Total Fertility Rate (TFR)

India’s improving (The Times of India: 20180115)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/#

There is good news on the population front as fertility approaches replacement levels

The steady decline in Total Fertility Rate (TFR) – the average number of children born to a

woman – is a positive development for India. The National Family Health Survey 2015-16

shows fertility rate is nearing replacement levels – where children will take the place of their

parents – heralding the possibility of population stabilisation in a few years. The past decade

has seen India’s TFR fall from 2.7 to 2.2. Muslims have recorded the highest TFR decline

from 3.4 to 2.6 while Hindus have fallen from 2.8 to 2.1. All other religious communities

have gone below replacement levels. Bihar is the only big state with TFR above 3 while four

other states which were in that club a decade ago – Uttar Pradesh, Madhya Pradesh,

Rajasthan, Jharkhand – are below that mark today.

Big states with sizeable Muslim population, like Jammu & Kashmir and Bengal, have one of

the lowest (1.6) TFR in the country. This explodes the myth of Muslims outnumbering

Hindus over the years, as propagated by right-wing organisations. The issue of high TFR is

more closely linked to culture than to religion. Overall figures suggest the bulk of youth

population will come from the north of the country. The government must prepare a blueprint

to convert this demographic dividend into opportunity.

Enhancing female literacy will go a long way in reducing TFR in states like Bihar. Limited

supplies and reluctance among rural women to go to medical stores to collect contraceptives

still remain problems. Only 54% of married women use some method of family planning, of

which 37% have adopted permanent methods like sterilisation as per the survey. In stark

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayMonday 20180115

contrast, male sterilisation constituted just 0.3%. Government must provide access to

preferred methods of family planning, rather than leaving women with no choice but to resort

to extreme measures like sterilisation.

Depression

Keeping depression at bay in old age (The Times of India: 20180115)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/#

New Delhi: Senior Citizens Council of Delhi and NGO Healthy Ageing organised a mass

screening of over 100 senior citizens in Delhi for cognitive impairment, leading to dementia.

On Sunday, specialists spoke to the senior citizens on ‘how to keep your brain healthy,’

stressing on the importance of keeping the brain active, socialising and keeping depression at

bay.

The talk, held in Green Park by the council, the NGO and a consulting firm, was conducted

by AIIMS specialist Dr Prashun Chatterjee and his team. During the talk, he stressed that the

seniors must keep their brains active and keep the cycle of learning to age actively. “Learn a

new skill, language or even computers. Keep your right brain active by using your left hand

more frequently,” advised the doctor to the seniors attending the talk.

He advised that seniors should learn a new language or a musical instrument to keep their

brain young and they should also get involved in social projects to keep a healthy circle of

people around them and stay empathetic. “Depression too can lead to dementia, and it is

important for older people to get help to prevent deterioration,” he advised.

He also chalked out the difference between normal forgetfulness that accompanies ageing and

dementia. “Forgetting small things is not troublesome. Dementia would be to forget basic

things like meals or even falling often,” he said.

Chatterjee said the screening test was a self-assessed test, with questions that would help the

assessment team flag certain patients and take them up for further consultation. He added that

the screening test would flag a possible patient if he/she has a hearing problem and is also

forgetful.“While the goal is to try and prevent dementia, if it strikes, the caregivers must be

made aware how to manage the condition,” said the doctor.

Cancer cases

Not lifestyle alone, geography too plays vital role in mapping of cancer

cases (The Times of India: 20180115)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/

Chennai: Over two decades back, doctors at Tata Memorial Hospital, Mumbai, noticed that

most gall bladder cancer patients were from the Gangetic belt states of Bihar, Uttar Pradesh

or West Bengal. This led to a series of studies that found high concentration of heavy metals

in the soil and ground water in this belt — a likely factor for high incidence of gall bladder

cancer.

It is now well known that the incidence of gall bladder cancer is highest in the country’s

eastern side while south India registers the lowest.

Environment and lifestyle are among the leading risks. The incidence of lung cancer is

registering a rise in metros, be it Bengaluru or Delhi. Women in urban India are more likely

to get breast cancer than those in rural areas.

The Indian government’s Million Death Study released in 2012 for the first time showed that

that the area an Indian lives in, his economic and educational status and religion contribute to

the malady’s outcome. A youngster from India’s northeast is four times more likely to

develop and succumb to cancer than one from Bihar.

“There is growing evidence that environment and lifestyle can cause cancer in younger

people as well,” said former director-general of ICMR, Dr Vishwa Mohan Katoch. “While

some cancers are common, others are specific to a region,” he said, adding that in the

Gangetic plains the risk of gall bladder cancer is very high due to polluted water, sediments

in water and high consumption of animal protein and fish.

Every day, 1,500 people die of cancer in India, making it the second most common cause of

death in India after cardiovascular disease. And nearly 2,000 new cancer cases are detected in

the country daily, according to National Institute of Cancer Prevention and Research.

Projections put the number of new cases by 2020 at 17.3 lakh.

In eastern India, rise in tobacco use has led to an increase in lung cancer among men, and

rapid changes in food habits have made women more vulnerable to breast cancer, said

Kolkata-based oncologist Gautam Mukhopadhyay.

Common cancers in the north-east are oesophagus, stomach and hypopharynx. Registries in

the north-east have also recorded the country’s highest incidence of nasopharynx and gall

bladder in Nagaland and Kamrupin Assam.

In Bengaluru and Chennai more than a quarter of the total number of cancers in women are of

the breast. Bengalurubased Dr PP Bapsy said mass screening is most important to detect

cancer early. “We need low cost, accessible treatment,” Dr Bapsy said.

Most oncologists insist that lifestyle changes will by itself bring down incidence. “By some

magic, if everyone stopped using tobacco in India, we will have at 50% lesser cancer cases,”

said Dr Rakesh Jalali, medical director of Apollo Proton Cancer Centre.

Robotic baby

Robotic baby helps understand how dust affects human infants (The Times

of India: 20180115)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/#

Washington: Scientists have developed a crawling robotic baby, that may help understand

how dirt and germs on the floor affect human infants in the first year of their life.

The research showed that when babies crawl, their movement across floors, especially

carpeted surfaces, kicks up high levels of dirt, skin cells, bacteria, pollen, and fungal spores.

The infants inhale a dose of bio bits in their lungs that is four times what an adult would

breathe. While this may sound alarming, scientists from Purdue University in US said this

may not be a bad thing.

“There are studies that have shown that being exposed to a high diversity and concentration

of biological materials may reduce the prevalence of asthma and allergies later in life,” said

Brandon Boor, assistant professor at Purdue University. PTI

A Dutch startup company has found a way to help mom and dad by helping to put babies to

sleep better. A ‘Hugsy Hearbeat’ records the heartbeat of mom or dad and plays it to sooth

the baby

Medicinal plants

Orangutans use plants for muscle pain relief (The Times of India:20180115)

https://epaper.timesgroup.com/Olive/ODN/TimesOfIndia/#

Orangutans have been observed using medicinal plants to sooth joint and muscle pain “for thefirst time ever”.

The Borneo based apes chew leaves of the Dracaena cantleyi plant to create a white lather,which they then rub onto to their bodies.

This is the first report of self-medication in an Asian ape, and also the first evidence for theuse of anti-inflammatory medication in animals.

Indigenous people on the Indonesian island are, however, known to use this plant for thesame purpose. “For the first time ever, self-medication activities of orangutans have beenconfirmed through this research,” said Dr Ivona Foitova who co-authored the study publishedin the Scientific Reports journal. Local knowledge about the plant’s healing properties,chemical analysis of the leaves suggested that its anti-inflammatory properties may bebeneficial to the apes. THE INDEPENDENT

Menstrual hygiene

Depts yet to pad up for napkins (The Tribune: 20180115)

http://www.tribuneindia.com/news/haryana/depts-yet-to-pad-up-for-napkins/528611.html

Data on beneficiaries not available I Self-help groups to be roped in

More than a month after Chief Minister Manohar Lal Khattar adopted Miss World Manushi

Chhillar’s pet project of menstrual hygiene for women and announced distribution of free

sanitary napkins for schoolgirls, several government departments are yet to get their act

together.

The announcement, so far, remains just that — an announcement with little headway made.

The only progress on the project is that the government has been able to address the

confusion over its ownership. It has decided that the project will be the baby of the Health

Department.

It has been made the nodal department that will coordinate the roll out of the project, which

was initially announced for government schoolgirls and later extended to women from Below

Poverty Line (BPL) families.

Sources say the first meeting related to the project was held last week. The meeting did

discuss the procurement of sanitary napkins, but no consensus could be arrived at. Sources

say the Health Department may place a partial or complete order for the napkins with SHGs

working under the National Rural Livelihood Mission.

With 13,000 SHGs working in the state, the department is looking at empowering women by

placing the order though there is some apprehension as regular bulk supply will be needed.

“Some of the SHGs are already supplying low-cost sanitary napkins to adolescent girls. The

only hitch is that SHGs newly roped in will have to first procure the machines and then be

trained for making napkins. This may delay the implementation of the project,” an officer

said, adding the government could not be expected to supply sanitary napkins available in the

market as it would be an expensive proposition. The other possibility is that the department

can invite tenders and get the supply.

Still there seems to be no clarity among the stakeholders about the number of beneficiaries

and the process to be followed as the departments work at a snail’s pace. It is unsure that the

project will see the light of day in the new academic session beginning in April. Sources in

the Health Department say things can proceed once several departments are armed with the

data. All the planning before that will only be hypothetical, they add.

It seems schoolgirls and women from Below Poverty Line families will have to wait longer

than expected with departments taking their own sweet time to get going.

What’s the hitch

Sources say the first meeting related to the project (free distribution of sanitary napkins

among schoolgirls and BPL women) was held last week

Several stakeholders, including the School Education and Social Welfare Departments, were

asked about the number of beneficiaries.

But for the want of data, nothing substantial could be crystallised, sources say

Departments have been asked to prepare a report before the next meeting.

The meeting did discuss the procurement of sanitary napkins, but no consensus could be

arrived at.

Anxiety

Anxiety may be early indicator of Alzheimer’s disease (The Tribune:

20180115)

http://www.tribuneindia.com/news/health/anxiety-may-be-early-indicator-of-alzheimer-s-

disease/528409.html

Heightened anxiety in older adults may be an early indicator of Alzheimer’s disease, a study

has warned.

Alzheimer’s disease is a neurodegenerative condition that causes the decline of cognitive

function and the inability to carry out daily life activities.

Past studies have suggested depression and other neuropsychiatric symptoms may be

predictors of AD’s progression during its “preclinical” phase, during which time brain

deposits of fibrillar amyloid and pathological tau accumulate in a patient’s brain.

This phase can occur more than a decade before a patient’s onset of mild cognitive

impairment.

Researchers at Brigham and Women’s Hospital in the US examined the association of brain

amyloid beta and longitudinal measures of depression and depressive symptoms in

cognitively normal, older adults.

The findings, published in The American Journal of Psychiatry, suggest that higher levels of

amyloid beta may be associated with increasing symptoms of anxiety in these individuals.

These results support the theory that neuropsychiatric symptoms could be an early indicator

of AD.

“Rather than just looking at depression as a total score, we looked at specific symptoms such

as anxiety. When compared to other symptoms of depression such as sadness or loss of

interest, anxiety symptoms increased over time in those with higher amyloid beta levels in the

brain,” said Nancy Donovan, from Brigham and Women’s Hospital.

“This suggests that anxiety symptoms could be a manifestation of Alzheimer’s disease prior

to the onset of cognitive impairment,” said Donovan.

“If further research substantiates anxiety as an early indicator, it would be important for not

only identifying people early on with the disease, but also, treating it and potentially slowing

or preventing the disease process early on,” she said.

As anxiety is common in older people, rising anxiety symptoms may prove to be most useful

as a risk marker in older adults with other genetic, biological or clinical indicators of high

Alzheimer’s disease risk.

The researchers derived data from the Harvard Aging Brain Study, an observational study of

older adult volunteers aimed at defining neurobiological and clinical changes in early

Alzheimer’s disease.

The participants included 270 community dwelling, cognitively normal men and women,

between 62 and 90 years old, with no active psychiatric disorders.

Individuals also underwent baseline imaging scans commonly used in studies of Alzheimer’s

disease, and annual assessments with the 30-item Geriatric Depression Scale (GDS), an

assessment used to detect depression in older adults.

The researchers calculated total GDS scores as well as scores for three clusters symptoms of

depression: apathy- anhedonia, dysphoria, and anxiety. These scores were looked at over a

span of five years.

Researchers found that higher brain amyloid beta burden was associated with increasing

anxiety symptoms over time in cognitively normal older adults.

The results suggest that worsening anxious-depressive symptoms may be an early predictor

of elevated amyloid beta levels - and, in turn AD - and provide support for the hypothesis that

emerging neuropsychiatric symptoms represent an early manifestation of preclinical

Alzheimer’s disease. PTI

Regular yoga

Regular yoga can slow down ageing of brain (The Tribune: 20180115)

http://www.tribuneindia.com/news/health/regular-yoga-can-slow-down-ageing-of-

brain/528388.html

NEW DELHI: Practising yoga regularly can slow down ageing of the brain and helps it stay

young, claims a study.

The study by the researchers of the Defence Institute of Physiology and Allied Sciences

(DIPAS), said that yoga might help in prevention of age-related degeneration by changing

cardiometabolic risk factors and brain-derived neurotrophic factors among men.

DIPAS is a laboratory of the Defence Research and Development Organisation (DRDO).

The research study, which was published in the American Ageing Association, focused not

only on the brain but comparative studies were conducted on hypertension, blood pressure,

heart rate, and stress.

According to the researchers, a brain develops till the age of 20-30. After that, development

of the brain halts and after 40 years, its slow degeneration starts.

As part of the study, done by Rameswar Pal, Som Nath Singh, Abhirup Chatterjee and Mantu

Saha, 124 healthy and physically active men aged between 20 and 50 years were randomly

selected and divided into three age groups — 20–29, 30–39, and 40–50 years.

Inclusion criterion were normal healthy and physically active males, absence of disease

which could have contributed to obesity, hypertension, and neurological disorders, not in

medication and no prior knowledge of yoga. Smokers, alcoholics, and tobacco eaters were

excluded from the study.

The respondents were made to practice yoga for one hour everyday for three months.

The blood pressure which was recorded at 122/69 in the age group of 20-29 before yoga

reduced to 119/68 (systolic pressure is 119 and the diastolic pressure is 68) after doing yoga.

Similarly, the blood pressure which was 134/84 among the respondents (40-50) came down

to 124/79 after yoga.

Cortisol, which is a stress hormone released by the adrenal glands and helps body deal with

stressful situations was 68.5 per cent in the age group of 20-29 which declined to 47.4 after

the exercise.

The cortisol level which was 95 before yoga reduced to 72.7 after three months of yoga in the

group 40-50 years.

Further, dopamine and serotonine levels which effectively improve motivation, focus, mood

and instill positivity were found to have improved in all the groups after yoga.

Those having low dopamine levels may experience feelings of depression, boredom, or

apathy. They may lack the energy and motivation to carry out ordinary tasks, the researchers

said.

“Based on the results of the study, it may be concluded that the ageing process has an active

role on degenerative changes in autonomic functions, and monoamines as well as levels of

BDNF, which may revert back towards normal or near- normal levels through yogic practice

in healthy active males,” the study said. PTI

Hypersensitive brain

Hypersensitive brain networks may cause chronic headaches (The Tribune:

20180115)

http://www.tribuneindia.com/news/health/hypersensitive-brain-networks-may-cause-chronic-

headaches/528030.html

Patients with fibromyalgia have brain networks primed for rapid, global responses to minor

changes, a study has found.

This abnormal hypersensitivity, called explosive synchronisation (ES), can be seen in other

network phenomena across nature, according to the study published in the journal Scientific

Reports.

Researchers from the University of Michigan in the US and Pohang University of Science

and Technology in South Korea report evidence of ES in the brains of people with

fibromyalgia, a condition characterised by widespread, chronic pain.

"For the first time, this research shows that the hypersensitivity experienced by chronic pain

patients may result from hypersensitive brain networks," said Richard Harris, from the

University of Michigan.

"The subjects had conditions similar to other networks that undergo explosive

synchronisation," Harris said.

In ES, a small stimulus can lead to a dramatic synchronised reaction in the network, as can

happen with a power grid failure (that rapidly turns things off) or a seizure (that rapidly turns

things on).

This phenomenon was, until recently, studied in physics rather than medicine. According to

the researchers, it's a promising avenue to explore in the continued quest to determine how a

person develops fibromyalgia.

"As opposed to the normal process of gradually linking up different centers in the brain after

a stimulus, chronic pain patients have conditions that predispose them to linking up in an

abrupt, explosive manner," said UnCheol Lee, from the University of Michigan.

"These conditions are similar to other networks that undergo ES, including power grids," Lee

said.

The researchers recorded electrical activity in the brains of 10 female participants with

fibromyalgia. Baseline EEG results showed hypersensitive and unstable brain networks,

Harris said.

Importantly, there was a strong correlation between the degree of ES conditions and the self-

reported intensity of chronic pain reported by the patients at the time of EEG testing.

They used computer models of brain activity to compare stimulus responses of fibromyalgia

patients to the normal condition.

As expected, the fibromyalgia model was more sensitive to electrical stimulation than the

model without ES characteristics, Harris said.

"We again see the chronic pain brain is electrically unstable and sensitive," Harris said.

Since ES can be modeled essentially outside of the brain or in a computer, researchers can

exhaustively test for influential regions that transform a hypersensitive network into a more

stable one.

These regions could then be targeted in living humans using non-invasive brain modulation

therapies. PTI

Fast food

How fast food is damaging your immune system (The Tribune: 20180115)

http://www.tribuneindia.com/news/health/how-fast-food-is-damaging-your-immune-

system/527534.html

How fast food is damaging your immune system

Fast food makes the immune system more aggressive in the long term, suggest researchers.

According to the University of Bonn study, even after a change to a healthy diet, the body's

defenses remain hyperactive.

These long-term changes may be involved in the development of arteriosclerosis and

diabetes, diseases linked to Western diet consumption.

The scientists placed mice for a month on a so-called “Western diet”: high in fat, high in

sugar, and low in fiber. The animals consequently developed a strong inflammatory response

throughout the body, almost like after infection with dangerous bacteria.

“The unhealthy diet led to an unexpected increase in the number of certain immune cells in

the blood of the mice, especially granulocytes and monocytes. This was an indication for an

involvement of immune cell progenitors in the bone marrow,” Anette Christ, postdoctoral

fellow in the Institute of Innate Immunity of the University of Bonn explains.

To better understand these unexpected findings, bone marrow progenitors for major immune

cell types were isolated from mice fed a Western diet or healthy control diet and a systematic

analysis of their function and activation state was performed.

“Genomic studies did, in fact, show that the Western diet had activated a large number of

genes in the progenitor cells. The genes affected included those responsible for proliferation

and maturation”, explains Prof. Dr. Joachim Schultze.

Fast food thus causes the body to quickly recruit a huge and powerful army. When the

researchers offered the rodents their typical cereal diet for another four weeks, the acute

inflammation disappeared. What did not disappear was the genetic reprogramming of the

immune cells and their precursors: Even after these four weeks, many of the genes that had

been switched on during the fast food phase were still active.

“It has only recently been discovered that the innate immune system has a form of memory”,

explains Prof. Dr. Eicke Latz.

“After an infection, the body's defenses remain in a kind of alarm state, so that they can

respond more quickly to a new attack.” Experts call this “innate immune training”. In the

mice, this process was not triggered by a bacterium, but by an unhealthy diet.

The scientists were further able to identify the responsible “fast food sensor” in immune cells.

They examined blood cells from 120 subjects. In some of the subjects, the innate immune

system showed a particularly strong training effect. In these subjects, the researchers found

genetic evidence of the involvement of a so-called inflammasome.

Inflammasomes are key intracellular signaling complexes that recognize infectious agents

and other harmful substances and subsequently release highly inflammatory messengers.

How exactly the NLRP3 inflammasome recognizes the exposure of the body to Western type

diets remains to be determined.

Interestingly, in addition to the acute inflammatory response, this also has long-term

consequences for the immune system's responses: The activation by Western diet changes the

way in which the genetic information is packaged. The genetic material is stored in the DNA

and each cell contains several DNA strands, which together are about two meters long.

However, they are typically wrapped around certain proteins in the nucleus and thus many

genes in the DNA cannot be read as they are simply too inaccessible.

Unhealthy eating causes some of these normally hidden pieces of DNA to unwind, similar to

a loop hanging out of a ball of wool. This area of the genetic material can then be read much

easier as long as this temporary unwrapping remains active. Scientists call these phenomena

epigenetic changes. “The inflammasome triggers such epigenetic changes”, explains Dr. Latz.

“The immune system consequently reacts even to small stimuli with stronger inflammatory

responses.” These inflammatory responses can in turn accelerate the development of vascular

diseases or type 2 Diabetes.

In arteriosclerosis for example, the typical vascular deposits, the plaques, consist largely of

lipids and immune cells. The inflammatory reaction contributes directly to their growth,

because newly activated immune cells constantly migrate into the altered vessel walls.

When the plaques grow too large, they can burst, leading to blood clotting and are carried

away by the bloodstream and can clog vessels. Possible consequences: Stroke or heart attack.

Wrong nutrition can thus have dramatic consequences.

“These findings therefore have important societal relevance”, explains Latz. “The

foundations of a healthy diet need to become a much more prominent part of education than

they are at present. Only in this way can we immunize children at an early stage against the

temptations of the food industry. Children have a choice of what they eat every day. We

should enable them to make conscious decisions regarding their dietary habits.” The results

are published in the journal Cell. — ANI.

Air quality

Air quality may dip this week, foggy mornings to return (Hindustan Times:

20180115)

http://paper.hindustantimes.com/epaper/viewer.aspx

MeT experts say low wind speed, moisture will aid haze formation

NEWDELHI: The Capital’s air quality, which was ‘very poor’ on Sunday, may deteriorate

from Wednesday for a brief period, scientists from the Central Pollution Control Board

(CPCB) said.

SUSHIL KUMAR/HT

n Minimum temperature on Sunday was 5.7 degrees Celsius, while the maximum hovered

around 25 degrees Celsius.

On Sunday the Air Quality Index (AQI) of Delhi was 358 just one notch higher than

Saturday’s 357. An AQI value between 300 and 400 on a scale of 0 – 500 is considered as

‘very poor’.

“An anti-cyclonic circulation is likely to form from Wednesday night. South-easterly winds

are likely to gush in. As a result, wind speed would drop and moisture levels will shoot up,”

said a senior official of the regional weather forecasting centre.

Over the past two days, Delhi benefitted from strong winds blowing at 15 km /hour. Winds

help flush out the pollutants and the air quality improved from ‘very poor’ category to ‘poor’

category on Friday.

“Low wind speed and increasing moisture levels could result in a spike in pollution. While

moisture traps the pollutants, the low velocity wind is not able to flush them out. As a result,

pollutants accumulate,” said D Saha, head of the air quality laboratory at CPCB.

TEMPERATURE

MeT officials have forecast that there won’t be any drastic change in temperature. On

Sunday, the minimum temperature was 5.7 degrees Celsius, two degrees below normal for

this time of the year.

With a clear sky and lot of sunshine, the maximum temperature hovered around 25 degrees

Celsius, which was five degrees higher than usual this time of the year.

Low wind speed and moisture could trigger foggy mornings and low visibility, said a Met

official.

“Even though at present we are witnessing some shallow fog in the morning hours with

visibility around 700-800m, there could be some moderate fog on Thursday because of these

changes in the weather parameters. Visibility could drop to less than 500m,” Saha added.

A senior MeT official said that this, however, won’t affect flight schedules.“The anti-

cyclonic circulation won’t last more than a day or two. We expect the winds to pick speed

from Friday again,” said the Met official.

Heart diagnostics

Change of heart diagnostics, numbers to make sense of ECG reports (The

Indian Express:

20180115)

http://indianexpress.com/article/technology/science/change-of-heart-diagnostics-numbers-to-

make-sense-of-ecg-reports-5024884/

Unlike many other diagnostic tests, like those for blood samples or urine for example, ECG

reports do not contain numerical values that can be compared to standard healthy values

We may not realise it but our hearts are like electric generators, inducing a small bit of

electric current every time they beat. The electricity generated is a very small amount, of the

order of a few millivolts, or a thousandth of a volt, enough to activate the heart functions.

The electric current generated by the heart can be used to assess the condition of the organ. In

fact, doctors now use this as a test of the heart all the time, using an instrument called the

electrocardiogram, or ECG for short. The ECG measures the electrical activity of the heart

and produces a waveform on a graph paper. Doctors look at these waveforms to make an

assessment of the health of the heart, whether it was beating normally or was under some

kind of stress.

Unlike many other diagnostic tests, like those for blood samples or urine for example, ECG

reports do not contain numerical values that can be compared to standard healthy values. In

fact, what appears on the graph paper is not a single waveform. It is a combination of many

waves of differing frequencies and amplitudes. That is because the heart is a very complex

system.

Several things happen inside its different chambers every time it beats. The result is a

complex non-linear ECG output, which an untrained person can make little sense of by just

looking at it. Doctors use their expertise and experience to draw conclusions from these

complex waveforms. The heights, or amplitudes, of these waveforms and the intervals at

which they occur in the ECG output are a couple of important things that doctors look out for.

There are several others.

What is more, there is no standard ECG waveform for a healthy heart. Different people

produce very different ECG outputs. Age, gender, habits, stress or anxiety levels, and many

other parameters determine the pattern that is produced. As such, doctors resort to a lot of

correlational analysis with the patient’s personal and medical history to understand the ECG

reports.

Though ECG reports have been quite a reliable tool in making an assessment of the health of

the heart, scientists have been trying to extract more from these waveforms by looking at the

complicated dynamics of the heart that produces these patterns on the graph paper. In

particular, there is an attempt to explore whether it can be made more quantitative, and

produce numerical values just like some other diagnostic tests do. The key to achieving this

lies in identifying those set of numbers — the fewer the numbers in the set the better — out

of the large number of parameters that the ECG instrument captures that can uniquely

describe the condition of the heart.

This is what the research group led by G Ambika with members, Snehal M Shekatkar and

Yamini Kotriwar, at the Indian Institute of Science Education and Research, Pune, and their

collaborator, K P Harikrishnan at The Cochin College in Kochi, have managed to do under a

Science and Engineering Research Board (SERB) research project funded by the Department

of Science and Technology (DST).

Maintaining that a mere visual examination of the ECG reports does not reveal complete

information on the complicated dynamics underlying the heart system, these scientists looked

at data from hundreds of ECG reports, from healthy as well as diseased hearts.

Using different scientific and analytical tools, they were able to zero in on a set of four

quantifiers whose values could uniquely reveal whether a heart was functioning normally or

afflicted with some disease. Ambika says in fact just two of them were enough for this

purpose. The range of values these quantifiers show and their variability for healthy hearts

are very different from those of diseased hearts. It is therefore possible to distinguish between

a diseased and normal heart just by knowing the values of these quantifiers, with a very high

degree of accuracy.

As of now, with their current level of research, the scientists cannot zero in on the kind of

disease that might be afflicting the heart by just looking at the values of these quantifiers. But

Ambika says it is possible to do so. For that, they need to look at data from many more ECG

reports for each specific disease.

The research, published in Scientific Reports last November, promises to significantly

improve the capabilities of diagnosing heart diseases, and also allows for continuous

monitoring of the heart for these specific quantifiers without the need to go in for full ECG

reports.

For your research to be considered for this column, please write to Amitabh Sinha at

amitabh.sinha@expressindia.com

Tobacco packs

85 per cent warning on tobacco packs: How the battle continues in the

courts (The Indian Express: 20180115)

http://indianexpress.com/article/explained/85-per-cent-warning-on-tobacco-packs-how-the-

battle-continues-in-the-courts-5024626/

Health advocates have long argued that prominently displayed pictures of what consumption

of tobacco can do to humans — including some grotesque depictions of tumours — help

drive home the message more powerfully and effectively.

The Supreme Court last Monday stayed an order of the Karnataka High Court, which had in

December 2017 struck down central Rules based on which 85% of the area of tobacco packs

has been covered by health warnings since April 2016.

“Health of a citizen has primacy and he or she should be aware of that which can affect or

deteriorate the condition of health,” the Supreme Court said. “Deterioration may be a milder

word and, therefore, in all possibility the expression ‘destruction of health’ is apposite,” the

court said.

Health advocates have long argued that prominently displayed pictures of what consumption

of tobacco can do to humans — including some grotesque depictions of tumours — help

drive home the message more powerfully and effectively than smaller pictures or written

warnings. India currently has some of the world’s most stringent rules on pictorial warnings

on tobacco packets.

How did it begin?

Five months after the government of Prime Minister Narendra Modi came to power in May

2014, the Ministry of Health notified amendments to The Cigarettes and Other Tobacco

Products (Packaging and Labelling) Rules, 2008. It was mandated that “the specified health

warning shall cover at least eighty-five per cent (85%) of the principal display area of the

package of which sixty per cent (60%) shall cover pictorial health warning and twenty-five

per cent (25%) shall cover textual health warning and shall be positioned on the top edge of

the package and in the same direction as the information on the principal display area…”

The Rules were to come into effect from April 1, 2015. There were cries of outrage from the

tobacco industry, and less than a month later, Health Minister Dr Harsh Vardhan was moved

out of the Ministry. Soon afterward, the Lok Sabha Committee on Subordinate Legislation

(CoSL) started to examine the government’s October 2014 notification on the 85% warnings.

Did the Rules come into effect from the appointed date?

No. In its interim report tabled in Parliament in March 2015, the CoSL “strongly urged” the

government to keep the notification in “abeyance” until it had examined various aspects of

the Rules in greater detail. The government agreed, and the move for which India was being

internationally applauded, was postponed indefinitely. Health Minister J P Nadda assured at

multiple fora that he was a firm believer in taking everyone along, and that the government

would like to wait for the Committee to make a considered decision before going ahead with

the 85%, picture-dominated, warnings on tobacco packets.

So, how did the notification finally come into effect?

As the matter dragged on, a group of activists approached the Rajasthan High Court, which,

in July 2015, asked the Centre and the state government to immediately implement the 2014

Rules. “After hearing the learned counsel appearing for the petitioner and considering the

research as well as orders passed by various High Courts and the Supreme Court, we find it

imperative, and in larger public interest, to stay the operation of the corrigendum… The

Rules of 2014 will come into force immediately, and will be enforced by the Centre and the

Government of Rajasthan,” the order, passed by a two-judge Bench of the High Court on July

3, 2015, said.

The Health Ministry filed an affidavit asking for six months’ time for the tobacco industry to

prepare. Thus was reached the new date of implementation of the warnings — April 1, 2016.

The notification came into effect on that date, exactly a year after it was originally supposed

to. In the interim, the CoSL tabled its final report in the Budget Session of Parliament in

2016, recommending 50% warnings. But the die had already been cast.

So, was the battle over?

Not quite — even though the impact of the pictorial warnings appeared to be clear very soon.

The Global Adult Tobacco Survey (GATS) 2016-17, released by the Ministry of Health and

Family Welfare showed that 62% of cigarette smokers and 54% of bidi smokers had thought

of quitting because of the 85% warnings on the packets. And 46% of smokeless tobacco users

had thought of quitting because of the warnings on smokeless tobacco products. Such tobacco

control efforts have saved 81 lakh lives in India, as per GATS-2.

According to a study supported by the Health Ministry and the World Health Organisation,

Economic Burden of Tobacco-Related Diseases in India, the estimated total costs attributable

to tobacco use was a staggering Rs 1,04,500 crore in 2011 — 12% more than the combined

state and central government expenditure on healthcare in that year, and 1.16% of India’s

GDP.

However, the tobacco industry approached the Karnataka High Court, where it argued that no

correlation had been established between tobacco and the diseases depicted on the packs, and

that the industry’s right to conduct business was being unfairly affected because of the

warnings. The court found merit in the contention, and ruled that India should go back to the

40% warnings that existed before the notification of the 85% Rules.

And what did the Supreme Court say?

The government made a powerful case in favour of larger warnings. Attorney General K K

Venugopal cited reports from the World Health Organisation to describe tobacco as the “most

dangerous thing in the world”. The three-judge Bench led by the Chief Justice of India said:

“Though a… submission has been advanced… that it will affect their business, we have

remained unimpressed… as we are inclined to think that health of a citizen has primacy and

he or she should be aware of that which can affect or deteriorate the condition of health…”

Yoga and Physical Fitness (Dainik Gagaran: 20180115)

http://epaper.jagran.com/ePaperArticle/15-jan-2018-edition-Delhi-City-page_10-2940-5416-

4.html

Organ Donation (Dainik Gagaran: 20180115)

http://epaper.jagran.com/ePaperArticle/15-jan-2018-edition-National-page_8-2871-17485-

262.html

Lipo-Protein (Navbharat Times: 20180115)

http://epaper.livehindustan.com/story.aspx?id=2485766&boxid=84007604&ed_date=2018-

01-15&ed_code=1&ed_page=18