Millions living with leprosy in spite of being curable

On January 26th The World Day of Leprosy, I saw a video on The Guardian global development news page by Maria Zupello  titled Leprosy in Brazil: Uncovering a hidden disease. Realizing that leprosy is still around was rather disturbing, especially because this is a curable disease and therefore there should be no such thing as living with leprosy in these times, but after doing some research it became apparent that is not the case.

WHO: Leprosy Statistics:

According to the World Health Organization's latest stats on leprosy in the world, there are still around 200,000 reported new cases of leprosy every year in the world. Also known as Hansen's Disease, leprosy is endemic in 91 countries around the world. The highest concentration of reported new cases (at the start of 2012) being in South East Asia (117,147). The majority of which are in India. The second highest incidence is in the Americas (34,801),  of these reported new cases the majority are from Brazil. But because of its long incubation period and the lack of tools to allow early detection leading to late diagnosis, the exact prevalence of Hansen's disease is not clear.

India:
Although the Indian Government declared it has eliminated leprosy in 2005. It has since then become clear that the claim was premature. Of the total leprosy cases in the world 55% are in India, and about 127,000 new cases were reported between 2010-2011. Besides lack of access to basic healthcare services, leprosy patients also suffer socioeconomic isolation as a result of the stigma and discrimination that still exists in India.

Brazil: 
Leprosy is more prevalent in Brazil than in any other country except India. More than 30,000 new cases are diagnosed each year. Despite economic development, expansion of public healthcare, and efforts of the leprosy control program in the past 30 years, this disease has not been eliminated, and new cases are still being detected. The leprosy control program in Brazil distributes free drugs as part of the World Health Organization multidrug regimen for treatment of leprosy. Unfortunately health care services are not available in rural parts of the country. The amazon region of Brazil where leprosy has been endemic for more than a century is almost deprived of such health services.

Leprosy is particularly prevalent among the poorest and most marginalised communities due to their lack of access to healthcare, poor sanitation and congested living spaces. - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

To understand why the stigmatization, socioeconomic isolation, discrimination leading to leprosy communities in countries like India and Brazil is so wrong, here are some basic facts about Leprosy( Hansen's Disease);

What is Leprosy?

Leprosy is a chronic bacterial disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. This infection primarily affects the skin, peripheral nerves and upper airway. It is well known that leprosy is not spread through casual contact. 

About 95% of human beings are naturally immune making leprosy the 'least contagious communicable disease'. The World Health Organization suggests that it is transmitted through moisture from the nose and mouth during frequent and close contact with an untreated leprosy-affected person. It might also happen if you are exposed to other nasal fluids (also known as secretions). Droplets and other secretions can contain the bacteria that cause Hansen’s disease. If you breathe these in, you can become sick with the disease.

According to the CDC,  as incubation period of the bacteria is long , it may take up to 2-10 years for signs and symptoms to appear. The disease mainly affects the skin, nerves and the mucous membranes. Common signs and symptoms include; disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored. Nerve damage can lead to loss of feeling in arms and legs and muscle weakness. Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes.

Treatment of Leprosy

Leprosy can be cured. In the last two decades, more than 14 million people with leprosy have been cured. The World Health Organization provides free treatment for all people with leprosy.

Treatment depends on the type of leprosy that you have. It is treated with a combination of antibiotics. The treatment may last anywhere from 6 months to 2 years. People with severe leprosy may need to take antibiotics longer. Antibiotics cannot treat the nerve damage.

Anti-inflammatory drugs are used to control swelling related to leprosy. This may include steroids, such as prednisone.

Patients with leprosy may also be given thalidomide, a potent medication that suppresses the body's immune system. It helps treat leprosy skin nodules. Thalidomide is known to cause severe, life-threatening birth defects and should never be taken by pregnant women.

According to the WHO 'Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000 population. Only a couple of endemic countries have still to achieve this goal at the national level; most are now applying the same elimination strategy at regional, district and sub-district levels. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.

Most countries that were previously highly endemic for leprosy have achieved elimination at the national level and are intensifying their efforts at regional and district levels.'

Information campaigns about leprosy in high risk areas are crucial so that patients and their families, who were historically ostracized from their communities, are encouraged to come forward and receive treatment. The most effective way of preventing disabilities in leprosy, as well as preventing further transmission of the disease, lies in early diagnosis and treatment with MDT. (WHO)

P.S: 
The Leprosy Mission India 
The Leprosy Mission Canada  
Hansen's Disease (CDC) 
Leprosy (WebMD)
Leprosy Today (WHO) 
National Hansen's Disease Program (HRSA) 
Watch Video: Leprosy in Brazil: Uncovering a hidden disease (The Guardian)

Watch Video: Battling leprosy in Brazil(BBC World)

Watch Video: Leprosy: India's Hidden Disease (The Guardian)

Photo Gallery: Colonia Antonio Alexio - Leprosy community in Manaus, Brazil (Photojournalist: Sharon Steinmann)

High Incidence of Diseases Endemic to the Amazon Region of Brazil, 2001–2006 (CDC)

 

Easy way to lose weight... just turn the heat down

Obesity and the struggle to lose weight is starting to become the plight of our time. Much research  is being done to find effective ways to understand the causes and finding effective ways to win this losing battle. Right now, more than one third of adults in the US are obese or overweight and a little more then a quarter of the adults in UK is obese or overweight.
Amongst all that research work a recent study published in Trends in Endocrinology & Metabolism Journal, suggests that central heating might be another contributing factor to rising number of overweight individuals. As the temperature in homes, offices, hospitals and most places is being kept high our bodies are no longer burning that many calories to keep the body warm. Normally our metabolism rate (BMR) rise in cold weather to produce body heat. About 80% of the energy produced from our food intake is used up by our BMR.

According to the researchers at Maastricht University, a temperature of 66F would suffice to maintain a normal balance. The report also points out that about 90% of people remain mostly indoors while keeping the temperature at maximum comfort levels in turn minimizing caloric use by our bodies to maintain normal body temperature, shifting the balance towards weight gain.

Although lowering the thermostat alone may not lead to weight loss but it will definitely help along with exercise and diet. The report also mentions a study from  Japan in which volunteers showed a decrease in body fat after spending two hours a day in 17C over a period of six weeks.According to BBC World reporter James Gallagher;

Dr Wouter van Marken Lichtenbelt told the BBC: "19C is enough - and not for the whole day.
"Energy increases were in the order of 6% in mild cold, and in the long term that could really make a difference.
"It could be a substantial influence and help in combination with food changes and exercise." 
He said people could "try turning the thermostat down" at home or "go outside".


P.S: 
Central heating may make you fat, say researchers (BBC World) 
Want to lose weight? Try turning your heating down: Being cold is a 'cheap way to get slim' (Daily Mail UK)





 

Shift work clearly detrimental to health

It is a fact that doing the night shift at work is terribly hard. It not only affect our personal and social lives it also throws our whole sleep cycle into chaos. Now scientists at the Sleep Research Center Surrey have found definite proof that night work can lead to long term damage starting at molecular level. Night shift work has been linked to a higher risk of type 2 diabetes, heart attacks and cancer.

According to an article in BBC World News by James Gallagher;
'Experts said the scale, speed and severity of damage caused by being awake at night was a surprise.

The human body has its own natural rhythm or body clock tuned to sleep at night and be active during the day.
It has profound effects on the body, altering everything from hormones and body temperature to athletic ability, mood and brain function.'

Scientists observed 22 individuals as their bodies adjusted from their normal patterns to working the night shift. Preliminary blood test showed that 6% genes had precise daily activity cycles. As the individuals got into a night work routine, these cycles were thrown off. 
The researchers call this 'Chrono-Chaos', here the scientists on the team explain it;

"Over 97% of rhythmic genes become out of sync with mistimed sleep and this really explains why we feel so bad during jet lag, or if we have to work irregular shifts," said Dr Simon Archer, one of the researchers at the University of Surrey.
Fellow researcher Prof Derk-Jan Dijk said every tissue in the body had its own daily rhythm, but with shifts that was lost with the heart running to a different time to the kidneys running to a different time to the brain.
He told the BBC: "It's chrono-chaos. It's like living in a house. There's a clock in every room in the house and in all of those rooms those clocks are now disrupted, which of course leads to chaos in the household."
Prof Dijk added: "We of course know that shift work and jet lag is associated with negative side effects and health consequences.
"They show up after several years of shift work. We believe these changes in rhythmic patterns of gene expression are likely to be related to some of those long-term health consequences."

According to Web MD about 8.6 million people do shift work, meaning either they work the night shift or they rotate shifts during the week.  These include police officers, firefighters, nurses, doctors, pilots, waitresses, truck drivers, and many more professionals. Even a personal trainer who works out at the gym with clients in the early mornings and evenings is a shift worker.
Some of the short term health problems seen more commonly in shift workers are; 

• Gastrointestinal symptoms like upset stomach, nausea, diarrhea, constipation, and heartburn
• Increased risk of injuries and accidents
• Insomnia
• Decreased quality of life
• General feeling of being unwell

Whereas the long term effects on health are harder to measure but there has been compelling proof that shift workers might be more prone to these long term medical problems;

• Cardiovascular disease
• Diabetes and Metabolic Disorder
• Depression and Mood Disorders
• Serious Gastrointestinal Problems
• Obesity
• Problems with Fertility and Pregnancy
• Cancer

 Although most of these long term effects may occur only after decades of disruptive shift work, but some health problems might develop much faster. For many professions shift work is inevitable, hence can not be completely avoided. In those cases, here are some suggestions on the Web MD to help minimize the damage:

• Eat Well and Exercise
• Get enough Sleep
• Change your Schedule
• See your Doctor

P.S:
References

Night work 'throws body into chaos' (BBC World News)

The Health Risks of Shift Work (Web MD)

Restoring sight with gene therapy

A great breakthrough in treatment of blindness has been seen as surgeons in Oxford UK, have used gene therapy to improve the vision of six patients who would have gone blind without it. BBC World News' science correspondent Pallab Ghosh reports;

'Surgeons in Oxford have used a gene therapy technique to improve the vision of six patients who would otherwise have gone blind.

The operation involved inserting a gene into the eye, a treatment that revived light-detecting cells.
The doctors involved believe that the treatment could in time be used to treat common forms of blindness.
Prof Robert MacLaren, the surgeon who led the research, said he was "absolutely delighted" at the outcome.
"We really couldn't have asked for a better result," he said.
BBC News exclusively reported on the start of the trial two years ago. The first patient was Jonathan Wyatt, who was 63 at the time.
Mr Wyatt has a genetic condition known as choroideremia, which results in the light-detecting cells at the back of the eye gradually dying.
Mr Wyatt was still just about able to see when he had the operation. His hope was that the procedure would stop further deterioration and save what little sight he had left.
He, like another patient in Professor MacLaren's trial, found that not only did the operation stabilise his vision - it improved it. The other subjects, who were at earlier stages in their vision, experienced improvements in their ability to see at night.
Mr Wyatt is now able to read three lines further down in an optician's sight chart.'
( Read on..)



P.S:

Gene therapy 'could be used to treat blindness'(January 15, 2014)

Gene therapy used in a bid to save a man's sight  (October 27, 2011)

We must bring back family mealtime chatting!

I grew up in a family where almost every meal was a sit down with the family and chat time. Although as we grew up it became less and less possible at breakfast and lunch, everyone had different schedules but dinner time stayed the same. Everyone had to show up at the dinner table at the same time, any late arrivals were expected to provide good reason.

But it wasn't just eating together, it was more talking to each other that was special. We talked about school, about issues with friends, family plans for the coming weekend or holidays, extended family updates, dad's job news, mom's social news, current affairs, and just anything and everything. We knew all the names of my mom's friends, dad's colleagues, and each others friends, enemies and frenemies too! And our parents were aware of what was happening in each of our lives. We shared, supported, discussed, advised, joked and teased throughout dinner. Basically we bonded and were constantly reminded that we were together and never alone.
Interestingly when I used to mention chatter at my house to friends, it became quite clear that this wasn't prevalent in every household. The friends who didn't get to sit down to eat and talk with family everyday expressed envy and unhappiness. That made me appreciate those family mealtimes at home even more!
That is also why it was no surprise, when today I read this piece of news 'Talking at mealtimes boosts children's confidence' on BBC World News, announcing that after studying about 35,000 UK children, they had come to the conclusion that eating meals together with family while chatting with each other was a confidence booster. I can only hope that when they do sit down to eat and talk to each other, the kids and parents leave their electronic devices in some other room! :)

P.S:
Talking at mealtimes boosts children's confidence

The rise of the drug-resistant infections

For many decades after the discovery of the first antibiotic, we have been able to root out and beat bacterial infections after bacterial infections. But when the medical professionals celebrated this invincibility with the widespread use of antibiotics, most of them forgot the fact that bacteria like any other life form know how to evolve. And thus after being victorious against even the most aggressive and deadly infections for almost a century, we are now facing a new breed of bacteria that have learned to survive even the strongest drugs in our antibiotic arsenal.

According to the CDC Antibiotic Resistant Threats 2013 Report;
Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection.
In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections.In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections. Many of these infections could have been prevented.
The most aggressive and lethal drug resistant infections are caused by gram-negative bacteria, which are mostly seen in healthcare settings, but other forms of bacteria are also showing presence of drug-resistant strains. As to who is more likely to be at high risk, according to the report, it is often individuals with suppressed, weak or damaged immunity. But many innovative treatments require effective treatment of any infection, as a result it is becoming very difficult to offer such options to individuals with other pre-existing conditions, such as diabetes, rheumatoid arthritis, and asthma.
Some of the common medical situations in which doctors are faced with this dilemma are;

1. Cancer Chemotherapy
2. Complex Surgeries (eg. Joint replacement, Cardiac Bypass)
3. Rheumatoid Arthritis
4. Dialysis for End-Stage Renal Disease
5. Organ and Bone Marrow Transplants

What makes these new infections worrisome it the fact these can happen anywhere. Data has shown that majority of these happen in the general population but the antibiotic resistance mostly develops in a healthcare setting such as a hospital or nursing home.


The CDC also classifies these drug-resistant superbugs by threat levels: 
Urgent:

These are high-consequence antibiotic-resistant threats because of significant risks identified across several criteria. These threats may not be currently widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission.

Serious:

These are significant antibiotic-resistant threats. For varying reasons (eg.,low or declining domestic incidence or reasonable availability of therapeutic agents), they are not considered urgent, but these threats will worsen and may become urgent without ongoing public health monitoring and prevention activities.

Concerning: 

These are bacteria for which the threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness. Threats in this category require monitoring and in some cases rapid incident or outbreak response.

The report in the end points to the lack of certain measures that might help, as a result, these are some of the suggested steps, that might allow healthcare professionals everywhere, better understand and cope with this serious growing medical problem, include;

 An efficient capacity to detect and respond to urgent and emerging antibiotic resistance threats at national, state and federal levels.
-A collaborative systematic international surveillance of antibiotic resistance threats.
-Systematically collect data on antibiotic use in human healthcare and agriculture.
-More widely use programs to improve antibiotic prescribing practices in the United States.
-Promote the use of advanced technologies that can identify threats much faster then current practices.

P.S: 
CDC Antibiotic Resistant Threats 2013 Report
CDC sets threat levels for drug-resistant 'superbugs' (CNN News)

Obesity spreads to developing countries

A UK think tank The Overseas Development Institute  report concludes that number of obese and overweight adults in the developing world has  almost quadrupled to about one billion since 1980.
According to the report, there are almost as many overweight or obese adults in North Africa, Middle East and Latin America as there are in Europe. It also highlights the fact that one in three adults in the world (1.46 billion) were overweight or obese in 2008, up by 23% since 1980.
 If these figure are not enough to make us realize that obesity is no longer a rich countries' problem instead is more of a worldwide health issue, then I do not know what is going to!
A major change seen in worldwide diets is the increasing consumption of sugar and sweeteners, which has risen by over 20% per person between 1961 and 2009. One big culprit for that is the increased consumption and marketing of processed foods everywhere.
In countries with emerging economies, people are making bigger incomes and hence now can chose more varied foods and change diets. A huge majority of these individuals in developing countries live in highly congested urban settings and get very little exercise.

South Korea's Health Wellness efforts at a national level have resulted in a 300% increase in fruit and 10% increase in vegetable consumption.  Major campaigns by the government and nutrition specialists to advertise and teach the public that the traditional diet which is low fat is a healthy diet. The most common ingredients in Korean traditional cuisine are vegetables along with use of ginger, garlic, herbs, and various condiments, the health benefits of which are well-known.  The educational and campaigning efforts also focused on providing new approaches to maintaining a traditional yet contemporary Korean diet. These efforts to improve the national diet has helped South Korea keep its obesity rate at 4%. This is the lowest in the OECD (The Organisation for Economic Co-operation and Developmen) but unfortunately it too is rising gradually and is expected to increase by about 5% in ten years.

I am sure that reasons and solutions as well, are far more complex and numerous then the ones I list, but it is clear that if we do not take major steps to change these dangerous dietary and lifestyle trends for the better, we are heading for a disastrous worldwide health catastrophe.


P.S:

• Obesity quadruples to nearly one billion in the developing world(BBC World)
• Overseas Development Institute(Website)
•  The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet (Public Health Nutrition Publication)