Losing just 10 kg sufficient for diabetes control: Lancet

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Losing just 10 kg sufficient for diabetes control: Lancet

Diabetes, blood checkA study published in prestigious medical journal The Lancet has shown that a mere 10 kg weight loss and not the drastic reduction earlier thought necessary can reverse Type 2 diabetes. The late onset diabetes is usually caused by the body’s inability to use blood sugar lowering hormone insulin even though it is available.

The study showed that after 1 year, participants had lost an average of 10kg, and nearly half had reverted to a non-diabetic state without using any diabetes treatment. “Our findings suggest that even if you have had type 2 diabetes for 6 years, putting the disease into remission is feasible. In contrast to other approaches, we focus on the need for long-term maintenance of weight loss through diet and exercise and encourage flexibility to optimise individual results,” says Professor Michael Lean from the University of Glasgow who co-led the study.

India is said to be the “diabetes capital” of the world. According to the World Health Organisation, India had 69.2 million people living with diabetes (8.7%) as per the 2015 data. Of these, it remained undiagnosed in more than 36 million people. Worldwide, the number of people with type 2 diabetes has quadrupled over 35 years, rising from 108 million in 1980 to 422 million in 2014. This is expected to climb to 642 million by 2040. This increase has been linked to rising levels of obesity and the accumulation of intra-abdominal fat. Bariatric surgery or gastric banding that is often used to treat morbid obesity or in a bid to control diabetes can cost around Rs 5 lakh.

“Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon but diabetes remission by cutting calories is rarely discussed. A major difference from other studies is that we advised a period of dietary weight loss with no increase in physical activity, but during the long-term follow up increased daily activity is important. Bariatric surgery can achieve remission of diabetes in about three-quarters of people, but it is more expensive and risky, and is only available to a small number of patients”, explains Professor Roy Taylor from Newcastle University, UK, who co-led the study.[1]

The Diabetes Remission Clinical Trial (DiRECT), included 298 adults aged 20–65 years who had been diagnosed with type 2 diabetes in the past 6 years from 49 primary care practices across Scotland and the Tyneside region of England between July 2014 and August 2016. According to Professor Taylor: “Our findings suggest that the very large weight losses targeted by bariatric surgery are not essential to reverse the underlying processes which cause type 2 diabetes. The weight loss goals provided by this programme are achievable for many people. The big challenge is long-term avoidance of weight re-gain. Follow-up of DiRECT will continue for 4 years and reveal whether weight loss and remission is achievable in the long-term.”

Writing in a linked Comment, Professor Emeritus Matti Uusitupa from the University of Eastern Finland discusses whether these findings should change treatment options for type 2 diabetes. He writes, “Lean and colleagues’ results, in addition to those from other studies of type 2 diabetes prevention and some smaller interventions in this setting, indicate that weight loss should be the primary goal in the treatment of type 2 diabetes… The DiRECT study indicates that the time of diabetes diagnosis is the best point to start weight reduction and lifestyle changes because motivation of a patient is usually high and can be enhanced by the professional health-care providers. However, disease prevention should be maintained as the primary goal that requires both individual-level and population-based strategies, including taxation of unhealthy food items to tackle the epidemic of obesity and type 2 diabetes.”

Sex survey shows higher acceptability in India for homosexuality

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Sex survey shows higher acceptability in India for homosexuality

“Gay” lions in Kenya may have officials up in arms, even willing to give them moral lessons but Indians are now more open than ever to homosexual behaviour.

Whether it was the courts or the gay pride parades or simply a sign of the times is anybody’s guess but a survey has found that attitudes to homosexuality in India have become increasingly accepting with over a half agreeing having a same-sex partner is acceptable. The Durex Global Sex Survey  found that 54% respondents believed that it is ok to have a partner of the same sex while 26% believed it is not acceptable. Forty six percent believed that society is comfortable with consensual sexual activity  including homosexuality.

The findings of the online survey show that even though homosexuality as per the Indian law is a crime – decriminalisation of consensual homosexual sexual activity by the Delhi High Court was subsequently overturned by the Supreme Court – there is an increased social acceptance. A large number of people including celebrities have come out about their sexual preferences since the Delhi HC judgement.

However sexuality continues to be a sensitive topic and 10% men and 5% women in India declined to state their sexual orientation. Over 80% respondents agreed that they have the freedom to practise their sexual rights. Moreover two-third of the participants feel it is difficult to admit to having a sexual problem. The multi-country Global Sex Survey (GSS) has been conducted at five year intervals over the past decade & is now in its third edition.

Nevertheless there were other findings of the survey which indicate a greater openness in the social space in talking about sex. 82% respondents said they talked about sex with their partners and 61% also talked to their friends about the goings-on in their bedrooms. On the other hand, knowing what to do when having sex is the biggest concerns amongst virgins –  surprisingly, it is even higher  for those who have had sex education. Painful sex is a concern for women. Over six in ten of 18-24 year olds said they had received sex education with an emphasis on understanding the biology of reproduction. Over two-fifths had learnt about how to have safe sex and about avoiding sexually transmitted diseases.

Questioning Modi on anaemia, Rahul Gandhi flagged biggest issue of women’s health

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Questioning Modi on anaemia, Rahul Gandhi flagged biggest issue of women’s health

In a rare departure from the Jain-Janeu debate that has eclipsed issues in the Gujarat Assembly elections, Congress vice president Rahul Gandhi, one day before his coronation as party president, asked prime minister Narendra Modi on Sunday why 55% of women in the poll bound state are anaemic. Health is rarely an election issue, and women’s health even less so, which is why Gandhi targetting the man who ruled Gujarat for 14 long years before becoming prime minister is a welcome change.

According to the latest National family Health Survey, 54.9 percent of Gujarati women are anaemic. This is slightly more than the national average of 53%. Gandhi is not the first person to flag the issue of undernutrition in Gujarat – in fact a lag in human development index is widely said to be one of the flaws of the “Gujarat” model. In 2012, while he was still CM of the state Modi had invited ridicule when in an interview to an US daily, he said girls in the state are malnourished because “they are more figure conscious than health conscious” and do not drink milk.

Anaemia essentially means that  the number of red blood cells circulating in the blood stream is less than normal or the amount of haemoglobin – the red compound that carries oxygen to the cells – in each RBC is less. The net effect in both cases is that the amount of oxygen being transported by the blood, is less. Deficiency of iron or folic acid or vitamin B12 could lead to anaemia. It is also often seen in pregnant women but anaemic women are more likely to have complications during childbirth and may also have issue of the heart and lung apart from generic complaints like tiredness.

India’s anaemia burden has been a cause for concern globally as reduction of maternal and infant mortality are among the sustainable development goals. The Global Nutrition Report 2017 that was released recently says: “Globally, 614 million women aged 15–49 years were affected by anaemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia. In India and Pakistan, more than half of all women of reproductive age have anaemia. It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland.” For India the anaemia prevalence in this age group is 53.1%. For Gujarat it is 55.1% – more than 3 times the “high” of 18% in developed countries that the report flagged.

Eating cheese may be good for your heart

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Eating cheese may be good for your heart

If cheesy pastas are your guilty pleasure, then here’s news that will lessen the guilt.

Chinese researchers have found that eating cheese, albeit in moderation, may lower the risk of cardiovascular diseases(CVD). The study, published in the European Journal of Nutrition looked at published research on the correlation of cheese and CVD risk – what is called a meta analysis – and found that CVD risk is inversely proportional to cheese consumption. That is, more the latter goes up, higher is the dip in the former.

Cheese is known to have a high content of saturated fatty acids – associated with the harmful LDL cholesterol- but what redeems it in cardiovascular terms is the fact that it also contains a number of potentially beneficial nutrients. The study however found that 40 gm of cheese per day is the optimum consumption for the beneficial effects to kick in.

for India the rising popularity of continental dining options and the availability of premium foreign products in the country may have contributed significantly to the rising cheese consumption.

The association between cheese and LDL cholesterol has long been the reason why health conscious individuals the world over have made yoghurt their dairy product of choice. Nevertheless cheese consumption overall has been on the rise; for India the rising popularity of continental dining options and the availability of premium foreign products in the country may have contributed significantly to the rising cheese consumption.

The British Heart Association describes cheese as a major source of protein and calcium but recommends that a person with high cholesterol should limit intake of high fat varieties of cheese.

“Some types of roquefort, halloumi, feta and cheese singles are saltier than seawater. Cheese contains calcium and protein, so it can be OK in moderation, but remember: low-fat yoghurt, tinned fish, tofu, lentils and beans are good sources of calcium and protein too.

Keep cheese portions small and weigh them to reduce temptation. Using lower-fat cheeses – such as mozzarella, feta, cottage cheese or reduced-fat cheeses – will provide less saturated fat,” BHA advises on cheese.

Advice from the Harvard Medical School is along similar lines as the latest study in the European Journal of Nutrition. “…dairy fat was not associated with a higher risk of cardiovascular disease (defined as nonfatal heart attack, fatal heart disease, and stroke) when compared with the same amount of calories from carbohydrates. However, replacing about 5% of calories from dairy fat with a similar amount of unsaturated fat from vegetables or vegetable oil was linked to a 24% lower risk of cardiovascular disease,” reads a newsletter from January 2017.

Tobacco packs may have to carry quit line number

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Tobacco packs may have to carry quit line number

The Indian health ministry is looking at making it mandatory for all tobacco products to mandatorily carry the number of the National Tobacco Cessation QuitLine-1800 227787. This comes a year and half after the notification making it mandatory for all tobacco packets to carry a pictorial warning covering 85% of the package, came into effect.

We are also planning to print the National Tobacco Cessation QuitLine number (1800-22-77-87) on packets. Also, the text warnings will mention the diseases caused due to consumption of tobacco

The ministry has now also started an exercise to ascertain how effective the existing statutory text and pictorial warnings are. “The aim of the exercise is to find out if the new set of pictures and text warnings are impactful or not. Our teams are going to people and taking their suggestions. We are also planning to print the National Tobacco Cessation QuitLine number (1800-22-77-87) on packets. Also, the text warnings will mention the diseases caused due to consumption of tobacco,,” said a health ministry official.

The tobacco cessation helpline is a dedicated toll-free number that helps tobacco users to receive

free support and guidance to get rid of their addiction.

In October 2014, the ministry had made it

mandatory for manufacturers to display health warnings on 85 per cent of the main display area on the packets of all tobacco products. The move ran foul not just of the tobacco industry but also a panel of Parliamentarians on whose recommendation it was put on hold. After a long battle fought mainly by anti tobacco activists, it was on the orders of the Rajasthan High Court that the ministry finally notified that the changes warning guidelines would have to come into effect from April 2016.

According to the second Global Adult Tobacco Survey

(GATS-2) published in June, tobacco use has gone down by six percentage points from 34.6 per cent of the country’s adult population in 2009-10 to 28.6 per cent in 2016-17. The report said the number of tobacco users in

India has gone down by 81 lakh. Tobacco use among young people (aged between 15 and 24) reduced from 18.4 per cent in GATS-1 to 12.4 per cent in

GATS-2. Also, there was an increase of one year in the mean age at initiation of tobacco use from 17.9 years in 2009-10 to 18.9 years in 2016-17, the report said.

The survey revealed that 19 per cent of men, 2 per cent

of women, and 10.7 per cent of all adults smoke tobacco, while 29.6 per cent of men, 12.8 per cent of women and 21.4 per cent of all adults use smokeless tobacco.

It also mentioned that 28.6 per cent of all adults (26.7 crore) use tobacco in some form or other.

Sri Lankan cricketers in masks one more pollution warning signal

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Sri Lankan cricketers in masks one more pollution warning signal

Not that Delhiites needed reminding but the sight of Sri Lankan cricketers on the Feroz Shah Kotla cricket field with masks on has once again driven home the dangerous air quality conditions that Delhi is grappling with.

Star Sports

At 3 pm on Sunday the air quality index monitor at Anand Vihar was at the “hazardous” level with the PM10 level at 384 and PM 2.5 level at 310. PM10 is particulate matter 10 micrometers or less in diameter, PM2.5 is particulate matter 2.5 micrometers or less in diameter. According to the World Health Organisation chronic exposure to both variants of particulate matter can increase the “risk of developing cardiovascular and respiratory diseases, as well as of lung cancer”. The last time air quality dipped to similar levels, the Indian Medical Association had said breathing this air is equivalent to smoking 50 cigarettes per day.

A Lancet study published last month estimated that some half a million Indians died prematurely in 2015 because of air pollution. The world over diseases caused by pollution were responsible for an estimated 9 million premature deaths in 2015—16% of all deaths worldwide—three times more deaths than from AIDS, tuberculosis, and malaria combined and 15 times more than from all wars and other forms of violence.

“Pollution is much more than an environmental challenge – it is a profound and pervasive threat that affects many aspects of human health and wellbeing. It deserves the full attention of international leaders, civil society, health professionals, and people around the world,” co-lead of The Lancet Commission for Environment and Health Professor Philip Landrigan, Icahn School of Medicine at Mount Sinai, USA had said while releasing the study.The Commission had reinforced what had long been known.

The effects of pollution on children are even more damaging than in adults. A quarter of all deaths in children younger than 5 years are caused by exposure to an unhealthy environment. Young children are particularly vulnerable to environmental toxicities because of their small size and developing organs, and their rapid periods of growth and development, especially in utero and in infancy.

Early exposure to environmental stressors can result in disease that will remain throughout the life course. For example, high levels of particulate matter in air is associated with preterm birth and low birthweight, both of which increase a newborn’s risk of developing asthma in later life. Similarly, exposure to lead via the placenta, breastmilk, or directly can result in neurodevelopmental defects, cognitive impairment, autism, or attention-deficit hyperactivity disorder, which can result in lower IQ, socioeconomic status, or social mobility in adulthood. Lead poisoning in early life results in mild to moderate mental retardation in approximately 600 000 children a year. Emerging environmental hazards, such as the disposal of electronic waste, pose new threats of toxic exposure.

Although pollution caused by lead, asbestos, dichlorodiphenyltrichloroethane (DDT), polychlorinated biphenyls (PCBs), and the ozone-destroying chlorofluorocarbons are in decline but newer synthetic chemicals that have entered world markets in the past 2–3 decades.

After hospital declares baby “dead” IMA issues advisory

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After hospital declares baby “dead” IMA issues advisory

One day after a private hospital in Delhi declared a living baby dead, inviting government inquiries and threats of licence cancellation, the Indian Medical Association has issued a detailed advisory on when to pronounce death due to hypothermia.

Hypothermia is a medical emergency that occurs when the human body loses heat faster than it can produce heat, causing a dangerously low body temperature.

“Never declare a patient dead under conditions of hypothermia A core body temperature below 95°F is hypothermia. Core temperature 90-95°F is mild hypothermia, 82 to 90°F is moderate hypothermia and core temperature below 82°F is severe hypothermia. In conditions of severe hypothermia in children, body metabolism is suspended, which may protect against hypoxia. Patients with core body temperature 82°F have been known to survive anoxia for 12-18 minutes and up to 60 minutes or more at core body temperature 68°F. Sometimes, hypothermic patients can be successfully revived with CPR even with total resuscitation time of 9 hours. Because of dilated pupils, asystole, hypoventilation, absence of shivering, the patient appears dead,” IMA said in its advisory

Hypothermia is a medical emergency that occurs when the human body loses heat faster than it can produce heat, causing a dangerously low body temperature. There has been a huge uproar after a renowned hospital in North Delhi declared one of twins dead and allegedly handed the baby to the family in a packet. It was some time later that the family noticed movement and realised that the baby is not dead. Delhi health minister Satyendra Jain has since said that if the charges are found to be true and the hospital negligent, it could lose its licence.

The apex medical association also said that for adults, successful revival is possible because of the neuroprotective effects of hypothermia. Several hours of CPR may be required for this. Efforts to revive the patient should be continued till the core body temperature reaches 90-95°F.

India launches National Strategic Plan for HIV/AIDS

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India launches National Strategic Plan for HIV/AIDS

The National AIDS Control Organisation (NACO) on Friday unveiled a even-year National Strategic Plan on HIV/AIDS and STI, 2017-24. The two pillars of the plan are  reaching the global 90-90-90 and elimination of transmission of HIV and Syphilis from mother to child by 2020. India is a signatory to the UN strategy of 90-90-90 and is aiming at ending AIDS as a public health threat by 2030. The strategy aims to ensure 90% of people living with HIV know their status, 90% are on ART and 90% have viral suppression.

Said a senior NACO official: “This seven-year National Strategic Plan on HIV/AIDS and STI, 2017-24 will herald the country to the dream of ‘Ending of AIDS’ by 2030 . The vision of NACO is that of ‘Paving the way for an AIDS free India’ through ‘attaining universal coverage of HIV prevention, treatment to care continuum of services that are effective, inclusive, equitable and adapted to needs’. The goals remain those of the ‘Three Zeros’ – i.e. zero new infections, zero AIDS-related deaths and zero discrimination, which form the basis of this strategic plan.”

NACO has also launched Mission “SAMPARK”, to trace those who are miss out on follow up and are to be brought under ART services. Standard antiretroviral therapy (ART), as defined by the World Health Organisation,  consists of a combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. ART also prevents onward transmission of HIV.

Unveiling the strategic plan, minister of state for health Anupriya Patel said that currently 11.5 lakh People Living with HIV(PLHIVs) are taking free ART through 536 ART centres in the country. Patel said that the recently passed HIV/AIDS Prevention and Control, Act, 2017 is a testimony to the government’s commitment to end discrimination against people living with HIV. “This landmark Act is people-centric, progressive in nature and brings in legal sanction to address the discrimination faced by People Living with HIV at various settings,”

50K more people on ART since India adopted WHO guidelines on AIDS

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50K more people on ART since India adopted WHO guidelines on AIDS

Months after adopting a World Health Organisation (WHO) guideline of treating all HIV+ patients irrespective of their immune status, with a special drug combination, India has registered 50,000 new patients, taking the total number of patents currently receiving anti-retroviral therapy (ART) in the country to 11 lakh.

Despite low prevalence of 0.26%, India, thanks to its massive population, is home to the third highest number of people living with HIV – estimated to be around 21 lakh. Of these about 14 lakh are known to be HIV positive. However not all of them are on ART because of an earlier policy of starting it only when a person reaches a certain CD4 count – an estimate of how much his or her immunity is compromised. Standard antiretroviral therapy (ART), as defined by WHO consists of a combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. ART also prevents onward transmission of HIV.

India is home to the third highest number of people living with HIV (around 21 lakh)

“In July 2016 ‘Test and Treat’ guidelines were released by WHO; the idea being to start people living with HIV early on ART without waiting for their immunity to fall to significant levels. We adopted it in April this year. As per June reports approximately 11 lakh people are on ART at 531 ART centers and 1108 link ART centres. Approximately 50,000 new patients have been initiated on ART in May and June 2017 after rolling out ‘Test and Treat’ guidelines – about 4.5% of the total number of people currently on the treatment,” said a senior health ministry official. India is a signatory to the UN strategy of 90-90-90 and is aiming at ending AIDS as a public health threat by 2030. The strategy aims to ensure 90% of people living with HIV know their status, 90% are on ART and 90% have viral suppression.

Protocol for starting patients on ART has repeatedly been revised over the years. In 2004, ART was started when a patient had CD4 count of less than 200. This was subsequently revised to 350 in 2012 and 500 in 2015. CD4 cells, also called T-cells, T-lymphocytes, or helper cells are an important component of the body’s immune system. CD4 count is a marker of immune status, lower counts being associated with more compromised immunity.

Latest WHO policy guidelines however say that CD4 count should no longer be used as the parameter for deciding whether to start ART. “Anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible. With its “treat-all” recommendation, WHO removes all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.The expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners,” said a WHO statement from 2015. The apex health body came out with the relevant guidelines a year later.

Bacteria developed antibiotic resistance even before humans started using them

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Bacteria developed antibiotic resistance even before humans started using them

Bacterial capacity to develop resistance to ampicillin may predate its use in humans and may actually be traced back to the antibiotics use in animals, according to new research published in The Lancet Infectious Diseases.

Molecular analysis of historical samples of Salmonella by researchers at the Institut Pasteur (Paris, France) suggests that the ampicillin resistance gene emerged in humans in the 1950s, several years before the antibiotic was released onto the pharmaceutical market. The findings indicate that a possible cause was the common practice of adding low doses of penicillin to animal feed in the 1950s and 60s.

Coming just weeks after WHO called for ending use of routine antibiotics in animals for growth promotion and disease prevention. “Our findings suggest that antibiotic residues in farming environments such as soil, waste water, and manure may have a much greater impact on the spread of resistance than previously thought,” says Dr Francois-Xavier Weill, Institut Pasteur, who led the study. Antibiotic resistance kills around 25,000 people a year in Europe, and this is predicted to rise to over 10 million people worldwide by 2050. Many bacteria that cause serious infections in humans like Salmonella, have already developed resistance to common antibiotics.

Ampicillin, the first broad-spectrum penicillin for the treatment of infections due to Enterobacteria, was released on the market in the UK in 1961. Shortly after that, in 1962–1964, the first outbreaks of disease in humans caused by ampicillin-resistant strains of the common zoonotic (which cause disease that can be spread between animals and humans) bacterium, Salmonella enterica var Typhimurium (S. Typhimurium), were identified in the UK.

This short timeline prompted the researchers to investigate the emergence of ampicillin resistance. In this study, they tested 288 historical samples of S. Typhimurium collected from humans, animals, and food and feed in Europe, Asia, Africa, and America between 1911 and 1969. Samples were tested for antibiotic susceptibility and were analysed by whole genome sequencing, in order to identify the mechanisms of resistance to ampicillin.

A report from the UK Central Public Health Laboratory in 1965 raised the idea that low doses of the narrow-spectrum antibiotic penicillin G (also known as benzylpenicillin), routinely added to animal feed, may have contributed to the emergence of ampicillin resistance in humans in the UK (a practice that was banned in the UK in 1969).

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