Category: HEALTH


'Inactive, sedentary life...': Gujarat's cardiology centre director on why youngsters suffering hear

Cases of young people experiencing heart attacks have witnessed an upward trend in the post-Covid period. Dr. Chirag Doshi, the Director of the UN Mehta Institute of Cardiology and Research Centre, sheds light on the potential causes of this grave condition.

Ahmedabad: The incidence of heart attacks remains nearly the same before and after 2020, encompassing the pre and post-Covid era. Nevertheless, one significant factor contributing to the rise in heart attacks among young individuals is the sedentary lifestyle of 35-40 percent of them, as disclosed by Dr. Chirag Doshi, Director of the UN Mehta Institute of Cardiology and Research Centre.

"...According to our data analysis... If we examine the data spanning the last six years, 9-10 percent of young individuals (below 40 years of age) have also endured heart attacks... You may have come across reports of young patients experiencing heart attacks after Covid. However, our data indicates that the cases are nearly identical before and after 2020... The primary causes of heart attacks have been smoking and tobacco consumption. The secondary reason is the inactivity and sedentary lifestyle prevalent among 35-40 percent of the young generation... Stress levels have also seen a rise...," stated Dr. Doshi.

Instances of heart attacks have observed an upward trajectory among young individuals, particularly in the post-Covid era.

with ani inputs


Karnataka: Zika virus detected in mosquito species in Chikkaballapura district

In Karnataka's Chikkaballapura district, authorities have confirmed the presence of the Zika virus in Aedes aegypti mosquitoes after examining samples from local waterbodies.

Officials in Chikkaballapura district, Karnataka, have detected the Zika virus in Aedes aegypti mosquitoes by collecting and analyzing samples from six waterbodies in the region. An alert has been issued within a five-kilometer radius of the affected area to curb mosquito breeding. It's important to note that the virus has been found in mosquito samples, not in humans. No human cases have been reported as of now.

Karnataka Health Minister Dinesh Gundu Rao emphasized that the virus was discovered in mosquito populations and reassured the public, saying, "No need to fear the Zika virus." He mentioned that individuals displaying symptoms such as fever and rashes have been hospitalized and tested, but so far, no positive cases have been confirmed. The health department is closely monitoring the situation, particularly for pregnant women, as the virus can impact unborn children.

State Health Commissioner D. Randeep clarified that the Zika virus was identified in mosquitoes, not in humans. Samples from three patients with fever were sent for testing at the National Institute of Virology, and they are reported to be in good health.

Various preventive measures have been put in place, including health awareness campaigns, sanitation initiatives, and mosquito fogging in the affected area. Blood samples from 33 patients, including pregnant women, have been sent for testing, and results are expected within about 10 days.

Officials have formed 53 teams to survey houses within a five-kilometer radius of the affected area, conducting regular screenings. The revenue department has also been enlisted to support efforts to prevent the further spread of the virus.

The situation is under close surveillance, and authorities are dedicated to ensuring public safety and controlling the spread of this mosquito-borne virus.

Image Source : FREEPIK


Protect your kids from air pollution by 5 simple precautions | EXPLAINED

Air Pollution: Inhaling Polluted Air Can Harm Your Child's Lungs, Brain, and Heart. To Keep Them Healthy in Worsening Air Quality, India TV Has Listed 5 Steps to Protect Kids.

Air Pollution: The Deteriorating Air Quality in Delhi-NCR, Caused by Changing Weather Patterns and Stubble Burning, Has Left Citizens Concerned. The Polluted Air Is Not Only Affecting the Health of Adults but Also Poses a Significant Health Risk to a Child's Well-being. Prolonged Exposure to Air Pollution Can Hamper a Child's Physical and Cognitive Development, Potentially Leading to Learning Difficulties and Behavioral Challenges.

As per a WHO Report on Air Pollution and Child Health, Every Day, Approximately 93% of the World’s Children Under the Age of 15 Years (1.8 Billion Children) Breathe Air That is So Polluted It Jeopardizes Their Health and Development. The Report Revealed That When Pregnant Women Are Exposed to Polluted Air, They Are More Likely to Give Birth Prematurely and Have Small, Low Birth-weight Children. Air Pollution Also Impacts Neurodevelopment and Cognitive Ability and Can Trigger Asthma and Childhood Cancer. Children Who Have Been Exposed to High Levels of Air Pollution May Be at Greater Risk for Chronic Diseases Such as Cardiovascular Disease Later in Life.

“Polluted Air is Poisoning Millions of Children and Ruining Their Lives. This is Inexcusable. Every Child Should Be Able to Breathe Clean Air So They Can Grow and Fulfil Their Full Potential,” Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, Said.

Air Pollution Can Affect a Child's Health in Several Ways. Check the 8 Points Below:

1. Respiratory Problems: Children Breathing Polluted Air Are at Higher Risk of Developing Asthma and Other Respiratory Diseases. Airborne Pollutants Can Irritate Their Airways and Make It Difficult to Breathe.

2. Developmental Delays: Prolonged Exposure to Air Pollution Can Affect a Child's Cognitive and Physical Development. It May Lead to Learning Difficulties and Behavioral Issues.

3. Low Birth Weight: Pregnant Women Exposed to Air Pollution Are at Risk of Giving Birth to Low-weight Babies, Who May Experience Health Problems and Developmental Issues.

4. Weakened Immune System: Pollutants in the Air Can Weaken a Child's Immune System, Making Them More Susceptible to Illnesses, Including Common Infections.

5. Heart Problems: Long-term Exposure to Air Pollution Can Increase the Risk of Heart Problems in Children, Such as Cardiovascular Diseases Later in Life.

6. Reduced Lung Function: Air Pollution Can Hinder the Growth of a Child's Lung Capacity, Which May Lead to Chronic Lung Diseases in Adulthood.

7. Cognitive Impairment: Poor Air Quality Has Been Linked to Cognitive Impairments, Potentially Affecting a Child's Ability to Concentrate and Perform Well in School.

8. Emotional Stress: Living in Areas with High Air Pollution Can Cause Emotional Stress in Children, Leading to Anxiety and Depression.

How to Protect Children from Air Pollution:
Protecting Children from Air Pollution Requires Multiple Actions, Involving Individuals, Communities, and Government Policies. People Need to Collaborate to Make the Air Cleaner and Healthier for Kids. WHO Has Listed Measures That Can Be Taken to Protect Children from the Harmful Effects of Air Pollution. Check Those Measures Below:

1. Stop Burning Household and Farm Waste.
2. Reduce Children’s Exposure to Air Pollution Caused by Vehicle Exhaust Emissions.
3. Keep Your Children Healthy – Ensure They Get Their Vaccinations, Consume Nutritious Food, and Have Ample Opportunities to Play and Stay Active.
4. Keep an Eye on Air Pollution Levels if the City You Reside in Has an Air Quality Monitoring Station.
5. Raise Awareness Among Your Community About the Health Impacts of Air Pollution.
image source freepic


7 Yoga Asanas To Strengthen Your Knees

If you're interested in bolstering the strength of your knees, here are seven yoga poses, or "asanas," that can contribute to knee stability and robustness.

Yoga serves not only as a means to enhance flexibility and alleviate stress but also as a potent instrument for fortifying particular body regions. Yoga presents a comprehensive strategy for enhancing knee health and vigour, although the key factor is consistency. Consistently engaging in these asanas, combined with other knee-friendly workouts, can significantly contribute to the upkeep of resilient and injury-free knees.

When you're performing these asanas, it's vital to sustain correct alignment and heed your body's signals. Prior to attempting these poses, it's always advisable to perform a warm-up. In case you have a history of knee injuries or discomfort, it's prudent to seek guidance on adjustments or substitute poses from a yoga instructor or a healthcare professional.

For individuals aspiring to reinforce their knees, we present seven yoga asanas that can play a part in nurturing knee strength and stability.

  1. Mountain Pose (Tadasana): Although it may seem uncomplicated, the mountain pose is a fundamental yoga posture that fosters accurate alignment and equitable weight distribution. It advances stability across the entire body, including the knees.

  2. Chair Pose (Utkatasana): Utkatasana is an outstanding pose for invigorating the quadriceps and, consequently, lending support to the knees. This pose subjects the muscles in your lower body to a test and heightens balance.

  3. Warrior I (Virabhadrasana I): This pose is exceptional for cultivating leg strength and augmenting knee steadiness. It extends the hip flexors and reinforces the quadriceps.

  4. Bridge Pose (Setu Bandha Sarvangasana): The bridge pose offers a brilliant approach to target the glutes, hamstrings, and quadriceps. A robust posterior chain can help alleviate pressure on the knees.

  5. Extended Triangle Pose (Trikonasana): Trikonasana extends and strengthens the legs, which includes the knees. It also enhances general equilibrium and flexibility.

  6. Tree Pose (Vrikshasana): In Vrikshasana, maintaining equilibrium on one leg engages the supporting leg, which, in turn, bolsters the knee and ankle. This pose additionally enriches concentration and balance.

  7. Child's Pose (Balasana): Though not a pose aimed directly at reinforcing the knees, Balasana is an exceptional restorative posture. It allows the knees to unwind and recuperate after more strenuous asanas, thereby helping to forestall overuse injuries.


World Polio Day 2023: What is polio disease, know symptoms and methods of prevention

World Polio Day is observed annually on October 24. This day serves as a global effort to raise awareness about the significance of polio vaccination.

World Polio Day takes place each year on October 24. It's a time when concerted campaigns are launched worldwide to eliminate polio and highlight the importance of vaccination against this disease. Interestingly, World Polio Day was initiated by Rotary International and coincides with the birthday of Jonas Salk, the leader of the pioneering team that developed the first polio vaccine. In 1988, the World Health Assembly embarked on a mission to eradicate polio from all nations. This initiative focused on administering vaccines to all children, safeguarding them from this devastating ailment, and World Polio Day is a part of this endeavour.

Polio is a dreadful ailment that can lead to paralysis when contracted, primarily affecting children under the age of 5. Therefore, it is crucial to administer timely vaccinations to all children. Notably, India achieved the status of being polio-free in 2014.

What is Polio? Polio, also known as poliomyelitis, results from an infection with the polio virus, which impacts the nerves in the spinal cord. This infection can lead to paralysis or even fatalities. As per the Cleveland Clinic, the polio virus initially infects the throat and subsequently the intestines, presenting flu-like symptoms. Following this, the infection affects the brain and spinal cord. It is a contagious disease that spreads easily from one person to another.

How Does Polio Spread? Polio can be transmitted through various means, including:

  1. Inadequate handwashing after using the toilet
  2. Consuming or preparing food with contaminated water
  3. Coming into contact with the saliva, spit, or feces of an infected individual
  4. Swimming in contaminated water
  5. Consuming contaminated food

What are the Symptoms? Polio may manifest with a range of symptoms, including:

  • Sore throat
  • Fever
  • Headache
  • Stomach pain
  • Vomiting
  • Diarrhea
  • Fatigue
  • Stiffness in the neck and back
  • Muscle pain
  • Difficulty moving legs or arms
  • Paralysis

How Can Polio be Prevented? The sole method of preventing polio is through vaccination. In India, oral polio vaccine drops are administered to every child under the age of 5. It is crucial to ensure that children receive these vaccinations on time to safeguard them from polio.

image source freepic


Nipah virus | General alert to continue in six districts in Kerala

Health Minister Veena George has stated that there have been no new cases of Nipah virus infection since September 15. However, 71 more samples have tested positive for the virus.

Individuals who had contact with Nipah-infected patients in Kozhikode district, Kerala, have been advised to self-isolate for at least 21 days. This announcement comes after 71 body fluid samples sent for lab testing turned out negative for the virus.

Health Minister Veena George made this announcement following a meeting with district medical officers from Kozhikode, Malappuram, Kannur, Wayanad, Thrissur, and Palakkad districts on Monday.

Apart from Kozhikode, 45 individuals in other districts are in quarantine due to their contact with infected individuals. Isolation wards and special ambulances are on standby in these areas, and the situation is reportedly under control.

Ms. George emphasized that despite no new cases since September 15, vigilance against the infection must continue for some more days.

Out of the six infected individuals, two have unfortunately passed away, while the others are receiving medical treatment. The condition of a nine-year-old child among them is improving, while the rest are stable.

Meanwhile, a Central team of officials, after visiting affected areas and interacting with locals and relatives of infected individuals, expressed satisfaction with the containment measures. They have collected samples from fruit-eating bats in Maruthonkara, the hometown of the first patient, and nearby areas.

Notably, teams from the National Institute of Virology, Pune, the National Centre for Disease Control, and the Indian Council of Medical Research are involved in this effort.

Another Central team from the Department of Animal Husbandry and Dairying is conducting field-level investigations in affected areas, collecting samples from pet animals, pigs, and fruit-eating bats. An online meeting with State Minister for Animal Husbandry J. Chinchurani took place later. These officials are expected to continue their work until Wednesday, with support from a team from the State Institute for Animal Diseases, Kerala.

On Monday, the Kozhikode district administration eased certain restrictions in nine gram panchayats that were declared as containment zones on September 13.

Photo Credit: PTI


43 lakh children below the age of five identified as obese or overweight: official data

In the last month, official data revealed that over 43 lakh children in the age group of 0-5 were identified as obese or overweight in India. This accounts for roughly 6% of all children surveyed at Anganwadi centers across the nation, as per the data.

The information collected from these government-run rural childcare centers also revealed that the percentage of obese or overweight children is almost equal to that of severely and moderately malnourished children found in Anganwadis, which stands at 6%.

Out of the total 7,24,56,458 children in the 0-5 age category who were "measured," approximately 6%, or 43,47,387 children, were classified as obese or overweight, according to data collated from the growth monitoring app 'Poshan Tracker'.

Thirteen states and union territories, including Madhya Pradesh, Maharashtra, Bihar, Rajasthan, Uttarakhand, and West Bengal, have obesity rates exceeding the national average of 6%, as indicated by the data.

Childhood obesity has been on the rise in recent years, which is a cause for concern. There has been a noticeable increase in the percentage of children under five years of age who are overweight in NFHS-5 compared to NFHS-4, as per data from the NHFS-4 (2015-16) and the NFHS-5 (2019-21).

Before the introduction of 'Poshan Tracker' in 2021, data was collected under the National Family Health Survey (NFHS).

In the NFHS-5, Mizoram, Arunachal Pradesh, and Jammu and Kashmir recorded the highest percentages of overweight children under five years of age, closely followed by Sikkim and Tripura. On the other hand, Madhya Pradesh, Bihar, and Andhra Pradesh reported the lowest percentages of overweight children under five years of age.

With the exception of Tamil Nadu and Goa, every state has seen an increase in the percentage of overweight children under five years of age in the NFHS-5 compared to the NFHS-4, according to survey data.

A recent global study by the World Obesity Federation underscored the seriousness of childhood obesity worldwide, and India is no exception. The study cautioned that if not addressed promptly, childhood obesity in India could witness an annual increase of 9.1% by 2035.

The study also pointed out that the risk of obesity for boys in India may rise from 3% in 2020 to 12% within the next 12 years. For girls, the risk, which was at 2% in 2020, may increase to 7% over the same period.

It is estimated that around 11% of the Indian population will be obese by 2035, with an annual increase in adult obesity projected to be around 5.2% between 2020 and 2035.

The study suggested that the continued failure to address and manage obesity could result in a global economic impact of USD 4.32 trillion by 2035, equivalent to nearly 3% of the global GDP. The report indicated that the likely impact on India's national GDP will be close to 1.8%.

Puja Marwaha, CEO of the child rights organization CRY, has identified several key factors contributing to the rising childhood obesity in India. These factors include a shift towards unbalanced diets, increased consumption of highly processed and packaged foods, and a sedentary lifestyle that limits the burning of excess calories.

She also emphasized the change in children's dietary habits, particularly in urban and semi-urban areas. Ms. Marwaha noted that children's preferences increasingly influence the purchase of marketed snacks, leading them to consume fast foods and sugary drinks, accumulating empty calories that their sedentary lifestyle does not allow them to burn off.

Highlighting another major contributor to dietary imbalance, she said that micronutrients are disappearing from the diet of the poor as traditional kitchen gardens are replaced by cash crops in villages. She stressed that the cost of nutritious vegetables, fruits, and protein sources has become unaffordable for many low-income families.

When asked about how to tackle obesity, Ms. Marwaha said that, like other behavioral issues among children, addressing childhood obesity must begin with proper parenting. Raising awareness among parents about what constitutes a balanced diet is crucial.

Ms. Marwaha pointed out that in urban areas, children often consume minimal fresh vegetables and fruits, and working parents may resort to offering junk food to ensure proper behavior in their absence.

This trend is not limited to urban areas, as even in rural settings, where both parents work as daily wage earners, children are sometimes given inexpensive packets of potato chips for lunch, she said.

Dr. Jyoti Kapoor, founder and director of Manasthali, said obese children face an elevated risk of developing various health problems, including Type-2 diabetes, heart disease, high blood pressure, and sleep apnea. These conditions can have immediate and long-term consequences on a child's quality of life and life expectancy.

Ms. Kapoor noted that childhood obesity often persists into adulthood, further increasing the risk of chronic health conditions and early mortality.


Deadly outbreak | Nipah virus

A zoonotic disease that jumped from animals to humans, NiV highlights the reality that human activities are driving the emergence of new global pandemics.

The Nipah virus outbreak in Kerala in 2018 was, looking back, the first major outbreak that people could remember. In a society accustomed to fast-paced narratives and thrilling stories of diseases, horror, and death, the 2018 Nipah virus (NiV) outbreak turned into a horrifying reality. In the recent outbreak in Kozhikode, six individuals tested positive, and two lost their lives. NiV, with its recurrent outbreaks in Kerala (now the fourth), has come to symbolize the fear and helplessness surrounding emerging diseases in the modern era.

NiV is a zoonotic disease that made the leap from animals to humans through a 'zoonotic spillover,' underscoring the fact that human-driven causes are responsible for the new pandemics worldwide. With these diseases emerging frequently, disrupting daily life and altering societal norms, it's crucial for those in positions of authority and healthcare professionals to recognize the evolving dynamics of diseases and address healthcare more comprehensively.

The name 'Nipah' originated from a Malaysian village where the first outbreak was reported in 1998. Initially, symptoms resembled encephalitis, but doctors soon realized that, in addition to neurological symptoms, there was acute respiratory distress syndrome, respiratory failure, and multi-organ dysfunction syndrome. Over time, the world learned about this new disease strain caused by a paramyxovirus, with pigs and fruit bats as vectors. Since then, India has witnessed several NiV outbreaks, primarily in Kerala (2018, 2019, 2021, and 2023), as well as in Siliguri in 2001 and a relatively small outbreak in Nadia, West Bengal, in 2007.

No licensed treatment
In Kerala, fruit bats are believed to be the primary reservoirs of infection, with the consumption of fruits or berries contaminated with bat saliva potentially causing the outbreaks. In other regions like Bangladesh and West Bengal, the consumption of date palm sap, also contaminated by bats, has been linked to outbreaks. Currently, there are no licensed treatments available for NiV infection, according to the Centers for Disease Control and Prevention. Treatment mainly involves supportive care, including rest, hydration, and symptom management. Some doctors have reported that the antiviral drug Favipiravir has shown some effectiveness against NiV. The m102.4 monoclonal antibody is also undergoing development and evaluation.

It was in 2018, when NiV struck Kozhikode district in Kerala, resulting in 21 out of 23 infected individuals losing their lives, that both the healthcare system and the public's attention were involuntarily drawn to the virus. Kerala's handling of the outbreak offered valuable lessons for dealing with public health emergencies, including patient isolation, contact tracing, quarantine measures, triage, and the implementation of infection control protocols.

Human-to-human transmission was how Patient Zero, Mohammed Salih, from Perambra in Kozhikode, contracted the virus. His brother had succumbed to similar symptoms the previous week. Even in the recent outbreak, healthcare workers were affected, indicating the potential for nosocomial transmission. The high mortality rates, along with the risk to healthcare workers and the possibility of multi-modal transmission, raised concerns.

It's now evident that addressing a single outbreak is not sufficient. Larger factors are at play, and a comprehensive approach to healthcare is required. Nations must recognize that human activities such as rapid expansion of agricultural lands and the destruction of natural habitats for wildlife, compounded by climate change, are contributing factors. The 'One Health' approach is increasingly being advocated. According to the WHO, 'One Health' is an integrated, holistic approach to optimizing the health of people, animals, and the environment. It's essential for preventing, predicting, detecting, and responding to health threats.

Ideally, this approach involves collaboration across multiple sectors, disciplines, and communities at various societal levels to tackle root causes and establish long-term, sustainable solutions. 'One Health' encompasses public health, veterinary medicine, and environmental concerns and is especially relevant for controlling zoonotic diseases.


Centre aims to open 10,000 new Janaushadhi Kendras across India by end of 2023

Uttar Pradesh leads with the highest number of outlets, while Ladakh has the fewest. Currently, there are Janaushadhi Kendras in only 651 districts, and online applications are being accepted from 765 districts.

Uttar Pradesh (1,432), Karnataka (1,098), Kerala (983), and Tamil Nadu (940) top the list of states with the most Janaushadhi Kendras across India. In contrast, Ladakh (two), Sikkim (five), and Andaman and Nicobar Islands (nine) lag behind.

With 9,782 outlets already operational, the Health Ministry aims to establish 10,000 new Janaushadhi Kendras across the country by year-end. The goal is to have a presence in 745 districts (including 112 aspirational districts), and the plan is to expand to 25,000 outlets by 2028-29, according to government data.

Janaushadhi Kendras, part of the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP), are dedicated to providing quality medicines at affordable prices, especially to the underprivileged. A senior Health Ministry official noted that in addition to reducing healthcare expenses, these Kendras are expanding their range of medicines and supplies.

As per the government's expansion plans, around 2,500-3,000 new Janaushadhi Kendras will be opened annually. Currently, Janaushadhi Kendras are present in only 651 districts, but online applications are being accepted from 765 districts.

The existing distance criteria of 1-1.5 km will also be revised based on viability and sales potential. Efforts are underway to cover all blocks in the country, as only 56% are currently covered under the scheme. The product range will be expanded to include up to 2,500 medicines and 350 surgical and consumable items. The objective is to establish a robust supply chain solution from end to end.

State governments, along with reputable NGOs, doctors, unemployed pharmacists, and individual entrepreneurs, are eligible to apply for new Janaushadhi Kendra stores. Applicants must employ a pharmacist with a B. Pharma or D. Pharma degree in their proposed store.

The Janaushadhi initiative not only ensures the availability of quality medicines at affordable prices through dedicated stores selling generic medicines but also promotes awareness about cost-effective drugs with prescriptions. It encourages doctors, particularly in government hospitals, to prescribe generic medicines.

The Central government is also actively identifying more high-quality suppliers to meet the growing demand for medicines and other equipment. Plans include increasing the number of warehouses to around 10 across India and establishing more testing labs with National Accreditation Board for Testing and Calibration Laboratories (NABL) accreditation, with approximately 25-50 labs spread across the country.


ICMR to expand its network of laboratories to strengthen health research and diagnostic infrastructu

It is also collaborating with eight premier scientific organizations in India to establish the National Institute of One Health, aimed at rolling out the National One Health Mission throughout the country.

Within the framework of the Prime Minister-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), the Indian Council of Medical Research is partnering with eight esteemed scientific institutions in India to set up the National Institute of One Health, with the goal of implementing the National One Health Mission across the nation. This initiative aims to bolster interdisciplinary approaches in health research.

Additionally, ICMR is actively working to expand its network of BSL-3 and BSL-4 laboratories to enhance diagnostic infrastructure and improve access to laboratory services across India. Rajiv Bahl, the Director-General of ICMR, discussed these initiatives during a recent press conference, outlining the council's vision for health research in India.

Dr. Bahl highlighted the government's efforts to fortify and advance public health research in India. He stated, 'As part of these ongoing efforts, ICMR has streamlined its Intramural Research Programme funding to support research on various priority health issues. Furthermore, we have increased funding under the Extramural Research Programme to promote research on vaccines, medications, disease diagnostics, and treatments, thereby strengthening public health systems.'

He also announced that with the introduction of the National Health Research Programme, ICMR will engage in extensive collaborative studies with national and state-level Departments of Health and Family Welfare, focusing on 12 key health areas. These areas encompass infectious diseases, non-communicable diseases, child health and nutrition, and the generation of crucial evidence to enhance health interventions in these domains.

Photo Credit: The Hindu


Nipah outbreak | Number of cases rises to six in Kozhikode

The tally of individuals affected by the Nipah virus has risen to 1,080, with 624 falling into the high-risk category, including 327 healthcare workers. In a recent development, another person has tested positive for Nipah in Kozhikode district, Kerala, bringing the total number of infected individuals to six.

Additionally, lab tests have confirmed that E. Mohammedali, the initial patient who passed away on August 30, was indeed infected with Nipah. Unfortunately, his body fluid samples couldn't be dispatched earlier. However, a throat swab, which had been preserved at a private hospital where he had been admitted, was eventually located and sent for testing. The results were disclosed on Friday. The infection is reported to have spread within this private hospital. Notably, 30 samples from healthcare workers at this facility have tested negative for the virus, and a total of 100 samples have been forwarded for lab analysis.

A team of Central officials visited Kallad near Kuttiadi, where Mohammedali's residence is situated. They conducted inspections at his house, a relative's house, and the farms in the backyard, where he is suspected to have been. They also examined the fruit plants on the premises and gathered information about his occupation and other details from family members. Representatives from the State Health department and local health authorities accompanied the team.

Health Minister Veena George previously mentioned that the condition of the 39-year-old Cheruvannur native, who tested positive for the virus on Friday morning, remains stable. He had come into contact with Mohammedali while the latter was receiving treatment at the hospital, where he had been acting as a caregiver for another patient.

The individuals who have contracted the virus include Mohammadali, 47, of Maruthonkara, who passed away on August 30, and M. Haris, 40, of Ayancheri, who succumbed on September 11. Among those currently receiving treatment are Mohammedali's nine-year-old son, his 24-year-old brother-in-law, and a 24-year-old healthcare worker. The count of individuals on the contact list for the infected has now reached 1,080, with 624 categorized as high-risk, including 327 healthcare workers.


Central team of officials to visit Nipah-hit areas

Five individuals have tested positive for the Nipah virus up to this point, and sadly, two of them have passed away.

A team of central officials is anticipated to visit the Maruthonkara and Ayancheri areas in Kozhikode district of Kerala on Friday, where two individuals recently lost their lives due to Nipah infection.

The count of confirmed virus cases currently stands at five, with two of them having succumbed to the illness, while the remaining individuals are presently receiving medical care. Restrictions are still in effect in at least nine grama panchayats in Kozhikode district, with educational institutions also observing a holiday until Saturday.

The central team arrived in Kozhikode on Thursday morning and held discussions with state authorities. As per sources, they will collaborate with the State Health and Animal Husbandry departments to implement containment measures.

This team comprises members from the National Centre for Disease Control, the Atal Bihari Vajpayee Institute of Medical Sciences in New Delhi, and the National Institute of Mental Health and Neurosciences in Bengaluru.

On September 14, 2023, the police erected barricades in the Ayanchery grama panchayat of Kozhikode district, which has been designated as a containment zone.

The National Institute of Virology in Pune has established a mobile testing laboratory at the Government Medical College Hospital in Kozhikode to analyze body fluid samples from suspected Nipah patients.

Official sources have confirmed that this lab adheres to biosafety level-III standards. Consequently, there is no need to dispatch samples from individuals who have been in contact with infected persons to Pune. The mobile lab is staffed by four scientists and four technicians, and there are sufficient monoclonal antibodies available to treat 25 patients.

Simultaneously, another mobile testing laboratory under the Rajiv Gandhi Centre for Biotechnology is expected to arrive in Kozhikode soon to expedite testing procedures. This lab complies with biosafety level-II standards and can process up to 96 samples simultaneously, with results available within three hours.

Health Minister Veena George has announced that all high-risk contacts of E. Mohammadali, the initial Nipah victim who passed away on August 30, will undergo lab tests. These individuals must self-isolate for a minimum of 21 days, and medical boards will be established in all hospitals treating Nipah patients to determine treatment protocols.

Photo Credit: PTI


Central and ICMR teams equipped with BSL-3 labs reach Kozhikode for on-ground testing of Nipah virus

A proficient team from the Department of Animal Husbandry has also been dispatched to aid the State in animal surveillance, according to official sources.

Distinguished teams from the Centre and ICMR-NIV, equipped with BSL-3 laboratories in mobile units, have reached Kozhikode. They will conduct on-ground testing, as stated by Union Minister of State for Health and Family Welfare, Dr. Bharati Pravin Pawar, on September 14, following her assessment of the measures taken to contain the Nipah virus outbreak in Kozhikode, Kerala.

This meeting was organized by the Indian Council of Medical Research – National Institute of Virology (ICMR-NIV) in Pune.

The Minister also declared that the affected gram panchayats in the Kozhikode area have been designated as quarantine zones.

A multi-disciplinary team, led by the Union Health Ministry, has also been assigned to support the state in implementing public health measures to address this outbreak.

"The Health Ministry and ICMR-NIV are closely monitoring the situation on a daily basis, and all necessary preparations are being made to address the viral outbreak," she stated.

The neurologically damaging virus has claimed two lives and infected three others in Kozhikode district thus far. On Wednesday, a 24-year-old healthcare worker became Kerala's fifth confirmed Nipah case since the recent outbreak.

"ICMR's mBSL-3, South Asia's first biosafety level-3 containment mobile laboratory, has been stationed in Kozhikode. It will facilitate early testing and detection of infections within the district," disclosed an official source.

Until now, samples were sent to the National Institute of Virology in Pune.

This mobile laboratory was established in February last year to investigate newly emerging and reemerging viral infections that are highly infectious and potentially lethal to humans.

Union Minister of State for Health Bharati Pravin Pawar visited the ICMR's National Institute of Virology in Pune and convened a review meeting in light of the reported Nipah virus cases in Kozhikode.

A five-member central team, comprising experts from the National Centre for Disease Control, RML Hospital, and NIMHANS, has been stationed in Kerala to assess the situation and assist the state government in managing the Nipah virus infection.

On September 14, the Kerala government reassured that there is no need to panic regarding the Nipah outbreak in Kozhikode district. However, they emphasized that caution should be exercised by the public in their daily activities.

The Kerala government also confirmed that the monoclonal antibody required for treating those infected with the Nipah virus has arrived in the state. State Health Minister Veena George mentioned that a meeting took place earlier in the day between the Principal Secretary of the Health Department and the Union Health Ministry, and now the monoclonal antibody has been delivered.

(with inputs from PTI)


Nipah outbreak | Number of cases rises to 5 in Kerala; 789 contacts kept under watch

In Kozhikode, the latest individual to test positive for Nipah virus is a healthcare worker from a private hospital, bringing the total number of cases in the district to five. The Kerala Health Department has swiftly responded to this development by compiling a list of 789 people connected to the two unfortunate individuals who succumbed to the infection and two others currently receiving treatment after testing positive.

To enhance public awareness and contact tracing, the department has unveiled a 'route map' detailing the travel history of the deceased patients, starting from the onset of their symptoms. In response to the situation, the government has imposed restrictions on large gatherings in Kozhikode until September 24.

The Indian Council of Medical Research (ICMR) is expected to provide monoclonal antibodies for treating the infected patients by Thursday morning.

Kerala's Health Minister, Veena George, conveyed to the media in Thiruvananthapuram that the cases are associated with the Bangladesh strain of the virus, which is relatively less contagious but has a significantly high mortality rate of 70%.

Official sources indicate that there are 371 individuals under medical surveillance who came into contact with the first victim, a 47-year-old man from Maruthonkara in Kozhikode. Additionally, 60 contacts of his nine-year-old son, currently receiving treatment at a private hospital in the city, have been identified. One of his brothers-in-law, a 24-year-old man, has 77 contacts, including the health worker who tested positive on Wednesday. Another health worker on the contact list has tested negative for the virus.

The second victim, a 40-year-old man from Ayancheri, has 281 persons on his contact list, and their conditions are reportedly stable, with most of them in isolation at their homes.

In a proactive move, the Health Department has sent 11 more body-fluid samples from suspected patients for laboratory testing at the National Institute of Virology (NIV) in Pune. Currently, 20 people are under medical observation: 13 at the isolation ward in the Government Medical College Hospital, Kozhikode, and seven at a private hospital in the city.

An expert panel of doctors has indicated that the 47-year-old victim may be the index patient from whom others contracted the virus. The second victim had come into contact with him at a private hospital in the city where the former was receiving treatment. The first patient sadly passed away on August 30, and the second on September 11.

Chief Minister Pinarayi Vijayan convened a meeting with Ministers and top government officials to evaluate the situation. Health volunteers conducted a fever survey, covering 313 households in the affected areas on Wednesday. Nine gram panchayats have been designated as containment zones in the district.

Ms. George announced the establishment of a State-level control room at the Directorate of Health Sciences. She also mentioned that a mobile laboratory set up by the ICMR would be operational at the medical college hospital by Thursday afternoon to expedite the testing of samples collected from suspected patients. Furthermore, a team from the NIV will conduct a bat survey, and another team of epidemiologists from Chennai will arrive in the State to conduct research studies.


Efforts to get permanent disability certificates for SCD patients stuck between Ministries for nearl

While Sickle-Cell Disease (SCD) remains a "lifelong" ailment, disability certificates issued to SCD patients are valid for only three years, according to the Health Minister. The government's current focus is on identifying the disease rather than extending the validity of these certificates.

A plan to secure permanent disability certificates for SCD patients over 5 years old has been entangled in bureaucratic hurdles for nearly three years, involving three Union Ministries. During the Monsoon Session of Parliament, a House panel called upon the government to expedite the process.

The Health Ministry determines the criteria and rules for disability certificates, while the Social Justice and Empowerment Ministry issues the certificates necessary for accessing reservations and other benefits. Given the prevalence of Sickle Cell Disease among tribal communities in India, the Tribal Affairs Ministry is eager to ensure that SCD patients, who endure chronic anemia, painful events, and complications resulting from damage to tissues and organs due to the destruction of red blood cell membranes, receive these certificates.

Despite the chronic and progressive nature of SCD, current patients are only eligible for disability certificates valid for three years, as the Union government promotes its campaign to "eradicate" SCD in India by 2047.

Health Minister Mansukh Mandaviya, in response to questions about permanent disability certificates, stated that the current focus is on "detection." A project is currently underway to screen seven crore tribal people in 17 States and Union Territories for SCD under the National Health Mission, coordinated by the Tribal Affairs Ministry.

Tribal Affairs Minister Arjun Munda has advocated for the issuance of these certificates. However, the Department of Empowerment of Persons with Disabilities (DEPwD) within the Social Justice Ministry maintains that the Health Ministry holds the final decision on permanent certificates for SCD patients. The Health Ministry is expected to release its report on the matter in a month.

When SCD was included in the list of disabilities under the Rights of Persons with Disabilities Act in 2016, patients could only obtain one-year validity disability certificates. In 2020, the Tribal Affairs Ministry initiated discussions with the DEPwD regarding the possibility of issuing permanent disability certificates in response to patient complaints about the renewal process and expert opinions that the disease only progresses.

Although the DEPwD extended the validity of disability certificates for SCD patients to three years, requiring a minimum of 25% disability, Mr. Munda emphasized the need for permanent certificates due to the progressive nature of the disease in those who survive beyond the age of five.

Officials within the DEPwD have formed a special committee to address stakeholders' and SCD patients' concerns about disability certificates, with consultations held earlier this year. DEPwD Secretary Rajesh Aggarwal stated, "Once the Health Ministry's Expert Committees complete their report, expected in about a month, we will know if they have recommended permanent disability certificates for SCD patients."

Responding to questions about the progress of obtaining permanent disability certificates for SCD patients, the Health Minister emphasized, "Sickle cell is a significant issue in India, especially in tribal areas. Our Ministry's primary focus is on identifying and, in the long term, preventing SCD. This will reduce our response time and help alleviate the disease's burden in the long run. Regarding permanent disability certificates, our current emphasis is on detection."

In a report presented in Parliament in August, the Parliamentary Standing Committee on Empowerment of Women examined health issues affecting tribal women in India. The Committee recognized SCD as a "lifelong illness" and suggested that blood and bone marrow transplants were the only cure, an option few, particularly among the tribal population, can undertake. The Committee recommended the government find a way to issue permanent disability certificates to SCD patients above the age of five who meet the criteria. If this is not feasible, it suggested increasing the temporary certificate's validity to five years.


Union Health Minister Mansukh Mandaviya confirms two Nipah virus deaths in Kerala

Union Health Minister Mansukh Mandaviya revealed on Tuesday that two fatalities in Kerala's Kozhikode district have been attributed to the Nipah virus. Mr. Mandaviya stated that a team of experts from the central government has been dispatched to Kerala to assess the situation and provide support to the state administration in managing the Nipah virus outbreak.

Official sources have indicated that samples from four more individuals in Kerala have been dispatched to the National Institute of Virology in Pune for testing against this deadly virus.

Simultaneously, the Kerala government has established a control center in Kozhikode and recommended the use of masks as a preventive measure. Chief Minister Pinarayi Vijayan, in a Facebook update, expressed serious concern over the two fatalities and disclosed that the health department has issued an alert in Kozhikode.

Photo Credit: Reuters


After WHO alerts, drugs regulator asks States to keep vigil against sale of falsified versions of 2

The Drugs Controller General of India has issued a crucial advisory urging patients to purchase medical products exclusively from authorized sources and ensure they have a proper purchase invoice.

The Drugs Controller General of India (DCGI) has instructed the drug controllers in all Indian States and Union Territories to maintain strict oversight over the sale and distribution of counterfeit versions of two vital drugs: Defitelio, a liver medication, and Adcetris, a cancer drug by Takeda (injection). This directive comes in response to alerts issued by the World Health Organization (WHO).

In an advisory dated September 5, the DCGI highlighted that WHO had issued a safety alert concerning multiple counterfeit versions of Adcetris injection 50 mg, produced by Takeda Pharmaceutical Company Limited, which were found in several countries, including India. These falsified products are typically accessible at the patient level and are distributed through unregulated supply chains, primarily online. WHO reported the presence of at least eight different batch numbers of these counterfeit versions.

Adcetris (Brentuximab Vedotin) is an antibody-drug conjugate directed towards CD30, indicated for treating patients with Hodgkin's lymphoma following an autologous stem cell transplant failure and systemic anaplastic large cell lymphoma.

On September 6, the DCGI issued another advisory, referencing a WHO safety alert dated September 4 regarding counterfeit Defitelio (Defibrotide) 80 mg/ml concentrate for infusion, manufactured by Gentium Srl. This falsified product was detected in India (April 2023) and Turkey (July 2023) and was distributed outside of regulated and authorized channels. The genuine manufacturer of Defitelio confirmed the falsification, emphasizing that using counterfeit Defitelio could result in ineffective treatment and pose serious health risks due to its intravenous administration, potentially being life-threatening in certain situations, as stated by the United Nations' health body.

In response to these safety alerts for both products, the DCGI has advised doctors and healthcare professionals to prescribe drugs carefully and educate patients about reporting any adverse drug reactions (ADRs). Additionally, the DCGI has called upon State and regional regulatory offices to closely monitor the movement, sale, distribution, and stock of these drugs in the market, taking necessary actions in accordance with the Drugs and Cosmetics Act and its rules.

For consumers and patients, the apex drug regulator has stressed the importance of procuring medical products exclusively from authorized sources and ensuring they obtain a proper purchase invoice.

On August 31, the DCGI issued an advisory alert regarding Abbott's antacid Digene gel, citing safety concerns. This came after the US-based drug maker voluntarily recalled several batches of Digene gel in India, following the drug regulator's alert. The DCGI urged consumers and patients to discontinue the use of Digene gel, manufactured at a Goa facility.

Regarding wholesalers and distributors, the DCGI recommended removing all impacted batches of the product, produced at the Goa facility and within its active shelf life, from distribution.

Takeda Pharmaceutical Company Limited responded to the situation by emphasizing that Adcetris (injection) should only be obtained from authorized distribution sources. They clarified that the Central Drugs Standard Control Organisation had issued a general advisory cautioning against counterfeit versions of Adcetris Injection in India. Takeda, authorized by the Drug Controller General of India, imports, sells, and distributes Adcetris in India through established supply chain networks. They strongly recommended procuring Adcetris exclusively from authorized Takeda distribution sources to ensure patient safety and combat counterfeit medicines, which pose a significant threat to public health, thereby emphasizing their commitment to safeguarding product integrity and patient safety as their top priority.



Drugs regulator issues alert after pharma firm Abbott India recalls antacid syrup Digene Gel

The Drugs Controller General of India, in a move aimed at ensuring public health and safety, has issued a strong advisory to patients and healthcare professionals regarding the discontinuation of the use of Digene gel, a widely used antacid, due to concerns about its safety.

The Central Drugs Standard Control Organisation (CDSCO) has taken proactive steps to alert various stakeholders, including healthcare professionals, consumers, patients, wholesalers, distributors, and regulatory authorities, regarding the voluntary recall of Abbott India's popular antacid syrup, Digene Gel. This product was manufactured at the company's facility in Goa.

A public notice published on the apex drug controller's website stated, "The impugned product may be unsafe, and its use may result in adverse reactions."

The Drugs Controller General of India (DCGI), who oversees the CDSCO, has also advised doctors and healthcare professionals to exercise caution when prescribing this product. They are encouraged to educate their patients about discontinuing the use of Digene Gel and promptly report any adverse drug reactions that may arise from its consumption.

In a formal statement, the DCGI emphasized, "Healthcare professionals should promptly report any suspicious cases of adverse events linked to this product."

The drug controller's notice detailed that the company initially withdrew one batch of its product available in mint flavor and four batches in orange flavor following a complaint received in early August. The reported issues included the product being white in color, having a bitter taste, and emitting a pungent odor. Subsequently, within a week, the company decided to recall all batches of Digene syrup, including those in mint, orange, and mixed-fruit flavors, that were manufactured at its Goa facility.

On August 9, it was reported that one bottle of Digene Gel Mint Flavor, used by customers, exhibited regular sweet taste and light pink color, while another bottle from the same batch was white in color with a bitter taste and pungent odor, as per the complaint.

Abbott India Limited voluntarily initiated the product recall and ceased the production of all variants of Digene Gel manufactured at their Goa facility. CDSCO has also urged distributors and users to discontinue the use of Digene Gel produced at the Goa facility, emphasizing that there is no need for panic.

Digene Gel is a well-known remedy for acidity and its associated symptoms such as heartburn, stomach discomfort, abdominal pain, and gas. It can also be prescribed for conditions like gastritis (inflammation of the stomach lining) and acid reflux (a condition in which stomach acid flows back into the food pipe). The product uses basic compounds like magnesium hydroxide to neutralize stomach acid.

An Abbott spokesperson clarified that the voluntary recall was initiated due to isolated customer complaints about taste and odor, with no reported concerns about patient health. The spokesperson also assured that other forms of Digene, such as tablets and stick packs, remain unaffected, and Digene Gel manufactured at their other production site in Baddi continues to be available in ample quantities to meet current demand.



Finding proof for the axiom that nutrition aids in health care recoveries

Traditional medicine relies on medication or surgery, but doctors always stress the importance of a proper diet. While the significance of nutrition is generally understood, periodic studies are needed to confirm its critical role in the body's healing process.

It appears that ideal nutrition, crucial for all bodily processes to function effectively, is a fundamental principle. Consequently, it becomes widely accepted that the right nutrition must be consumed for the body to recover and heal while undergoing medical treatment. However, there is often a significant gap between this principle and its practical application.

Nutritional and environmental factors influencing health are now extensively studied. While conventional medicine primarily employs medication and surgery for treatment and recovery, doctors rarely forget to recommend an appropriate diet. The challenge arises when conditions are treated in a fragmented manner, without considering the patient's culture or affordability, particularly regarding food. This is why research confirming the importance of nutrition in the body's recovery process is periodically conducted.

The latest development in this field is the RATIONS trial led by Anurag Bhargava and his team, which explores the relationship between nutrition and tuberculosis within a syndemics framework. The researchers examined the impact of enhanced nutrition through a combination of food provisions and micronutrients on TB patient recovery and the prevention of TB in close family members of infected individuals. Prof. Bhargava elaborates, "This trial has a backstory. My wife, Madhavi, and I worked with the non-profit organization Jan Swasthya Sahyog, which we co-founded in the rural Bilaspur district. We ran a TB treatment program and realized that undernutrition was a blind spot in TB care and prevention. In 2013, we published a study showing that low body weight in Indian patients posed a risk factor for TB mortality." This was followed by a 2014 paper demonstrating that undernutrition was the primary risk factor for TB incidence in India, and addressing it could substantially reduce TB cases.

"In the current RATIONS trial, conducted in collaboration with the NTEP in 28 tuberculosis units across 4 districts in Jharkhand, we focused on two target populations: household members in contact with pulmonary tuberculosis patients and the patients themselves undergoing treatment."

In the study, he adds, "Household members in 14 TB units were randomly assigned to an intervention group that received a 6.5 kg food basket (5 kg rice + 1.5 kg pulses per head per month). The control group in the other 14 TB units continued with their usual PDS-based diet. Patients were not randomized because it was deemed unethical to withhold a food basket, which consisted of 10 kg per month, including rice, milk powder, and oil. All participants were followed up for two years in this pioneering trial sponsored by the ICMR and led by us at Yenepoya Medical College, with contributions from the National Institute of Research on Tuberculosis - Chennai."

The study revealed a high prevalence of undernutrition among household members, with one-third experiencing undernourishment. In patients, he notes, "We observed some of the lowest weights recorded in TB literature, with one in every two patients having a BMI below 16." Dr. Madhavi and Dr. Bhargava explain that early weight gain of about 5% of body weight in the first two months was associated with a 60% reduction in the risk of death. The RATIONS patients exhibited higher weight gain, lower mortality, and only a 1% dropout rate from treatment. "Most importantly, 75% of patients returned to work after treatment, compared to just over 5% at the start of treatment," she added.

It is also believed that an inadequate diet is a significant, largely preventable risk factor for non-communicable diseases, which appear to be affecting India extensively. A 2017 study conducted by GBD Diet Collaborators and published in Pubmed estimated that in that year alone, 11 million deaths and 255 million Disability Adjusted Life Years were attributed to dietary risk factors.

An emerging and compelling body of research highlights the potential of food and nutrition in preventing, managing, and even reversing diseases. Incorporating food into healthcare interventions may lead to improved health outcomes and reduced healthcare costs, as discussed by Sarah Downer and her colleagues in an article in the British Medical Journal. They emphasize how a global epidemic of diet-related chronic diseases has prompted experimentation with food as an integral part of patient care and treatment. Suboptimal diets are responsible for one in every five deaths worldwide, surpassing other risk factors like tobacco.

Another field where the role of nutrition in recovery is well-documented is in the context of HIV/AIDS. HIV infection and poor nutritional status are closely intertwined, as L. M. Houtzager noted in a 2009 article in the Benin Journal of Post Graduate Medicine. The impact of HIV infection on nutrition was recognized early in the epidemic, with wasting being one of the most noticeable signs of malnutrition in AIDS patients. Houtzager's review highlights that malnutrition impairs immune function and weakens the body's ability to resist infection. The combined effects of HIV and malnutrition further damage the immune system and worsen nutritional status.

In response to these concerns, the World Food Programme initiated a pilot phase of distributing nutrition supplements along with nutritional counseling for People Living with HIV (PLHIV) receiving Anti-retroviral Therapy (ART) in Tamil Nadu around 16 years ago. This initiative, in collaboration with the Tamil Nadu State AIDS Control Society, began in September 2007 in all ART centers in the state, benefiting over 25,000 PLHIV. In a mid-term assessment, researchers observed improvements in both BMI levels and hemoglobin in the experimental group compared to the control group. BMI and HB were considered crucial indicators for assessing outcomes and impact.

In a welfare state, the responsibility for ensuring adequate nutrition unquestionably falls on the government. Any shortcomings in this regard must be rectified, taking into account the relevant political and social contexts to support healthcare with nutritional supplements and provide the best possible chances of recovery for patients.


Chest X-ray interpretation using AI can detect more TB cases

In 2021, the World Health Organization (WHO) recommended the use of Computer-Aided Detection (CAD) products that employ Artificial Intelligence (AI) to automate the interpretation of digital chest X-rays for tuberculosis (TB) screening and triage in individuals above 15 years of age.

India possesses a powerful technology known as AI-assisted chest X-ray for screening potential TB cases. The AI algorithm, called qXR, developed by Mumbai-based, can swiftly detect individuals with suspected TB, including those with subclinical TB, in less than a minute. According to the 2019-2021 National TB Prevalence Survey in India report, omitting chest X-rays would have resulted in missing nearly 43% of TB cases.

When implemented on a large scale for population-based or targeted screening, the AI software, in combination with molecular TB confirmation tests, significantly enhances the detection rates. Systematic TB screening for early diagnosis is a key component of the End TB strategy.

qXR received European CE certification earlier this year and was also cleared by the Indian drug regulator a few months ago. WHO referenced qXR as one of the three AI algorithms when updating TB screening guidelines in March 2021.

Awaiting Approval

Although there are no restrictions on State governments using the software for TB detection, the Central TB Division's directive to States to procure and deploy the tool for early TB disease diagnosis will greatly promote widespread adoption. The Central TB Division has not yet recommended the use of qXR as it awaits approval from the Health Technology Assessment, which has evaluated three AI software options, including qXR.

qXR software meets WHO requirements with over 90% sensitivity and more than 70% specificity for individuals older than 15 years. In a large study conducted in Bangladesh involving nearly 24,000 individuals aged over 15 years, qXR demonstrated a sensitivity of 90.2% and specificity of 74.3%. A 2019 study found qXR to have over 95% sensitivity and over 80% specificity.

The 2019 study demonstrated that qXR has the potential to increase capacity and aid in TB diagnosis, especially in settings with a shortage of trained human readers, which is a significant challenge in using chest X-rays for TB screening.

India's ambitious goal to "eliminate" TB by 2025 can become achievable only when early diagnosis and initiation of care for millions of TB patients become a reality. The large-scale use of AI-assisted chest X-rays for screening is a critical first step in achieving this goal.

In Vietnam's Ca Mau Province, community-wide screening of individuals older than 15 years using a molecular test between 2014 and 2017 resulted in a lower prevalence of pulmonary TB in 2018 compared to standard passive case detection alone. Unlike in Vietnam, using the AI algorithm to interpret digital X-rays before molecular testing as part of community screening can reduce TB prevalence and minimize the number of molecular tests needed to detect TB cases.

qXR is already being used in over 50 countries. In India, 24 states are using it in approximately 150 sites. However, the software is not yet widely adopted in India, and in some states, it is used in only one site, such as in Kerala, according to Dr. Shibu Vijayan, Medical Director-Global Health at Dr. Vijayan emphasizes that a digital solution must be implemented at scale to have a significant impact. In Chennai, around six outreach mobile vans use qXR for TB case detection, while nine government hospitals and one mobile van in Mumbai are equipped with the AI software for TB surveillance. The AI algorithm was first installed at S.K. Patil Hospital in Mumbai in January 2021 and in a mobile van a month earlier, in December 2020.

Promising Results

As of December 2022, over 100,000 X-rays from the nine Mumbai hospitals were screened for TB. Dr. Vijayan explains that these X-rays were taken for various purposes, making it possible to detect TB in non-presumptive TB cases. The Mumbai exercise led to the detection of 13% additional TB cases, and the use of the algorithm for X-ray screening increased the yield of GeneXpert molecular tests by 18-27%.

In the case of the mobile van using the qXR algorithm, of the 10,000 people screened for TB, one in four presumptive TB cases identified by the algorithm turned out to be confirmed TB cases.

Dr. Mangala Gomare, former Executive Health Officer at Brihanmumbai Municipal Corporation (BMC), Mumbai, remarks that the AI algorithm for screening presumptive TB cases has been quite useful. It enabled the incidental diagnosis of TB in people who had come for completely different purposes.

Active case finding received a boost when partnered with Mylab Discovery Solutions to use the qXR software in Mylab's portable chest X-ray device, MyBeam. This allows screening of presumptive TB cases with the AI algorithm even in rural areas.

Apart from digital X-rays, the qXR algorithm can also detect TB disease from film-based X-rays. A photograph of the X-ray film is taken and processed by the algorithm, similar to digital X-rays. Dr. Vijayan notes that there is no significant difference in the impact of the AI algorithm between digital and analogue (film-based) X-rays for TB detection.

The significant advantage of using the AI algorithm on film-based X-rays, if adopted in all 730 district hospitals in India, is the potential to detect around 80,000 incidental TB cases from approximately 280,000 chest X-rays taken each year for purposes other than TB diagnosis.

While WHO's guidelines for AI-assisted TB detection using digital X-rays are limited to individuals above 15 years, qXR's AI algorithm has CE certification for use in the pediatric population. It has been successfully used in children above three years in Bangladesh and children above four years in Myanmar. Dr. Vijayan mentions ongoing efforts to develop more pediatric-specific algorithms with disease severity probability as radiological evidence of TB in children is less specific than in adults.

Photo Credit: Getty Images


Most avian flu outbreaks in India reported from post-monsoon to pre-summer season: study

HPAI H5N1 Viruses Continuously Evolve Globally, Affecting Poultry, Wild Birds, and Humans, Reveals Study

Highly pathogenic avian influenza (HPAI) viruses, specifically H5N1 and H5N8, have emerged as prominent causes of avian diseases worldwide. These viruses have inflicted substantial economic losses and pose potential risks to human health. They are known to infect individuals who have close contact with infected poultry, leading to respiratory illnesses, ranging from mild to severe, and even fatalities. A recent study has cast more light on HPAI outbreaks in India.

The most recent research paper titled "Spatial and Temporal Patterns of Highly Pathogenic Avian Influenza H5N1 and H5N8 Outbreaks in India, 2006-2021," published in the Indian Journal of Medical Research, reports a total of 284 H5N1 outbreaks since 2006, with a significant surge in 2021. Initially, H5N1 outbreaks primarily affected poultry. Similarly, since 2016, there have been 57 outbreaks of H5N8, primarily affecting wild birds.

The study further reveals that the majority of HPAI outbreaks occurred between the post-monsoon and pre-summer seasons, specifically between October and March, peaking in January during the winter.

In addition to poultry, various bird species like owls, Indian peafowls, lesser adjutants, crows, and wild migratory birds such as demoiselle cranes, northern pintails, and bar-headed geese have tested positive for HPAI.

The paper emphasizes the importance of studying the seasonality of HPAI outbreaks to develop effective prevention and control strategies. Recent human infections with H5N1 and H9N2 viruses underscore the need to enhance surveillance among wild, resident, migratory birds, and poultry.

To compile data for the paper, information on outbreak occurrences and locations in India and affected bird species were collected from the Food and Agriculture Organization (FAO) of the United Nations database. This data was then grouped by month and year to analyze the distribution and seasonality of HPAI H5N1 and H5N8 viruses.

As of December 2021, H5N1 virus outbreaks had been documented on a significant scale among poultry and wild birds in over 77 countries. By March 2022, there were 863 reported human cases of avian influenza (AI) H5N1 worldwide, with an average case fatality rate of 53%.

The paper reports a notable increase in HPAI outbreaks among domestic and wild birds in October 2021, indicating expanded virus circulation. India reported its first human case of H5N1 virus infection in June 2021, coinciding with the monsoon season.

The study concludes by highlighting that HPAI H5N1 viruses are continually evolving globally through complex genetic changes, affecting poultry, wild birds, and even humans.

According to the paper, India's first HPAI H5N1 outbreak was reported in 2006 in Navapur, Maharashtra, followed by annual outbreaks. From 2007 to 2010, most outbreaks occurred in eastern and northeastern states, primarily in West Bengal. Odisha reported outbreaks from 2011 to 2020, with the highest number in 2018. The H5N8 virus was first reported in India in November 2016, causing mortality in wild birds in five states, with Kerala reporting the highest number of cases (25). There were no reports of H5N8 in India in 2018 and 2019.

A sudden increase in H5N8 outbreaks began in 2020, suggesting a potential reintroduction of the virus.


Long-term health issues following COVID-19

The impact of COVID-19 on blood vessels, heart, and nervous system has raised concerns about potential health issues in the future.

In May 2023, the WHO declared that the emergency phase of the pandemic was over. While COVID-19 continues to come in waves, its effects have reduced. Now, the focus is shifting towards the ongoing health of those who survived the initial infection. The impact of COVID-19 on blood vessels, heart, and nervous system is causing worries about possible delayed health problems.

Since this is a new disease, it takes time to get definite answers. Examining large amounts of data can reveal hidden patterns — for example, the connection between smoking and cancer was established when large groups of smokers and non-smokers were studied. COVID-19 is similar in this regard. Many individuals who survive COVID-19 and feel alright might believe it's just a regular cold, which is not accurate.

Three studies published this month have tackled this concern. They analyzed extensive databases of individuals who had COVID-19 and were followed up for one to two years.

The group from Washington University/VA St. Louis Health Care System examined 1,38,818 individuals who survived COVID-19, out of which 20,580 had been hospitalized. Those initially hospitalized faced more problems later on compared to those who hadn't been infected. They had higher death rates, more hospitalizations, and other health issues for at least two years. In contrast, the death rates among those who had COVID-19 but didn't require hospitalization were higher, but only for the first six months.

However, the risk of other health outcomes including hospitalization persisted. The risk of Long COVID, a range of health conditions, continued for two years. This was more noticeable in the hospitalized group compared to the non-hospitalized group. Among the 80 health conditions that make up Long COVID, 65% of them persisted at two years in the hospitalized group, while 31% persisted in the latter group. Compared to uninfected individuals, those who had previously contracted COVID-19 had a higher risk of issues like blood clots, lung disease, fatigue, digestive problems, muscle and joint issues, and diabetes for up to two years. A significant level of disability occurred, with 25% of it reported in the second year. These findings were published in Nature Medicine.

A study in JAMA compared over 0.2 million people who had survived COVID-19 with over one million uninfected individuals. The difference in death rates between the two groups was striking. At the end of two years, 8.7% of those with a history of COVID-19 had died, compared to only 4.1% in the other group. The death rate was highest in the initial few months. Among those who survived the first six months, the death rate decreased afterward, unexpectedly falling below the average death risk of the comparison group.

This apparent drop could be due to a phenomenon known as the 'depletion of susceptibles' in the COVID-19 group — the initial period might have eliminated those more likely to die. The individuals who survived and were relatively healthier had a lower death rate than the comparison group. Additionally, close healthcare monitoring might have contributed to preventing a few deaths.

An ICMR study examined 14,419 individuals who had survived COVID-19 hospitalization, revealing a one-year death rate of 6.5%. New or persistent symptoms of post-COVID conditions such as fatigue, breathlessness, and memory problems lasting four to eight weeks were present in 17% of the patients. Death during the follow-up period was more common among such individuals. Those who had received prior vaccination had a lower risk of death.

These extensive studies emphasize the necessity of reducing the risk of infection, particularly during surges.

Photo Credit: Getty Images/iStockphoto


Cinnamon and its active components prevent prostate cancer: National Institute of Nutrition study

An announcement shared by NIN has revealed that as part of a research initiative, mature rats were provided with cinnamon or its active components through their diet before the onset of cancer. This feeding continued for a span of 16 weeks.

A research endeavor conducted by the ICMR-National Institute of Nutrition (NIN) has indicated that cinnamon and its active constituents - cinnamaldehyde & procyanidin B2 — when ingested by rats, exhibited a hindering impact on early-stage prostate cancer.

The study, titled 'Chemopreventive effect of cinnamon and its bioactive compounds in a rat model of premalignant prostate carcinogenesis', which was published in the globally recognized journal Cancer Prevention Research, aimed to gauge the effectiveness of cinnamon (CN) and its bioactive elements (cinnamaldehyde or procyanidin B2) in controlling cancer development in male rats. NIN, in a statement, highlighted that during this research, fully grown rats were fed with cinnamon or its active compounds through their diet prior to the commencement of cancer induction, and this dietary regimen was continued for a duration of 16 weeks.

The statement pointed out, "It was observed that feeding cinnamon or its active compounds led to 60-70% of rats exhibiting a normal prostate histologically."

Dr. Ayesha Ismail, who headed the study as Scientist F and also leads the Endocrinology Division, conveyed, "We attempted to unravel the potential mechanism(s) for the cancer-preventive effect and observed that both cinnamon and its active components were able to alleviate oxidative stress, curtail the spread of cancer cells in the prostate gland. Interestingly, we also noticed positive effects on bone mineral content and a reduction in bone degeneration among these rats."

Dr. Hemalatha R, Director of ICMR-NIN, shared, "It is heartening to witness these findings regarding cinnamon, an Indian spice that is commonly incorporated in our culinary practices. However, it is imperative for more comprehensive investigations to be conducted before formulating any specific dietary recommendations.
Photo used for representation purpose only.


Health Ministry withdraws fiat mandating doctors prescribe only generic drugs

The earlier notification from the National Medical Commission (NMC) stated: 'Every Registered Medical Practitioner (RMP) should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets.' The Indian Medical Association (IMA) had requested its withdrawal, stating that it should not be implemented until the quality standards of medicines are assured.

On Thursday evening, the National Medical Commission (NMC), India's regulatory body for medical professionals, and the Indian Medical Association (IMA), a nationwide voluntary organization of physicians with over 300,000 members, resolved a two-week-long dispute. This standoff was centered around one aspect of the NMC's August 2 notification, which urged registered medical practitioners (RMPs) to exclusively prescribe generic medicines. The Ministry of Health has now extended the negotiation period for both parties.

In the most recent notification, the NMC has temporarily suspended the proposed regulations until further notice. The Commission stated, "The NMC Registered Medical Practitioner (Professional Conduct) regulations, 2023 are hereby held in abeyance with immediate effect."

Dr. Sharad Agarwal, the national president of the IMA, stated, "This is a significant victory as all the regulations have been suspended. The medical community has stood up for the benefit of the people."

The previous NMC notification emphasized, "Every RMP should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets."

The IMA demanded the withdrawal of this requirement, arguing that it shouldn't be enforced until the quality standards of the medicines are guaranteed.

Advantages of Generic Medicines The NMC explained its standpoint, emphasizing that individual spending on medication is high, and since generic medicines are 30% to 80% cheaper than branded drugs, promoting their prescription could reduce healthcare costs and enhance access to quality care.

In contrast, the IMA contested this directive, expressing concerns about the perceived low quality of generic medicines available in India and their potential negative impact on patient health and treatment. They even met with the Union Health Minister to voice their strong objections. Other arguments against the move include the sale of medicines by chemists, where the prices of generic medicines vary significantly, and substantial profit margins exist for the same combination drugs produced by different companies. The unregulated proliferation of pharma companies producing generic drugs and limited options for patients are also points of concern.

While doctors were previously expected to prescribe generic drugs, there were no outlined penalties for non-compliance.

The suspended notification, however, indicates that in case of violations, a doctor might receive a warning to adhere to the regulations more carefully, attend an ethics-focused workshop or academic program, or face the suspension of their medical license for a specific period after repeated violations.

K. Senthil, State President of the T.N. Government Doctors Association, noted that the idea of prescribing generic drugs isn't new and dates back to 2016. He highlighted that the primary difference now lies in the severity of the punishment prescribed.

Challenges and Concerns A challenge pointed out is that even if doctors prescribe generic drugs, pharmacists or chemists are not obligated to provide them, and they could instead offer branded drugs. Additionally, prescribing combination drugs using generic names is not feasible.

Regarding the quality of drugs, concerns were raised about the shortage of personnel in the Drug Controller's offices in most states, making it difficult to ensure the quality of drugs. Drugs in India fall into categories such as branded patent drugs, branded generics, and generic drugs. Branded generics, which are cheaper than branded patents but costlier than bulk-manufactured generic versions, lack strict price regulation. This raises concerns among doctors that patients might not fully benefit from a particular drug due to variations in quality.

The Importance of Quality C.N. Manjunath, director of the state-run Sri Jayadeva Institute of Cardiovascular Sciences and Research, highlighted that the quality of a generic drug isn't guaranteed through quality control or clinical trials. He pointed out that the same company manufacturing both branded and generic drugs indicates a shift in quality.

Maintaining stable drug levels in patients is crucial, especially in cases like transplant recipients. Differences in formulation and potency between branded and non-branded generic drugs can impact drug levels and outcomes for patients. Doctors argued that ensuring consistency in brand usage is essential for drugs with a narrow therapeutic window. Switching between different generic brands could lead to variations in drug levels, jeopardizing patient care.

The Perspective on Prescriptions Rajeev Jayadevan, a member of the Public Health Advisory Panel of the Kerala State IMA, emphasized that doctors aim for complete patient recovery and well-being. Doctors develop prescribing patterns based on years of practice and patient feedback, fostering a unique patient-doctor relationship. Writing only a generic name on the prescription might lead pharmacy salespeople to dispense products with the highest profit margins. The non-uniform quality control, storage, distribution, and dispensation of drugs in India remain a significant concern for doctors.

Prescription Guidelines The NMC's notification outlined prescription guidelines, emphasizing the prescription of drugs using generic names. Exceptions could be made for drugs with a narrow therapeutic index, biosimilars, and similar cases. The notification also stressed rational and optimal drug prescription to avoid overprescribing and underprescribing, considering possible drug interactions. Judicious use of fixed-dose combinations was recommended, and only approved rational fixed-dose combinations were to be prescribed.

Hospitals and local pharmacies were advised to stock generic drugs and prescribe those available and accessible to patients. The notification discouraged the prescription of "branded" generic drugs and encouraged patients to purchase drugs from Jan Aushadhi Kendras and other generic pharmacy outlets.

India's Healthcare Approach During the recent G-20 health summit, the Indian Health Ministry reaffirmed its commitment to making healthcare affordable and accessible. India is a major supplier of vaccines globally and a significant exporter of generic medicines. The country's $50 billion drug-manufacturing industry exports medicines to over 200 nations.

Individual doctors and healthcare activists have shared their perspectives on the NMC-IMA dispute. S.P. Kalantri, director professor of MGIMS and Medical Superintendent of Kasturba Hospital, questioned whether the strict approach of severing links between medical professionals and the pharma industry is the solution. He raised the idea of subjecting all drugs, generic or branded, to bioequivalence testing before entering the market. Gopal Dabade, president of Drug Action Forum, Karnataka, welcomed the NMC's notification, asserting that using generic drugs will enhance healthcare affordability and reduce patient out-of-pocket expenses. He disputed claims that switching to generic drugs could harm patients, citing a lack of scientific evidence.

(Inputs from Afshan Yasmeen in Bengaluru, Zubeda Hamid in Chennai, and C. Maya in Tiruvananthapuram contributed to this article.)


‘India must ramp up testing and maintain close watch on new global variants of COVID-19’

The Health Ministry of India has presented a comprehensive update on the global status of COVID-19, along with insights into newer strains such as BA.2.86 (Pirola) and EG.5 (Eris), which have been identified on a worldwide scale.

"While our country's COVID-19 situation remains stable and our healthcare systems are fully prepared, it is essential for the states to closely track instances of Influenza-like Illness (ILI) and Severe Acute Respiratory Infections (SARI). They should also send ample samples for COVID-19 testing, while concurrently enhancing Whole Genome Sequencing efforts," stated P.K. Mishra, Principal Secretary to Prime Minister Narendra Modi. He shared these remarks following a high-level meeting on August 21, which aimed to assess the global and domestic COVID-19 scenario, the emergence of new virus variations, and their implications for public health.

He also emphasized the need for India to vigilantly monitor emerging global virus strains.

In a recent update, the Health Ministry shed light on the current worldwide COVID-19 landscape, incorporating insights into newer strains BA.2.86 (Pirola) and EG.5 (Eris), both of which have been reported internationally.

As per information from the World Health Organization (WHO), the EG.5 (Eris) variant has been documented in over 50 countries, while the BA.2.86 (Pirola) variant has been identified in four countries.

The update also highlighted that globally, a total of 296,219 fresh COVID-19 cases were reported during the past week. Remarkably, despite representing nearly 17% of the global population, India contributed only 223 cases (0.075% of the global new cases) during the same period.

Furthermore, the daily average of new COVID-19 infections across the entire nation has consistently remained below 50 cases. Impressively, India has managed to sustain a weekly test positivity rate of under 0.2%. The update also offered insights into the genetic makeup of various circulating variants within India.

The meeting witnessed the presence of several prominent figures, including Vinod Paul, Member of NITI Aayog, and Rajiv Gauba, Union Cabinet Secretary, among others.

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WHO global partners commit to advance evidence-based traditional, complementary and integrative medi

The WHO survey has identified approximately 100 countries that possess national policies and strategies related to traditional, complementary, and integrative medicine (TCIM). These initial findings were revealed by the World Health Organization (WHO) through its Global Survey on Traditional Medicine 2023.

These findings were recently discussed during the inaugural World Health Organization (WHO) Traditional Medicine Global Summit 2023.

"In numerous member states of the WHO, TCIM treatments are integral to essential medicine lists, crucial health service packages, and are encompassed by national health insurance programs. A significant majority of individuals turn to traditional, complementary, and integrative medicine interventions for the management, prevention, and treatment of noncommunicable diseases, as well as palliative care and rehabilitation," stated the WHO in a press release.

The global partners are committed to promoting evidence-based traditional, complementary, and integrative medicine, according to the release.

Bruce Aylward, Assistant Director-General for Universal Health Coverage and the Life Course at WHO, underlined the necessity for a "stronger evidence base — a priority for WHO — to empower countries to devise suitable regulations and policies surrounding traditional, complementary, and integrative medicine."

Role of Artificial Intelligence
The summit also emphasized the significant potential of artificial intelligence in scrutinizing intricate data concerning traditional medicine, with the goal of identifying practices that hold potential for further scientific assessment.

Over time, and with ethical and equitable safeguards, this evidence could be translated into policies that expedite the secure and effective integration of traditional medicine into healthcare systems.

Health ministers from the G-20 nations and other countries, along with scientists, traditional medicine practitioners, healthcare personnel, and members of civil society from 88 countries, took part in the summit held in Gandhinagar on August 17 and 18.

The summit offered a platform for all stakeholders to exchange their distinct experiences, best practices, and collaborative ideas. It featured a diverse assembly of Indigenous Peoples originating from various corners of the world, including Australia, Bolivia, Brazil, Canada, Guatemala, and New Zealand. For these communities, numerous TCIM approaches are not only pivotal in healthcare but also deeply intertwined with culture and livelihoods.

Shyama Kuruvilla, senior strategic advisor and head of the WHO Traditional Medicine Global Centre, who also led the organization during the summit, remarked, "We garnered substantial insights into existing policies, tools, and practices. Nonetheless, it's evident that we still have a substantial voyage ahead of us in leveraging science to gain a deeper comprehension, formulate, and deliver the complete potential of TCIM approaches to ameliorate people's health and well-being, all while maintaining harmony with the planet that sustains us."

India's G20 Presidency is spearheading the creation of the new Global Initiative on Digital Health, one of its key accomplishments.
Photo Credit: PTI


Digital innovations in healthcare must be for public good: PM Modi

Appealing for resilience in post-COVID global health systems, PM asserts that the world must be prepared to 'prevent, gear up, and respond to the subsequent health crisis'; emphasizes fair access to technology.

Prime Minister Narendra Modi stated on Friday that innovations in digital healthcare must be made available for the common welfare. He urged G-20 Health Ministers to avoid duplication in funding and ensure even-handed access to technology.

'The Global Initiative on Digital Health... will enable countries in the Global South to bridge the gap in healthcare delivery. It will bring us a step closer to realizing the aim of achieving universal health coverage,' he commented, addressing the ongoing G-20 Health Ministers' meeting in Gujarat's capital.

The COVID-19 pandemic has underlined that health should be at the core of our decisions, Mr. Modi remarked, also noting that it has highlighted the importance of international collaboration, whether in medical supplies and vaccine distribution or in repatriating individuals.

'Embracing resilience is pivotal,' he stated. Highlighting resilience as one of the most significant lessons from the pandemic, the Prime Minister advocated for global health systems to exhibit resilience. 'We should be equipped to thwart, prepare, and counter the upcoming health crisis. This holds even more significance in today's interconnected world. As we observed during the pandemic, health challenges in one part of the globe can impact all other regions in a very brief span,' he articulated.

He cautioned against the serious threat of antimicrobial resistance to worldwide public health and all pharmaceutical advancements made thus far. In relation to tuberculosis, he remarked that India was making considerable progress towards achieving elimination ahead of the global target of 2030.

Taking a comprehensive approach, Mr. Modi stated, 'In India, we are embracing a comprehensive and inclusive strategy.' He added that India is expanding its health infrastructure, endorsing traditional medicine systems, and delivering affordable healthcare for all.

The Prime Minister also highlighted India's belief in the potential of holistic health and wellness to enhance overall resilience. He pointed out the significance of establishing the WHO Global Centre for Traditional Medicine in Jamnagar, Gujarat. The WHO Global Summit on Traditional Medicine, held concurrently with the G-20 Health Ministers' meeting, will amplify efforts to tap into its potential. He called for collaborative efforts to create a global repository of traditional medicine.

Underscoring the intrinsic connection between health and the environment, Mr. Modi mentioned that clean air, safe drinking water, adequate nutrition, and secure shelter are pivotal factors for good health. Being healthy entails achieving harmony and equilibrium between the mind and body, signifying that health is the fundamental basis of life, according to Mr. Modi.

He extended a warm welcome to dignitaries on behalf of India's 2.1 million doctors, 3.5 million nurses, 1.3 million paramedics, 1.6 million pharmacists, and numerous others contributing to the healthcare sector."
Photo Credit: PTI


India pharma ally, but must meet U.S. standards: U.S. Health Secretary

Meeting U.S. drug standards will also aid India's export growth globally, says Xavier Becerra; discusses collaboration on drug safety, availability in talks with Health Minister Mansukh Mandaviya.

Indian firms need to comply with U.S. drug standards to continue exporting medicines to America, stated U.S. Health and Human Services Secretary Xavier Becerra on August 18, emphasizing the potential for growth in the partnership.

Speaking on the sidelines of the ongoing G-20 Health Ministers’ meet in Gujarat’s capital, Mr. Becerra also cautioned against unregulated spread of artificial intelligence in the health sector, while stressing the importance of utilizing technology's innovative potential.

"Meeting drug standards would not only sustain India's trade with the U.S., but also uphold global standards and growth," he remarked, adding that India is a vital partner in fulfilling U.S. pharmaceutical needs.

Need for standardized drugs
India has recently faced criticism from certain countries for alleged drug contamination in its exports. Mr. Becerra, stating that India remains a key partner in maintaining global drug supply, expressed the U.S.'s need for deeper collaboration and standardized drugs, enabling acceptance of Indian-manufactured medicines worldwide.

"India stands stronger today than a few decades ago, and we foresee its capacity expansion," he stated.

He further mentioned that U.S. participation in the G-20 meeting signals a strengthening relationship with India and will yield benefits for both nations. "This will indeed benefit the world, as India and the U.S. are seen as global leaders," he said, highlighting their strong, interdependent pharmaceutical relationship.

"We rely on India, and India relies on us. Together, we can thrive in ensuring medicines' availability not just for our citizens but globally," he remarked.

Partnership on drug supplies
Mr. Becerra revealed that his meeting with Health Minister Mansukh Mandaviya included discussions on "coordinating and collaborating to ensure pharmaceutical medicine safety and availability."

The U.S. Secretary also acknowledged recent shortages of certain cancer and influenza drugs in the U.S., stating that top U.S. Food and Drug Administration (FDA) officials would soon visit India to prevent disruptions in the medicine supply chain and ensure American access.

Lessons from the pandemic
Commenting on the U.S.'s commitment to G-20 outcomes and lessons learned from the COVID-19 pandemic, he said, "COVID has taught us that everyone's safety is intertwined. G-20 is a positive step where we unite as a community to establish protocols for handling future health crises."

"During the pandemic, both India and the U.S. demonstrated the ability to combat health crises, creating vaccines for their citizens. COVID showed us the significance of collaboration, highlighting the importance of a G-20-like meeting. We are also gearing up for the upcoming World Health Assembly next year," he stated.

He emphasized that climate change's connection to health outcomes is vital and commended India for prioritizing this area. "We appreciate India's focus on this," he concluded.
Photo Credit: AP


Melting Glaciers Could Give Rise to New Ecosystems in India by the End of the Century

Melting Glaciers Could Give Rise to New Ecosystems in India by the End of the Century

As global temperatures continue to rise due to climate change, the impact on glaciers has become increasingly evident. Melting glaciers are not only contributing to rising sea levels but also have the potential to create new ecosystems in various regions, including India. This article explores the phenomenon of melting glaciers leading to the formation of new ecosystems within the Indian context.

The Impact of Melting Glaciers:
The alarming rate at which glaciers are melting is a direct consequence of climate change. Glaciers in the Indian Himalayan region, including the iconic Gangotri Glacier and others, have been retreating rapidly over the past few decades. This phenomenon is primarily driven by rising temperatures, causing ice to melt and form glacial lakes.

The Emergence of New Ecosystems:
While the melting of glaciers raises concerns about sea-level rise and its impact on coastal areas, it also presents a unique opportunity for the creation of new ecosystems. As glaciers retreat, they leave behind bare rock surfaces and newly formed glacial lakes. These areas provide a blank canvas for nature to paint a different picture, giving rise to previously nonexistent ecosystems.

Potential Benefits for Biodiversity:
The formation of new ecosystems brings the potential for increased biodiversity. As plant life begins to colonize the exposed rock surfaces, it creates habitats for various organisms. In some cases, these newly formed ecosystems could harbor plant and animal species that are adapted to extreme conditions, contributing to the overall biodiversity of the region.

Challenges and Concerns:
While the creation of new ecosystems might seem like a positive outcome, it's essential to consider the challenges and concerns. The rapid pace of change and the unpredictability of these new ecosystems could pose difficulties for existing wildlife and human populations. Moreover, invasive species could potentially disrupt the delicate balance of these emerging habitats.

Conservation and Management:
To harness the potential benefits of these emerging ecosystems, proactive conservation and management strategies are crucial. Close monitoring of the evolving habitats, as well as research into the species that might inhabit them, can aid in understanding and safeguarding these unique environments. Additionally, collaboration between scientists, conservationists, and local communities is essential for effective management.

As the world grapples with the consequences of climate change, the phenomenon of melting glaciers leading to the formation of new ecosystems presents a silver lining. India's diverse geography, including the Himalayas, could witness the emergence of unique habitats before the end of the century. While challenges exist, proactive efforts in conservation and management can help capitalize on this opportunity to protect and foster these nascent ecosystems.


The story of how the deadliest virus to humans was revived

In 1997, a 72-year-old doctor embarked on a challenging journey to Alaska to accomplish what he had set out to do as a young graduate student 46 years earlier.

This is Part I of a two-part tale about the Spanish flu virus. Part II will be published on August 18.

In August 1997, the members of the village council of a small settlement in Alaska called Brevig Mission were confronted with an unusual request. A man named Johan Hultin sought their permission to dig up an almost 80-year-old mass grave. He asserted that he had attempted this before, 46 years ago, but his previous effort had been unsuccessful.

The council granted him approval upon learning his intentions. According to him, hidden beneath the frozen ground lay the preserved blueprint for crafting the most lethal virus that humanity had ever faced.

Crafting a Virus
Scientists often engineer new viruses in laboratories. They modify the genetic material (DNA or RNA) of existing viruses to generate new versions that might not exist naturally. This enables scientists to compare the properties of the altered variants with their natural counterparts, shedding light on the impact of the changes made.

For instance, if they observe that certain patients carry a higher viral load in their blood for a particular disease, and they identify a specific mutation in the DNA of viruses taken from those patients, they can introduce that mutation into viruses that do not naturally possess it. This allows them to determine if the mutation enhances viral production in controlled conditions.

However, while scientists can readily introduce alterations to the genetic material of a virus, they cannot construct an entirely new virus from scratch. They must rely on nature for this process.

Hence, scientists collect samples from patients, amplify the genetic material using a method called polymerase chain reaction, and analyze the sequence of bases forming its genetic material. Once the sequence is obtained, they can manipulate it.

Introducing 'H' and 'N'
In 1995, molecular pathologist Jeffery Taubenberger, who was researching the influenza virus, sought to comprehend why certain virus strains triggered pandemics while others did not. Taubenberger recognized that to achieve this, he needed to decipher the genetic makeup of the deadliest strain of influenza that had ever afflicted humans: the virus responsible for the 1918 Spanish flu.

At that time, exactly 105 years ago today, the virus had infected an estimated 500 million people – about one-third of the global population at the time. It was infamous for causing severe illness in individuals aged 15-34. The death toll was estimated at 50 million. (For comparison, the COVID-19 pandemic is believed to have caused around 6.9 million deaths.)

Scientists classify influenza strains based on the types of two genes they possess, known as haemagglutinin and neuraminidase, designated as 'H' and 'N'. There are 18 subtypes of haemagglutinin (H1-H18) and 11 types of neuraminidase (N1-N11) in nature. An influenza virus carries one of each type, determining its classification.

For instance, the 1918 Spanish flu was caused by the H1N1 variant; the 1957 Asian flu resulted from H2N2; and the 1968 Hong Kong flu was caused by H3N2. Further variations exist within these primary classifications, where distinct mutations in the 'H' and 'N' genes can further alter a virus's properties. For instance, both the 1918 Spanish flu and the 2009 swine flu were caused by H1N1, but variations in the H1 and N1 genes contributed to differences in disease severity.

Taubenberger sought the 1918 version of H1N1. However, a problem emerged. The virus had disappeared after 1920, at the conclusion of the pandemic. Although subsequent influenza outbreaks occurred in 1957, 1968, and 1977, those viruses were dissimilar and far less lethal than the 1918 strain. Taubenberger was determined to study the most severe variant of influenza to enhance his understanding of the virus.

A Letter from Johan Hultin
Overcoming significant challenges, he managed to obtain preserved lung samples from a soldier who had succumbed to the disease in 1918. He extracted a small portion of the virus's genetic material. However, due to limited starting material, Taubenberger could not sequence the complete RNA. Consequently, he, along with another scientist named Ann Reid, published a partial sequence in March 1997.

A few months later, Taubenberger received a letter from a doctor named Johan Hultin, who had read his article and offered a solution to his scarcity of samples. Dr. Hultin stated that in a tiny seaside village in Alaska named Brevig Mission, a mass grave existed containing the remains of 72 individuals who had died from the Spanish flu in 1918. The Alaskan permafrost had preserved the bodies remarkably well, along with the virus.

Dr. Hultin added that he had visited the site in 1951 and had retrieved a few samples. However, due to the lengthy return journey, the samples began to thaw, prompting him to re-freeze them using carbon dioxide from a fire extinguisher. Despite his efforts, the freeze-thaw cycles had damaged the samples.

In a phone call, Dr. Hultin proposed returning to Brevig Mission to collect more samples at his own expense. Taubenberger agreed.

Sequencing the Full Genome
Consequently, in August 1997, 72-year-old Johan Hultin returned to Brevig Mission to complete the mission he had undertaken as a young graduate student 46 years earlier: obtaining the deadly 1918 H1N1 influenza virus. His endeavor was laden with the risk of contracting the lethal virus and almost certain death. However, neither the danger nor the lack of specialized equipment deterred Dr. Hultin. He pressed on with his mission undeterred.

The samples he brought back allowed Taubenberger and Reid to determine the complete genetic sequence of the virus. This sequence enabled other scientists to gain insights into the virus's origins. It appeared to have an avian ancestor, but there were also indications that the virus had adapted and evolved to infect mammals.

In essence, the ancestral avian virus had transitioned to infecting humans or swine. It had undergone years of circulation, improving its efficacy, before disappearing. Subsequently, it re-emerged as one of the deadliest pathogens to afflict humanity.

Despite these remarkable discoveries, the virus's genetic sequence did not unveil significant insights about the virus itself. It did not clarify how the virus could swiftly infect people or why it caused millions of deaths. While there were minor variations in the genetic material, this is typical for RNA viruses. The essential question remained unanswered: recreating the virus was the only way to address it.

Arun Panchapakesan is an assistant professor at the Y.R. Gaithonde Centre for AIDS Research and Education, Chennai.
Photo Credit: Public domain


In TB detection, India far from meeting the 2025 goal

In 2022, the cases of TB confirmed through lab testing among notified TB patients in the government healthcare sector were only 59% (1.07 million), and testing for rifampicin resistance among these confirmed TB patients was only 77% (0.82 million).

In March 2016, during his Mann Ki Baat address, Prime Minister Narendra Modi urged people to make India free from TB; in 2018, he set the target to "eliminate TB by 2025". To achieve this, the Ministry of Health introduced the National Strategic Plan (NSP) 2017-2025 to eradicate TB by 2025. Despite outlining a new approach and strategy to achieve this ambitious goal, it became evident by 2020 that the NSP would fall short of meeting its objectives. As a result, a new National Strategic Plan 2020-2025 to end TB was launched.

Regarding diagnostics, the NSP 2017-2025 aimed to decrease the number of presumptive TB patients undergoing sputum smear microscopy from over 9.1 million in 2015 to 5.8 million in 2022, while increasing the usage of molecular tests from 40,000 in 2015 to over 13.4 million in 2022. However, the India TB report for 2022 showed that India was far from achieving the ambitious target set by the NSP 2017-2025. Smear microscopy was used to detect 77% (13.9 million) of presumptive TB cases, while only 23% (4.1 million) of cases were identified using molecular tests.

If the diagnostic goals outlined by the NSP 2017-2025 were not met, the revised National Strategic Plan 2020-2025 set even higher standards for precision tests for initial diagnosis. Three years after the revised plan was introduced, India has not come close to meeting this target.

A primary objective of the revised NSP is the early detection of presumptive TB cases. It emphasizes "prompt diagnosis" using highly sensitive diagnostic tests to identify presumptive TB cases at the first point of contact in both public and private healthcare sectors. The plan also advocates for universal access to high-quality TB diagnosis, including drug-resistant TB.

The revised plan for 2020-2025 underscores the need to "expand advanced diagnostic services and TB surveillance capacity by replacing sputum microscopy services with new precision diagnostic tools." It explicitly states that smear microscopy services should be replaced by precision diagnostic tools, which are molecular tests, in all TB diagnostic centers across the country. Despite three years passing since the revised NSP was introduced and only two years left to achieve the 2025 goal of eliminating TB, the transition from smear microscopy to molecular tests has not been fully realized. This is concerning, especially considering the revised NSP's emphasis on rapidly transitioning to molecular testing.

Of greater concern is that, in 2022, only 59% (1.07 million) of bacteriologically confirmed TB cases among notified patients in the public sector and a mere 28% (nearly 0.16 million) in the private sector were reported. This suggests that a significant number of diagnoses rely on X-rays and clinical evaluation without bacteriological confirmation.

Even more worrisome is that only 77% (0.82 million) of bacteriologically confirmed TB patients were tested for rifampicin resistance in 2022. Conducting drug-susceptibility testing for all drug-sensitive TB cases is crucial for promptly identifying drug-resistant TB. The revised NSP clearly emphasizes "universal access" to drug resistance testing, which has yet to be fully implemented.

In November 2019, the World Health Organization (WHO) and the Joint Monitoring Mission conducted a comprehensive review of the TB program. Among the recommendations deemed "absolutely necessary" to achieve the Prime Minister's 2025 goal is the urgent replacement of smear microscopy with molecular tests nationwide.

To expand the availability of advanced molecular tests throughout the country and accelerate progress toward the 2025 goal, the WHO-JMM team suggested that the National TB Elimination Program (NTEP) should leverage the molecular testing capacity available in the private sector to conduct 20 million molecular tests annually.

In addition to the limited availability of 5,090 machines for conducting molecular tests, there are challenges related to trained personnel and a shortage of molecular tests. Due to limited molecular test supplies, there is a need to prioritize testing vulnerable groups with presumptive TB, such as pediatric populations, those with extrapulmonary TB, individuals who are HIV positive, and previously treated patients. The revised NSP also underscores the importance of replacing smear microscopy with rapid molecular diagnostic tests for active case finding, alongside digital chest X-ray screening. The plan acknowledges the challenge of limited access to the latest NAAT-based molecular tests at peripheral health institutions for active case finding. Lastly, all presumptive TB cases identified through smear microscopy should undergo drug resistance testing using molecular tests. These challenges emphasize the need to outsource molecular tests to the private sector to enhance case detection at the first point of contact until universal access to molecular tests in the public sector becomes a reality.

photo credit the hindu


Many countries aren’t testing enough for COVID-19, new variants may emerge: WHO Director-General

G20 presents a distinct opportunity to exhibit India’s leadership in the realm of traditional medicine: Rajesh Kotecha, Secretary of AYUSH, ahead of the G20 Health Ministers’ assembly.

Cautioning that numerous countries are not conducting sufficient testing and that novel SARS-CoV-2 virus variations could emerge, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, stated on Wednesday (August 16) that testing and remaining vigilant are crucial to persist in the battle against COVID-19.

"We would remain unaware if the virus is altering, if we do not test adequately. Testing holds paramount importance to monitor the virus's progression," Dr. Ghebreyesus commented.

The head of WHO is in Gujarat as part of the G20 Health Ministers’ event scheduled from August 17-19.

"While COVID is in our past and India gave its utmost during that period, we should anticipate the emergence of fresh and more variants," Dr. Ghebreyesus remarked while addressing his visit to the Health and Wellness Centre in Adraj Moti village, Gandhinagar.

He also underscored the necessity for nations to invest in enhancing their primary healthcare centers, asserting that 80% of healthcare needs can be met at these primary centers and outbreaks can be identified and averted.

"To ensure the success of any healthcare initiative, a robust primary healthcare system is pivotal. India’s healthcare scheme, Ayushman Bharat, is a prudent investment, and the telemedicine facility is also aiding patients," Dr. Ghebreyesus supplemented. He noted that many countries, even affluent ones, were caught off guard by COVID due to their inadequate investments in primary healthcare.

India, which took over the G20 Presidency in December 2022, is currently part of the G20 troika alongside Indonesia and Brazil. India’s G20 Presidency signifies the first troika comprised of three developing and emerging economies.

Supplying particulars about the summit, an official from the Health Ministry conveyed that the G20 Health Ministers’ conclave will prioritize the G20 health trajectory's three key aspects — averting health emergencies, readiness and response with a focus on anti-microbial resistance, and a comprehensive health framework.

Speaking about the summit, Rajesh Kotecha, Secretary of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy), remarked that the G20 provides a unique avenue to display India’s mastery in the realm of traditional medicine.

"Over the past nine years, India has made an eightfold advancement in traditional medicine. By year-end, over 12,500 AYUSH-based health and wellness centers will be operational across the nation, with 8,500 already functional," Mr. Kotecha revealed.

The AYUSH Secretary spotlighted that the Global Centre on Traditional Medicines in Jamnagar, Gujarat, established by the WHO, is the first center of its kind in a developing nation. He also indicated that the WHO, in conjunction with the Ministry of AYUSH, will host the Traditional Medicine Global Summit on August 17-18 in Gandhinagar, aiming to "explore the role of traditional, complementary, and integrative medicine in tackling pressing health challenges and propelling global health and sustainable development."

Delegates from 19 G20 member nations, 10 invited states, and 22 international organizations will partake in the 4th Health Working Group gathering in Gandhinagar."


Can’t be forced to do the work of chemists or prescribe poor quality drugs to patients: IMA

The demand of the Indian Medical Association comes in light of the National Medical Commission's directive to doctors to prescribe generic medicines.

Following the recent regulation by the National Medical Commission (NMC) that instructs doctors to prescribe generic medicines, the Indian Medical Association (IMA) on August 14th has urged the government for immediate action. They have stated that doctors should not be compelled to perform the role of pharmacists and prescribe medicines of "inferior quality" to patients.

"The main challenge with generic medicines is the uncertainty surrounding their quality. Due to the inadequate quality control measures in the country, there is very little assurance regarding the quality of medicines. Prescribing medicines without guaranteed quality could adversely affect patient health," the IMA mentioned in their statement.

They further revealed that less than 0.1% of the drugs produced in India undergo quality testing. The IMA has requested that this new directive be postponed until the government can ensure the quality of all medicines released in the market.

The association has argued that if the government and the NMC intend for all doctors across the nation to exclusively prescribe generic medicines, they should instruct pharmaceutical companies to manufacture drugs without brand names.

"This step merely shifts the responsibility. The primary concern, training, and duty of doctors revolve around the health of patients; it is the pharmacist or the individual in the pharmacy who dispenses medicines. This approach may not be in the best interest of the patient," the association stated.

The IMA also raised a question about why branded medicines should be licensed if doctors are not permitted to prescribe them. This is especially noteworthy since medicines from the modern medical system can only be provided upon a doctor's prescription.


National Medical Commission lists drugs which can be sold without prescription

In the recently issued regulations by the National Medical Commission (NMC), they've, for the first time, provided a list of therapeutic categories of medicines which can be sold over the counter without needing a prescription. However, this list doesn't specify the names of individual medicines.

In the 'Regulations relating to Professional Conduct of Registered Medical Practitioners' released on August 2, the NMC has stated that over-the-counter (OTC) medicines can be legally sold without a doctor's prescription.

The list of OTC therapeutic categories mentioned by the NMC includes medicines for conditions like piles, skin antibiotics, cough suppressants, acne treatments, and anti-inflammatory drugs that don't contain steroids.

It also includes antiseptics, painkillers, decongestants, aspirin, medications that widen blood vessels, antacids, medicines to help remove mucus, antifungal drugs, drugs for allergies, medications for gas relief, and medicines to quit smoking.

The NMC defines OTC medicines as remedies for common health issues that can be bought directly from a shop and are safe and effective for the general public to use without needing advice from a healthcare professional. Any medicines not listed as 'prescription drugs' are categorized as non-prescription or OTC medicines, as stated by the NMC.

The Drugs and Cosmetics Act and the related rules don't provide a clear definition of OTC medicines. Furthermore, there are no specific guidelines to regulate these medicines, according to an official source.

However, Schedule H of the Drugs Rules outlines a set of medicines that can only be dispensed with a prescription. This list is updated periodically, with the latest update being in 2019. "Because there aren't well-defined regulations for OTC medicines, they aren't readily available. But the NMC's recent regulations cover a wide range of therapeutic categories without naming any specific medicines. This could lead to misuse of habit-forming medicines like the cough suppressant Codeine," a source explained.

Additionally, using certain medicines without proper medical guidance could result in harmful effects. When these medicines are available over the counter, there's no professional advice on the appropriate dosage, how to take them, potential contraindications, or necessary precautions to be taken, as per the source.

A few years ago, the Drugs Consultative Committee, operating under the Drugs and Cosmetics Act, formed a sub-committee to define OTC medicines and create a list of such medicines. This sub-committee submitted its report to the Central Drugs Standard Control Organisation in 2019.

As of now, the government is yet to accept the recommendations made by the sub-committee.