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

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1 DAILY NEWS BULLETIN LEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE Day Monday Healthcare Rs450cr spent in a year, but healthcare in ICU (The Times of India: ) Neglect And Poor Management Define All Five Big Hospitals Run By The Cash-Strapped North Corporation. TOI Explores New Delhi: There is a big financial crunch in North Delhi Municipal Corporation, which has five major hospitals under its jurisdiction. It does, of course, spend at least Rs 450 crore every year on the hospitals, except that 90% of the amount goes into paying staff salaries. In the past three months, when even employees haven t been given their salaries, it is easy to understand why today the hospital complexes have stray dogs and monkeys in places occupied by patients. NDMC s five big hospitals are Hindu Rao (Malka Ganj), Kasturba Gandhi (Daryaganj), Balak Ram (Tughlakabad), Girdhari Lal (Ajmeri Gate) and Rajan Babu Institute of Pulmonary Medicine & Tuberculosis (GTB Nagar). These are major institutions Hindu Rao is the biggest of the multispeciality centres, while Kasturba logs the most number of child deliveries annually but neglect and mismanagement are evident on the campuses. Despite the north corporation employing around 900 sanitation workers for these hospitals, the conditions there are nowhere close to the standards required of a health facility. Earlier, there was no problem in maintaining these facilities, but after the Municipal Corporation of Delhi was trifurcated in 2012, these hospitals fell into our jurisdiction. Our expenses increased, but our source of income has remained the same, said a senior corporation official. In the absence of adequate funds, the hospitals are struggling with a staff shortage. At Kasturba Gandhi, for instance, there are only five gynaecologists against the 13 provided for.

2 The situation is similar in other hospitals. Doctors there claimed that many of their colleagues have left due to inconsistent payment of salaries. There is an urgent need of doctors, but the delay in salaries deters many, while some quit a few months after recruitment, confided a doctor at Hindu Rao. Change has been slow too. While Rajan Babu, which has 1,153 beds, remains empty most of the time because cases of tuberculosis, the specialty at the hospital, has come down rapidly, the upgradation of Balak Ram in Tughlakabad from 100 beds to 200 has remained on paper. We are planning to upgrade Rajan Babu into a multi-speciality hospital from being just a tuberculosis care centre since just beds are occupied at any one time, said a senior civic official. But such plans haven t taken off either in the case of Rajan Babu or at Balak Ram. The plans to merge the north body s hospitals to cut down on expenses and to hand over Balak Ram to Delhi government too haven t worked out. The civic body can hand over the hospitals to the state government during financial stress, but as officials claimed, only the deliberative wing of the corporation can take such decisions.

3 We are trying to increase our revenue collection, but it is going to take some time, admitted a corporation official. The north corporation can only hope that fourth Delhi Finance Commission report is implemented by Delhi government. Under the report, which was to have been implemented in 2012, the north civic body is assured of an additional Rs 1,000 crore a year. This amount could resolve the problems created by the fund crunch, pointed out the official. Pollution Focus on indoor air too, study claims it could be far worse (The Times of India: ) New Delhi: You might be aware about the pollution levels outside, but do you know that the indoor air you inhale might be far worse? A study by the environmental studies department of Delhi University shows that poor ventilation and structural designs can trap volatile organic compounds (VOCs), bioaerosols and particulate matter inside that can lead to various health ailments, including acute respiratory illnesses and impairment of lung function. The nearly five year-long research, conducted on 900 people across several households of varied income groups, pointed out that the high and low level groups were most vulnerable to respiratory diseases due to the lifestyle and design flaw of their houses.

4 Chirashree Ghosh, associate professor, DU environmental science department, said it is difficult to measure the actual impact of indoor air pollution owing to an absence of indoor air policy in the country. The study aims to bust the myth that the air quality indoors is safe. In fact, it could be even worse because the outside pollutants gets trapped inside. In addition, there are several pollutants and sources indoors that can cause pollution levels to rise gradually, unless there is proper ventilation, Ghosh told TOI. The research found that most houses had high volatile organic compounds dust, radon, CO2 and high concentration of bioaerosols (organisms or dust that consists of pathogens, viruses, fungi, allergens and pollen). Poor ventilation was the primary source of indoor air pollution. Using any form of spray or room freshener releases high amount of volatile organic compounds in the air, which stays for several weeks without proper ventilation. VOCs are carcinogenic and can cause long-term damage to people, said Ghosh. The study found that in low-income households, the pollution levels were highest around evening when cooking begins and family members return home. For higher income households, mornings and nights were most polluted, Ghosh said, adding that the poor indoor air quality can lead to increased instances of chronic bronchitis, acute respiratory illnesses and impairment of lung function, among other hazards. The next phase of the study would focus on household structures within DU to analyse different sources of indoor pollution and components according to seasons. The ministry of earth sciences has asked us to find the source and solution to the problem. We will look at five different types of structures within DU and analyse the architectural component and design that may be causing the problem, said Ghosh.

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6 Weight How you can lose 2.5kg in a year without exercising (The Times of India: ) New Delhi: If you want to lose weight, stand for at least six hours daily. Top doctors from Mayo Clinic in the USA and Spain s Gregorio Maranon University hospital have recommended the additional muscle activity on the basis of a metaanalysis of 46 studies that measured the difference between energy expenditure in sitting and standing. They found that standing burned 0.5 kilo calorie (kcal) per minute more than sitting. Assuming no increase in food intake, it equates to 2.5kg in a year and 10kg in four years. The results of the metaanalysis have been published in European Journal of Preventive Cardiology. Francisco Lopez-Jimenez, senior author and chief of preventive cardiology at Mayo Clinic, said standing not only burns calories, it is also linked to lower rate of heart attacks, strokes and diabetes. As many people spend seven to eight hours at work, obesity is also being termed as a lifestyle problem. In 2015, the UK had issued guidelines designed to curb such health risks. The guidelines, prepared by a panel of international experts, recommended at least two hours of light activity and standing during working hours for all employees whose jobs were predominantly deskbased. Standing at regular intervals to work in a desk-based job is likely to get better results than targeted exercise, the guideline, published online in British Journal of Sports Medicine, stated. It added that employers should encourage their staff to follow healthy practices, such as cutting down on drinking and smoking, eating a nutritious diet and alleviating stress. Dr Anoop Misra, chairman of Fortis C-Doc Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, said non-communicable diseases are causing a health and economic crisis. Due to poor lifestyle and lack of physical activity, a generation of young professionals in their 20s and 30s are battling with health problems like obesity and fatty liver which, till about a decade ago, was seen in older people. If light activities and standing at offices for a few hours can help as the research suggests, we must adopt it in our lifestyle, he added. Experts said when we sit for long hours without a break our muscles burn less fat and blood flows more sluggishly. This leads to clogging of the heart by fatty acids. He added that lifestyle changes such as regular exercise, controlling obesity, less smoking and reducing alcohol consumption can help delay the onset of heart disease. Standing at work also helps reduce the risk of problems related to posture, backache for instance, said Dr Deepak Chaudhary, director of Safdarjung Sports Injury Centre.

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8 Malnutrition (The Asian Age: )

9 Dengue (The Asian Age: )

10 Dengue (Hindustan: )

11 Organ Donation In Good Faith: Lives of others (The Indian Express: ) Moral desirability of organ donation must be balanced against the coercion that altruism usually carries in unequal societies. The recipient of the first successful transplant lived for eight years after the surgery. (Representational photo) In 1954, the seemingly impossible idea of replacing a failing vital human organ with a working one became a reality when two doctors at a Boston hospital transplanted a kidney from one identical twin to another. But ethical issues surfaced immediately after the transplant. How could consent be obtained from the donor without moral coercion? How informed is the donor s choice? Does she understand the risks that surround her donation and recognise the uncertainties they involve? Organ donation saves lives. The recipient of the first successful transplant lived for eight years after the surgery. But what about the guiding ethic of the medical profession, primum non nocere above all, do no harm? Kidney donors are known to live healthy lives. However, studies in the European Union and China have shown that a third of them are vulnerable to urinary and chest infections. Doesn t the potential risk to the donor violate the first traditional rule of medicine? Rules in most parts of the world initially allowed only genetically-related family members to donate kidneys. But within a decade of the first transplant, developments in medical science allowed the use of other organs from unrelated deceased donors. Progress in research also allowed harvesting kidneys from unrelated donors for transplants. It is now possible for living donors to donate organs other than kidneys, including parts of the liver and lung. The ethical dilemmas around medical transplants have only grown sharper as a result. Strictly speaking, donation means an act of giving. The donor, the one who gives, is necessarily alive, the moral agent. But the developments in medical science have somewhat upset this definition. The donor can now be a cadaver, incapable of willing anything. How to define consent in such cases? The simple solution is to obtain such consent beforehand. Many countries thus have registries where people state their willingness to donate organs after the end of their lives. Consent remains a fuzzy concept even then with the next-of-kin often expected to make decisions on behalf of the deceased. The NHS in Britain, for example, regularly complains that bereaved families block transplants from registered donors. Two weeks ago, the Netherlands joined a small group of countries including Spain, Belgium, and Wales in the UK that have tweaked the consent rules in ways that obviate

12 the role of a dead donor s next-of-kin. On February 13, the country s Parliament passed a law that deems all Dutch adults potential organ donors, unless they opt out. Is this scheme morally defensible? It has been critiqued on the grounds that in an atmosphere where support for organ donation is all pervasive, a greater proportion of people who do not want to donate will end up having their organs used against their wishes. Though these are early days, the opt-out system does seem to be working better. Transplants in Wales, for example, have risen by a third after the health system there adopted this system in Spain is known to have one of the highest transplantation rates in the world. We have no way of finding out how many of such donors opt-in of their will. But the systems in Spain, Belgium, Wales, and now the Netherlands, are founded on a fundamental ethical shift: Instead of putting the onus on the donor to prove altruism, they assume that the urge to save another life is innate to human beings. Altruism does have moral resonance. Consider, for example, the moral argument against the driver who speeds past someone grievously injured on a highway. Shouldn t a similar moral force be attached to donating organs after death, given the long waiting lists for transplants in most parts of the world? In India, for example, more than 1.5 lakh patients are waiting for organs with a mere 12,000 donors available. More than 1 lakh people die of liver diseases, while just 1,000 get a liver transplant. The Ministry of Health estimates that the annual requirement for kidneys could range between 1-2 lakh while a mere 5,000 transplants happen annually in the country. The opt-out system might, however, be put to test in cases where live donors are deemed as viable as cadavers. In the US, for example, kidney transplants as a result of donations by family members or friends outnumber those obtained from a cadaver. This often goes into making the case for a regulated market in human organs. The example often cited in support is that of Iran which offers people a legal way to sell their kidneys. However, only the desperately poor would want to sell their organs. Their decision might seem to be a rational one from the perspective of economic choice but is not necessarily a free choice. As the bioethicist Arthur Caplan points out, Watching your child go hungry while you lack a job and a wealthy person waves a wad of bills in your face is not exactly a scenario that inspires confidence in the choices that the poor would make in a market for body parts. There is, of course, no guarantee that the opt-out system would succeed in places other than the small number of countries in which it has been adopted. Surveys in most parts of the world show that people do appreciate the ethical need for organ donation. But their altruism is also premised on the presumption that organs will be distributed in a fair manner to those in need. That rarely happens. According to Caplan, an impressive number of papers in professional journals show that women, the elderly, the disabled and the minorities are not represented in the ranks of those receiving transplants to the extent that they could and they should. That remains the fundamental unresolved ethical problem of organ donation systems.

13 Fertility (The Asian Age: )

14 National Health Protection Scheme NHPS to focus on quality generics, not just branded: Ananth Kumar (The Indian Express: ) In the Union Budget , an initial corpus of Rs 2,000 crore was provided for the NHPS that aims to provide medical cover of Rs 5 lakh to over 10 crore poor and vulnerable families. The central government s National Health Protection Scheme (NHPS) is going to put all of its focus on quality generic medicines, and not just the branded generic medicines, said Union Chemical and Fertiliser Minister Ananth Kumar while addressing a closed door session with chief executives (CEOs) of pharmaceutical companies in Bengaluru on Feburary 15. The Department of Pharmaceuticals comes under the Ministry of Chemicals and Fertilisers. In his closing address to the CEOs, Kumar said that Namocare (NHPS) is all about quality generics, and not just branded generics and added that if they (CEOs) focus on quality generic medicines, their business will gallop under Namocare, according to three persons who were present in the closed door session. The minister s office confirmed The Indian Express that he made this statement at Bengaluru. Some executives who were present at the CEO roundtable were Satish Reddy, Chairman, Dr. Reddy s Laboratories; Luca Visini, Managing Director, Eli Lilly and Company (India); Annaswamy Vaidheesh, vice-president (South Asia) and managing director, GlaxoSmithKline Pharmaceuticals Ltd; Jawed Zia, Country President, Novartis India; Vivek Vasudev Kamath, Managing Director, MSD Pharmaceuticals; Ajit Singh, Chairman, ACG Worldwide. Indian pharmaceutical industry earns majority of its revenues by selling branded generic drugs in the country. Generic drugs are cheaper than branded generic drugs. Whenever a drug s patent expires, the company that wants to produce generic version has to get the license for it from the drug regulator. Generic drug is sold by its salt name, while the branded generic drug is sold by the company under a particular brand label. For example, as Paracetamol is the salt name, the generic drug is sold with a label Paracetamol only, while the branded generic versions are sold in India by companies under their respective brand labels such as Calpol, Dolo and Sumo. While inaugrating a charity hospital in Surat on April 17, 2017, Prime Minister Narendra Modi indicated that central government may bring in a legal framework under which doctors will have to prescribe generic medicines, which are cheaper than equivalent branded generic drugs, to patients. Modi said: Doctors write prescriptions in such a way that poor people do

15 not understand the handwriting, and he has to buy that medicine from private stores at high prices We will bring in a legal framework by which if a doctor writes a prescription, he has to write in it that it will be enough for patients to buy generic medicine and he need not buy any other medicine. One of three aforementioned persons, who attended the closed door session at Bengaluru, told The Indian Express: The chemicals minister stated that consumption of medicines is lopsided in India. He stated that the persons who belong to groups such as below poverty line (BPL), poverty line (PL), Economically Weaker Section (EWS), and other low income groups, consume just 20 per cent of medicines, even though they consist of the 60 per cent of the population in India. On the other hand, 80 per cent of the medicines is consumed by the top 40 per cent population in India, as per the minister. The person added: The minister asked the industry to prepare a grand plan for one year, two year, three years and so on for the Namocare. He said that Namocare will change the healthcare sector and quality generics will be the focus of it. He added that he is not satisfied with the progress of Indian pharma industry per se and admitted that more needs to be done and more will be done. In the Union Budget , an initial corpus of Rs 2,000 crore was provided for the NHPS that aims to provide medical cover of Rs 5 lakh to over 10 crore poor and vulnerable families. Projections made by the NITI Aayog pegged the cost of the NHPS at around Rs 12,000 crore in total. The Centre expects to launch the scheme by October this year and the overall expenditure will be borne jointly by the Centre and the states in a 60:40 ratio. Flu Cough, sore throat, fever? Delhiites reeling under flu (Hindustan Times: ) It is taking longer for symptoms to settle down; normally 3-5 days is enough time to recover but we see people with symptoms for even 10 days to two weeks. SRIKANT SHARMA, consultant, department of medicine, Moolchand Hospital NEW DELHI: Seasonal flu seems to have hit Delhi in the past two months as many residents are battling symptoms like sore throat, fever, runny nose and chest infection, which many doctors blame on changing weather.

16 According to doctors, nearly 90% patients these days complain of high-grade fever 102 degrees Fahrenheit or above and severe cough. Initial symptoms usually include sore throat and body ache. I see at least 10 patients suffering from flu each day with severe symptoms, said Dr Atul Gogia, senior consultant, department of medicine, Sir Ganga Ram Hospital. This month has been particularly bad with unusually high number of cases, Gogia added. The pollution only makes the symptoms worse as people tend to develop secondary bacterial infections that need a course of antibiotics and takes longer to treat, said doctors. For some people, it is pollen allergy that aggravate asthma symptoms and they land up in a hospital with wheezing or shortness of breath. It is taking longer for symptoms to settle down; normally three to five days is enough time to recover but we see people with symptoms for even 10 days to two weeks, said Dr Srikant Sharma, consultant, department of medicine, Moolchand Hospital. In most cases, symptoms are self-limiting and do not require medicines. At most, doctors prescribe symptomatic treatment and warn against using antibiotics till the disease is limited to the upper respiratory tract. We usually prescribe symptomatic treatment to bring down fever and decongestant drugs. It also helps to drink plenty of warm fluids such as soup, herbal tea etc. to keep the body well hydrated as fever tends to dehydrate the body, said Dr RK Singal, director, internal medicine, BLK Super-Speciality Hospital. If the infection goes down to the lungs and leads to bronchitis or pneumonia, it may require a dose of antibiotics. The worst affected in this weather are the children, people above 65 years of age, and those with low immunity owing to underlying medical conditions such as diabetes, hypertension, cancer, heart disease, tuberculosis, among others. This group needs to be extra careful and see a doctor immediately after developing symptoms, said Dr Singal.

17 Smoking E-cigarettes leak toxic metals, study finds (Medical News Today: ) Several recent studies have suggested that electronic cigarettes may not be as safe as we may think, and a new study now adds that these popular devices leak harmful metals some of them highly toxic. New research suggests that toxic metals leaking from e-cigarettes could endanger health. Ever since their release on the global market, electronic cigarettes (e-cigarettes) have been hailed, generally, as a safer alternative to the regular ones. These devices work by heating up a flavored liquid that sometimes though not always contains nicotine. Instead of smoke, e-cigarettes release aerosols, or "vapors," which is why users of ecigarettes are often referred to as "vapers," and the act of "smoking" using this device is dubbed "vaping." Despite the popular belief that e-cigarettes are better for our health than traditional ones, recent research has indicated that these devices could bring about fresh, and little understood, risks. It has been suggested that people who use e-cigatattes could have a higher risk of cardiovascular problems and cancer, and a study published earlier this month found that a few certain e-cigarette flavors are particularly toxic. Now, a team of scientists from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, concludes that e-cigarette vapors could also be harmful. Senior study author Ana María Rule and team surmise that the danger may arise from the toxic content of ecigarette heating coils. "It's important for the FDA [Food and Drug Administration], the e-cigarette companies, and vapers themselves to know that these heating coils, as currently made, seem to be leaking toxic metals which then get into the aerosols that vapers inhale." Ana María Rule The researchers' findings are now published in the journal Environmental Health Perspectives. Concentration 'higher than safe limits'

18 In a previous study, Rule and colleagues identified a series of toxic metals cadmium, chromium, lead, manganese, and nickel in e-cigarette liquids. The new research took these findings and went further, testing the e-cigarettes of actual users in order to try to understand how exposed people were to these toxic substances, and under what circumstances. Rule and team worked with 56 participants who used e-cigarettes on a daily basis. The researchers tested the participants' e-cigarettes, verifying the presence of 15 metals in the refilling dispensers, the vaping liquids "loaded" into the e-cigarettes, and the vapors that resulted from the liquids' heating. The pros and cons of e-cigarettes revealed To what extent are e-cigarettes helpful or harmful? The researchers were able to confirm that toxic metals were present in the e-liquids from refilling dispensers, though in fairly small concentrations. But a completely different story unfolded in the case of tank-filling solutions that had already been heated by the inbuilt coils. These e-liquids had much higher concentrations of toxic metals, which the researchers say suggests that the solutions themselves are not the source of these substances. Instead, Rule and colleagues infer that the toxic metals may come from the heating coils. Due to the contamination of the e-liquid, traces of toxic metals were also found in the aerosols released by the e-cigarettes. The metals that the study's authors express most concern about are lead, chromium, nickel, and manganese, all of which have been linked with important health risks, including cancer, brain damage, and disorders of the respiratory system. In aerosols, the median concentration for lead alone was around 15 micrograms per kilogram, and 48 percent of the vapor samples that the team tested had lead concentrations that exceeded the limit recommended by the United States Environmental Protection Agency. "These were median levels only," says Rule. "The actual levels of these metals [including those of nickel, chromium, and manganese] varied greatly from sample to sample, and often were much higher than safe limits." Mysterious sources of toxic metals As previous research has confirmed, the heating coils contained in e-cigarettes are often made of a combination of nickel and chromium, plus other substances. This supports the thesis that many of the toxic metals whose traces were found in e-liquids and aerosols must have leaked from those coils. However, it remains unclear where the lead is coming from, or how all of these metals contaminate the e-liquid.

19 "We don't know yet whether metals are chemically leaching from the coil or vaporizing when it's heated," says Rule. Study co-author Angela Aherrera also led a separate investigation using data from the same 56 participants. Her additional inquiry revealed that the e-cigarette users had increased levels of nickel and chromium in their urine and saliva. These were consistent with the concentration of these metals identified in e-cigarette vapors. Interestingly, however, toxic metal traces were found in higher concentrations in vapors produced by e-cigarettes whose heating coils were frequently replaced. This suggests that the leaks likely occur from new heating coils, and perhaps less so in the case of older elements. Another worrying result indicated that arsenic a highly toxic substance was found in refill e-liquid, tank liquid, and vapors in no fewer than 10 out of the 56 sets of samples provided by the study participants. Why arsenic was present remains to be clarified. "We've established with this study that there are exposures to these metals, which is the first step," says Rule, adding that there is a "need also to determine the actual health effects." Schizophrenia Schizophrenia: A byproduct of the brain's complex evolution? (Medical News Today: ) New genetic evidence, published in the journal Schizophrenia, suggests that the condition is an "unwanted side effect" of the evolution of the complex human brain. The human brain is complex, and in its equally complex evolution, schizophrenia may have come up as 'an unwanted side effect.' More and more studies have been illuminating the genetic components of schizophrenia, a condition that affects about 1 percent of the world's population. The largest twin study of schizophrenia put 79 percent of the risk of the condition down to genes, while another believed that genetic mutations in the brain's glial cells may be responsible for the disorder.

20 Now, a new study conducted by three researchers from the Florey Institute for Neuroscience and Mental Health in Parkville, Australia, finds genetic changes in a frontal brain area commonly linked with schizophrenia traits, supporting the theory that the condition may be an undesired side effect of the human brain's evolution. Prof. Brian Dean, of Swinburne University's Centre for Mental Health in Hawthorne, Australia, as well as the Florey Institute, is the new study's corresponding author. Altered gene expression found in frontal pole Prof. Dean and colleagues conducted a postmortem examination of the brains of 15 people who had schizophrenia and 15 who did not. The scientists measured the levels of messenger RNA (mrna) in the frontal pole of the brain, the dorsolateral prefrontal cortex, and the cingulate cortex. Using mrna levels, the researchers predicted genetic pathways "that would be affected by the changes in gene expression." Schizophrenia risk gene plays key role in early brain development Scientists identify a risk gene for the condition. In the brains of people who had been diagnosed with schizophrenia, the researchers found 566 instances of changes in genetic expression in the frontal pole of the brain and surrounding areas, which are regions known to be involved in schizophrenia-related traits. As the study authors explain, "The frontal pole is critical in maintaining the cognitive flexibility that underpins human reasoning and planning abilities," which are two functions "that are impaired in individuals with [schizophrenia]." New genetic pathway uncovered The study also uncovered a genetic pathway in the brain's so-called Brodmann area that comprised interactions between 97 genes. "A better understanding of changes in this pathway could suggest new drugs to treat the disorder," says Prof. Dean. He goes on to explain the findings, saying, "It's thought that schizophrenia occurs when environmental factors trigger changes in gene expression in the human brain." Such potential environmental triggers for epigenetic changes include pregnancy and delivery complications, as well as psychosocial stressors such as growing up in a dysfunctional family. "Though this is not fully understood," adds Prof. Dean, "our data suggest the frontal area of the brain is severely affected by such changes." "There is the argument that schizophrenia is an unwanted side effect of developing a complex human brain and our findings seem to support that argument."

21 Prof. Brian Dean "A major finding of this study," the authors continue, "is that [...] no gene had altered levels of expression in all three regions of the cortex from subjects with [schizophrenia]." According to them, this means that in terms of gene expression, schizophrenia-related molecular changes are not uniform across the cortex. "These data also raise the possibility that the symptoms of [schizophrenia] that are thought to result from the dysfunction of different cortical regions could be due to changes in gene expression specific to the cortical region thought to be central to the genesis of a symptom," they say. Multiple sclerosis Multiple sclerosis: Skin cells may help to repair nerve damage (Medical News Today: ) A personalized treatment for multiple sclerosis may be one step closer, thanks to a new study that reveals how a person's own skin cells could be used to repair the nerve damage that the disease causes. Researchers reveal how neural stem cells derived from skin may help to treat MS. Led by scientists at the University of Cambridge in the United Kingdom, the study took skin cells from adult mice with multiple sclerosis (MS) and then reprogramed them into neural stem cells (NSCs). These "induced neural stem cells" (inscs) were transplanted into the rodents' cerebrospinal fluid. There, they reduced inflammation and repaired damage to the central nervous system (CNS). Lead study author Dr. Stefano Pluchino, of the Department of Clinical Neurosciences at the University of Cambridge, and team believe that their strategy could offer a promising treatment for MS and other neurological diseases. The researchers recently reported their findings in the journal Cell Stem Cell.

22 MS is a progressive neurological disease that is estimated to affect more than 2.3 million people across the globe. While the precise causes of MS remain unclear, "an abnormal immune system response" is thought to be involved. Such a response leads to inflammation in the CNS, which causes the destruction of myelin, or the fatty substance that protects nerve fibers. As a result, the nerve fibers become damaged. This disrupts neuronal signaling and triggers the neurological symptoms of MS, including tingling in the face or extremities and problems with movement, balance, and coordination. Using stem cells to treat MS Previous research has investigated the use of NSCs for the treatment of MS. NSCs are stem cells that have the ability to transform into different types of cell in the CNS including neurons and glial cells. However, there are some barriers to this strategy. As Dr. Pluchino and colleagues note, NSCs are derived from embryos, and it would be hard to obtain them in high enough quantities to sustain clinical treatment. Brain-repairing protein may lead to new MS drugs New MS drugs could be in the pipeline, thanks to a brain-repairing protein. It is also possible that the immune system would see embryo-derived NSCs as foreign invaders and try to destroy them. As such, researchers have turned their attention toward inscs, or NSCs that can be developed by reprogramming adult skin cells. Importantly, since these cells would be derived from the patients themselves, the risk of an immune system attack would be significantly reduced. To test whether inscs could be a feasible treatment option for MS, Dr. Pluchino and his colleagues tested them on adult mice that had been genetically engineered to develop the condition. The team took cells from the skin of the mice and reprogramed them into NSCs, effectively making inscs. Next, the team transplanted these inscs into the cerebrospinal fluid of the mice. Study yields promising findings The researchers found that this led to a reduction in levels of succinate, which is a metabolite that the team found is increased in MS. This increase prompts microglia a type of glial cell found in the CNS to trigger inflammation and cause nerve damage. By reducing succinate levels, the inscs reprogrammed the microglia which, in turn, reduced inflammation and brain and spinal cord damage in the mice.

23 Of course, human clinical trials are needed before inscs can be considered as a suitable treatment for MS, but this latest study certainly shows promise. "Our mouse study suggests that using a patient's reprogrammed cells could provide a route to personalized treatment of chronic inflammatory diseases, including progressive forms of MS." Dr. Stefano Pluchino "This is particularly promising," Dr. Pluchino adds, "as these cells should be more readily obtainable than conventional neural stem cells and would not carry the risk of an adverse immune response." Gastrointestinal What are the natural ways to get rid of gallstones? (Medical News Today: ) Overview Natural treatments Medical treatments Prevention When to see a doctor While medication and surgery are often used to resolve gallstone complaints, many people turn to natural remedies instead. Gallstones are a common complaint, affecting 10 to 15 percent of American adults. Read on to learn more about popular natural treatments for gallstones, along with some tips to stop them from forming in the first place. Fast facts on getting rid of gallstones naturally: Gallstones are solid particles that form in the gallbladder. Not much research exists to suggest that home remedies are effective treatments. It is important to see a doctor before treating gallstones with natural or home remedies. What are gallstones? Gallstones will be either cholesterol gallstones or pigment gallstones. Gallstones vary in shape and size, with some growing to the size of a golf ball. There are two types of gallstones:

24 Cholesterol gallstones: These are the most common form and are primarily made up of undissolved cholesterol. Pigment gallstones: Made up of excess bilirubin (a pigment that forms during the breakdown of red blood cells), these stones are brown or black. Not all gallstones cause symptoms. When symptoms are present, they include: pain in the upper right abdomen pain in the right shoulder or between the shoulder blades nausea gray stool diarrhea vomiting How to get rid of gallstones naturally Although there is no reliable evidence that these remedies work, the following treatments are popular natural alternatives to medical interventions. 1. Gallbladder cleanse One of the most common treatments for gallstones is a gallbladder cleanse. Proponents of this method claim it breaks down the gallstones and flushes them from the body. A 2009 paper states that although scientific evidence to support a gallbladder cleanse is minimal, anecdotal reports indicate it may be helpful for some people. A gallbladder flush involves consuming a blend of apple juice, herbs, and olive oil for 2 to 5 days. Recipes vary, and some procedures allow a person to eat food while others do not. This diet may be unsafe people with diabetes or blood sugar problems, who do not consume solid food during the cleanse. 2. Apple cider vinegar with apple juice Some people believe that apple juice softens gallstones, allowing them to be excreted from the body with ease. One cleanse involves mixing apple cider vinegar into the apple juice before drinking it. Although there is limited evidence to suggest that apple cider vinegar does have some health benefits, no studies support its use as a treatment for gallstones. Furthermore, people with diabetes, stomach ulcers, and hypoglycemia should be wary of consuming large amounts of fruit juice. 3. Dandelion

25 According to the National Center for Complementary and Integrative Health, dandelion has been used historically to treat gallbladder, liver, and bile duct problems. Supporters believe that the bitter roots may stimulate bile production in the gallbladder. People usually drink dandelion teas or coffees to remove their gallstones. However, there is no evidence to suggest this is beneficial. Furthermore, people with gallstones, gallbladder problems, or kidney problems should speak with a doctor before consuming dandelion. 4. Milk thistle Milk thistle has been used medicinally to detoxify the liver for centuries. While it may support the liver and gallbladder, there are no studies evaluating its effects on gallstones. A person can take milk thistle as a tonic or in a capsule or tablet form. People with diabetes, ragweed allergies, or a history of hormone-sensitive cancers should discuss the use of milk thistle with their doctor. 5. Lysimachiae herba Lysimachiae herba or gold coin grass is a popular traditional Chinese remedy for gallstones. Research suggests it may be beneficial for treating or preventing cholesterol gallstones. The supplement is available as a powder or liquid. 6. Artichoke artichokes Extract of artichoke may aid gallbladder function. Extracts of artichoke have been shown to stimulate bile production and aid both gallbladder and liver function. However, there is no research specifically focusing on the effects of artichoke on gallstones. Globe artichokes can be cooked and prepared in various ways. But the research is based on artichoke extract supplements, which are probably more potent than the vegetables. It is essential to speak with a doctor before taking artichoke extract because it may cause a gallbladder attack if a bile duct is obstructed. 7. Psyllium husk Psyllium is a soluble fiber derived from the seeds of the Plantago ovata plant. Research has shown it to benefit the heart, pancreas, and other areas of the body. A very old study found that psyllium husks protected hamsters from the formation of cholesterol gallstones. A more recent study, from 1999, supports these findings. 8. Castor oil pack

26 Castor oil packs are a popular remedy among naturopaths and natural living enthusiasts for a wide variety of complaints. To apply a castor oil pack, soak a cloth in warm castor oil and place on the abdomen. Cover with a towel. Some people choose to place a heat source, such as a hot water bottle or heating pad, on top. Leave the pack on the abdomen for up to an hour. There are no scientific studies to support the use of this treatment for gallstones. 9. Acupuncture Acupuncture may relieve gallstone symptoms, although the research is very limited. In one study on 60 people with cholecystitis (gallbladder inflammation), acupuncture was found to alleviate back pain, stomachache, and nausea, while also regulating the volume of the gallbladder. It should be noted that this research does not look specifically at gallstones, and it may only relieve symptoms, rather than helping people to pass the stones. What are the most common gallbladder problems? The gallbladder is commonly misunderstood and not often discussed organ. Learn more about it here. 10. Yoga Some yoga poses are said to cure gallstones, although no studies support this claim. The following poses are believed by some to be beneficial for people with gallstones: Bhujangasana (Cobra Pose) Dhanurasana (Bow Pose) Pachimotasana (Seated forward bend) Sarvangasana (Shoulderstand) Shalabhasana (Locust Pose) Medical treatments If natural remedies do not treat gallstones effectively, then a person might want to consider medications or surgery. Medication Smaller gallstones may be treated with bile acids such as ursodeoxycholic acid and chenodeoxycholic acid. Potential disadvantages of these medications include:

27 the time they take to work (up to 2 years) the potential for gallstones to return once medication use is stopped Surgery Gallstones are often treated by removing the gallbladder. This ensures that the gallstones cannot re-form. Gallbladder removal surgery or cholecystectomy is one of the most common operations performed on American adults. There are minimal side effects to gallbladder removal. Preventing gallstones fresh fruit and veg A diet high in fruit and vegetables may mean a person is less likely to have their gallbladder removed. Not all risk factors for gallstone formation can be modified, such as: being female increasing age (over 40) ethnicity family history However, other risk factors can be addressed, including: obesity rapid weight loss a high-fat diet sedentary lifestyle Therefore, preventative techniques should involve focusing on the factors that can be modified. The following tips may reduce the risk of gallstones for some people. Can diet prevent gallstones? Women who eat more fruits and vegetables are less likely to have their gallbladders removed than women who eat very little fresh produce, according to a 2006 study. Also, other sources of fiber such as the psyllium husks mentioned earlier may be beneficial for the gallbladder. Foods that may cause gallbladder problems include: high-fat foods

28 eggs sugar Weight management As obesity increases the risk of gallstones, those who are overweight should aim to achieve and maintain a healthy weight. However, following a diet that is very low in calories (500 per day) can be a risk factor for gallstone formation, according to a 2013 study. However, those who ate between 1200 and 1500 calories a day for 12 weeks lost weight but were much less likely to get gallstones. When to see a doctor Anyone considering trying natural treatment should always consult a doctor first. Symptoms of a gallbladder problem include: pain in the abdomen that lasts for 5 hours or more fever chills yellowing of the skin or eyes tea-colored urine pale stools nausea vomiting People who suspect they have had a gallbladder attack should contact a doctor without delay to reduce the risk of future complications.

29 Diet/Nutrition (Dainik Jagran: )

30 Cardiac Arrest and Heart Attack (Dainik Jagran: )

31 Breast Cancer (Dainik Jagran: ) ȣ Ȣ ȧज च Þã Ǘf j न ȣ Ȣ ȧज च बढ़ न ȧ ȡǐ ȧ(dainik Jagran: ) नई Ǒ ã ȣ, ĤȯĚ : æ è ȡèØ स गठन ( Þã Ǘf j ) न र ग ( ȣ Ȣ) स म क बल क f नय Ǒ ȡǓ ȶ ȡ ȣ ȡह ^ Ʌ Ȣ ȡ ȣक f ज च और इल ज Ʌत ज ल न ȧ ȡǐ ȧह ख स त र स ^ ȧ चप ट Ʌआन व ल Ǘ ɉ ज स Í ȯऔर एचआइव स Ȣ Ȫ ɉ तक पह च बढ़न क कह गय ह ȡǐ Ʌ ǕÜ ȣ Ȣ ȲĐ (f ȣ Ȣ] ^) क f नए लघ उपच र क ȡ ȡ गय ह 1नए Ǒ ȡǓ ȶ क यह ह ê : इस कदम क ê f ȣ Ȣ] ^ स Ē è

32 Ȫ ɉ तक ज च और उपच र क पह च न ह इसक क रण यह ह ` ǕÈ इल ज ȣȳह न पर इसस Ȣ å ǔè ɉ Ʌ ç Ʌ ȣ Ȣबढ़न क खतर बन रहत ह 1 æ è ȡèØ Ǔ ȡ न कह ह ɉ क एचआइव स Ȣ Ȫ ɉऔर प च स ल स कम ` Ĩ क Í ɉ ȧज च और इल ज क Ĥ ȡ ȡद न ह ग ǔ Û Ʌ ȣ Ȣह उनक Ȳ [ Ʌआन पर एचआइव Ȣ और छ ट Í ȯ ȲĐ ह सकत ɇ@ 1इनक ȲĐ ह न क खतर Ĥ : æ è ȡèØ Ǔ ȡ न कह ह, Þã Ǘf j न प य ह प च स ल य उसस Ï ȡ ȡ` Ĩ क एचआइव -Ǔ ȯǒ Í ȯ, Ȫ और è Ǒ ȣ Ȣक ȣ क Ȳ [ Ʌआत ɇत उनक ȲĐ ह न क खतर Ĥ रहत ह इस आय [क Ȫ ɉक ã ȣ-ĝ - ȯǔ è Ʌ ȣ Ȣ(एमड आर- ȣ Ȣ) व ल Ȫ ɉक भ खतरन क ह ^ f ^Û Ʌ\ स वध न बरतन ȧसल ह ȣगई ह Ȳ [ Ʌआन

33 Antibiotic drugs (Hindustan: )