Threat of Superinfections looms over India

Threat of Superinfections looms over India

The incidence of drug-resistance has increased manifolds in the country due to uncontrolled prescriptions and the misuse of antibiotics

Manzoor-ul-Hassan

India is facing a threat of Superinfections due to the growth of drug-resistant bacteria among its population following the rampant misuse of antibiotics.

Doctors have warned that if the problem is not tackled it will lead to a serious ‘drug-resistant’ pandemic in the country.

“If the misuse of antibiotics goes unabated we will be left with no alternative for the treatment of different infections,” said Dr. Ajay Kumar, a leading Gastroenterologist.

He said self-medication must end and chemists shouldn’t be allowed to sell antibiotics without prescription, which is otherwise going on rampantly.

Dr. Kumar, who is also the HOD at the Institute for Digestive and Liver Diseases at BLK Hospital, said the drug misuse was going on at every level, be a private clinic or government hospital.

It has also given rise to serious infections related to the digestive system, he said.

“The unnecessary antibiotic use creates a serious impact on our gut as it becomes vulnerable. Bacteria gets favorable hygiene which leads to Superinfections, like an infection of the colon called Clostridium difficile,” he told Health Wire.

According to him, the overuse of antibiotics will make infections untreatable leading to thousands of deaths.

Superinfections are the unusual infections which are unrelated to the first infection for which the antibiotic was originally taken, as per Dr. Kumar.

“The second infection emerges due to the unnecessary antibiotic treatment because it disturbs the normal microbiota in the body. Imbalance in the microbiota which stays there for a long time following treatment leads to drug resistance,” he explains.

As per National Center for Biotechnology Information (NCBI), U.S National Library of Medicines when the gut microbiota is reduced, it provides an opportunity for pathogenic microbes to grow and potentially cause a new infection, called superinfection.

“The microbes can come from a person’s own microbiome or from the outside environment. The risk for superinfections is higher when using broad-spectrum antibiotics, as compared to narrow-spectrum antibiotics affecting a smaller number of bacteria. Further, the long duration of antibiotic treatment, immunosuppression and poor health status of the patient increases the risk. Superinfections range from mild infections, that do not need further treatment to very severe infections that can lead to death,” said one of the NCBI studies.

Although the government of India has introduced the National Action Plan on Antimicrobial Resistance its implementation remains a challenge.

The government’s action plan aims to control and contain antimicrobial resistance through a multi-thronged approach. However, the multidisciplinary plan is a daunting task and requires proper implementation.

“Antimicrobial resistance is a serious threat to global public health that requires action across all government sectors and society and is driven by many interconnected factors. Single, isolated interventions have limited impact and coordinated action is required to minimize the emergence and spread of antimicrobial resistance,” said JP Nadda, Minister of Health and Family Welfare at the ‘Inter-Ministerial Consultation on AMR containment’ while introducing the action plan.

The document is based on the National Health Policy 2017 which highlights the problem of antimicrobial resistance and calls for a rapid standardization of guidelines regarding antibiotic use, limiting the use of antibiotics as over-the-counter medications, banning or restricting the use of antibiotics as growth promoters in animal livestock, and pharmacovigilance including prescription audits inclusive of antibiotic usage – in the hospital and community.

In addition, the ministry also identified AMR as one of the top 10 priorities for its collaborative work with WHO for 2018–2019.

Public health experts suggested some tough and long term measures to bring the change.

“The action plan requires strong policy decision and huge public awareness so that people don’t take antibiotics unnecessarily,” Dr. Kumar said adding that use of antibiotic should be put in schedule X of the Drug and Cosmetic Act so that these can’t be given over the counter without a prescription.

Drug resistant TB still poses a threat in India

Drug resistant TB still poses a threat in India

Pvt doctors callous in notifying disease,

Service providers to face jail in case they hide TB cases

-Manzoor-ul-Hassan

The burden of Multidrug Resistant Tuberculosis (MDR-TB) is still a major challenge in India because a large number of patients go unreported due to callous approach of private practitioners in reporting the disease.

Tuberculosis was declared notifiable diseases in May 2012 and it became mandatory for private practitioners in the country to notify the local health authorities about cases of tuberculosis.

However, seven years down the line most of the private doctors and clinics don’t adhere to the compulsory guidelines.

Despite this order, notification of tuberculosis cases from the private sector has remained low and the majority of notified cases are from the public sector.

A report published by Central TB Division of Ministry of Health and Family Welfare said that TB notification by private practitioners is just 29 per cent in India while the rest of the reported cases are the patients who are getting treated under the Government of India (GoI) sponsored Revised National TB Control Programme (RNTCP) at different health institutions and DOT centers.

“Only 3.8 lakh TB patients have been notified by private practitioners in 2017 in India which are just 29 percent of the total patients treated by them,” the report says.

It says the total reported cases including those notified by public-sector health institutions have gone up to 18.3 lakh in 2017.

The unreported cases throw a challenge of rising cases of drug-resistant TB.

As per official figures, Tuberculosis kills 4,80,000 Indians every year while there are more than a million cases which still go unreported per year.

“Most of these cases are either undiagnosed or inadequately diagnosed or treated in the private sector,” as per the report.

It says that some of the states have negligible reporting by private practitioners.

While most of the Union Territories have zero reporting percentage, some major states like Odisha, Himachal Pradesh, J&k, Arunachal Pradesh, Assam, Chandigarh, Sikkim, Mizoram and Haryana are also at the bottom vis-a-vis reporting percentage by private practitioners.

Dr Ashwini Khanna, a leading Pulmonologist in Delhi said that Drug resistant TB continues to pose a challenge to the government.

However, he said, some initiatives taken by the health ministry’s Central TB Division had improved the situation to a large extent.

“The doctors and other service providers related to TB will land in jail if they don’t notify TB,” he said.

Dr Khanna, who is also the State TB Officer in Delhi claimed the notification issued in March 2018 has improved the situation in many states including Maharashtra, UP and most of the northern states.

The government aims to eliminate tuberculosis by 2025 and it will be possible only when all infected patients are brought under the treatment protocol.

It has also introduced its own online portal for TB notification (http://nikshay.gov.in) on which notification can be done easily by generating a user ID and password with the help of any simple Android application-based phone or with a computer. However, most of the private practitioners are callous about the existing norms and the reporting platform NIKSHAY.

Cancer test uses gold & can detect the disease in 10 minutes,

Cancer test uses gold & can detect the disease in 10 minutes,

It’s a universal test and can spot traces of cancer: Australian researchers

Health Wire Desk

Researchers in Australia have developed a test that can find traces of cancer cells in any tissue of the human body in just 10 minutes, according a newly published study.

The procedure which uses gold and colour changing fluid to find the affected area anywhere in the body without using expensive equipment and medicines was developed by the University of Queensland, Australia

The cheap diagnostic test is expected to revolutionise the cancer treatment in low-income countries including India because it’s considered as the biggest killer in the country.

According to researchers at the University’s Institute for Bioengineering and Nanotechnology (AIBN), the test can prove as convenient and affordable as it uses a unique DNA signature that appears to be found in all cancers as per the team. Their findings are published in the journal Nature Communications.

“This test can find every type of cancer from different tissues including blood or a biopsy sample using a simple signature common to all cancers,” they said.

“It has been difficult to find a simple signature common to all cancers, yet distinct from healthy cells because cancer is an extremely complicated and variable disease,” one of the team members, Abu Sina said in a statement.

According to him, the team noticed that in cancer cells, methyl groups make bunches at specific positions on the genome, something which make them distinct from healthy cells where the groups are isolated.

“This ‘unique’ signature was studied in all types of breast cancer looked at as well as various other types of cancer, including bowel, prostate, and lymphoma cancers,” Sina said.

Matt Trau, a professor at AIBN who led the research, describes it as like a genetic program or app that the cancerous cell needs for functioning.

“Virtually every piece of cancerous DNA we examined, had this highly predictable pattern,” he explained.

He also pointed out an interesting finding saying that these DNA signatures are ‘gold-hungry’ which means they are attracted to Gold and can be found with a simple color-change test.

“Trials are still in the initial stages and it has only been tested on breast, bowel, prostate, and lymphoma cancers but the researchers say it could have the ability to spot any type of cancer with up to 90 percent accuracy,” Trau said.

He said it looks really interesting as an incredibly simple universal marker of cancer, as a very accessible and inexpensive technology that does not require complicated lab-based equipment like DNA sequencing.

PROCESS OF TEST

The 10-minute test is expected to be put on clinical trials before used on humans.

The test uses free DNA of the human body to detect the malignant area.

These DNA fragments present in biopsy sample or circulated through blood stream carry unique cancer signature. It makes possible for the doctors to identify cancer even if its source is not known.

The test uses a water-based solution containing gold nanoparticles, which turns the liquid into a reddish color. When cancerous cells come in contact with the solution, the methyl groups cause the DNA fragments to fold up into 3D structures.

These are attracted to the gold nanoparticles and the solution remains the reddish color. In contrast, when healthy cells are added, the DNA and gold nanoparticles interact differently and the solution turns blue.

While the test might not be able to tell you exactly where the cancer is located, a positive result could spur further testing to identify the source. Plus it is cheap and quick, offering up a result in less than 10 minutes.

Kader Khan’s death & rare brain disorder Progressive Supranuclear Palsy (PSP)

Kader Khan’s death & rare brain disorder Progressive Supranuclear Palsy (PSP)

-By Health Wire Desk

Veteran actor and dialogue writer, Kader Khan passed away on January 1 in Canada after admitted to a hospital following his illness. He was 81.

As his death left everyone in the film industry mourning, it has also put a spotlight on a rare brain disorder—Progressive Supranuclear Palsy (PSP)—the deceased actor suffered from.

PSP is a degenerative disease that causes loss of balance, memory and difficult in walking, etc.

As per doctors, the actor was put on ventilator after he complained of breathlessness due to pneumonia. His health deteriorated due to the rare disorder that left him paralysed for many years.

About PSP

According to Dr K K Aggarwal—a leading physician, Progressive Supranuclear Palsy is a degenerative brain disorder prevalent in 3 to 7 persons per 0.1 million population and the mean age for the onset of this condition is approximately 65 years.

“No cases of PSP have been reported in patients younger than age 40 years,” Dr Aggarwal said.

He said PSP could be characterized by various symptoms including progressive supranuclear ophthalmoplegia (inability to move eyes), gait disorder (difficulty in walking and postural), dysarthria (difficulty in speech), dysphagia (difficulty in eating) and rigidity etc.

Diagnosis

The disease is difficult to diagnose as some doctors confuse it with Parkinson’s disorder due to some similar features.

“The two most common types of PSP are Richardson syndrome and PSP parkinsonism.

PSP with predominant parkinsonism (PSP-P) is characterized by asymmetric onset of limb symptoms, tremor, and a moderate initial therapeutic response to levodopa. It may be confused with idiopathic Parkinson disease,” said Dr Aggarwal.

He said the diagnosis of PSP during life is based upon the clinical features and suspicion for PSP is raised when new-onset neurologic, cognitive, or behavioural deficits progress in absence of other identifiable cause in a patient ≥ 40 years of age.

“The core clinical features include postural instability, oculomotor deficits, especially vertical gaze palsy, akinesia/parkinsonism, and frontal lobe impairments, including speech and language problems and behavioral change. No laboratory or imaging studies are diagnostic,” Dr Aggarwal said.

“Neuropathologic examination remains the gold standard for its definitive diagnosis,” he added.

How inclusive are Ayushman Bharat?

How inclusive are Ayushman Bharat?

-By Manzoor-ul-Hassan

Ayushman Bharat has gained momentum in India and attractedthe world’s attention following the announcement by Prime Minister, Narendra Modi saying that 10.74 crore families will be covered under the free healthcare scheme in the country. He also claimed that the scheme will provide universal health coverage too poor families without any financial burden on them.

Ayushman Bharat (AB) has been declared as the biggest health insurance scheme in the world by the Prime Minister while the Union Health Minister, J P Nadda says his ministry will create a history of sorts with the implementation of  ‘first-of-its-kind health benefit scheme’ across the country.

Besides, new beneficiaries, the scheme has incorporated families already covered under Rashtra Swasthya Bima Yojana (RSBY), which was launched by UPA government in 2008. The UPA had announced three stimulus packages in the same year including Rs 71,000-crore farm loan waiver without much resentment from the state government.

Ayushman Bharat program aims to cover 76 per cent beneficiaries belonging to rural areas while 22 per cent are from an urban background. It says the central government will provide 60 per cent of the financial assistance while the state governments have been asked to contribute the remaining 40 per cent to every beneficiary.

The benefits, as claimed by the government and PM, make the scheme very popular among many poor families. However, many probable beneficiaries have been left-out because the program only covers BPL families registered in Socio-Economic Caste Census (SECC) of 2011.  

Although more than 50 crore Indians have been covered under the insurance scheme as per the official claims but people from other economically weaker sections who regularly face debt following different diseases and families with the monthly income of Rs 10,000 have been dropped.

As per the guidelines, families owning a fridge or a landline phone or even a water pump also stand in the elimination list

The rules have also eliminated a cross-section of the society especially the labour class who earn a meagre monthly salary.

According to Trading Economics Global Macro Models and Analysts’ Expectations, the average daily wage (labour rates) in India is nearly Rs 350. The average daily wage rate is likely to trend around Rs. 375-400 per day and monthly it comes above Rs. 10,000. That means the central government (or PM), otherwise and incidentally accepted that above 50 crore Indians do not have an income of even Rs 10,000/- per month.

Since the scheme has covered 50 crore people in India, this means nearly 50 crore people in India have no access to refrigerators, motorcycles or even a water pump etc.

Income tax payers or landline phone users are obviously out of this but a family that owns a refrigerator, motorised vehicle (2 wheeler, three or four-wheeler), a fishing boat etc shall also stay away from the free healthcare benefits under the scheme and thus stands clear-off.

The farmers having Kisan Credit Cards with a credit limit of Rs 50,000 is also in the elimination list. They will not get reimbursements from Ayushman Bharat. This means, a long list of small-scale farmers is also kept out and even if a family with 2.5 acres of land or irrigation equipment is also not in the list of beneficiaries and so on.

Citing some of the above reasons and other pretexts, West Bengal pulled out of the scheme, accusing the Narendra Modi-led NDA government of ‘playing dirty politics’ under the garb of the health coverage programme. Like-wise, few other states also withdrew from the scheme. The government must include all probable beneficiaries in the scheme to make it inclusive otherwise it will prove a failure.