LEPROSY makes a comeback in India

Between April and Dec 2018, 362 cases of leprosy were detected in Mumbai. In the last 5 years, the city recorded nearly 2500 new cases, and total 10,000 cases since its elimination in 2005.

 

Nearly 14 years after leprosy was eliminated from India, lakhs of persons continue to be infected with the bacterial infection, known to affect the skin and peripheral nerves and in advanced stages cause deformity and disfigurement. In 2017-18, an estimated 1.26 lakh people were detected with leprosy in India,home to 60% of the world's new cases. Almost 50% of the new cases are  multibacillary, and nearly 40% afflicted are women. At least 12,000 (8-9%) of the infected are children. Bihar, UP and Maharashtra account for more than a third of the country's new detections. These states record anything between 12,000 to 16,000 cases annually. They are followed by states like West Bengal, Odisha and Chhattisgarh. prosy with deformity indicates we are missing early diagnosis, and infection in children...both are bad news if we are looking at eradication

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Leprosy is...

• Caused by mycobacterium leprae

• 100% curable. Bacilli has incubation period of 3-6 years

• Infected people don't feel pain as no toxins are produced

• Disease affects nerves

• If not treated early, can lead to deformities

Leprosy is transmitted by...

• Healthy person breathes droplets containing bacteria

• Prolonged, close contact with someone with untreated leprosy

• 95% people are naturally immune

Leprosy does not spread

• By shaking hands or hugging

• Sitting next to an infected person on a bus or train

• Sitting together for a meal

Leprosy can be prevented by

• Early diagnosis, treatment of infected people

• Preventive doses available for households with infected people

• Annual examinations recommended for at least five years

Leprosy cases worldwide in 2017

• Southeast Asia - 153,487

• Americas - 29,101

• Africa - 20,416

• Western Pacific - 4,084

• Eastern Mediterranean - 3,550

• Europe 33

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Migration is one of the biggest challenges in leprosy...It makes it difficult to trace the index case as well as follow-up with patients. "Migration is one of the biggest challenges in leprosy, like in any health programme. It makes it difficult to trace the index case as well as follow-up with patients," said Dr Raju Jotkar, assistant director, Maharashtra's state health services. Around 25 of the 362 cases found in the year 2017-18 in Mumbai were from Bainganwadi alone. “Till leprosy is wiped out from places like Baiganwadi, Mumbai can never eradicate the disease as the infection will continue to travel,” said Swapnadip Jadhav, programme coordinator at LSS. He says the slums have hundreds of people moving in every day. “Even if you screen the entire population today, there will be new residents tomorrow. It's a vicious cycle.”In several instances, leprosy has also been found to infect multiple members from a single household, a phenomenon normally associated with more virulent communicable diseases such as tuberculosis or chicken pox.

Leprosy on rise, Bihar may see all-time high of 50,000 new cases in 2018. Health dept says aggressive campaign led to more cases; experts blame poor living conditions.

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Under Leprosy Case Detection Campaign (LCDC) of the National Leprosy Eradication Programme (NLEP), funded jointly by the Centre and the state government, all people from Scheduled Caste (SC) communities across Bihar's 38 districts approximately 2 crore people were surveyed for leprosy detection between January 9 and 13 in 2018. Although the survey result will be published only in the first week of February, sampling of collections and initial reports indicate nearly 50,000 new leprosy cases, according to Dr Bijoy Kumar Pandey, additional director (headquarters), health services, and state programme officer for leprosy.If that projection turns out to be true, it will be an all-time high detection of new leprosy cases in the state.

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Poor living conditions lead to leprosy cases in SC households

More leprosy cases are emerging among people from SC communities in districts bordering Jharkhand and West Bengal due to their poor living conditions, according to officials. In 2017-18, 15 out of Bihar's 38 districts showed a prevalence rate of more than 1 per 10,000. Banka, for instance, reported prevalence rate of 3.40 - 1,457 new cases, including 779 women, were detected in the district. Of these, 248 infected people are from SC and 79 from ST communities. The main cause of concern, according to experts, was detection of 488 multibacillary MB) cases, which can cause deformity. Fifty-four cases Grade II deformity were found. Supaul district reported a prevalence rate of 3.07, followed by Jamui (2.64).

“It is a projected figure based on initial findings of the survey. We decided to conduct the survey after our first pilot project of 12,500 SC people in Samastipur, Motihari and Munger (districts) early this year yielded 125 new cases,” said Dr Pandey, who plans to survey the entire population of the state in the next financial year.

Leprosy cases in Bihar had a prevalence rate of 0.79 (cases per 10,000 people) in 2015-16 with detection of 16,185 new cases. In 2016-17, that prevalence rate went up to 1.10 with 21,818 cases, and to 1.18 (21,353 new cases) in 2017-18.

People on the ground - accredited social health activist (ASHA) workers, volunteers and specialist doctors - attribute this rise to a variety of factors: unhygienic living condition, too many people living in one room and sharing the bed, and a more active search and increased level of awareness, among others. Sandhya Devi, an ASHA worker in Naubatpur town, about 25 km from state capital Patna, where several new cases were detected in the recent round of survey, said, “If any patch or mark on the body is not congenital and does not hurt and give sensation after being pinched or pricked, it could be signs of leprosy.”

The percentage of children among the cases detected across the state was 14.20 in 2015- 16, 13.70 in 2016-17, and 12.56 in 2017-18, it was informed. Dr R K Singh, who has attended to several leprosy patients in Hajipur district, said, “One obvious reason leprosy cases are going up in Bihar is the lack of single-dose rifampicin (SDR) programme for people living in close contact of an affected patient. Lack of sanitation and general awareness of hygiene are the other reasons.”

An official associated with NLEP said lack of infrastructure is also a hurdle in the way of monitoring cases. “In some districts, such as Gopalganj, there is no NLEP staff. One non- medical staff has to look after several primary health centres (PHCs),” the official said. “Posts of leprosy consultant and physiotherapist remain vacant. Very few vacancies out of the sanctioned 434 paramedical workers have been filled. We have to depend on ASHA workers and other volunteers. We get technical assistance from four NGOs: NLR India, The Leprosy Mission, DFIT and Lepra Society.

Dr Pandey, the state programme officer (SPO) for leprosy, however, said it should not be called a rise in the number of cases. The increased numbers, he said, is due to the “active search undertaken by our sustained campaign, especially after launch of LCDC in 2015-16. We take entire Bihar as endemic.”Asked why cases are going up despite a sustained NLEP, Dr Pandey said, “Maybe 20 per cent population was not covered under the previous survey. The people not covered could have been from SC communities.”

In the case of leprosy, though, what is worrying is that it is seeing transmission into newer areas. And that's not the only scary part. In the fresh detections, 63% were multibacillary cases, meaning the person had more than five patches, indicative of the disease's advanced stage. Another sign of missed or late detection is deformities -- 11% of the cases had some deformity at the time of diagnosis. Worryingly, 12% of the freshly infected were children. A microanalysis shows the city is detecting cases from every nook and corner.

10% of Indian patients develop pure neural leprosy, where there are no external signs such as skin patches or nodules. Dr Pai says such manifestation is typical to India. For instance, UP native Sheikh Mohammed (33), who works at a meat shop in Chembur, was perplexed when he couldn't grip things with his right hand. “The mug would slip out of my hand while bathing. I struggled to tear chapati or button my shirt. Gradually, I realised my right hand couldn't feel heat, burns or cold,” he said. The shop owner removed him from the job of cutting meat fearing that Sheikh may hurt himself and not feel a thing. It was only after he developed clawed fingers that a doctor suspected leprosy. Pai added that to detect such presentations swiftly there has to be a paradigm shift in training doctors, nurses, community workers, who may not look beyond the obvious external signs.

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Leprosy Has Been Curable Since 1980, Don't Treat Leprosy Survivors As Disabled Persons : SC

The Supreme Court in July,2018 recommended that the Union of India, as well as the states, take steps to repeal such provisions of legislations that represent leprosy as being non- curable and contagious. Hearing two PILs praying for statutes which attach a stigma with leprosy, ultimately resulting in a disability, to be declared as being violative of Articles 14, 19(1)(b) and 21, a bench of Chief Justice Dipak Misra, Justice AM Khanwilkar and Justice DY Chandrachud issued a slew of directions.

That the Union of India in the Department of Health and other departments concerned carry out awareness campaigns so as to sensitize the public about its curability and non-contagiousness; That a separate wing be created to expand the sphere of awareness and authorities concerned may be nominated for the said duties;
 

• That specific programmes be aired on All India Radio and Doordarshan at the Central and state level and the regional channels so as to educate the public that leprosy is non-communicable; 

• That the programme be displayed at an appropriate time so that the majority of people may watch That hospitals shall not refuse treatment and to administer the first injection under the Multi-Drug Therapy. It has to be remembered that a person has a right to health and to obtain treatment at government hospitals; That there must be a holistic approach to awareness and the campaigns shall extend from the urban areas to the Panchayat level; 

• That the state government shall take steps for the rehabilitation of persons who are suffering or have suffered from leprosy, it shall be the primary duty of the state to see that these people do not suffer from any kind of stigma.

The Apex court bench proceeded to appreciate the order dated November 28, 2014, in Pankaj Sinha v UOI- “...this is a cause which can be taken on a priority basis by the States, for what has been agitated before us is that the leprosy, as on today, is curable. Yet, because of apathy shown by the concerned authorities, it still remains a stigmatic disease in the society. It is inconceivable as it affects the human dignity and the basic concept of humanness.” “There is no doubt that a person suffering from leprosy also has a right to live with dignity...after he has been cured totally, there is no need to treat him as disabled person...it has to be understood in today's context and the sufferer of a curable disease may not be treated in a stigmatic manner...no person can be denuded of humanness and cannot be treated as an 'unperson'...there has to be a social awakening...sympathy from the concerned authorities and then the members of the society must acknowledge and accept that they deserve to be treated with equality...,” observed the bench. Chief Justice Misra remarked, “Leprosy has been curable since 1980...the laws should be declared unconstitutional by now......”

 

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Leprosy & Divorce

A bill seeking to remove leprosy as a ground for divorce was passed by Lok Sabha on Jan 7, 2019. It sought to remove leprosy as a ground for divorce in 5 personal laws - Hindu Marriage Act, Dissolution of Muslim Marriages Act, Divorce Act (for Christians), Special Marriage Act and Hindu Adoptions and Maintenance Act - since the disease is curable.

 

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Poor care for lower back pain -scans, painkillers &mismanagement leads to disability,low productivity nd poor quality of life

Iron-deficiency anaemia, migraine and other musculo-skeletal conditions (that include everything other than osteoarthritis and rheumatoid arthritis) are the top three causes of disability in India, according to the Lancet series author and now, low back pain has become the fourth highest cause of disability. World wide Low back pain affects 540 million people and is the leading cause of disability and too many patients receive the wrong care. Evidence suggests that low back pain should be managed in primary care, with the first line of treatment being education and advice to keep active and at work. The Lancet series highlights “However, in reality, a high proportion of patients worldwide are treated in emergency departments, encouraged to rest and stop work, are commonly referred for scans or surgery or prescribed painkillers including opioids, which are discouraged for treating low back pain,” .

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The series also reviewed evidence from high- and low-income countries that suggests that many of the mistakes of high-income countries are already well established in low-income and middle-income countries. Low back pain results in 2.6 million emergency visits in the US each year, with high rates of opioid prescription. In India, studies suggest that bed rest is frequently recommended, and a study in South Africa found that 90% of patients received pain medicine as their only form of treatment, the series has highlighted. “India was no different from the rest of the world. Indian clinicians manage back pain just as poorly as the rest of the world. For instance a 2008 survey of all 186 registered physiotherapists in Maharashtra showed that 46% advised patients with low back pain to rest. 63% of Indians believe that bed rest is the mainstay of therapy. This is a misconception as bed rest delays recovery,”.

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Imaging for low back pain also seems to be highly prevalent in several low-income and middle-income countries, including India. A study in 2008-10 showed that among 251 patients with chronic low back pain reviewed in an Indian orthopaedic clinic, all underwent imaging, with 76% diagnosed with non-specific low back pain and 10% with spondylosis. “Most people do not need imaging. It can be harmful including radiation, anxiety as well as risks increased use of unnecessary tests and treatments which might also be harmful,”. In terms of burden of low back and neck pain in India — it accounts for almost 7% of years lived with disability. This is the extent to which the condition is mistreated, often against best practice treatment guidelines.

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The Global Burden of Disease study (2017) found that low back pain is the leading cause of disability in almost all high-income countries as well as in many regions. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Dr Arvind Chopra, director of the Centre for Rheumatic Diseases, Pune, and senior research professor at SRM Medical College, Chennai, said that in the WHO community programme for control of rheumatic diseases, an India survey of 56,546 persons from 11 sites found the prevalence of back pain at 7%, and 13% among those aged over 65. “This would mean that millions of Indians suffer from back pain which leads to disability, low productivity and poor quality of life,” he said.

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Landmark Pune study on diabetes begins testing the third generation

Thin Indian babies ‘fatter’ than European babies and are at greater risk of diabetes: A study carried out by Chittaranjan Yajnik, head of the Diabetes Research Centre at KEM Hospital and followed up for long 25 years in three generations.

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This landmark research led by Dr. Yajnik’s team to embark upon the Pune Maternal Nutrition Study launched in Twenty five years ago in the year 1993 and being last followed up in December, 2017 has helped in explaining why diabetes was so widely prevalent in India, even among malnourished populations, when, globally, the disease was very commonly associated with obesity. “We showed that the ‘small and thin’ Indian babies were ‘fatter’ than the Europid babies and the risk of future diabetes was present at birth itself. Evidence also showed that the role of maternal micronutrient nutrition for the baby’s growth was crucial,” Yajnik told. Twenty five years later, it has led to pioneering ideas in the field of fetal programming.

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The first stage of the study that began in 1993 included 814 women from six villages in Pune district. Between 1994 and 1996, a total of 770 of these women delivered babies. The weight and size of these babies were monitored every six months. Their insulin resistance was observed at the age of six, 12 and 18 years. These children were followed up by social workers who ensured that they did not drop out of the study. The observations showed that children born to mothers with high homocysteine and low vitamin B12 levels had lower birth-weight and higher insulin resistance.

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By 2012, the research team had been following up on 577 children born to the mothers of the 1993 cohort. They started providing them Vitamin B12 supplements in order to reduce the future diabetes risk in their own offspring. Till December 2017, 107 of this group of 577 had given birth to children, forming the third generation of subjects under observation. The newly born babies will now be studied for various metabolic parameters as the researchers have stored the babies’ cord blood, placenta and other samples at the unique bio-bank. The researchers are waiting for this third-generation sample size to grow up to 200 before doing data analysis.

The Yajnik’s Centre has been successful in monitoring three generations so far, retained the study participants, got consent from the in-laws after the girls got married to continue in the study and now their babies will be assessed. Dietary patterns are being analysed and other physical changes are being documented. Counselling is provided for each participant and after a total of 200 deliveries the data will be further analysed. There has been more than 90 per cent follow-up rates which documented the nutritional and socioeconomic transition in the society. The unique bio-bank has samples stored for measurements of DNA, RNA, metabolites, hormones, and so on. This will be a unique legacy for future investigators.

Yajnik’s centre now collaborates with researchers Indian Institute of Science Education and Research (IISER) in Pune, Centre for Cellular and Molecular Biology (CCMB) in Hyderabad and Indian Institute of Science (IISc) in Bangalore.

These findings can have important implications in controlling diabetes and heart disease epidemic in the country.

 

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In India, six per cent have diabetes, 20-25 per cent hypertension

A study led by researchers at Harvard TH Chan School of Public Health has found hypertension more prevalent among young adults in India than previously thought, and rates of diabetes and hypertension among middle-aged and elderly people high across all geographical areas and socio demographic groups. Described by the authors as the first nationally representative study of these conditions, it was published online in JAMA Internal Medicine. It looked at health data, which included plasma glucose and blood pressure measurements, from 1.32 million adults in 27 states (except Gujarat and J&K) and five UTs between 2012 and 2014.

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Standardised for age, diabetes prevalence in India was 6.1% among women and 6.5% among men; for hypertension, it was 20% among women and 24.5% among men. For comparison, the paper cites corresponding estimates for prevalence in the US — for diabetes, 6.4% among women and 8.1% among men; for hypertension, 10.8% among women and 15.5% among men. The prevalence of both conditions among middle-aged adults in the poorest households in rural areas, too, was high (5.9% had diabetes and 30% had hypertension), contrary to the perception that these are conditions affecting the city wealthy.

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Diabetes was most prevalent in Andhra Pradesh, Goa, Karnataka, Kerala, Tamil Nadu, Delhi and West Bengal. The hypertension prevalence tended to be highest in Punjab, Himachal Pradesh, Kerala, Sikkim and Nagaland. The prevalence of diabetes varied from 2.33% among women in Madhya Pradesh to 17.90% among men in Goa. Hypertension was higher among adults under 45 but common even among younger groups — for example, at 12.1% in age group 18-25.

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Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services. This study is the latest reaffirmation of India’s dual burden of rising non communicable diseases and continuing communicable diseases. India has a window of opportunity to invest in its health system to effectively tackle hypertension and diabetes — both major killers. The potential for harnessing new technologies to reverse the course of these epidemics is real. However, because the epidemics are worsening rapidly, now is the time for immediate action. The diagnosis of hypertension and diabetes is straightforward, but mostly gets untapped due lack of awareness and regular medical checkups. There is urgent need to focus on these two silent killers as well as other non communicable diseases to reduce the burden of preventable premature morbidity and mortality. If unchecked, we will see a lot more victims of these two diseases in next two decades.

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India ranks 145th among 195 countries in healthcare, disparity among states

India ranks a lowly 145th among 195 countries in terms of healthcare access and quality in 2016, as assessed in a Global Burden of Disease study published in The Lancet. The study used an index based on 32 causes of death that should be preventable with effective medical care. Each country was given a healthcare access and quality (HAQ) score between 0-100. India’s HAQ score is 41.2, up from 24.7 in 1990. For the first time, the study also analysed healthcare access and quality between regions of seven countries including India. China and India had the widest disparities of 43.5 and 30.8 points, respectively, while Japan had the narrowest of 4.8 points. In India, the 30.8-point difference marks an increase in disparity from 23.4 points in 1990. Goa and Kerala had the highest scores in 2016, both over 60, whereas Assam and Uttar Pradesh had the lowest, both below 40.

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While India has seen improvements since 1990, its HAQ score was lower than 50 for 23 of the 32 causes of death. Particularly low were scores like 12 for skin cancer, 24 for neonatal deaths and adverse medical treatment, and 30 for tuberculosis and chronic kidney ailments which is really disappointing – well behind BRICS countries. India’s low score in TB is because it is often missed by practitioners, and MDR-TB is diagnosed very late. In the public system, patients are lost along the entire care cascade, and this means only 1 in 2 TB patients make it to the finish line. With MDR-TB, only 1 in 5 patients cross the finish line and successfully complete therapy. All this makes for a poor HAQ score. The bottom line, simply focusing on coverage of TB services is not enough. We need to also improve quality of TB care, in both private and public sectors. 

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The reason for India’s poor show is also due to low density of health workers in the poorly performing states. For instance, the Janani Suraksha Yojana has registered a rise in the number of institutional deliveries, however there is no demonstrable correlation with lowering of maternal mortality in certain states. This scorecard clearly shows that the health system is weak and while centrally funded schemes have provided health access in some areas, quality has not improved in certain states.

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Why 77% of the elderly in Delhi don't report abuse

A survey on the abuse faced by the elderly in the capital highlighted that most victims do not report the matter to authorities concerned because of the taboo associated with the issue, often citing it as a “confidential family matter”. While at least 33% of 218 respondents in Delhi — which was among the top five cities with highest incidents of elderly abuse —have experienced some form of abuse. Only 0.5% of them said they had availed benefits available to them under Maintenance and Welfare of Parents and Senior Citizens Act that makes it legally binding for children and heirs to provide maintenance to senior citizens.
 

The most striking feature of the report was that the respondents had been facing abuse for the last six years but 77% of the participants did not report it, thinking of it as a “confidential family matter”. Other reasons included lack of awareness of the process of reporting the abuse, fear of “retaliation” or “lack of confidence” in themselves or agencies dealing with abuse, including police helplines and MWPSC tribunals. The study states that while verbal abuse (58%), disrespect (48%), neglect (34%), economic exploitation (11%) and even physical violence (10%) remained the top factors contributing to abuse, social media and technology have widened the generation gap between senior citizens and their children, leading to further alienation. The primary perpetrators of the abuse were sons (62%), followed by daughter-in-law (44%), spouse or partner (11%) and grandchildren (7%).

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Delhi: AIIMS explores link between yoga and mental health

Since there is huge potential for yoga in preventive medicine, 20 different research projects at AIIMS are currently focusing on a yoga-based lifestyle, ranging from its effects on patients with migraine to those with chronic bronchitis to rehabilitation for those who have suffered a stroke.

One such recent study is a result of a five-year research project conducted by the lab for molecular reproduction and genetics at the department of anatomy. Published in Restorative Neurology and Neuroscience in March 2018, the study found that meditation and a yoga-based lifestyle could result in a “decrease in depression severity” and improvement in “systemic biomarkers of neuroplasticity”, and, hence, could be “considered a therapeutic intervention” in the management of depression.

The study, which looked at 236 subjects, saw that the introduction of yoga into lifestyle resulted in a decrease in cortisol, the body’s main stress hormone; increased levels of melatonin, a hormone that regulates sleep and wakefulness; and balanced oxidative stress, a reflection of the body’s ability to detoxify. It also increased serotonin levels — a chemical that nerves produce, a deficiency of which can result in depression —and decreased DNA damage.

“While depression is a global pandemic, not everyone responds to drugs and there are a lot of side-effects. Our research found that after just 12 weeks, there was a reduction in symptoms of depression. This was a randomised controlled trial, where we had two groups — one that took the medicines, and the other which practiced yoga alongside it,” said Dr Rima Dada, author of the study.

Dr Gautam Sharma, professor in charge at the Centre for Integrated Medical Research at AIIMS, said they were conducting 27 clinical trials. “Of the 27, 16 are ongoing trials. For instance, we have a trial looking at the benefits of stress reduction in nurses who are in ICUs… The results from the trials have been encouraging,” said Dr Sharma.

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300 Community Health Centres in UP’s 75 districts to get a psychologist each

The Centre has sanctioned 300 posts for appointment of psychologists in community health centres (CHCs) of Uttar Pradesh to tackle growing cases of mental illness. People living in the rural areas of the state at present have no access to psychologists as only district hospitals have such a facility besides three government mental hospitals in Bareilly, Agra and Varanasi. According to National Mental Health Survey report of 2015-16, families had to spend nearly Rs 1,000-1,500 a month mainly for treatment and travel to access care. The hidden and intangible costs are difficult to monetize and add to this burden, said the report.. It will be now easier to reach out to patients suffering from mental illnesses at the grassroots level and help them.

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A community psychologist appointed for CHC will get a monthly honorarium of Rs 25,000 and he or she should hold a postgraduate degree in clinical psychology or psychology. Those with a masters degree in plain psychology will be first given training before they join any CHC. Community psychologists at CHCs will help in creating awareness and conducting basic diagnosis of mental disorders, including depression, mania, mood disorder, obsessive compulsive disorder and schizophrenia. They can prescribe treatment for mild depression, anxiety and provide counselling for drug and alcohol abuses, tobacco control and marital discord. Even psychiatrists will visit CHCs and psychologists can also refer patients to district hospitals.

Under National Mental Health Programme, UP has set up mental health cells in 45 districts. Each cell has psychiatrists, a clinical psychologist, a social worker and other staff. District mental health cell’s out-patient department (OPD) is functional for three days in a week (Monday, Wednesday and Friday) while the staff visits CHCs on Tuesday and Thursday on a rotational basis. On Saturdays, the staff visits schools to create awareness about mental illness among children. The Centre has now sanctioned mental health cells in remaining 30 districts of the state.

 

The country’s mental healthcare suffers from an acute shortage of staff. Minister of state for health and family welfare Anupriya Patel had recently informed Lok Sabha that there are only 898 psychologists against 20,250 required in the country and less than 900 psychiatric social workers against the 37,000 needed. Also, as of January 2015, there were 3,827 psychiatrists against the 13,500 required in the country. According to the 2011 Census, more than 7.22 lakh people across the country were suffering from “mental illness”, while over 15 lakh were “mentally retarded”. With 76,603 people suffering from some sort of mental illness, Uttar Pradesh has the highest number in the country followed by West Bengal at 71,515, Kerala at 66,915 & Maharashtra at 58,753.

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New evidence for viruses’ role in Alzheimer’s disease

Herpes virus genes found in patients’ brains provide unprecedented evidence for a connection, but the viruses’ exact role remains unclear.

Results of a recent study breathe new life into an old hypothesis: that viruses, herpes viruses in particular, could play a role in Alzheimer's disease. Researchers analysed DNA and RNA sequencing data from brain tissue donated by 622 people who had Alzheimer’s disease and 322 people who didn’t. They found that specific herpes viruses were more abundant in the brains of patients who had Alzheimer’s when they died. For two of the viruses, HHV-6A and HHV-7, the association with Alzheimer’s was particularly strong, even when compared to tissue samples of people with other neurodegenerative diseases. The idea that viruses could somehow be involved in Alzheimer’s isn’t new. Previous studies have examined HSV-1, the virus that causes cold sores, but this evidence was less compelling. “Earlier studies focused on the presence of anti-HSV-1 antibodies, which meant that those with antibodies had encountered HSV-1 at some time during their lives. This new study showed HHV-6 and HHV-7 viral genes in the brains of Alzheimer’s disease patients at the time they died,” explains Sam Gandy, an Alzheimer’s disease specialist at the Ichan School of Medicine at Mount Sinai and one of the study’s senior authors.
 

The researchers also modelled how the viruses’ genes interacted with human genes. “We were surprised to find that expression of a half dozen recognizable Alzheimer's genes was apparently modulated by HHV6/7,” said Gandy, “We tend to think of viral causes and genetic causes separately, but it is possible that viral proteins are acting as transcription factors that turn on Alzheimer’s disease genes.” The study does not suggest that Alzheimer’s disease is contagious. HHV-6A and HHV-7 are extremely common viruses. Nearly everyone above the age of six has at least one of them circulating in their blood. In most cases, the viruses are latent. "There are still a lot of unanswered questions around how we go from being able to detect it circulating in someone's blood to knowing whether it's active in a state that might be relevant to Alzheimer's disease," said Readhead, one of the lead author of the study. "While these findings do potentially open the door for new treatment options to explore in a disease where we've had hundreds of failed trials, they don't change anything that we know about the risk and susceptibility of Alzheimer's disease or our ability to treat it today," said Gandy.

Others in the Alzheimer’s research community are also cautious in their assessments of the study’s significance. David Reynolds, who was not involved in the study, is Chief Scientific Officer at Alzheimer’s Research UK. He points out that the part of the study involving actual human brain tissue does not provide any evidence for cause and effect. Still, Renyolds says the study is an important step forward: “This detailed analysis of human brain tissue takes this research further [than previous studies], indicating a relationship between the viruses and the activity of genes involved in Alzheimer’s, as well as brain changes, molecular signals, and symptoms associated with the disease. This was a well-conducted study, and the authors’ findings were supported by evidence drawn from three independent sources of donated brain tissue.”

More research will be needed to determine why people with Alzheimer’s have more of these herpes viruses in their brains, and what role (if any) they play in the onset and progression of the disease. If scientists can solve these puzzles, they may uncover new ways to treat Alzheimer’s with antiviral medicines. Based on previous studies looking at HSV-1, clinical trials with the antiviral medicine Valtrex are already underway.

Beyond highlighting HHV-6A and HHV-7 as viruses of interest, the new study also demonstrates a promising path to progress in Alzheimer’s research. The researchers drew not only on samples and data from multiple brain banks, but also from cohort studies and raw genetic data. Richard Hodes, Director of the National Institute on Aging, which funded the study, said: “This research highlights the importance of sharing data freely and widely with the research community."

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Is Autism Linked To Food Allergies?

Could there be a link between autism and food allergies? A new study from the University of Iowa suggests one, but researchers are still trying to discover how and why.

 

The study, published in June 2018, found that children with autism are more than twice as likely to experience a food allergy than children who do not have ASD. Researchers analyzed the health information of nearly 200,000 children between the ages of 3 and 17 collected by the U.S. National Health Interview Survey, an annual Centre for Disease Control and Prevention survey of American households. The data covered 1997 to 2016.

 

The study found that 11.25 percent of children reportedly diagnosed with ASD have a food allergy, compared with the 4.25 percent of children who are not diagnosed with ASD and have a food allergy. The findings, researchers said, add to a growing body of research that already suggests immunological problems as a possible risk factor for developing autism. Because the study is observational, though, researchers couldn’t identify a cause-and-effect relationship between food allergies and autism, said Wei Bao, an author of the study and assistant professor of epidemiology at the university. “We don’t know which comes first, food allergy or ASD,” Bao indicated. Previous studies about a possible link between autism and allergies focused mainly on respiratory and skin allergies, and yielded inconclusive results, Bao said.

 

The Iowa study found 18.73 percent of children with ASD also had respiratory allergies, compared with 12.08 percent of children without ASD who had them. It also found that 16.81 percent of children with ASD had skin allergies, compared with 9.84 percent of children without ASD. That suggested to researchers some type of mechanical link between the two. But more study will be needed to understand how allergies and autism, both on the rise, could be connected, paediatric allergist Scott H. Sicherer at the Icahn School of Medicine at Mount Sinai in New York, told the American Journal of Managed Care. “I wouldn’t want people to misinterpret this to say that a food allergy is causing autism,” nor should children with ASD be routinely screened for food allergies, Sicherer told the Journal.

 

One issue: Parents of children with autism might report their children have a food allergy, but it’s not always possible to know whether it’s really an allergy or simply a behavioural preference, Sicherer said. Still, Thomas Frazier, chief science officer for the advocacy group Autism Speaks, told Health Day News that parents and physicians need to be aware “of the increased prevalence and ensure that individuals receive appropriate evaluation for allergies with subsequent treatment. “This is particularly true for very young children and nonverbal or minimally verbal children who may not be able to express to parents or providers the effects of allergies.” The findings suggest allergies could be a contributing factor to challenging behaviours, such as irritability and mood shifts, in people with autism.

 

The study, “Association of Food Allergy and Other Allergic Conditions with Autism Spectrum Disorder in Children,” was published in JAMA Network Open.

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Bill proposes affordable treatment to Autism-affected

The Autism Spectrum Disorders (Recognition and Treatment) Bill, 2017 proposes that treatment of ASD including counselling, therapeutic sessions and rehabilitative care shall be provided free of cost at public health centres.

 

Autism Spectrum Disorders refer to an umbrella group of developmental disorders, resulting from a delay in the maturation of the central nervous system. The Bill is aimed at recognising the rights of individuals suffering from autism spectrum disorders and making its treatment accessible and affordable.. At the same time, state governments shall recruit more mental health care professionals in public hospitals to maintain the doctor-patient ratio. i.e. at least a doctor for every 40 patients suffering from ASD, it says. The proposed legislation also says that the central government shall provide funds for medical research, which will ascertain the causes of ASD & other developmental disorders. In majority of the cases, ASDs manifest themselves in children below 1 year. "The government can mitigate the incidence of ASDs through many measures such as encouraging screening of pregnant women and ensuring that they get their vaccination and maintain their haemoglobin levels,".

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AIIMS, RML doctors delve into effects of yoga on migraine and schizophrenia

Studies done by AIIMS and RML indicate that the ancient Indian discipline can improve cognitive functions in a person suffering from mental disorder and can be an add-on therapy to reduce migraine attacks. Yoga can improve cognitive functions in a person suffering from mental disorder and can be an add-on therapy to reduce migraine attacks, two separate studies by top hospitals in the city indicate. Research at RML Hospital suggests that mentally ill persons could benefit from simple yoga exercises if these are incorporated into their treatment regimens. This cognitive improvement may help them in their rehabilitation and adjustment in society.

 

The study has now been published in the Journal of Acta Neuropsychiatric, was sponsored by National Institute of Health (NIH), United States. Researchers across the world have been trying to determine the effectiveness of the ancient Indian discipline as a complementary intervention for conditions such as cancer, schizophrenia, asthma, and heart disease.  Dr Triptish Bhatia, principal investigator of Indo-US projects at the Department of Psychiatry, RML Hospital, told MAILTODAY, "This was a random study on 286 patients with schizophrenia admitted at RML. It was done to evaluate whether yoga training or any type of physical training enhance cognitive functions in schizophrenia." Patients above 18 years who attended RML psychiatry clinics from 2010 to 2014 were included. "The results confirmed greater improvement in the speed index of 'attention cognitive domain' after yoga therapy in individuals with schizophrenia than physical exercise at six months followup," said Dr Bhatia.

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YOGA CAN BE CONSIDERED COGNITIVE ENHANCEMENT THERAPY

 

Dr Smita Deshpande, head, psychiatry department, RML Hospital, added impaired cognition is a hallmark of schizophrenia. "Current pharmacologic treatments produce improvement in psychotic symptoms, but do not improve cognitive impairments substantially. As yoga includes mindfulness training and physical exercise, it can also be considered cognitive enhancement therapy (CET)."

 

While yoga therapy improved "attention domain" among patients with schizophrenia, it showed good improvement in cognitive domain such as abstraction and mental flexibility, face memory, spatial memory, spatial ability, working memory, sensorimotor, emotions among such patients. These cognitive functions were assessed with the University of Pennsylvania's computerised neurocognitive battery (CNB). Patients were on mediation and also practising yoga every day. Firstly, cognitive parameters were evaluated on 21 days and they showed improvement. With the same figures accessed on CNB, doctors evaluated their cognitive domain at the third month, which again showed much improvement, and at the end of sixth month, there was greater improvement in yoga following patients. Dr Randeep Guleria from AIIMS said yoga was found to be as effective as standard pulmonary rehabilitation in improving dyspnoea, inflammatory markers and chronic obstructive pulmonary disease. "We are studying 160 patients with migraine who are following yoga practice along with medicine. Right now, what we can hypothesise is that yoga can be an add-on therapy to reduce migraine attacks as the relaxation techniques are believed to have a positive impact on certain chemicals in the body and brain," Dr Rohit Bhatia, neurologist at AIIMS, told MAIL TODAY.

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Over 300 Million People Suffer From Depression Globally: WHO

Depression is characterised by persistent sadness and a loss of interest in everyday activities and work. Depression is now the leading cause of ill health and disability worldwide with more than 300 million people suffering from it, the World Health Organization (WHO) said ahead of World Health Day.

Rates of depression have risen by more than 18 per cent since 2005, but a lack of support for the mental health combined with a common fear of stigma means many don't get the treatment they need to live healthy, productive lives. "These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency it deserves," WHO Director-General Margaret Chan said. The report further indicated that the declining mental health has been a major cause of suicides, especially in the low and middle-income countries.  The figures were far from being a relief even closer home, it stated that more than five crore Indians suffered from depression in 2015, and over three crore dealt with anxiety disorders. Latest estimates from WHO show that by 2030, depression will be the leading cause of disability worldwide, drawing attention to the fact that immediate measures must be taken by all countries to address depression and prevent it. The WHO is running a mental health campaign to tackle stigma and misconceptions. "For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery," said Shekhar Saxena, director of the WHO's mental health department.

Depression is a mental disorder where the person suffers from prolonged period of sadness, which disrupts not just their mood but daily activities as well. Patients find it even difficult to wake up and get out of bed in the morning. You can also notice visible changes in the person's behaviour, feelings and sense of well-being. We all feel low sometimes, but this negative state of being can trigger suicidal tendencies and various health problems like diabetes and heart disease, which are themselves among the world's biggest killers . As we go about with our day, we often fail to realise that some of our silly habits can be putting us at risk of depression. After all, our lifestyle choices play a big role for our overall health, and sedentary lifestyle or unhealthy habits can lead to the onset of various ailments in the long run.

The WHO expressed concern that in many countries there is little or no support for people with mental health disorders, and said only around half of people with depression get treatment in wealthier nations. On an average just three per cent of government health budget is spent on mental health, varying from less than one per cent in poor countries to five percent in affluent ones, according to the WHO. "A better understanding of depression and how it can be treated ... is just the beginning," said Mr Saxena. "What needs to follow is sustained scale-up of mental health services accessible to everyone, even the most remote populations."

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Here are some habits we need to We Need to Cut Down Today

1. Binge Eating

When the hunger pangs kick in, some of us just lose control and go on a binge eating spree, savouring pizzas with extra cheese, king-size burgers and fries, sugar loaded beverages, etc. Binge eating doesn't just add extra kilos around your belly, but may put you at depression risk, says a study. Binge eating episodes lead to obesity which, in turn, causes depression owing to weight stigma, poor self-esteem and reduced mobility.

 

2. Taking Stress

The hectic lives we lead today, stress is almost inevitable. But is comes with severe health consequences. Serotonin is a chemical compound in the body, which is popularly referred to as the happiness hormone. It plays a significant role in a person's mental and psychological well-being. Due to stress, the level of serotonin secretion could reduce, contributing to the development of depression.

 

3. Internet Addiction

According to a study done by McMaster University in Canada, excessive use of internet may significantly increase the risk of mental health problems such as depression and anxiety, especially among college-going students. The findings showed that individuals with internet addiction had more trouble dealing with their day-to-day activities, including life at home, at work/school and in social settings.

 

4. Daytime Sleepiness

We have all been found guilty of being drowsy in the middle of the day, despite a good night's sleep. While you may think it has much to do with your body's need for a caffeine boost, in reality it could also indicate obesity and depression. A common symptom of depression is improper sleep. Physiological sleep disturbances, including taking longer to fall asleep and waking up in the middle of the night, explains daytime drowsiness in people undergoing depression.

 

5. Fatty Foods

Let's admit it. We love fried and fatty foods knowing very well that they are harmful for health. The thought of biting into samosas, French fries, greasy burgers, and cheesy pizzas make our mouth water instantly, but let's not give into temptation. In a study done by researchers at the Louisiana State University, they found that a high-fat diet can alter behaviour and produce signs of brain inflammation. Further, it may also increase the risk for depression and other psychiatric disorders.

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6. Lack of Exercise

The importance of physical activities for our well-being is not a new thing. A few minutes of walking, jogging or dancing and other activities can charge you up instantly, releasing those happy hormones. The more tied up we get with our work, giving into stress and letting go of exercise, we put ourselves at risk of various health issues, including mental diseases.

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Differently-abled category kids shine

As many as 3,335 students from the differently-abled category passed their CBSE Class X exam this year, bringing the pass percentage to 95.18%.The category included visually impaired, hearing impaired, orthopaedic impaired, spastic, dyslexic and autistic students, among others. The number of orthopaedically impaired students was bigger compared to others with different disabilities.

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Unnat Dave, who has cerebral palsy, did not let anything come in his way of success. The bright student of Rajhans Vidyalaya in Andheri scored 93.1%. "I never faced any problem while preparing for my board exams. I used to go for my physiotherapy sessions everyday. So after school hours, I wasn't left with much time to study. I tried to make full use of the time I got to study and my tuition teacher was also very dedicated. My school also cooperated and supported me throughout the year. I am planning to go for the engineering stream."

Nimilika Puppala, a differently-abled student from Rajhans Vidyalaya, has secured 8.8 CGPA in her CBSE examination. Her parents and teachers were very happy with her performance. Puppala has autism, which makes it difficult for her to have social interactions. She never took any tuition classes. "I like writing poems and stories in Marathi and English. Language is not an issue for me, though many people have this misconception about my disorder. I aspire to become a writer. My grandmother has always supported me and she helped me score this much."

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Visually Impaired Girl Cracks UPSC in First Attempt. Will Become IAS Officer.

She could not see with her eyes but that did not stop her from visualizing a dream and working hard to make it come true. Pranjal Patil, a 26-year-old visually-impaired Ulhasnagar resident, cleared the Union Public Service Commission (UPSC) exams in 2016, getting an All-India ranking of 773.

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Pranjal was just 6 years old when a student in her class hit one of her eyes with a pencil. After this, Pranjal lost vision in this eye. Doctors warned her parents that she might soon lose vision in the other eye too. And unfortunately, the warning proved to be right just after a year. But her parents never let her blindness come in the way of her education. They sent Pranjal to Smt. Kamla Mehta School for the Blind in Dadar, Mumbai. After passing Class 10 with flying colours, Pranjal also secured 85% in Class 12 and stood first in the Arts section of Chandibai College. After this, she took admission in St. Xaviers College, Mumbai to do B.A. After finishing her graduation, Pranjal did her MA from JNU, Delhi. Pranjal started preparing for UPSC in 2015, along with pursuing her degree in MPhil. Technology played a big role here. She installed software called Job Access with Speech (JAWS), a computer screen reader program that allows blind and visually impaired users to read the screen either with a text-to-speech output or with a Refreshable Braille display.She used to get the books, get them scanned and then use JAWS to listen to them. She couldn’t use those hand-written notes which saves time as JAWS only reads printed documents. Her next challenge was to find a writer who could match her speed. And Vidushi was the perfect answer. The main exam paper is three hours long. People who have to write it with the help of a writer get four hours to finish. She had perfect tuning with Vidushi. Although Pranjal does not know as yet where she will be posted, this brave lady is full of determination and wants to be an inspiring officer. She believes every single individual is important for the betterment of the nation. “Success doesn’t give inspiration; the struggle behind success gives you the inspiration. But success is important because only then people will be interested to know your struggle. The attitude and the approach to do something matters and each individual can become a building block for a beautiful society,” she concludes. We wish a great future for this brave girl.

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