Hepatitis – A to E

Hepatitis is an inflammation of the liver commonly caused by viral infections. but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. Hepatitis can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer.

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. Types B and C especially lead to chronic disease in a majority of affected people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of food or water contaminated by the virus from faecal matter. Hepatitis B, C and D usually occur as a result of parenteral contact (contact with infected body fluids). Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Acute infections may be asymptomatic or associated with Jaundice, Dark urine, Fatigue, Nausea and abdominal pain.

Hepatitis A Virus Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. Hepatitis B Virus spreads mainly through parenteral route and as a Sexually Transmitted Disease(STD). Safe and effective vaccines are available to prevent HBV.

There is no vaccine for Hepatitis C Virus and it mainly spreads through blood and blood products. It can also be an STD, though rarely.

Hepatitis D virus infects only those people who are already affected by HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

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Holy sites ‘may offer clues to antibiotic resistance

Anti-Microbial Resistance(AMR) Study Report says Mass-bathing in the Ganga during pilgrimages may be contributing to anti-microbial resistance.
Travel can be pointed to as one of the reasons for the rise of antibiotic resistance. How large gatherings of people could become hotspots for the spread of the genes that cause resistance.

Antibiotic resistance in bacteria is controlled by naturally occurring genes. These genes are found on plasmids, small rings of DNA that are separate from chromosomes.

Plasmids can move easily between bacteria, allowing them to acquire traits, such as antibiotic resistance, very quickly.

Many people have some organisms in their gut that contain these genes. Generally, these do not affect a person until they take certain antibiotics.

Summary:

When the amount of human waste entering the river rises , the resistant organisms in people’s guts can be washed into the river in faeces.
The faecal organisms tend not to live very long, but the plasmids that carry antibiotic resistance genes can be quickly transferred to other organisms in the river.

This increases the probability that people will ingest bacteria with antibiotic resistant genes when they drink or bathe in the water.

Once they are exposed, they can then carry them back to their own towns and cities in their gut – carrying antibiotic resistance genes to the wider world.

Significance:

The spread of the antibiotic resistance genes adds to existing health concerns. This study is important in tackling the spread of antibiotic resistance. They could provide clues to the mechanisms behind its spread.
Research helps in understanding the importance of the environment in evolution of antimicrobial resistance.

 

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President of India inaugurates Global Clubfoot Conference

The President of India, Shri Ram Nath Kovind, inaugurated the Global Clubfoot Conference being organised by the CURE India in partnership with the Ministry of Health and Family Welfare, Government of India, in New Delhi .
It can cause permanent disability if not treated early. This affects the child’s mobility and confidence. Inevitably, education and schooling suffer – and the child cannot fulfil his or her potential.

The President said that in India the burden of disability affects more than 10 million people. The differently-abled or Divyang as we call them deserve equal opportunities in all avenues of life. Mainstreaming their social and professional experience is a commitment for all of us. Having said that, many of these disabilities are preventable or curable – which is often forgotten. Prevention, treatment and mainstreaming have to go in parallel.

Clubfoot

  • Clubfoot is one of the most common orthopaedic birth defects.
  • It can cause permanent disability if not treated early.
  • Clubfoot is a birth defect where one or both feet are rotated inwards and downwards.
  • This affects the child’s mobility and confidence. Inevitably, education and schooling suffer – and the child cannot fulfil his or her potential.
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Threefold rise in budget to fight tuberculosis

India’s domestic budget for fighting tuberculosis showed a dramatic jump from about ₹700 crore in 2015 to ₹2,500 crore last year, according to a report from the World Health Organisation (WHO).

Typically most of India’s budget to combat the bacterial infection —that claimed 4.2 lakh last year—used to be dominated by international funding.

But, for the first time this has flipped. Domestic resources accounted for 74% of the $525 million spent in India last year, while it was only 38% in 2015.
In 2016, India recorded a 12% dip in the number of TB deaths from the previous year though the incidence dipped marginally by 1%.

The number of notified cases of drug-resistant tuberculosis (MDR-TB) jumped from 79,000 to 84,000 in 2016, pointing to the deployment of better diagnostics.

However, with 1.7 million new cases in 2016, India still continues to be the largest contributor to the global burden with up to a quarter of the 6.3 million new cases of TB (up from 6.1 million in 2015). Inspite of the dip, India accounts for about 32% of the number of people worldwide who succumbed to the disease.

The government has committed to achieve a ‘90-90-90 target’ by 2035 (90% reductions in incidence, mortality and catastrophic health expenditures due to TB). This is premised on improved diagnostics, shorter treatment courses, a better vaccine and comprehensive preventive strategies. In 2016, the WHO said that India had many more deaths and incidence of the disease than had been estimated over the years.

However, several activists say that inspite of the government commitments, TB is still stigmatized and under-reported — especially from the private sector — and top-line drugs are still inadequate to treat people who suffer from the drug-resistant forms of the disease.

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Faster, cheaper urinary tract infection test

Urinary tract infection (UTI) is the second most common infectious disease that affects millions of people globally each year. The 48-hour wait for urine test report delays treatment, and inappropriate use of antibiotics make the problem even worse by giving rise to multidrug-resistant pathogens.

Now, researchers have developed a new test that can provide results in just 4 hours and also indicate which medicine should be prescribed for the infection. The diagnostic technique was developed by scientists at BITS-Pilani, Hyderabad campus, and published in BMJ Innovations.

The scientists visited hospitals in Punjab, Rajasthan and Telangana and collected urine samples from suspected UTI patients. The urine was filtered in a special filter to trap the pathogenic bacteria, and the bacteria was cultured in a specially designed growth media.

Antibiotic sensitivity strips

The strip contains 15 common antibiotics and helps in identifying the antibiotic sensitivity of the bacteria and deciding the most appropriate medicine to be used for the patient.

The new diagnostic technique has 93% sensitivity and 96% specificity. The researchers found that among the 426 tested samples, conventional microbiological method showed 243-positive and 183-negative whereas the new test showed 234-positive and 192-negative. There was very small fraction of false positive and false negatives reported. Further tests were carried out with more people.

The long delay in getting the test results often leads to wrong antibiotics being used. “Due to doctors prescribing broad spectrum antibiotics, the main agents of UTI [E. coli and K. pneumoniae] have developed antimicrobial resistance. These resistant bacteria not only cause long lasting infection but also reduce effectiveness of the available antibiotics. So our main aim was to develop a test which can minimise the irrational use of antibiotics,”

According to the scientists, the test does not require any other specialised equipment, dedicated space/lab or trained personnel. As the strip already has the panel of antibiotics, it is easier, faster and cheaper.

The team has already won several awards for the test. “The test is now undergoing multi-centric clinical validation in various labs and hospitals. We are waiting for the permission from CDSCO [Central Drugs Standard Control Organisation] to commercialise the test. It will probably hit the markets in three months,” adds Dr. Kapur.

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Scientists link new virus to kala-azar

Researchers have stumbled upon tantalizing evidence of an unknown virus that may be responsible for the persistence of kala-azar or visceral leishmaniasis, a parasite infection that has spawned epidemics and sickened thousands of Indians for over a century.

It’s still early to pointedly blame the virus but its discovery portends a new kind of treatment regime and may aid attempts to eradicate the disease.
Historically, the parasite Leishmania donovani is believed to be responsible for the dreaded infection. People get infected when bitten by an insect called the sandfly, which harbours the disease-causing parasite.

This month, a group of scientists from West Bengal and Uttar Pradesh said that another parasite may be involved. Another parasite called Leptomonas seymouri may also be present, according to Subhajit Biswas, one of the scientists involved in the study.

The researchers inferred this after they found the L seymouri and a virus called Lepsey NLV1 within it in 20 of 22 biological samples of patients who had a residual L donovani infection. They reported their findings in an online version of the peer-reviewed Archives of Virology.

Kala-azar is endemic to the Indian subcontinent in 119 districts in four countries (Bangladesh, Bhutan, India and Nepal). India itself accounts for half the global burden of the disease. If untreated, kala-azar can kill within two years of the onset of the ailment, though the availability of a range of drugs has meant that less than one in 1,000 now succumbs to the disease.

Kala Azar

It is also called Visceral Leishmaniasis, Black Fever and Dum Dum Fever. It is the most severe form of leishmaniasis and, without proper diagnosis and treatment, is associated with a high death rate.

Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus. The life cycle of Leishmania is completed in two hosts, humans and sandflies. The adult female sandfly is a bloodsucker, usually feeding at night on sleeping prey. The parasite migrates to the internal organs such as the liver, spleen (hence “visceral”), and bone marrow, and, if left untreated, will almost always result in the death of the host. Signs and symptoms include fever, weight loss, fatigue, anaemia and substantial swelling of the liver and spleen. Of particular concern, according to the World Health Organization (WHO), is the emerging problem of HIV/VL co-infection.

This disease is the second-largest parasitic killer in the world (after malaria), responsible for an estimated 200,000 to 400,000 infections each year worldwide.

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Peru Legalises Medical Cannabis

Peru has approved measures to legalise cannabis for medicinal use with overwhelming support of congress.

The law makes production, import and commercial sale of cannabis oil legal.

President Pedro Pablo Kuczynski had proposed the measure earlier this year, raising objections that drug gangs would branch into cannabis.

Peru is the second-largest producer of coca and has a thriving illegal drug trade. It is now the sixth country in Latin America to legalise cannabis.

Uruguay was first in 2013, allowing sales with a limit of 40 grams per month. Mexico, Argentina, Colombia and Chile followed suit.

President Kuczynski proposed the relaxation in February after police arrested a group of parents who were distilling cannabis oil at home, for children with cancer and severe epilepsy. The drug will only be sold to those who are fully registered with a licensed pharmacy.

Ahead of this week’s vote, pro-government lawmaker Alberto de Belaunde said: “Science is on our side, the regional current is on our side, let’s not let our fears paralyse us.”

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IIT teams use plant extract, heat to kill skin cancer cells

Nanoparticle formulation of a chlorophyll-rich biomolecular extract of an Indian medicinal plant Anthocephalus cadamba combined with a near-infrared dye has been found to selectively kill skin cancer cells.

The plant extract is particularly toxic to cancer cells as there is enhanced generation of reactive oxygen species (ROS) while the dye aids in the destruction of cancer cells through photothermal therapy. Near-infrared light was used to heating up the nanoformulation.
The results were published in the International Journal of Biological Macromolecules.

Two teams from Indian Institute of Technology (IIT) Hyderabad and IIT Bombay working together have achieved promising results using skin cancer cell lines.

While the plant extract is hydrophobic and hence the uptake by cells will be less, the nanoformulation of the extract makes it less hydrophobic, thereby increasing the bioavailability significantly. The extract and the dye together are encapsulated in a FDA-approved polymer to produce the nanoformulation.

Unlike the highly selective nature of the extract, the photothermal ablation produced by the dye when exposed to near-infrared light is not selective.

The NIR dye used (IR-780) for photothermal effect is an inherently imaging agent. The makes the use of any other chemical as an imaging agent redundant.

On being irradiated with near-infrared light, the dye gets heated up and facilitates the release of the extract from polymer membrane.

After 4-5 minutes of irradiation, about 80% of cancer cells were killed. AFter irradiation, the temperature of nanoparticles that contained the dye and the extract increased to 51 degree C. Cells die when heated beyond 42 degree C.

“The nanoformulation with only the plant extract killed less than 20% skin cancer cells while the nanoformulation with only the dye killed 45-50% cells. But the extract and the dye used together killed 82-83% cancer cells,”

But the crude extract (not made into nanoformulation) killed 51% cancer cells at 20 microgram per ml concentration. “The reduced toxicity of the extract in nanoformulation was because only very little of the extract could come out of the polymer coating,”

The use of nanoformulation containing both the extract and the dye will be particularly useful in treating resistant cancer cells.

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Experimental Ebola vaccines found effective

Two experimental Ebola vaccines are safe and can elicit an immune response that lasts for at least one year, a large clinical trial in Liberia has shown.

The findings, published in the New England Journal of Medicine, are based on a study of 1,500 adults that began during the West Africa Ebola outbreak. This clinical trial has yielded valuable information that is essential for the continued development of these two Ebola vaccine candidates and also demonstrates that well- designed, ethically sound clinical research can be conducted during an epidemic.

The trial enrolled men and women ages 18 and older with no reported history of Ebola virus disease at Redemption Hospital in Monrovia. Three groups of 500 volunteers received one of the vaccine candidates or a placebo (saline injection). Participants provided blood samples before vaccination and again at one week, one month, six months and one-year post-vaccination.

Investigators then tested each of these samples for antibodies to the Ebola virus. Responses at one week were modest with both vaccines.

However, by one month, 71 percent of cAd3-EBOZ recipients and 84 percent of rVSV-ZEBOV recipients developed an antibody response compared to 3 percent of placebo recipients. At one year, antibody responses were largely maintained in both groups: 64 percent of cAd3-EBOZ recipients and 80 percent of rVSV-ZEBOV recipients had an antibody response compared with seven percent of placebo recipients.

Some participants who received the investigational vaccines experienced mild to moderate side effects that resolved, such as a headache, muscle pain, feverishness and fatigue. Overall, researchers did not identify any major safety concerns related to the vaccines. Most of the serious medical issues reported during the trial were due to malaria.

At the beginning of the trial investigators found that four percent of participants already had a certain threshold of Ebola antibodies indicative of past Ebola infection – but no known history of Ebola virus disease.

Researchers also found unexpectedly that the proportion of participants developing malaria by one year was lower for participants who received the investigational vaccines as compared with those receiving placebo, particularly among the rVSV-ZEBOV recipients. Future studies are needed to determine if this is a chance finding or if it has some significance related to cross-reactive immunity.

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Hypertension high in Kerala, low in Bihar’

According to the study, titled ‘Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidaemia in Urban Men and Women’, non-communicable diseases (NCDs) have become a growing threat to global health. The study assessed the diet and nutritional status of India’s urban population.

The survey was carried out by the National Nutrition Monitoring Bureau during 2015-16 by researchers from the National Institute of Nutrition.

The study has brought to light the prevalence rates for non-communicable diseases as well as stunting, under-nutrition and obesity in children under 5 years in the 16 States surveyed.

Non-communicable diseases (NCDs) have become a growing threat to global health. The increase in the incidence of NCDs can be attributed to a change in food habits, sedentary behaviour and unhealthy lifestyles, among other risk factors.

Kerala has the highest prevalence of hypertension as well as high cholesterol in urban men and women. Puducherry tops the list of States with the highest prevalence of diabetes. Diabetics were the highest in the age group of 60-70 and lowest in the age group of 18-30.

The southern States were among the 10 with the highest prevalence of obesity among urban adults. Puducherry topped with almost 60% women and 42% men being overweight.

Tamil Nadu was close behind with 54% men and 38% women recorded as obese. Kerala, Karnataka and Andhra Pradesh recorded high levels of obesity among its urban men and women.

Tamil Nadu, Karnataka, Andhra Pradesh and Kerala were among the top six States which had the most tobacco smokers among urban men.
While U.P. had the highest (43.6%) proportion of underweight children followed by Madhya Pradesh (32.3%), Puducherry had the lowest (14.2%).

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