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WHY IS INDIA SEEING A SPIKE IN COVID-19 CASES? TOP DOCTORS EXPLAIN

Healthcare experts and doctors answer key queries around rising coronavirus cases and if there a need to ramp up the vaccination drive in the country.

Shalini Bhardwaj

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Top healthcare experts and doctors discuss why India is again witnessing a massive spike in Covid-19 cases. Dr Anjan Trikha, Chairman of Clinical Managerial Group, Covid Centre at AIIMS, Dr Neeraj Nischal, Associate Professor, Department of Medicine at AIIMS, Dr Dhiren Gupta, Senior Consultant and Paediatric Intensivist at Sir Ganga Ram Hospital, and Dr Rakesh Mishra, Director at CSIR-CCMB, share their views. Excerpts:

Q. Why so many cases are increasing, particularly in states like Karnataka, Kerala, Punjab, Gujarat, and Tamil Nadu, 86% of the Covid-19 cases have been reported from these states. Do you think there is some kind of mutation of the virus?

Dr Rakesh Mishra: There is certainly a reason otherwise things won’t happen without any reason. Mutation of the virus is the most dreadful reason which we were afraid of. Probably that is not the reason as so far whatever the sequence we have seen it doesn’t look like a new variant is common in the new cases. This means it is not a new variant unless it is that subtle that we are not able to pick. Also, we have seen that while we detect a lot of UK variant and some South Africa variant in travellers who come from international travel, we have not seen a lateral spread of this beyond primary contact in a few cases. Either we are able to control well or these are not infectious for the entire population. or whatever reason, these are not posing any major concern. That leads us to the most likely possibility that most of us think is correct, the spread was not happening as we were taking the correct steps of wearing a mask, social distancing, not going to crowded places and taking care of ourselves, what we call covid appropriate behaviour. We have stopped doing that and once you don’t do that anymore, the virus is always waiting, leading to a big spike in cases. There is correlation to recent past, it might have happened due to a local election, marriage function and people in trains travelling without masks. Luckily, it is not the variant that is causing this as it can ring new surprises and new troubles. But if we continue doing things this way, a lot of people get infected and the virus keeps spreading, any variant will emerge in this population. That is the biggest fear I have that a new variant can come and create new kinds of problems and compromise the vaccine program and other things that we have achieved so far.

Q. What kind of implications can there be from the P1 virus which is a Brazilian virus?

Dr Rakesh Mishra: One thing is that it is not spreading in our population and we must be practising the Covid safety rules so that we are safe. But some studies show that strains require more antibodies to get neutralised and there is a report that shows it might be less effective against this. But it is only a quantitative difference and vaccines largely are more likely, particularly that we are using in India, effective against these variants. These are surprises that cannot be predicted, there may be a situation that this variant has acquired some resistance. If one more mutation happens on top of this in that direction it might be a problem. To prevent the spread as sufficiently as possible, particularly when we detect new variants like P1 or UK, we should be extremely careful and implement strict rules so that we don’t end up with one more lockdown which will be worse than the disease itself.

Q. BBMP has to deploy Marshalls at temples to control the crowd. Do you think that people are not that serious now and have taken things for granted?

Dr. Anjan Trikha: Yes, people have lowered their guard, they are taking things for granted. We have had hesitations; we have had elections and we have seen a lot of people getting together for various rallies and marriages. Earlier there were no marriages, then marriages with 20 people, which increased to 50 people and then further to 200 people. I have at least five wedding cards with five functions for each wedding, the way a big fat Indian wedding used to take place. I can assure you that all the people there will be having masks but in their pockets. The guard has been lowered. The same is with temples, we have to realise that God can only take care of people who take care of themselves. Wherever God may be, it could be a temple, a gurdwara, or a mosque, any religion for that matter, people have lowered their guard. We have to suffer because of that.

Q. What kind of precautions need to be taken by those who have been vaccinated for the first dose? A lot of cases have been seen that people are getting infected after a single dose and are blaming the vaccine. What would you like to say about it?

Dr Neeraj Nischal: Most of us are not aware of or not willing to learn that it is biological vaccination along with social vaccination that is going to save us during this pandemic. If we take the vaccine, it will take some time for us to develop immunities. After taking the first dose we rectify to take the second dose. Once you take the second dose, then after two weeks we anticipate that the adequate immunity level will come. Even after you have immunity the chances of getting infected is still there. It’s just that this vaccine most probably is going to prevent you from getting a severe form of the disease. That’s why getting one shot of a vaccine and thinking that you have become immune to this infection is wrong. We have to ensure that even if we have taken both sets of doses, we have to practice social vaccination after that. Otherwise, we will start saying the vaccine is not working. The idea of vaccination is to prevent morbidity and mortality due to this infection but chances of cutting down transmission may not be 100% or even 70-80% as efficacy is just against the severe disease. We have to keep our guard up even after taking the vaccine.

Dr Dhiren Gupta: What Dr Nischal has said is right. I witnessed five cases who got an infection after the second dose and all these cases were symptomatic though they were young medical students. In young you can’t say they are not severe as otherwise also they are not that severe in the elderly population, probably nobody knows the authenticity of these vaccines. These vaccines have been approved by just a very small trial which has never happened in the past, nobody knows what is the effect of the new strain and the constant mutating viruses. We don’t need any virus to be imported from Brazil, the UK, and South Africa. Recently there was a paper which stated that over 7,000 mutations have happened in India but we are just doing 0.6% entries for the mutation and 5% of the samplings. So we don’t know what is happening but we can’t lower the guard unless the whole population gets vaccinated which means it can still spread despite some people being vaccinated.

Q. Do you think Covid-19 is mild among children?

Dr Dhiren Gupta: Yes, it used to be mild but the problem with the paediatric age group is they can spread it and spoil the game. They may not suffer from severe covid infections especially classical Covid not very much prevails in the paediatric age group which we have seen in the previous two academics in Delhi and India. But in the UK strain, they have found that the prevalence was a little bit more in the paediatric age group than any other mutation. The post-Covid multi-organ inflammatory syndrome is quite life-threatening in this age group. We can say that it is rare but it is not that rare that we should not worry. We follow the cases among adults once the academic is in the adult as the adult population carries the infection to the home. Still, we don’t have the schools open. The Covid-positive children can spread the virus to the elderly, they become very well variables for the infection as the paediatric age group is very attached to their grandparents. It can spread to the most vulnerable population is worrisome.

Q. What can be done as some children have started going to schools, other schools will open in future including for toddlers?

Dr Anjan Trikha: Yes, we can’t have another year of schools not opening. They could be closed for a couple of months, say four to five more months but that is also unreasonable. One thing which we are forgetting is by closing schools we are trying to hinder the development of a child. A child develops a lot mentally when he goes to school, some kind of vaccine behaviour has to be brought to the child. Maybe in the class, they’ll have to be seen that they don’t share food and water, and have to be masked. They have to be told not to touch here and there and put their fingers in the nose, eyes and mouth after every hour. I know it is a tough call but we tend to teach our children not to pick their nose, so we have to teach them not to put things in their mouth. This kind of behaviour has to be taught to them and as I have been pointed out that kids would likely to be bigger spreaders than to be getting affected. We have got our share of children who got Covid and landed in ICU. That behaviour would have to be taught to children and it’s going to be another eight months to a year if not more before some kind of vaccine can be available as a mass vaccination for children.

Dr Dhiren Gupta: First adults have to follow that behaviour then only they can teach their children.

Dr Anjan Trikha: Adults have to get it but the earlier we start the better it is. 

Dr Dhiren Gupta: I see that even the doctors are getting fed up with masks. The tolerance to have a mask for a whole day is not easy. We did a study if you wear a mask for a whole day, for a few hours without interruption, then it is leading to an actual problem in health and that we proved in our nurses. We know that recently it has been found that this virus doesn’t spread by touch but hand washing has to be there. Our vaccination is very slow which means it has almost been the third month of vaccination and we have got the best system in the world including the government and the private regarding vaccination and we couldn’t utilise that system very well to date. All we need to be is quick and fast or once a mutation arrives your existing vaccination would never be sufficient.

Q. What would you like to say about ramping up vaccination?

Dr Neeraj Nishal: Adults have to be role models for children. Once you are there in the home and following all the Covid appropriate behaviour, children are going to learn about that. Every parent has to make a conscious decision that if his/her child is not ok, they should not be sending them to school. Everyone has to pitch in not just children or adults, it has to be a combined effort including the school administration who can start telling this in online classes. They can guide the children and what is expected when they come to school for physical classes. As far as vaccination efficacy against strain is concerned, we should not be worried too much about this as the vaccine is there. We could have ramped up the vaccination on day one but are people going to come and take those vaccines so this vaccination program needed to be slowly implemented. People are taken into confidence so that there is no hesitancy whatsoever. When the time comes everybody will get a chance to take the vaccine, I’m sure they will come forward and take it. The support that the vaccine is getting is improving day by day. I feel the rate may be slow but it is effective and will be wrapped up in time. We should not be in a hurry to ramp up everything on day one and if something wrong would have happened then the whole program would have collapsed so it was a proper way.

Q. What can be the reason behind Maharashtra reporting more than 30,000 cases in a single day? 

Dr Rakesh Mishra: That is how we began. The reason is most likely that the people have stopped taking precautions. We should be aware that this virus spreads very efficiently. The good thing is that we know how it spreads so we can stop that, and like other coronaviruses, it has a tendency to mutate and we have seen out of 6,000 variants or 6,000 isolates in India we have documented 7500 mutations, luckily most of them are not of much consequence they are just academic records.

Mutation and transmission are not correlated, those are just recorded in those isolated. Either it is very transmissible otherwise itself normal mutation. 

Q. Do you think people are not following guidelines?

Dr Rakesh Mishra: Exactly, we are not behaving as we should and that is the best tool that we have, even if there are vaccines now maybe there will be many more but vaccines have limited benefits. 1000% people are not going to get 100% protection which means if we keep playing with the virus, allowing it to hang around in a larger number for a longer time we will certainly discover one day, which will trouble us heavily and the whole thing can become a big problem. The cause for the increase in the number of cases is most likely not a new variant although we have to keep monitoring everyday a large number of isolates by samples, at least 5% in particular where there is a large number of cases. Then very easily we can tell whether the new variant is happening or not. But since we haven’t seen something so far and there is a direct correlation to the people being careless it is very likely we are encouraging the virus and inviting trouble for ourselves. We have to go back to the social vaccine and trust in that and then only the full advantage of the real vaccine will be there otherwise all will go in vain and we will be back to the drive out.

Q. Do you believe the vaccine that is going to work is the social vaccine?

Dr Anjan Trikha: Yes, everything has been rightly said by Dr Gupta, Dr Nishal and Dr Mishra, I would like to add that injectable vaccines are a totally different ball game and a social vaccine is equally important. I also feel like Dr Nishal, the government has done a considerably good job in starting vaccination at a slow phase. If you realise that we people like to discuss a lot, everybody in the country is discussing which vaccine to take and not to take. Let us have faith in our government and they are doing a good job. There were a group of people who never took the vaccine in a state as somebody had told them they can’t have alcohol after taking the vaccination for 15 days. So the vaccination drives go for a dodge. These kinds of issues will be solved. We are one of those countries where lockdown and everything else was criticised but we did a good thing. The economy went for a toss and it has gone for a toss everywhere in the world. Even if you go to the USA it’s the same thing, my son who is 35 is not vaccinated in Cincinnati as only above 60 years are getting vaccinated. We are following the same thing and are on the right track. We have hiccups in India. There are going to be elections in West Bengal, Kerala, and Tamil Nadu, so this will go on.

Q. There are people who are thinking they should Covishield or Covaxin. What would you like to say about it?

Dr Neeraj Nischal:Theoretically there may be differences between these two vaccines but at the time of the pandemic, we cannot be choosing among these two. If you are eligible, go ahead and take the available vaccine. Don’t try to differentiate between these two vaccines and try to find out which vaccine you should take. Unless there are clear cut contraindications as far as one of the vaccines is concerned, say immune-compromised patients should avoid taking this vaccine, you should not be taking that vaccine but if this is not the case, go with whatever vaccine you are getting and don’t wait which is better and which is not. This is pandemic time and if we wait for the perfect solution then it might be too late. Everybody was worried about when the vaccine will come and now that the vaccine is here, we should know the vaccine is not going to end the pandemic, vaccination will. So, whenever the turn comes, irrespective of the vaccine you are getting, come forward, take it and help in ending this pandemic.

Q. What message would you like to give?

Dr Dhiren Gupta: I think what Dr Nischal said is true, we should not have any hesitations in getting vaccines, whatever type of vaccine is available you get it as soon as possible. Don’t go by the rumours. I would like to advise the media that there will be a reaction in adult vaccination and paediatrics patients as they do not react to vaccination much as compared to adults. But if you compare the disease severity, hardly any reactions are there. Get yourself vaccinated, practice social distancing, and wear a mask which we can’t forget even after vaccination.

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Medically Speaking

FASTING REQUIRED TO SEE FULL BENEFIT OF CALORIE RESTRICTION

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Over the last few decades, scientists have discovered that long-term calorie restriction provides a wealth of benefits in animals: lower weight, better blood sugar control, even longer lifespans.

Researchers have largely assumed that reduced food intake drove these benefits by reprogramming metabolism. But a new study from the University of Wisconsin-Madison researchers finds that reduced calorie intake alone is not enough; fasting is essential for mice to derive full benefit. The team published their findings in the journal Nature Metabolism.

The new findings lend support to preliminary evidence that fasting can boost health in people, as trends like intermittent fasting continue to hold sway. These human and animal studies have added to the growing picture of how health is controlled by when and what we eat, not just how much.

The research further emphasizes the complexity of nutrition and metabolism and provides guidance to researchers trying to untangle the true causes of diet-induced health benefits in animals and humans.

The researchers discovered that combined with eating less, fasting reduces frailty in old age and extends the lifespan of mice. And fasting alone can improve blood sugar and liver metabolism. Surprisingly, mice that ate fewer calories but never fasted died younger than mice that ate as much as they wanted, suggesting that calorie restriction alone may be harmful.

The research was led by UW School of Medicine and Public Health metabolism researcher Dudley Lamming, his graduate student Heidi Pak and their colleagues at UW-Madison and other institutions.

Pak and Lamming were inspired to conduct the study because researchers began to realize that previous studies had unintentionally combined calorie restrictions with long fasts by providing animals with food just once a day. It was difficult, then, to distinguish the effects of one from the other.

“This overlap of treatment — both reducing calories and imposing a fast — was something that everybody saw, but it wasn’t always obvious that it had biological significance,” said Lamming, who has long studied the effect of restricted diets on metabolism. “It’s only been in the past few years that people started getting interested in this issue.”

To untangle these factors, Lamming’s group designed four different diets for mice to follow. One group ate as much as they wanted whenever they wanted. Another group ate a full amount, but in a short period of time — this gave them a long daily fast without reducing calories.

The other two groups were given about 30 per cent fewer calories either once a day or dispersed over the entire day. That meant that some mice had a long daily fast while others ate the same reduced-calorie diet but never fasted, which differed from most previous studies of calorie restriction. It turned out that many of the benefits originally ascribed to calorie restriction alone — better blood sugar control, healthier use of fat for energy, protection from frailty in old age and longer lifespans — all required fasting as well. Mice who ate fewer calories without fasting didn’t see these positive changes.

Fasting on its own, without reducing the amount of food eaten, was just as powerful as calorie restriction with fasting. Fasting alone was enough to improve insulin sensitivity and to reprogram metabolism to focus more on using fats as a source of energy. The livers of fasting mice also showed the hallmarks of a healthier metabolism. The researchers did not study the effect of fasting alone on lifespan or frailty as mice age, but other studies have suggested that fasting can provide these benefits as well.

While the mice that ate fewer calories without ever fasting did show some improved blood sugar control, they also died younger. Compared with mice who both ate less and fasted, these mice that only ate less died about 8 months earlier on average.

“That was quite surprising,” said Lamming, although other studies have also shown some negative effects from restricting calories. The team also measured frailty through metrics like grip strength and coat condition. “In addition to their shorter lifespans, these mice were worse in certain aspects of frailty, but better in others. So, on balance, their frailty didn’t change much, but they didn’t look as healthy.”

The primary studies were done in male mice, but Lamming’s lab also found similar metabolic effects of fasting in female mice. The research reveals how difficult diet studies are, even in a laboratory environment. That difficulty is magnified for human studies, which simply can’t match the level of control possible in animal models. The new study can provide direction to future work trying to answer whether fasting improves human health.

“We need to know whether this fasting is required for people to see benefits. If fasting is the main driver of health, we should be studying drugs or diet interventions that mimic fasting rather than those that mimic fewer calories.” Lamming said.

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Common dialysis treatment for patients with acute kidney injury can lead to poor outcomes

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Patients with acute kidney injury who receive continuous renal replacement therapy (CRRT), a common dialysis method, have a high incidence of needing this dialysis method reinstituted after having it removed. This contributes to poor 90-day outcomes, according to recent research led by an international team of scientists.

The study was published in the journal Mayo Clinic Proceedings. Though CRRT is a common dialysis method for critically ill patients with acute kidney injury, little research has been performed to determine at what point in kidney function recovery the patient should be “liberated” from CRRT.

This study, by researchers at Mayo Clinic and Zhongnan Hospital of Wuhan University in China, is believed to be the first to investigate outcomes for patients with acute kidney injury who were not successfully liberated from CRRT.

The retrospective cohort study examined the records of 1,135 patients with acute kidney injury who were treated with CRRT at Mayo Clinic in Rochester between January 2007 and May 2018. Of those patients, 20 per cent were successfully liberated from CRRT. In 39 per cent of patients, CRRT had to be reinstituted within 72 hours, and 41 per cent of these patients died.

Successful CRRT liberation was marginally associated with fewer major adverse kidney events and improved kidney recovery at the time of 90-day follow-up, though the causal relationships could not be established.

“In current clinical practice, CRRT liberation is typically based on physicians’ personal experience because there has been only limited and inconsistent research available,” says Kianoush Kashani, M.D., a nephrology intensivist at Mayo Clinic and the study’s senior author.

Kianoush added, “Our study demonstrated a high occurrence of CRRT liberation failure, as well as poor 90-day outcomes. Thus, there is a critical need for identifying preventive measures to avoid the need for CRRT or interventions that lead to early liberation from CRRT among critically ill patients with advanced acute kidney injury.”

Acute kidney injury is a common complication for patients in ICUs. As many as 57 per cent of ICU patients have acute kidney injury. Dialysis is used to treat about 13 per cent of those patients, and this treatment is associated with 60 per cent mortality, according to research.

“There are limited data and little consensus on how and when to liberate patients from CRRT properly, the high rate of liberation failure observed in our study may reflect variations in clinical practices. Development of consistent approaches that can guide decision-making on when to remove CRRT should be a top priority of future research,” he added.

CRRT is frequently used as a dialysis mode for critically ill patients because it provides continuous control of fluid status during treatment and doesn’t interfere with the body’s normal blood flow while achieving uremic control.

But recent studies have found that prolonged CRRT may lead to adverse events and impede kidney function recovery, while premature CRRT liberation also can lead to complications.

Other dialysis options are associated with even lower changes in kidney recovery, says Dr. Kashani, the study’s senior author. The study clearly indicates that CRRT liberation, when successful, can be associated with improved clinical outcomes for critically ill patients and lower costs of care, he says.

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INCREASE IN DAIRY INTAKE LOWERS RISK OF FRACTURES AMONG OLDER HOME RESIDENTS

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Increasing intake of foods rich in calcium and protein such as milk, yoghurt, and cheese, reduces falls and fractures in older adults living in residential care, finds a new study led by an international team of scientists.

The randomised controlled trial was published in ‘The BMJ’ (British Medical Journal). This is one of only a few studies to examine whether getting these nutrients from foods (as opposed to supplements) are effective and safe, and the researchers say this approach has “widespread implications as a public health measure for fracture prevention.”

Older adults living in residential care often have low calcium and protein intake, which can lead to weak bones and an increase in the risk of falls and fractures. It is estimated that older adults in aged care are the source of about 30 per cent of all hip fractures.

It is well known that foods rich in calcium and protein, such as milk, yoghurt, and cheese help prevent bone fragility, but few studies have investigated whether increasing daily intake of these foods is an effective and safe way to reduce fracture risk in older adults.

So researchers based in Australia, the Netherlands and the US set out to examine whether achieving recommended daily intakes of calcium (1,300 mg) and protein (1 g/kg body weight) from food sources would reduce the risk of fragility fractures and falls among older adults in residential care facilities.

The two-year trial involved 60 aged care facilities in Australia housing 7,195 residents (72 per cent women; average age 86 years) replete in vitamin D but with daily calcium and protein intakes below recommended levels.

Thirty intervention facilities were randomised to provide residents with additional milk, yoghurt, and cheese, achieving intakes of 1,142 mg calcium/day and 1.1 g protein/kg body weight/day. The remaining 30 control facilities continued with their usual menu (700 mg/day calcium and 0.9 g protein/kg body weight/day).

Data from 27 intervention facilities and 29 control facilities were analysed and a total of 324 fractures (135 hip fractures), 4,302 falls, and 1,974 deaths occurred during the study period.

The intervention was associated with risk reductions of 33 per cent for all fractures (121 v 203), 46 per cent for hip fractures (42 v 93), and 11 per cent for falls (1,879 v 2,423). There was no group difference in all-cause mortality.

The relative risk reduction for fractures was similar to that found in trials using potent drug therapy to increase bone strength in people with osteoporosis.

A randomised controlled trial is considered the most reliable way to determine whether an intervention actually has the desired effect, but the researchers do point to some limitations. For example, the loss of participants limited their ability to examine the possible mechanisms that may contribute to fewer fractures and falls.

Nevertheless, they say, improving calcium and protein intakes by using dairy foods “is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in institutionalised older adults.” They also added that this nutritional intervention has widespread implications as a public health measure for fracture prevention in the aged care setting and potentially in the wider community.

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ENHANCING VACCINATION IS THE RIGHT STEP IN CURBING SPREAD OF COVID

Mumbai for the first time has recorded no Covid-related deaths recently.

Dr Rahul Pandit

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From battling the most tumultuous second wave of Coronavirus to driving the world’s largest vaccination program, India’s journey in tackling Covid-19 has been exceptional. Today, India has achieved a milestone by inoculating 100 crores of its population. Adding to this, Mumbai for the first time has recently recorded no Covid-related deaths. This is truly a moment of pride as we can now be certain that we can tackle Covid-19 in a better way and save more lives. If we continue following protocols and actions to save more lives, we will be able to achieve the goal of zero deaths due to Covid in India.

India has already provided more than one billion vaccinations covering around 1/7th of the population. So about 70% of the eligible population has received at least one dose, and nearly 25 % have received both the doses. With the introduction of vaccines for children, this program will take a new leap. The progress made so far is thus, commendable. It takes 5-10yrs to test and develop vaccines, but India researched and developed an in-house vaccine, ensuring that all necessary arrangements such as complex manufacturing, the humongous logistics involving setting up cold chains, airport transfers, vaccines to states, local storage, and last-mile connectivity were set up in no time. Moreover, India devised an excellent strategy to encourage pharma companies to produce vaccines within the country. This coupled with the efforts put by healthcare providers, media, and health activists in spreading awareness and reiterating time & again the significance of vaccination in saving lives, has been huge.

Enhancing the vaccination process is the right step in curbing the spread of the virus, as well as saving as many lives as possible. Mumbai is a case in point. After a concerted effort made by the government, local bodies, private hospitals, doctors, nurses, paramedics, and the public at large for the last 18 months, the city saw a day with zero deaths. This is how the nation needs to work against the infection. However, one needs to note that Mumbai’s achievement is a result of multiple factors put together, and among these, vaccination is the key. Around 50% of Mumbai’s population has been fully vaccination and more than 90% have received the first dose. Maharashtra’s vaccination drive across districts has brought the state closer to the 10Cr mark; that too, at record breaking speed.

For any infectious disease, the first line of action is to save lives and prevent the spread. That’s what Mumbai did. From being a highly impacted region, to becoming a city with zero deaths, our actions delivered.

However, staying cautious is critical, as it is yet too early to declare victory over the virus. At present, we are better equipped to confront any new challenge. People should however, not lower their guards and continue following Covid-19 protocols. Even after vaccination continue to mask up and follow Covid-19 protocol. Get vaccination and encourage others to do so. Only then can we together someday win the war against Covid-19. It’s not too long before we’d be vaccinating another 10Cr nationals, setting golden examples for the world to follow.

The writer is Director-Critical Care, Fortis Hospitals Mumbai & Member of the honorable Supreme Court appointed National Covid-19 Task Force.

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PGIMER releases documentary titled ‘Front of Package Labeling: A Game Changer for Healthy India’

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A documentary titled ‘Front of Package Labeling: A Game Changer for Healthy India’, prepared by the Department of Community Medicine and School of Public Health (DCM & SPH), Post Graduate Institute of Medical Education and Research, Chandigarh.

This documentary is a part of a project being undertaken by the Institute in collaboration with Government of Punjab and Strategic Institute of Public Health Education and Research (SIPHER) and is supported by Global Health Advocacy Incubator, USA.

“A rapid rise in hypertensive cases is being observed in Punjab, which is worrisome. Through the project, we are collaborating with the Government of Punjab to prevent and better manage hypertension through sensitization of media and the general public regarding the risk factors like trans fats in food. We strongly feel that warning labels on food items are effective way of helping people to make nutritious food choices. The documentary drives home the importance of Front of Package Labeling (FOPL) for averting a cardiovascular health, obesity and diabetes crisis in India.” said Dr. Sonu Goel.

As per WHO, Non-communicable diseases (NCDs’) account for 70% of the global deaths. The state of Punjab has become a capital of hypertension with one out of three people suffering from this silent killer.

Excessive intake of fats, sugar and salt available in packaged foods such as cake, pizza, pastry, french fries, ice cream, etc. are the primary cause of NCDs. Under this project which started in 2019, PGIMER Chandigarh has signed a pact with Food and Drug Administration, Punjab to implement and regulate the trans-fat surveillance in Punjab.

The documentary highlights key features such as transition of food practices from traditional to modern, ways to making healthy food choices, identifying good and bad food, diseases associated with bad food. etc.

It was released at the juncture of festivals such as Diwali, aims to generate awareness among policymakers, implementers, and the general public about the importance of healthy and wholesome food to keep Non-Communicable Diseases (NCDs’) like hypertension at bay and to generate support for an intense Front-of-Pack Labelling (FOPL) policy to be developed by Government of India. It took around two months to prepare this documentary of approximately 7 minutes, which is a collaborative effort of the project team. The documentary has been conceptualized and narrated by Dr. Sonu Goel, Professor, Dept. of Community Medicine and School of Public Health, PGIMER, Chandigarh and Principal Investigator of the project.

Dr. Geeta Mehra, Head, Dept. of Food Sciences, MCM DAV College, Chandigarh emphasized the importance of reading food labels while purchasing any packaged food product. She stressed that “FOPL, if implemented in India, will allow the consumers to identify products containing excess sugars, trans-fats, oils, and sodium easily, quickly, and correctly and help them to make informed food choices.”

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STUDY SHOWS REGULAR MILLET CONSUMPTION CAN COMBAT ANAEMIA

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A new study has shown that regular consumption of millets can improve haemoglobin and serum ferritin levels to reduce iron deficiency anaemia, which is rising globally.

The findings of the study were published in the journal ‘Frontiers in Nutrition’. The research, a meta-analysis of 22 studies on humans and eight laboratory studies on millets consumption and anaemia, was undertaken by seven organisations across four countries and was led by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT).

“The study concluded that millets can provide all or most of the daily dietary iron requirements of an average person. Although the amount of iron provided depends on the millet variety and its form of processing, the research clearly shows that millets can play a promising role in preventing and reducing high levels of iron deficiency anaemia,” highlighted Dr S Anitha, the study’s lead author and Senior Nutritionist at ICRISAT.

The researchers found that millets increased haemoglobin levels by as much as 13.2 per cent. Four studies in the review also showed serum ferritin increasing by an average of 54.7 per cent. Ferritin is an iron-containing protein in the blood and is a clinical marker for iron deficiency.

The studies in the analysis involved nearly 1,000 children, adolescents and adults, and six different millet types – finger millet, pearl millet, sorghum and a mixture of kodo, foxtail and little millets. The participants in the studies were found to have consumed millets for anywhere between 21 days and 4.5 years. The findings were published on 14 October in Frontiers in Nutrition.

“1.74 billion people were anaemic in 2019. That number is rising,” said Dr Jacqueline Hughes, Director General, ICRISAT.

“It has been proven that iron deficiency anaemia affects cognitive and physical development in children and reduces productivity in adults. The need for a solution is critical, and therefore bringing millets into mainstream and government programs is highly recommended,” added Dr Hughes.

“Now that there is strong evidence of the value of millets in reducing or preventing iron deficiency anaemia, it is recommended that one major research study be undertaken on anaemia covering all the different types of millet, common varieties and all major forms of processing and cooking, using a uniform testing methodology. This will provide the detail required for designing interventions needed to have a major impact on reducing anaemia globally,” said Professor Ian Givens, a co-author of the study and Director at the University of Reading’s Institute of Food, Nutrition and Health (IFNH) in the UK.

“It has often been claimed that iron in millets is not highly bioavailable due to the supposed high levels of antinutrients. Our analysis proves this is a myth. Instead, millets were found to be comparable to typical iron bioavailability percentages for plants. Also, the levels of antinutrients in millets were identified to be similar or lower than common staples,” said Ms Joanna Kane-Potaka, former Assistant Director-General, ICRISAT, and Executive Director of the Smart Food initiative who is a co-author of the study.

The research also showed that processing can significantly increase the amount of iron bioavailable. For example, millet snacks made by expansion (extrusion) increased bioavailable iron 5.4 times, while fermentation, popping and malting more than tripled the iron bioavailable. Germination (sprouting) and decortication (dehulling) more than doubled the bioavailable iron.

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