Maternal mortality ratio: 90 per cent of pregnancy-related deaths in India due to delay in selection of good hospital

By Syed Akbar
Hyderabad:  About 90 per cent of pregnancy-related deaths are due to delay in selection of a good hospital and lack of adequate transport facility in the country. Only 10 per cent of maternal mortality cases are linked to medical issues.
According to senior gynaecologists Dr P Balamba and Dr Shanta Kumari, the high maternal mortality ratio in the country can be curbed if pregnant women choose a good hospital in the initial stages of pregnancy, instead of going round hospitals at the eleventh hour.
 "Women need help to reach emergency obstetric facilities. Raising awareness about the need for women to access emergency care is critical for saving lives. Any slight delay in provision of medicare during the critical period will prove dangerous to the life of mother and child," they said.
Dr Balamba said hundreds of gynaecologists and obstetricians from across the country and abroad will descend on Hyderabad for three days from January 5 to discuss a number of health issues including infertility, maternal mortality ratio, child mortality rate, safe pregnancy and delivery and survival of the girl child.
About 8,500 doctors will participate in the 54th Congress of Obstetricians and Gynaecologists, being conducted by the Obstetrics and Gynaecologists Society of Hyderabad.
They said India has one of the highest maternal mortality ratio with 254 out of every one lakh women dying during or after delivery. About 30 per cent of all women need emergency care during delivery and hence reaching hospital in time will save the life.
Official statistics point out that only 35 per cent of all deliveries are conducted by a doctor and 15 per cent are conducted by a nurse, ANM, midwife or lady health visitor. In urban areas more than 69 per cent of the deliveries take place in institutions as against 30 per cent in rural areas.
They said distance to primary health centre could be difficult to cover in many rural areas and the delay can cause maternal deaths in case of complications.
There will be a public forum on January 7 between 4.30 pm and 5.30 pm at HICC on the burning issue "environmental pollution - impact on reproductive health".
Regarding high percentage of caesarean procedures in the country, they said the WHO had stipulated that there should not be more than 15 caesarean operations for every 100 deliveries. "In government hospitals, however, the percentage of caesarean deliveries has touched 35 and it is mainly due to girls insisting that their delivery should be labour-free," they added.

Indibacter genus: India enters baterial domain

Syed Akbar

Hyderabad:  India has entered the bacterial domain with a new genus of bacteria, discovered recently, named after the country.

Though some plant and animal species are named after India, it is the first time that a whole genus is named after it. The Indibacter genus discovered by a team of CCMB researchers in Lonar lake of Buldhana district of Maharashtra could be useful in biotech industry for starch hydrolyses or breaking down of starch into sugars.

"We have named the bacteria in honour of our country, India," the CCMB team said. CCMB, ISRO and other research organisations in the country have earlier discovered a number of new bacteria, but they are

named either after ancient Indian personalities like Aryabhata or after the unique properties the organism exhibits or the place of their discovery.

The discovery of Indibacter will throw new insight into the complex system of breaking down of sugars. It could also be useful in the fast emerging biotechnology sector in the country.

Indibacter is a gram-stain-negative, rod-shaped, non-motile bacterium. The CCMB team isolated it from a water sample collected at a depth of 3.5 m from the Lonar, a soda lake. "The cell suspension was reddish-orange due to the presence of carotenoids. It tolerates 8 per cent salinity and high alkalinity up to 12 per cent," the CCMB team led by Dr S Shivaji pointed out.

Lonar lake is noted for its high alkalinity thanks to the presence of sodium carbonate in water. As many as 55 species of bacteria from 41 genera have been discovered so far. Indibacter is the latest addition to this group of bacteria that loves alkalinity.

Earlier, 16 genera of bacteria were discovered from the Lonar lake. The new bacteria named after India was able to reduce nitrate to nitrite and hydrolyse aesculin and starch.

Crimean-Congo haemorrhagic fever: Many Congo fever cases may have been wrongly diagnosed as dengue

By Syed Akbar


Hyderabad, Feb 3: With many doctors unable to distinguish between dengue and Congo fever based on symptoms, the Indian Council of Medical Research has asked health officials to review cases of  fever that have been declared as dengue, particularly in rural areas.
The ICMR suspects that some of the fever cases that had been diagnosed as dengue may  actually be those of Congo fever. The State and several parts of the country have witnessed many cases of death related to dengue. The emergence of a new serotype of dengue virus, dengue-4 or Denv-4, has further complicated 
the task of doctors, many of whom had no first hand experience of treating patients suffering from Crimean-Congo  haemorrhagic fever.
The symptoms of Denv-4, which was first reported in Hyderabad in 2007, and those of Congo  fever interlap making it difficult to diagnose the case at first sitting. Since Congo fever had not been  reported in the country prior to January this year, many doctors suspect complicated cases of fever as those of dengue. In  both the cases haemorrhage or bleeding is common. The fatality rate of Congo fever, however, is higher.  Common dengue is mild, while cases related to serotype Denv-4 may turn out to be fatal.
Cases of dengue haemorrhagic fever have increased in the country since 1990 after the  common dengue virus
underwent mutation leading to change in the virus "lineage especially with regard to  Denv-2 and Denv- 3", according to Dr D Cecilia of the National Institute of Virology. Dr Cecilia's team has recently  found re-emergence of Denv-4 in Maharashtra after a gap of 35 years. Denv-4 cases have thus far been rare.
"It's true that unless thorough clinical investigation is done, it is difficult to  differentiate between dengue and Congo fevers initially because the symptoms of both are almost the same such as haemorrhage and  fever," says Dr K Subhakar of Government Chest Hospital in the city. He agrees that the blood samples collected need to be studied properly to find out whether it’s a dengue virus or Congo fever virus.
While the NIV has called for a close monitoring of Denv-4 cases, senior physician of Care  Hospitals Dr S Vijay Mohan accepts that some Congo fever cases are being passed off as dengue fever mainly  because of ignorance about this new disease.
"Except the four cases in Gujarat, it hasn’t been found anywhere in India. Since symptoms  of the two diseases are more or less the same, only a blood test can reveal whether it’s dengue fever or some  other kinds of viral fever. There are hundreds of country-specific viruses, causing unknown fevers. Unless, a 
specific test to detect the Congo fever virus is conducted, it will be difficult to point out the nature of the fever causing virus," he adds.
Even as the ICMR has suggested a review of dengue cases from rural areas, a study by NIV  scientists warns that the high degree of diversity in the envelope gene observed for the Denv-4 viruses circulating  in the subcontinent indicates that the "serotype is evolving". And if this happens, there may be newer dengue 
strains.

Congo fever and dengue similarities: ICMR calls for review of dengue cases

2011

Syed Akbar

Hyderabad, Feb 3: With many doctors unable to distinguish between dengue and Congo fever based on symptoms, the Indian Council of Medical Research has asked health officials to review cases of fever that have been declared as dengue, particularly in rural areas.

The ICMR suspects that some of the fever cases that had been diagnosed as dengue may actually be those of Congo fever. The State and several parts of the country have witnessed many cases of death related to dengue. The emergence of a new serotype of dengue virus, dengue-4 or Denv-4, has further complicated the task of doctors, many of whom had no first hand experience of treating patients suffering from Crimean-Congo haemorrhagic fever.

The symptoms of Denv-4, which was first reported in Hyderabad in 2007, and those of Congo fever interlap making it difficult to diagnose the case at first sitting. Since Congo fever had not been reported in the country prior to January this year, many doctors suspect complicated cases of fever as those of dengue. In both the cases haemorrhage or bleeding is common. The fatality rate of Congo fever, however, is higher. Common dengue is mild, while cases related to serotype Denv-4 may turn out to be fatal.

Cases of dengue haemorrhagic fever have increased in the country since 1990 after the common dengue virus underwent mutation leading to change in the virus "lineage especially with regard to Denv-2 and Denv- 3", according to Dr D Cecilia of the National Institute of Virology. Dr Cecilia's team has recently found re-emergence of Denv-4 in Maharashtra after a gap of 35 years. Denv-4 cases have thus far been rare.

"It's true that unless thorough clinical investigation is done, it is difficult to differentiate between dengue and Congo fevers initially because the symptoms of both are almost the same such as haemorrhage and fever," says Dr K Subhakar of Government Chest Hospital in the city. He agrees that the blood samples collected need to be studied properly to find out whether it’s a dengue virus or Congo fever virus.

While the NIV has called for a close monitoring of Denv-4 cases, senior physician of Care Hospitals Dr S Vijay Mohan accepts that some Congo fever cases are being passed off as dengue fever mainly because of ignorance about this new disease.

"Except the four cases in Gujarat, it hasn’t been found anywhere in India. Since symptoms of the two diseases are more or less the same, only a blood test can reveal whether it’s dengue fever or some other kinds of viral fever. There are hundreds of country-specific viruses, causing unknown fevers. Unless, a specific test to detect the Congo fever virus is conducted, it
will be difficult to point out the nature of the fever causing virus," he adds.

Even as the ICMR has suggested a review of dengue cases from rural areas, a study by NIV scientists warns that the high degree of diversity in the envelope gene observed for the Denv-4 viruses circulating in the subcontinent indicates that the "serotype is evolving". And if this happens, there may be newer dengue strains.

Burden of non-communicable diseases: Kerala has the highest central obesity, Andhra Pradesh the least

By Syed Akbar
Hyderabad, Feb 1: People in Andhra Pradesh are the slimmest among the Dravidian lot if the size of the waist is taken into account.
The Indian Council of Medical Research in its latest survey report on the risk of non-communicable diseases points out that only 14 per cent of people in Andhra Pradesh fall in the category of central obesity. The
figure for Kerala is 43 per cent and Tamil Nadu is 25 per cent.Karnataka was not covered under the study in the first phase, which included Andhra Pradesh, Kerala, Tamil Nadu from South India.
The waist circumference is one of the sensitive indicators for abdominal obesity. Abdominal obesity has got a stronger association with coronary heart diseases as compared to BMI.
The higher the obesity or underweight levels in a population, the higher the risk of non-communicable diseases line hypertension, cardiac problems, diabetes, cancers of colon and breast, and osteoporosis.
Grade I overweight people form 15 per cent in Andhra Pradesh, 18 per cent in Tamil Nadu and 22 per cent in Kerala. The obesity of grade 2 and above is 5 per cent in Tamil Nadu and Kerala and 4 per cent in
Andhra Pradesh.
A cut-off level of 102 cm in males and 88 cm in females have been recommended for developed countries. However, lower cut-off levels of 90 cm in males and 80 cm in females has been fixed for Indians.
Stating that lack of physical activity leads to obesity, hyper-lipidemia, diabetes mellitus, hypertension, and coronary heart disease, the ICMR survey noted that "most time spent is mainly related to work only". The
mean time spent in travel related activities (cycling/ walking) is a low 31 minutes per day in Andhra Pradesh. Also the mean time spent in recreational activities is low (4 minutes per day) in the State.
Referring to nutritional inadequacy, a major risk factor of many non- communicable diseases, the survey said 99 per cent of people in Tamil Nadu had less than five servings of fruits and vegetables a day. The
figures for Andhra Pradesh and Kerala are 88 and 87 respectively. On an average people consumed fruits only two days in a week in Andhra Pradesh, and Tamil Nadu and three days in a week in Kerala.
"Overall, the population of states in low category of physical activity were  66 per cent in Tamil Nadu, 68 per cent in Andhra Pradesh, 76 per cent in Kerala. The population of state detected with pre hypertension
stage was 43 per cent in Andhra Pradesh and Tamil Nadu. However, the stage I and stage II hypertension among people was recorded between 17 per cent in Andhra Pradesh," ICMR report said.

Green salads: Beware of contaminated ready-to-eat vegetables, they cause gastro, typhoid and intestinal bleeding

By Syed Akbar

Hyderabad, Jan 31: Green salads are not always healthy, and may cause severe health  complications if
proper standards are not maintained. 
The Codex Alimentarius Commission, which comes out with the "food book", warns that green salads
have been found to be contaminated with heavy metals and a variety of harmful bacteria that cause
diseases ranging from typhoid to intestinal bleeding and gastroenteritis. The problem gets worse if
natural manure like cattle dung or polluted water is used for leafy vegetables, which have a tendency to
absorb harmful elements.
The green salad, which many consider to be healthy for its ability to prevent cancer, can be contaminated with human faeces if polluted water is used in the orchards. If natural manure like cow or buffalo dung is used, the final product can be contaminated with animal faeces. If a food is contaminated with faeces, whether human or animal, it carries the risk of bacterial, viral, helminth and protozoan infections.
Health experts point out that if a hotel does not serve properly cleaned and washed green salad, it poses
the risk of infectious diseases. "People with weak immune system are at risk. Many hotels do not observe
strict cleanliness regime when it comes to serving green salads. Certain leafy vegetables like lettuce,
spinach, pudina and spring onion have the tendency to take in dangerous elements. They stay in the
plant body and pass on to human beings when consumed," says Dr P Ramachandra Murthy, expert in
internal medicine.
According to Codex, a body under Food and Agriculture Organisation of the United Nations, "international and national concerns have grown in response to recent outbreaks and illnesses related to fresh leafy vegetables. A broad array of microbial pathogens have been associated with these products as reported in international outbreak data".
Doctors have found enterohemorrhagic Escherichia coli, Salmonella enterica, Campylobacter  species,Shigella species, Hepatitis A virus, Norovirus, Cyclospora cayetanensis, Cryptosporidium parvum,
Yersinia pseudotuberculosis and Listeria monocytogenes thriving on green salads.
"One has to be extra careful about consuming ready-to-eat greens as no cooking is  involved. Cooked
vegetables carry almost no risk of diseases as the harmful agents are killed during cooking. Green salads
and vegetable salads carry the risk of spreading infection," cautions senior physician Dr MA Azeem.
Infectious diseases expert Dr Suneetha Narreddy says the impact of these infections can be as simple a self limiting acute gastroenteritis (vomiting and diarrhea) to a severe infection involving multiple organs and can potentially be fatal.  “Ready to eat vegetables and greens should have potable water during harvest, picking and processing. Processing area should be restricted to the essential people who are trained in the handling of perishable foods. Salads and green leafy vegetables can be disinfected by spraying them with vinegar and hydrogen peroxide,” she adds.
While enterohemorrhagic Escherichia coli cause intestinal bleeding and gastroenteritis, Salmonella species cause typhoid and paratyphoid. Hepatitis A virus is known to cause severe liver problems including jaundice. Norovirus is the main culprit responsible for non-bacterial gastroenteritis.