and jamming enemy radio and radar signals. They can even play havoc with the enemy’s missiles and electronic equipment. Advanced nations like the US have already developed the technology to put their EWS on satellites. India plans to manufacture the technology indigenously.
The city-based Defence Electronics Research Laboratory will develop the satellite EWS technology in association Bharat Electronics Limited and Electronics Corporation of India Limited. “Since the technology needs to be lightweight to be put in satellites, we are going for miniaturisation. The size of the equipment needs to be reduced by 10 times,” a senior defence scientist told this correspondent.
The miniaturisation of EWS will involve strengthening of electronic signalling systems so that it can have a large electromagnetic range. Once the satellite-based EWS is in place, India will have a greater military advantage in the region as it can monitor enemy nations. In another development, the Indian Army will get a boost with the induction of Samyukta electronic warfare system by November. DLRL has developed integrated electronic warfare systems for tactical battlefield operations as well as low conflict scenarios to meet the Army’s operational requirements. Samyukta will be India’s largest EWS. It is fully mobile and developed for tactical battlefield use. Its advantages include coverage of wide range of frequencies and the electromagnetic spectrum.