DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Wednesday

Transcription

1 DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Wednesday Viral illness Why you shouldn't dismiss fever as mere viral illness (The Times of India: ) Swine Flu Symptoms Similar But Intensity Higher: Doctors Is the government underplaying swine flu deaths in Delhi? While official records say only five people have died of the viral illness so far this year, a random check with five top hospitals in the capital reveals more than 40 deaths in the past two months. Some other hospitals refused to divulge information on deaths. Among hospitals that shared data with TOI, Ram Manohar Lohia (RML) had recorded the maximum numbers of deaths at 22, of which 13 patients were from Delhi, seven from Uttar Pradesh and two from Haryana. At Safdarjung hospital, 11 swine flu patients were recorded to have died -five from Delhi and the rest from neighbouring states. AIIMS officials said there have been four swine flu deaths in the hospital in August alone. Among private hospitals, Sri Balaji Action Medical Institute and Sir Ganga Ram Hospital (SGRH) confirmed four and three deaths due to the disease, respectively. Many private hospitals and some government ones refused to share details of swine flu fatalities, saying the data had been sent to the authorities concerned. Last year, we faced a lot of harassment for sharing data on dengue deaths with the media, an official of a top private hospital said. Off the record, the official said more than seven people had died of swine flu at their hospital this year. Asked about the discrepa ncy over swine flu dea ths in Delhi, state government

2 officials claimed most of the deaths were of patients from other states. Also, the central government hospitals, where the maximum deaths have taken place, may not be sharing data with us. We will look into it, said an official. The official said, as per government records, 15 swine flu-related deaths had been reported from various hospitals of which five were confirmed to have been caused by the viral illness. The death review committee examined all cases and swine flu was responsible for only five of the deaths. The rest of the patients had other co-morbidities that could have led to death, the official said. Proper surveillance and reporting of deaths due to notifiable diseases is crucial to the management of these illnesses. If we don't report correctly and keep saying the situation is under control, people may not realise the seriousness of the situation until it is too late, said a senior doctor. Last year, the committee set up by the Delhi government to review cases of deaths attributed to dengue and chikungunya had said co-morbid conditions had led to death in many cases. Some death reports sent from hospitals were rejected due to lack of records. Swine flu assumed epidemic proportions in 2009 for the first time and since then there have been sporadic outbreaks of the disease, caused by the H1N1 virus, across the country. But this year, the disease appears to have a strong comeback claiming more than 900 lives across the country in the past eight months, with nearly 20,000 people being infected.maharashtra and Gujarat are the worst affected with 404 and 190 deaths, respectively. In Delhi, officials say, about 1300 people have tested positive for swine flu and five have died. Clinicians suspect the H1N1 virus, which causes swine flu, may have mutated.the disease initially spread through pigs but now transmits from human to human. Union health ministry officials said government has put Oseltamivir, marketed as Tamiflu, in schedule H1to enable it to be sold by all licensed chemists under prescription.the drug was earlier in schedule X, wherein only certain selected pharmacists were authorised to stock it. Symptoms of swine flu are similar to common viral illnesses. But the intensity is higher. Doctors say those suffering from asthma, diabetes and other pre-existing illness are vulnerable to serious manifestations and preventive flu vaccination is suggested. Regular follow-up with doctors is important. Patients often delay visiting the doctor which leads to complications and in some cases, death, said Dr Arup Basu, senior chest physician at SGRH.

3

4 Combating drug menace Combating drug menace: For this war, 4 weeks was not enough (The Indian Express: ) / Even as the Congress government claims that its crackdown is on track, doctors tell The Indian Express about decline in number of patients at rehabilitation centres, absence of mechanism to keep tabs on addicts, shortage of psychiatrists and the urgent need to squeeze supply. ON APRIL 14, when the new government completes four weeks, statements such as it has kept its promise of ending the drug menace in the state in four weeks are likely to be made. The Special Task Force (STF), consisting of three IG-rank officers, is said to have launched a crackdown on the big drug dealers in the state. Police have been arresting street peddlers. Also, the government is likely to declare that it has broken the drug supply chain. Twenty-five years after they broke drug cartels in Colombia, the US is still struggling with the cocaine supply chain, but even overlooking that small detail and assuming that the government s claim is true, the challenge is really on the health front. Doctors and psychiatrists in the state say that if the government is really sincere about dealing with the drug problem in Punjab, it must come up with a master plan that includes major interventions on the health front even as law enforcers put a squeeze on supplies. Medical professionals know better than anyone that as long as there is demand, there will be supply and, as long as there is supply, there will be demand. Dealing with it is a continuous process, not one deadlined to four weeks or eight or even 54.

5 The problem with our politicians is that they talk without really knowing the problem. They make issues emotive. Diseases are not emotive issues, a senior psychiatrist at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, told The Indian Express. There can be many other issues which are emotive, but diseases have to be tackled in a very dispassionate and scientific manner, he added. punjab, punjab drugs, punjab drugs menace, punjab government, amarinder singh, congress, drug addiction, rehabilitation centres, punjab rehabilitation centres, indian express news, india news, punjab news Special Task Force chief Harpreet Singh Sidhu (right) with other members; In 2012, the Punjab government had roped in PGIMER doctors to chalk out a plan to address the issue through medical intervention. The drug issue over the years, doctors believe, has been politicised so much that it has now become a social evil. We never talk of other diseases as social evils as in the case of drugs. If we regard it as medical illness, then the role of society is to provide effective, readily available, accessible and affordable treatment to those suffering from it, said a PGIMER doctor, who was part of the previous government s plan to tackle the menace. Doctors said PGIMER had submitted plans, which were implemented, resulting in the creation of a lot of infrastructure. However, the concern for doctors is that the facilities have remained unutilised. This concern was also highlighted by a recent CAG report. According to the Punjab health department, drug de-addiction and rehabilitation infrastructure has been established at a cost of Rs 134 crore. But, all put together, only 1,835 patients have been treated at these centres so far. In March 2017 alone, only 184 patients were admitted. Statistics also show that the number of visitors at the outpatient department in government hospitals across Punjab in the past three years has gone down, signalling that people are not coming forward for treatment. The number was the highest in 2014 when 2,89,366 patients were registered in the OPD. In 2015 and 2016, the registration went down to 1,89,242 and 1,46,401, respectively. The situation was the same in the Inpatient Department. In 2014, 8,236 patients were admitted while the numbers in 2015 and 2016 were 7,972 and 7,708 patients, respectively. punjab, punjab drugs, punjab drugs menace, punjab government, amarinder singh, congress, drug addiction, rehabilitation centres, punjab rehabilitation centres, indian express news, india news, punjab news Some of the drug peddlers arrested recently The story behind these numbers is that when the government focused on the showy business of arrests and seizures, there was pressure on supplies, which sent the prices soaring. That pushed addicts to de-addiction centres. Once the crackdown eased, they found their supplies and life went back to how it was before the arrest.

6 All the noise was on the supply issue and the authorities focused on law enforcement and supply reduction. Our study showed how the problem on the treatment side remained unaddressed, said Dr Atul Ambekar of National Drug Dependence Treatment Centre, AIIMS, New Delhi. His study has found that Punjab has a huge opioid drug usage. The major issue which seems not to have received adequate attention is that these people are suffering from opioid addiction and they have not received appropriate and adequate treatment, he said. What needs to be done for treatment? Doctors said a stepped care approach is needed which provides different types of treatment for various types of needs. The most evidencebased treatment available worldwide and in the country is known as opioid substitute therapy. There are specific mechanisms to ensure that diversion of medicines does not take place. We can try it and we can control the problem to a large extent, said Dr Atul. In the current scenario, Atul said, drug de-addiction centres are opened, patients are admitted for a few days and then discharged with the belief that the disease must be cured by now. Dr Arun Bansal, consultant psychiatrist at the civil hospital, Fazilka, said the biggest problem right now was that there was no mechanism to keep track of an addict. We can t keep track of them or what has happened to them. They don t visit us regularly. When we ask them why they cannot check into a rehabilitation centre, they say they are the breadwinners of their family and they cannot afford to lose their income, he said earners. Do you expect them to stay away from home for three months? said Dr Atul. They need the kind of treatment which makes it possible for them to work. One of the missing links in the current approach of the government is that there is no outreach to the addicts. This is a highly stigmatic illness. It is not a disease like toothache. They are drug users and they will hide it. They are marginalised people. To reach out to them is the responsibility of the state and society, said the PGI doctor. Dr Atul said addiction to opioids should be seen as a chronic non-communicable disease. Addicts should not be seen as criminals involved in an illegal act. They are victims who need treatment, he said. It becomes an emotive issue because people see it as a law enforcement problem. They see it as a sign of failure of the law enforcement machinery. We need to move this discourse. If you make effective treatment services available to people, you will find a lot of people visiting hospitals, he reasoned. Another worry is that there is a shortage of psychiatrists and other health specialists, which could become a major obstacle in the Punjab government s battle against drugs. Against the sanctioned posts of 63 psychiatrists in the Punjab government medical service, there are only 34 at present. There is a shortage of psychiatrists in the state and it needs to be dealt with by the government. The government should look into this issue, said a psychiatrist posted in

7 Ludhiana district, adding, In Punjab, there are only a few seats for this programme. The government is not able to get more people because the salary is not much. According to the Punjab health department, they are now training medical officers to provide de-addiction service under the guidance of psychiatrists in the state. Doctors said another issue, which needed to be taken care of, was awareness. The government needs to address the most important issues like unemployment, provide proper recreational facilities and promote sports to channelise the energy of the youth. The government should make the youth aware of the ill-effects of drugs, said a doctor posted in Amritsar. Punjab health director Dr H S Bali told The Indian Express that the department would now hold awareness camps across the state so that more addicts were motivated to join the rehabilitation centres. The activities to end the drug problem have been intensified in the state after the new government took over, he said, adding that the department is now monitoring both government and private drug de-addiction centres in the state for their smooth functioning. Meanwhile, doctors are worried that the four-week deadline may worsen the problem further. There is a medical system to tackle the disease. Let us not be emotive about it. Politicising something and making it an emotive issue aggravates the problem instead of solving it. You have started picking people and it shouldn t go wrong in a hurry, cautioned the PGIMER psychiatrist. It was an overreaction in 2014 and so is now. The supply was then stopped and addicts started approaching the hospitals. There was a sudden surge then. The surge triggered the creation of infrastructure. But, the problem on the medical front was not addressed. The results are for everyone to see and there are more addicts now, he said. Vini Mahajan, former Punjab health secretary, who was recently shifted, agrees that the drug problem is serious. All we know is that it is a serious problem, sufficiently serious, to warrant all actions that the government can take. Action needs to be taken in a prompt manner because many stakeholders are involved. It is an issue which deserves the time and attention of the decision makers, she said.

8

9

10 Pneumonia Vaccine Prevenar 13 India Grants Pfizer Patent for Pneumonia Vaccine Prevenar 13(The Economic Times: ) Patent-for-Pneumonia-Vaccine-Prevenar Médecins Sans Frontières said it is a `major setback' to hopes for affordable vaccine India has granted US drug giant Pfizer a patent for its blockbuster Prevenar 13, a vaccine that helps prevent cases of pneumonia, one of the leading causes of deaths of children under five years of age. The approval comes more than a decade after it applied for the patent in the country. Global medical humanitarian organisation Médecins Sans Frontières (MSF) said it is a major setback to hopes for an affordable vaccine and is likely to legally challenge the patent approval. Prevenar 13 helps prevent pneumococcal pneumonia and infections caused by 13 strains of streptococcus pneumonia bacteria, according to Pfizer. This vaccine and GlaxoSmithKline's Synflorix are the only two pneumococcal conjugate vaccines (PCV) available in the country. In the private market, Prevenar 13 is priced at `. 3,800 per dose, and Synflorix at `. 1,800 per dose, industry insiders said. Three doses are required for each child, they said. Pneumonia killed nearly a million children under the age of five years in 2015 alone, according to the World Health Organisation. India has seven pneumonia related deaths per 1,000 live births, according to the 2016 Pneumonia and diarrhoea Progress Report by John Hopkins Bloomberg School of Public Health. Pfizer subsidiary Wyeth internationally applied for a patent for Prevenar 13 in 2006 and its application was oppo sed by Indian vaccine maker Panacea Biotec and MSF over the years. Panacea is developing its own version of the vaccine, while MSF procures and provides Prevenar 13 to children in developing regions as part of its immunisation campaigns. Panacea and MSF claimed Pfizer's vaccine lacked the novelty for it to be considered for a patent.

11 India's patent office, in its approval granted on August 11, dismissed these arguments. Pfizer has demonstrated surprising effects that have to be considered as establishing that its vaccine is inventive, it said. A Pfizer spokesperson said, We are pleased to note that the validity of the Prevenar 13 patent has now been recognized by the Indian Patent Office. The company said the patent is valid in India until Each dose of Prevenar 13 requires 400 different raw materials, 580 manufacturing steps, 678 quality tests and 2.5 years to produce, the Pfizer spokesperson told ET. There has not been any price increase for this vaccine since its launch in India in 2010 even though regulations allow for annual price increases, the person said.

12 HIV cases HIV cases drop by 38% in last 9 yes(hindustan Times: ) MUMBAI: The country reported a 38% drop in Human Immunodeficiency Virus (HIV) infections across nine years, according to data from National AIDS Control Organisation (NACO). However, more than half the new cases are concentrated in three states Andhra Pradesh, Maharashtra and Karnataka. While Andhra Pradesh (22% remained on top, its followed by Maharashtra (19%) and Gujarat (13%). Responding to an RTI query, the Basic Services Division of NACO, mentioned that in , 184, 047 new HIV patients were identified at Integrated Counselling and Testing Centers (ICTC) as opposed to 299,015 in Officials revealed that major causes of transmission, as told by patients to the counsellors were heterosexual intercourse (157,666), parent-to-child transmission (8,511), homosexual intercourse (4,051), infected needles and syringes (4,011) and through blood and blood related products (1,487). Dr Om Srivastava, who heads the Tripple H Clinic at Jaslok Hospital said, As the cases rise in a particular demography, so does the awareness about the risk factors of HIV infection which leads to a drop in numbers. But the statistics do change with urbanisation and changing demographics of a state or city. The prevalence of mother-tochild HIV transmission is at 4% in the country across the country. Officials said the rate might be high because of lack of awareness about the triple drug regime followed by NACO. A senior pathologist of the state government, also pointed out a need for differentiation of the source of infected needles. The source of infected needles can either be hospitals or drug addicts. But NACO... isn t collecting data to differentiate between the two and study the sources, which might result in further spread, he said. However, officials from NACO said that the data, being sourced from patients themselves, doesn t paint an accurate picture. HT breaks down the major causes of transmission reported

13 Pneumonia Vaccine (The Asian Age: )

14

15 Healthcare Sector ((The Asian Age: )

16 Gut bacteria Gut bacteria influence the brain indirectly, study shows (Medical News Today: ) A new study has found that gut bacteria influence changes in the brain through serum cortisol. A new study has found that there is a three-way relationship between a type of gut bacteria, cortisol, and brain metabolites. This relationship, the researchers hypothesize, may potentially lead to further insight into autism, but more in-depth studies are needed. Research previously covered by Medical News Today suggested that there might be a link between bacteria found in the gut and the development of autistic behavior. Recent studies continue to establish links between the gut microbiome and autism spectrum disorders (ASD). However, the exact way in which gut microbes might influence brain development is still subject to debates and further studies. Now, researchers from the University of Illinois at Urbana-Champaign have found that there may be a three-way mechanism of communication between gut microbes and brain metabolites, involving cortisol as the channel through which the "message" is transmitted. First study author Austin Mudd, a doctoral student at the University of Illinois, explains that brain metabolites can have a strong impact on the development of infants, and that these could be influenced by the gut microbiome. "Changes in neurometabolites during infancy can have profound effects on brain development, and it is possible that the microbiome - or collection of bacteria, fungi, and viruses inhabiting our gut - plays a role in this process," he says. It was this mysterious interaction between the brain and the gut that motivated the researchers to investigate the mechanism at play. The researchers' findings were published in the journal Gut Microbes and are available online. Gut bacteria predict brain metabolites In this study, the scientists used 1-month-old piglets, since they are the animals with most similarities to human infants when it comes to the development of the brain and the gut microbiome.

17 "Using the piglet as a translatable animal model for human infants provides a unique opportunity for studying aspects of development which are sometimes more difficult or ethically challenging to collect data on in human infants," explains Mudd. "For example, in this study we wanted to see if we could find bacteria in the feces of piglets that might predict concentrations of compounds in the blood and brain, both of which are more difficult to characterize in infants," he adds. First, the researchers found that the Bacteroides and Clostridium bacteria, identified in the animals' feces, predicted higher levels of myo-inositol, which is a substance that plays a role in cell signaling. Bacteroides could also predict higher quantities of creatine - an amino acidlike compound - in the brain. Link between chronic fatigue syndrome and gut bacteria explored Link between chronic fatigue syndrome and gut bacteria explored What role do gut bacteria play in chronic fatigue syndrome? READ NOW The scientists also noticed that Butyricimonas bacteria could positively predict nacetylaspartate (NAA), an amino acid found in the brain. At the same time, they found that an abundance of Ruminococcus bacteria in the feces correlated with lower concentrations of NAA in the brain. Mudd highlights the fact that previous research had already suggested a link between abnormal NAA and the development of ASD, but so far, nothing had led scientists to note correlations between gut bacteria and NAA. "These brain metabolites have been found in altered states in individuals diagnosed with autism spectrum disorder [...], yet no previous studies have identified specific links between bacterial genera and these particular metabolites." Austin Mudd Cortisol acts as communication channel Next, the researchers sought to establish whether these types of bacteria could also predict the concentration of certain compounds in the blood. Study co-author Ryan Dilger, who is an associate professor at the University of Illinois, explains that collecting fecal samples and blood biomarkers from infants would be more feasible than carrying out other tests. If this approach is proven effective, it would enable easier tests that could flag up potential ASD predictors. "Blood biomarkers are something we can actually collect from an infant, so it's a clinically relevant sample. It would be nice to study an infant's brain directly, but imaging infants is

18 logistically and ethically difficult. We can, however, obtain feces and blood from infants," says Prof. Dilger. It was found that the microbes from feces could predict levels of serotonin and cortisol, both of which are influenced by gut bacteria. Bacteroides bacteria were linked with higher levels of serotonin, and abundant Ruminococcus were associated with lower levels of both compound The study authors note that their findings support the results of existing studies that separately observed the associations between ASD and altered levels of serotonin and cortisol, on the one hand, and an abundance of Bacteroides and Ruminococcus in the feces, on the other. Using "mediation analysis," a statistical method, the researchers tested the existence of a three-way relationship between Ruminococcus, NAA, and cortisol. They found that cortisol in the blood acted as a sort of "channel of communication" between fecal Ruminococcus and cerebral levels of NAA. This suggests that Ruminococcus influence changes in the brain indirectly, through serum cortisol. The researchers conjecture that this three-way mechanism could play a role in determining ASD symptoms, but they caution that this must be confirmed by further in-depth studies. "We remain cautious and do not want to overstate our findings without support from clinical intervention trials, but we hypothesize that this could be a contributing factor to autism's heterogenous symptoms," says Mudd. Microcytic anemia Microcytic anemia: Symptoms, types, and treatment (Medical News Today: ) Lack of oxygen in the body may be due to a lack of red blood cells. Microcytic anemia is a condition in which the body's tissues and organs do not get enough oxygen. This lack of oxygen can happen because the body does not have enough red blood cells, or because the red blood cells do not contain enough hemoglobin, which is a protein that transports oxygen in the blood. When there is a lack of hemoglobin in a red blood cell, the cell is smaller in size and can carry less oxygen.

19 Microcytic anemia is not one condition, but rather describes several different types of anemia. Irritability, tiredness, and pale skin may be symptoms of severe anemia. Many people have no symptoms of microcytic anemia in its earlier stages. The American Academy of Family Physicians (AAFP) state that doctors discover it by chance when a person is having a blood test for another reason. For those who have more severe anemia, symptoms may include: pale skin that looks gray pale color inside the eyelids or under the nails weakness or tiredness irritability shortness of breath rapid heart rate pica, which is a desire to eat things such as ice, dirt, and clay Causes of microcytic anemia Microcytic anemia can be caused by several different health conditions, ranging from mild problems to more serious issues. It is important to work with a healthcare team to find the underlying cause. An article in the International Journal of Laboratory Hematology states that microcytic anemia is usually caused by one of the following conditions whose names form the acronym TAILS: Thalassemia Thalassemia is an inherited blood disorder that parents can pass down to their children as a result of abnormal genes. If someone has thalassemia, their body does not make enough of a particular protein typically found in hemoglobin. Without this protein, red blood cells will not form properly or work as well as they should. The lack of this protein causes anemia, which can range from mild to severe depending on how many genes are affected. An article in The BMJ states that iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. These two conditions may also occur together in some people.

20 Anemia of chronic disease Certain chronic diseases and conditions can cause microcytic anemia. This is usually called anemia of inflammation and chronic disease (AI/CD). Chronic infections or inflammation can interfere with the way the body processes iron. About one-fourth to one-third of these types of anemia are classified as microcytic. Some of the conditions that can cause this type of anemia include: kidney disease certain cancers, such as Hodgkin's disease, non-hodgkin's lymphoma, and breast cancer inflammatory diseases such as diabetes, heart failure, Crohn's disease, inflammatory bowel disease, rheumatoid arthritis, and lupus infectious diseases including HIV, AIDS, tuberculosis, and some heart and bone infections Iron deficiency anemia The AAFP states iron deficiency is the most common cause of microcytic anemia. The reason behind iron deficiency often varies depending on a person's age and sex. In children, nutritional deficiencies are usually the cause of iron deficiency anemia. In menstruating women, menstrual blood loss is the most common culprit for iron deficiency. The most common reason for iron deficiency in adult men and nonmenstruating women is blood loss. Most commonly, this blood loss occurs in the gut, which may be the result of a bleeding ulcer in the stomach. In some cases, a tumor in the gut can cause bleeding. Some people may need additional testing to look for a tumor or to rule it out. Older adults may have iron deficiency anemia from because their diet lacks certain nutrients, or because they have particular chronic health conditions that hinder their body's ability to absorb iron. An article in American Family Physician found that anemia prevalence ranges from 8-44 percent in older men. Anemia: Causes, symptoms, and treatments Anemia: Causes, symptoms, and treatments Learn more about anemia in general. What other ways can this condition be caused? READ NOW Lead poisoning

21 Children who are exposed to lead-based paint because they live in an older home, or because it is on toys or other objects, can get lead poisoning when they put objects in their mouths. Contaminated water and exposure to heavy industrial pollution can also cause lead poisoning, though this is less common. Sideroblastic anemia Congenital sideroblastic anemia is an inherited blood disorder that affects the bone marrow's ability to produce red blood cells. Though it can cause microcytic anemia, it is less common than the other causes. Treatment iron supplements on a spoon A doctor may recommend iron supplements to treat anemia. People that develop anemia of any type should see their doctor for treatment, even if no symptoms are present. Although somebody who has mild anemia may feel fine, the condition can cause damage to critical organs in the body over time. Severe or long-lasting anemia can even cause death. Treatment depends on the underlying cause of microcytic anemia. Doctors may need to carry out some tests to determine a cause so that they can put together a treatment plan. Doctors may recommend iron supplements, which often resolve microcytic anemia in children. If they do not help, further tests may be needed to check for blood loss or another possible cause. Other treatment options include: antibiotics to treat chronic infections that are causing anemia hormones to treat heavy menstrual bleeding a medication that stimulates the body to make more red blood cells blood transfusions (in more severe cases). surgery to correct a bleeding stomach ulcer or a tumor in the gut Chelation, which is a therapy that helps reduce lead levels in the body, may also be used. This therapy is sometimes helpful in children with anemia, because anemia makes them more likely to get lead poisoning. Prevention In some cases, such as with an inherited disorder, there is no proven way to prevent microcytic anemia completely.

22 Eating a balanced diet high in iron, vitamin B12, vitamin C, and folic acid can be helpful for almost anyone with anemia. People who do not get enough iron in their diets may need to take supplements under a doctor's supervision. Preventing anemia in babies The American Academy of Pediatrics says that infants should not be given cow's milk especially before they are 12 months old. Giving cow's milk to a child too early can cause blood loss in the stool and can interfere with iron absorption. Parents should ask their pediatricians about the right age to introduce cow's milk. Breast-fed babies usually get enough iron from their mothers up to 4 months of age. Once the baby is ready for solid foods, introduce foods with added iron to their diet. Give formula-fed babies formula that has proper amounts of iron. Children and cow's milk Older children can usually consume up to 2 cups of whole cow's milk per day. Drinking more than this amount can lead to iron deficiency anemia. Anemia can occur because: milk is naturally low in iron milk can fill a child up, leaving less room for iron-rich foods in the diet milk contains calcium and casein, which interfere with the body's ability to absorb iron Good food sources of iron People of all ages can benefit from iron-rich foods that can help prevent some types of anemia. Also, foods high in vitamin C, such as citrus fruits, help the body absorb iron better. The body absorbs the animal form of iron most efficiently, so vegetarians may need to be more mindful of getting enough iron. Some of the most common iron-rich foods include: red meat egg yolks fortified grains and cereals beans leafy, green vegetables

23 tomatoes potatoes raisins Outlook The long-term outlook for people with microcytic anemia depends largely upon the cause of the anemia. Most cases are mild, particularly those that are caused by a slight iron deficiency. More severe forms or those caused by thalassemia, ulcers, or tumors may require more medical care. The key to a higher quality of life with microcytic anemia is to identify it and treat it as soon as possible. Getting regular complete blood counts (CBCs) can help diagnose anemia in those who have no symptoms. This leads to earlier treatment of the underlying cause and usually a better quality of life overall. Visit our Blood / Hematology category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Blood / Hematology. All references are available in the References tab. RELATED COVERAGE What is vitamin b12? Vitamin B12 is necessary for healthy nerve tissue, brain functioning, and red blood cell production. It is normally only available in animal-based foods. READ NOW Nutritional deficiency anemia: causes, symptoms, and treatment Nutritional deficiency anemia can result from a lack or iron or certain vitamins in the diet. Find out how they happen and how to prevent them. READ NOW Anemia: causes, symptoms, and treatments Learn about anemia - the most common disorder of the blood. Find out how it is diagnosed, what causes it, and the range of available treatments. READ NOW What are the health benefits of iron?

24 Find out about the potential health benefits of iron including assisting with a healthy pregnancy, helping both mental and physical performance and preventing anemia. READ NOW Autoimmune hemolytic anemia: get the facts Learn all about the causes, symptoms, and treatment of autoimmune hemolytic anemia, a condition where the immune system destroys red blood cells. Type 2 diabetes Type 2 diabetes: Sponge implants may reduce blood sugar and weight gain(medical News Today: ) Scientists have found that by injecting polymer sponges into the fat tissue of patients with type 2 diabetes, communication between fat and the rest of the body can be restarted, thereby preventing weight gain. In a search for new treatments for type 2 diabetes, researchers have discovered that implanting polymer sponges into fat tissue might offer a way forward. So suggests new research from the University of South Carolina (USC) in Columbia that is featuring at the American Chemical Society's 254th National Meeting & Exposition, held in Washington, D.C. The team found that 3 weeks after receiving polymer sponge implants in their fatty abdomens, obese mice with type 2 diabetes fed on a high-fat diet gained less weight and had lower levels of blood sugar than untreated equivalent mice. Diabetes is a long-lasting disease that develops when the body either does not make enough insulin (type 1 diabetes) or cannot use insulin effectively (type 2 diabetes). Insulin is a hormone that helps cells to take up sugar from the blood so they can use it for energy. Major tissues and organs, such as the liver, brain, and skeletal muscles, need lots of blood sugar to work properly. If untreated, diabetes can result in vision loss, heart disease, stroke, kidney disease, and other health problems, due to damage caused by excess glucose in the bloodstream. Body fat is an 'active organ'

25 Around 30.3 million people in the United States have diagnosed or undiagnosed diabetes. Approximately 95 percent of them have type 2 diabetes. The number of U.S. adults with diabetes has more than tripled in the past 20 years, largely as a result of an aging population and rising numbers of overweight and obese people. Insufficient sleep raises type 2 diabetes risk in children Insufficient sleep raises type 2 diabetes risk in children Learn how losing just 1 hour of sleep might raise risk factors for type 2 diabetes in children. READ NOW As yet there is no cure for diabetes, and current treatments depend heavily on patients' ability to manage them. Thus, researchers are keen to discover ways to manage diabetes that do not need patients to perform daily tasks. Important discoveries in recent years have revealed that body fat is not just a passive reservoir of excess energy but an "active organ" that releases hormones and communicates with other parts of the body. For example, obesity research has revealed that fat tissues participate in an intricate pattern of "inter-tissue crosstalk" that influences metabolism and inflammation. Polymer sponges One member of the USC team had previously experimented with pancreatic cells embedded in polymer sponges, implanting them into the fat pads of mice with type 1 diabetes as a way to restore insulin production. R. Michael Gower, Ph.D. - now a USC assistant professor of chemical engineering and of biomedical engineering - had done this work while at Northwestern University in Evanston, IL. In the new study, Prof. Gower and colleagues wanted to find out what effect the polymer sponges - which are made of poly(lactide-co-glycolide) (PLG) - on their own might have on fat tissue. The researchers regard themselves as "tissue engineers" who are addressing diabetes by restoring the communication between fat tissue and other parts of the body. Prof. Gower explains, "When people eat poorly, don't exercise, and are under a lot of stress, they gain weight. When fat stores get too large, communication with other parts of the body breaks down and can lead to diabetes. What we're trying to do is restart that conversation." Implanted mice improved glucose transport

26 The team worked with obese mice that had developed symptoms similar to those of type 2 diabetes and were fed on a high-fat diet. They implanted PLG sponges into the abdominal fat pads of the mice. Within 1 week, the pores of the implanted PLG sponges had filled with fat cells, immune cells, and blood vessels. After 3 weeks on the high-fat diet, the implanted mice had increased body fat by only 10 percent, whereas mice on the same diet that had not received PLG implants increased body fat by 30 percent. When they examined the animals' calf muscles, the team found that compared with nonimplanted mice, the PLG-implanted mice had 60 percent raised levels of glucose transporter type 4, which is a protein that helps to transport sugar from the blood into muscle cells. The mice appeared to suffer no negative side effects from the polymer material, which the researchers note is present in sutures, stents, and other types of implant already in use. The researchers are already trying to work out how the polymer sponge lessens weight gain and reduces blood sugar. After this, they will test ways to fine-tune the method and enhance its effect by encapsulating the material with bioactive compounds. During another related study, which features at the same meeting, the team had already discovered a compound that appears to enhance the material's effects. The compound is resveratrol, which is found in red wine and other foods. "I think what's really exciting about this work and its implications is that we're looking at how implanting this biomaterial in fat tissue, which has the ability to communicate with other organs, is affecting the whole body." Heart Cells त Ǒ ȧखर ब Ȫ ȡf Ȳख द ɉ Ȣ Ȥ (Dainik Gagaran: ) Ǒ ȧखर ब ह Ǖ ȧ Ȫ ȡj Ȳक è : ȣह न क ȣ ȡ Ȱ ȡǓ ɉन ढ ढ Ǔ ȡ ȡह इसक ǐ f ǿ ȡ ȡ ( ȡ [ फ ल) और Ǒ स स ब ध \ Û Ȣ ȡǐ ɉ स Ē è ȣ ɉ क इल ज Ʌ Ȱ ȡǓ ɉक मदद सक ग दरअसल, Ȫ ȡ[j Ȳन ȨÛ न न- Ȫ Ȳ ȣ ȪÛ ǗǔÈ f

27 (एनस आरएनए) ȧपहच न ȧह, ज Ǒ ȧ Ȫ ȡj Ȳक Ȥ करन य ` Û Ʌ Ǖ ȸ करन व ल ज न क Ǔ Ȳǒğ करत ह Ȱ ȡǓ ɉ न इस ȯ आरएनए क Ȳ ȡ [ न म Ǒ ȡ ह Ȱ ȡǓ ɉ क म नन ह यह ç Ʌǿ ȡ ȡ क उपच र Ʌसह यक ȡǒ ह सकत ह 1 Ǘ ȣ Ȫ ȡf Ȳखद ह ज त ɇ Ȥ : म नव ȣ ȧï ȡ ȡ Ȫ ȡf Ȳखर ब ह न पर è : Ȥ ह न ȧ ȡरखत ɇ, ȯ Ǒ ȧ Ȫ ȡj Ȳक स थ ऐस ȣȳह त ह ȣवजह ह \ Û Ȣ ȡǐ ɉ ȧत लन ɅǑ स ब ध Ȣ ȡǐ ɉस ल ग \ Ē è ह त ɇऔर इसस Ǚ Ǖभ Ï ȡ ȡह त ह 130 ȧ Ǚ Ǖ Ȳ ȡ Ǖ Ʌ: एक \ Ú क Ǖ ȡǒ, Ȱǔæ è पर ह न ȡ ȣ ȫ ɉ क एक बड़ क रण ǿ स ब ध र ग ह त ɇ@ [2015 Ʌ ȡ [ Ȫ è Ǖ Ȣ (Ǒ ȧ Û Ȣ ȡǐ ɉ) क क रण एक कर ड़ 77 ल ख Ȫ ɉ ȧ ȡ Ʌगई थ ^ Ʌस 30 ȧ ȫ Ʌ क वल Ȳ ȡ Ǖ Ʌह ई ȢȲ@ Ȳ ȡ Ǖ, ĤȯĚ : Ǒ ȧ खर ब ह Ǖ ȧ Ȫ ȡj Ȳक è : ȣह न क ȣ ȡ Ȱ ȡǓ ɉ न ढ ढ Ǔ ȡ ȡ ह इसक ǐ f ǿ ȡ ȡ ( ȡ [ फ ल) और Ǒ स स ब ध \ Û Ȣ ȡǐ ɉ स Ē è ȣ ɉ क इल ज Ʌ Ȱ ȡǓ ɉ क मदद सक ग दरअसल, Ȫ ȡ[j Ȳन ȨÛ न न- Ȫ Ȳ ȣ ȪÛ ǗǔÈ f (एनस आरएनए) ȧपहच न ȧह, ज Ǒ ȧ Ȫ ȡj Ȳ क Ȥ करन य ` Û Ʌ Ǖ ȸ करन व ल ज न क Ǔ Ȳǒğ करत ह Ȱ ȡǓ ɉ न इस ȯ आरएनए क Ȳ ȡ [न म Ǒ ȡह Ȱ ȡǓ ɉक म नन ह यह ç Ʌǿ ȡ ȡ क उपच र Ʌसह यक ȡǒ ह सकत ह 1 Ǘ ȣ Ȫ ȡf Ȳख द ह ज त ɇ Ȥ : म नव ȣ ȧï ȡ ȡ Ȫ ȡf Ȳखर ब ह न पर è : Ȥ ह न ȧ ȡरखत ɇ, ȯ Ǒ ȧ Ȫ ȡj Ȳक स थ ऐस ȣȳह त ह ȣवजह ह \ Û Ȣ ȡǐ ɉ ȧत लन ɅǑ स ब ध Ȣ ȡǐ ɉस ल ग \ Ē è ह त ɇऔर इसस Ǚ Ǖभ Ï ȡ ȡ ह त ह 130 ȧ Ǚ Ǖ Ȳ ȡ Ǖ Ʌ: एक \ Ú क Ǖ ȡǒ, Ȱǔæ è पर ह न ȡ ȣ ȫ ɉक एक बड़ क रण ǿ स ब ध र ग ह त ɇ@ [2015 Ʌ ȡ [ Ȫ è Ǖ Ȣ (Ǒ ȧ Û Ȣ ȡǐ ɉ) क क रण एक कर ड़ 77 ल ख Ȫ ɉ ȧ ȡ Ʌ गई थ ^ Ʌस 30 ȧ ȫ Ʌक वल Ȳ ȡ Ǖ Ʌह ई थ è ɇ (Dainik Gagaran: )

28 è ɇ स ह न ȡ ȣ ȫ ɉक र कन स भव 1भ रत Ʌè ɇ क म मल लग त र बढ़त ज रह थ ȣ^ ȧवजह स ह न ȡ ȣ ȫ ɉ ȧ ȲÉ ȡ Ʌभ Ǚƨ ह ȣह \ ȯǐ ȧ Ȫ ȡ[j Ȳन Ȣ Ǒ ȡj Ȳ ȧज न बच न क आस न ȣ ȡढ ढ़न क द व ȡह ȯ ɉक कहन ह 40 [ ȧ` Ĩ क ब द स ल न Ȱ ȪĒ ȡ ȧ(è Ʌम जद ɪ Ǘ क f È -र क ǐ ȯपत लग न क ȣ ȡ) कर न स è ɇ स ह न ȡ ȣ ȫ ɉ Ʌ40 ȧ तक ȧ कम ल ई ज सकत ह Ȫ ȡ[j Ȳन 40 और ȧआय Ʌस ल न, [ ȧ` Ĩ और [ ȧआय ɅĤǓ द [ Ʌएक ब र Ȱ ȪĒ ȡ ȧकर न ȧज च पड़त ल ȧ@ ȡ ȣ [ ȧ` Ĩ स हर स ल Ǔ ज च क सबस Ï ȡ ȡफ यद स मन आय ह -आइएएनएस1 Ǘ [Ē क ड ट स त य र ȧस ग त ȧधन 1 Ȫ ȡ[j Ȳन \ ȯǐ ȡ Ʌह ए Ǘ [Ē क ड ट क ǐ f एक स ग त ȧधन त य र ȧह यह ड ट, स रज, च द ȧ Ǔ और गहर त अ ध र और ल टत उज ल क आध र पर त य र ȡह \ ȯǐ ȡ ȧ Ȩǔ [ ȡ^Ȳè ȣɪ Ǘ ऑफ ȯè Ȫ Ȩ Ȣक Ȫ ȡ[j Ȳक दल Ʌ ȡ भ रत य म ल क Ȱ ȡǓ अवर ष क म र क Ǖ ȡǒ, इस धन क त य र करन क f हमन द ğȯ ȣ ɉ ȧमदद ȣ@ ^ Ʌस एक न पहल Ē द ख ह आ थ ` Û ɉ ȯबत य Ē क द र न ` Û Ʌउनक आस-प स क म ह ल स क स Ú Ǔ सन ई द त ह इसक ब द हमन Ē क अनस र धन त य र ȧ@जब च द न स रज क ढकन ǕǾ ȡत स ग त ȧ ह ई थ, ज उस प र ढकन तक बढ़त गई इसक ब द Ē ह त ह ए कम ȧ@क म र कहत ɇ, Ē क द र न बह त ȡ ȣ Ǔ ɉक आप स ग त Ʌअन व द कर सकत ɇ@इस Ĥ Ȫ क प छ हम र ` Ƨȯæ ऐस धन त य र करन थ, जसस पत चल सक आसम न ɅÈ ȡह रह ह -Ĥ ȯě Horney Surgery (Navbharat Times: )

29