August 29   2015, Saturday
eMedinewS
editorial
Caffeine–Alcohol combination in paralysis
Dr KK AggarwalA drug Caffeinol containing caffeine and alcohol may help stroke patients recover.

In a small study at Texas Health Science Center in Houston, 60% of stroke patients who were given the drug, had no or minimal disability when they were discharged from the hospital. In contrast, only 26% of stroke survivors given standard therapy with tissue plasminogen activator, or tPA, fared that well.

Caffeinol contains about as much caffeine as 5 to 7 cups of good, strong New Orleans coffee and the equivalent of two shots of alcohol.

The study involved 100 people who had suffered an ischemic stroke. All received intravenous tPA; 10 were also given an infusion of caffeinol. Caffeinol allows cells to tolerate reduced blood flow longer, thereby giving tPA a longer opportunity to do its action.

Will these findings be applicable to heart attack? Only time will tell as heart attack is also treated with tPA.
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Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
News
Diabetes
Antibiotic use seems to be associated with an increased risk for type 2 diabetes, reported a new population-based, case-control study published online August 27 in the Journal of Clinical Endocrinology and Metabolism.

Pulmonary Medicine
Currently being involved in farming appears to diminish lung function in young adults, suggests a long-term study published online in Occupational & Environmental Medicine. Researchers noted that continuing farming exposure in young adults was associated with a negative effect on lung function development when compared to those who quit farming.

Surgery
A new study, published online in JAMA Surgery, suggests that a standardized preadmission shower regimen that includes 118 mL of aqueous chlorhexidine gluconate, 4%, per shower and a minimum of 2 sequential showers result in maximal skin surface concentrations of chlorhexidine gluconate sufficient to inhibit or kill gram-positive or gram-negative surgical wound pathogens.

Oncology
The introduction of generic versions of aromatase inhibitors (AIs), which are substantially cheaper than the branded products, has improved adherence in breast cancer survivors, suggests new research published in the August issue of the Journal of the National Cancer Institute.

Psychiatry
Addiction

Two new studies on the impact of cannabis use on the brain have been published online in JAMA Psychiatry wherein one study finds no significant effect of cannabis use on brain volume, but rather hints that the brains of users may be smaller to begin with. The second study suggests that marijuana may alter brain structure in young men at high genetic risk of developing schizophrenia, which can be triggered by cannabis use.
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Cardiology eMedinewS
Cardiology
Neurology

A large meta-analysis focusing on short-term outcomes finds support for off-pump CABG surgery, with no differences in the rate of MI and all-cause mortality between off-pump surgery and CABG with cardiopulmonary bypass (CPB) but documenting a reduction in stroke with the off-pump procedure. The findings are published in the Journal of Thoracic and Cardiovascular Surgery.

Cardiology
The US Food and Drug Administration (FDA) approved evolocumab for lowering LDL-cholesterol levels, specifically, for use in addition to diet and maximally tolerated statin therapy in adults with heterozygous and homozygous familial hypercholesterolemia (FH) or clinical evidence of atherosclerotic cardiovascular disease who require further LDL-cholesterol lowering.
Pediatrics eMedinewS
Pediatrics
Cardiology

Timing of epinephrine administration matters in children who experience in-hospital cardiac arrest with initial nonshockable rhythm, suggests a new study published in JAMA. Delayed epinephrine administration was found to be associated with decreased chance of survival to hospital discharge, return of spontaneous circulation (ROSC), 24-hour survival, and survival to hospital discharge with a favorable neurological outcome.

Pediatrics
Infectious Diseases

HIV-uninfected children in tuberculosis-endemic countries who have a positive QuantiFERON-TB Gold In-Tube test are candidates for isoniazid preventive therapy (IPT), suggests new research published online in the Pediatric Infectious Disease Journal.
Dr KK Spiritual Blog
Why Spirituality is Friendly to wellbeing
  • What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  • Positive thinking produces nearly a 30 percent drop in perception of pain.
  • Spirituality and the practice of religion are associated with a slower progression of Alzheimer’s disease.
  • Those who regularly attend organized religious activities may live longer than those who do not. Regular participation lowers mortality rate by about 12 percent a year.
  • People undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  • Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  • Spirituality stimulates the relaxation response. When the body is relaxed, the heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  • Spirituality can affect function of the immune system. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  • Prayer heals the heart. Positive talking and thinking in the ICU produces better results.
  • Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, meditation, Pranayama, religious meeting, chanting, mind-body relaxation, etc.
  • Spirituality is something that can help all the way from promoting wellness to helping with recovery.
Inspirational Story
Finding Happiness

Once a group of 50 people was attending a seminar, suddenly the speaker stopped and started giving each person a balloon. Each one was asked to write his/her name on it using a marker pen. Then all the balloons were collected and put in another room.

Now these delegates were let in that room and asked to find the balloon which had their name written, within 5 minutes. Everyone was frantically searching for their name, pushing, colliding with each other, and there was utter chaos. At the end of 5 minutes, no one could find their own balloon.

Now each one was asked to randomly collect a balloon and give it to the person whose name was written on it. Within minutes everyone had their own balloon. The speaker began: This is exactly happening in our lives. Everyone is frantically looking for happiness all around, not knowing where it is. Our happiness lies in the happiness of other people. Give them their happiness, you will get your own happiness.

And this is the purpose of human life.
Make Sure
Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.
Dr Good Dr Bad
Situation: A young female with tinnitus came for marriage counseling advice.
Dr Bad: It is familial.
Dr Good: It is not familial.
Lesson: Tinnitus does not appear to be a highly heritable condition (Source: Arch Otolaryngol Head Neck Surg 2010;136:178–82).

(Copyright IJCP)
eMedinewS Humor
Proportions

One semester when my brother, Peter, attended the University of Minnesota in Minneapolis, an art student friend of his asked if he could paint Peter’s portrait for a class assignment. Peter agreed, and the art student painted and submitted the portrait, only to receive a C minus.

The art student approached the professor to ask why the grade was so poor. The teacher told him that the proportions in the painting were incorrect.

"The head is too big," the professor explained. "The shoulders are too wide, and the feet are enormous."

The next day, the art student brought Peter to see the professor. He took one look at my brother and said, "Okay, A minus."
eIMA Quiz
Since sunscreen-awareness campaigns began, have skin cancer rates decreased?

A. Yes, fewer people are getting skin cancer.
B. No, skin-cancer rates and deaths from the disease are on the upswing.
C. No, skin cancer is on the rise, but fatalities are down.
D. Skin-cancer rates have been stable over the past decade.
E. Yes, but only among older women.

Yesterday’s Mind Teaser: How much exercise do you really need?

A. 45 minutes twice a week.
B. 30 minutes three or four days a week.
C. 60 minutes at least three or four days a week.
D. 30 minutes at least four or five days a week.
E. It depends on your age and overall physical-fitness level.

Answer for Yesterday’s Mind Teaser: D. 30 minutes at least four or five days a week.

Answers received from: Dr B R Bhatnagar, Dr KV Sarma, Dr K Raju, Dr Shangarpawar, Dr Ridu Kumar Sharma.

Answer for 27th August Mind Teaser: d. Carotene

Correct Answers received from: Dr Bitaan Sen & Dr Jayashree Sen, Dr Jainendra Upadhyay.
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Rabies News (Dr A K Gupta)
Is observing the dog for 10 days without initiating treatment risky or justifiable?

Observing the dog for 10 days without initiating treatment is risky and not at all justifiable. It is mandatory to start treatment soon after exposure. The vaccination must be started immediately irrespective of the status of the biting animal. Improper treatment to animal bite victims may lead to rabies death and litigation under Consumer Protection Act (COPRA). According to Consumer Protection Act, the animal bite should be considered as "medical urgency" and treated with due care.
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
Press Release
Monsoon maladies and necessary precautions

The rains may have brought with them a much-needed respite from the heat, but they also bring along some diseases. The dramatic change in weather during and post-monsoon results in a range of health concerns. Taking adequate precautions are one of the best ways to avoid monsoon-related ailments.

Speaking about this, Padma Shri Awardee Dr. KK Aggarwal, President Heart Care Foundation of India & Honorary Secretary General Indian Medical Association said, “What most people do not realize is that the monsoon season brings with it a host of diseases and necessary precautions must be taken. Diseases like dengue, malaria, are easily preventable if adequate measures are taken.”

Here are the top five post monsoon illnesses, which one can prevent:

1. Dengue Fever: Dengue fever is a disease caused by viruses that are transmitted by mosquitos. It is spread by what’s known as the tiger mosquito (Aedes Aegypti), which has black and white stripes and typically bites early in the morning or at dawn. These mosquitoes are also known to spread the Chikungunya fever virus. The symptoms include severe joint and muscle pain, swollen lymph nodes, headache, fever, exhaustion and rashes. Because a virus causes dengue fever, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Given the painful nature of the disease, prevention is essential.

Preventive measures: Unfortunately, there aren’t any drugs available to prevent the virus. As it’s transmitted via mosquitoes, one should use a strong insect repellent containing DEET to prevent mosquito bites. People should also wear full sleeve clothing when out in the day. It is important to remember that the dengue mosquito usually bites only in the day time and breeds in clean, fresh water. So any water accumulation should be checked for.

2. Malaria: One of the most common monsoon-related diseases, malaria, is caused by the Anopheles mosquitoes breeding in the dirty water. It is characterized by fever, bodyache, chills, and sweating. If untreated, it can lead to jaundice, severe anemia or even liver and kidney failure.

Preventive measures: Take an antimalarial drug such as mefloquine, atovaquone/proguanil, or doxycycline. Also take measures to prevent mosquito bites such as the use of mosquito repellents and wearing full sleeve clothing. Dirty water must not be allowed to accumulate to prevent malaria mosquito breeding.

3. Viral fever: Sudden weather change often causes viral fever characterized by fatigue, chills, bodyaches and fever. The illness is communicable and spreads through infection droplets in the air or by coming into physical contact with infected secretions. It lasts from 3 to 7 days, with the severity of the fever being the highest in the first three days. Respiratory symptoms tend to develop later on and can include a cough and in severe cases pneumonia. Staying in wet clothes for long periods and prolonged exposure to humid air from air-conditioners increase your chances of catching a cold.

Preventive measures: One must ensure that they do not get wet in the rain or stay in wet clothes for a long period, wash their hands often, boost their immunity by eating vitamin C-rich foods and green leafy vegetables. They must also keep a distance from an infected person. Given that viral fever spreads rapidly thought the air, if found to be suffering from the illness people should control side effects and symptoms using OTC drugs in consultation with their doctor.

4. Food Poisoning: Gastroenteritis and food poisoning are quite common during the monsoon season, and the high humidity helps in the growth of disease-causing bacteria.

Preventive measures: While eating out, keep in mind that soups, pastas and other such foods, which are supposed to be served hot, must not be allowed to become lukewarm, which is ideal for the growth of bacteria. It is applicable for frozen foods like ice cream as well which must be served completely frozen and ensure that melted ice cream is not refrozen since this could lead to food poisoning. Try and avoid eating raw food like salads because it is difficult to ascertain whether they have been washed, cleaned and stored at the right temperature before being served. Also don't go for chutneys and sauces since they are stored at room temperature and are loaded with harmful microorganisms. High sugar content and milk makes for an ideal environment for bacterial growth. Avoid eating roadside foods including panipuri, which may be made in contaminated water and trigger diarrhea.

5. Allergies and Hay Fever: Many trees start pollinating from September to October, triggering seasonal allergies among people. Common symptoms include inflammation in the lining of the nose and eyes. Allergic bronchitis, which affects the lung area can induce breathing problems.

Preventive measures: Allergy symptoms can be treated to a certain extent by taking anti-allergy and antihistamine drugs. Those who suffer from asthma should always carry their inhaler.
eIMA News
Report on the 1st meeting of National Executive Committee on Haemovigilance Programme of India, held on 21.08.2015 AT NIB, Noida
The meeting was attended by Team IMA.

Dr Neelam Marwaha, Head, Transfusion Medicine, PGIMER, Chandigarh was on Chair and Dr Surinder Singh, Director NIB was the Coordinator. It was attended by Officers from NACO, NBTC and Experts on Transfusion Medicine on Govt & Private Sectors.

A Centralized Haemovigilance Programme to assure Patient Safety and to promote Public Health is already launched in the country on 10th December, 2012. Discussion was centred on Transfusion Reactions Reporting Format based on the Analysis of 1728 Transfusion Reaction Reports collected after launching of the Haemovigilance Programme on 10.12.2012 till 16.12.2014.

The format was discussed in detail by the Committee. The software of the reporting format is already under process simultaneously. The Programme will be launched after final approval of the concerned Authority.

Apart from monitoring the Transfusion Reactions, the Programme will also aim at Creating Awareness among Health Professionals, Create National and International Linkages and communicate the findings to all Key Stakeholders, where IMA will be playing a big role.

Dr N V Kamat, Principal Advisor, IMA
WMA Annual General Assembly
(27.08.2015) October 14-17 World Trade Center Moscow, Russia

The annual General Assembly of the World Medical Association will be held at the World Trade Center Moscow from 14 to 17 October 2015.

The programme of the meeting will be:
Wednesday 14 October: Committees
Thursday 15 October: Scientific Session
Friday 16 October am: Council meeting
Assembly Ceremonial Session
Saturday 17 October: General Assembly

The themes of the Scientific Session are "Medical Education” and "Climate Changes". The speakers will include Professor David Gordon, President of World Federation for Medical Education, Sir Michael Marmot, President-elect of WMA, Dr. Robert Wah, Past President of the American Medical Association, Professor Kenji Matsubara, Vice President of the Japanese Medical Association and Professor Leonid Eidelman, President of Israeli Medical Association.

At the Ceremonial Session, Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, will be installed as President of the WMA for 2015/16.

Among the issues on the agenda at the meeting are:
Proposed Declaration on alcohol
Health support for street children
Use of riot control agents
Proposed Statement on mobile health
Elimination of nuclear weapons

Proposed Declaration on protection of human reproductive health

Any journalists wishing to attend the Scientific Session and the Assembly sessions on Friday and Saturday should contact Nigel Duncan, WMA Public Relations Consultant, on:

+ 44 (0) 20 8997 3653 (work)
+ 44 (0) 7984 944 403 (mobile)
nduncan@ndcommunications.co.uk
India free of maternal, neonatal tetanus: WHO
Sushmi Dey, TNN | Aug 28, 2015, 04.01 AM IS

NEW DELHI: India has eliminated maternal and neonatal tetanus. It has been reduced to less than one case per 1000 live births across the country, the World Health Organisation (WHO) has validated adding India to the list of countries that have successfully battled the disease.

"This is a huge achievement for India which until a few decades ago reported 150,000 to 200,000 neonatal tetanus cases annually," WHO regional director for South-East Asia Poonam Khetrapal Singh said.

Highlighting the achievement, Prime Minister Narendra Modi said, "India has eliminated maternal and neonatal tetanus. The validation for this has happened much before the global target date of December 2015. This gives us the confidence to achieve other targets well before the target date."

Maternal and neonatal tetanus have been among the most common lethal consequences of unclean deliveries and umbilical cord care practices. When tetanus develops, mortality rates are extremely high, especially when appropriate medical care is not available. In many developing countries, deliveries take place in unhygienic circumstances, putting mothers and their newborns at risk for a variety of life-threatening infections.

Experts said India's national immunization programme helped ensure that children and pregnant women are reached with vaccines.

"Maternal and neonatal tetanus elimination demonstrates India's strong commitment and leadership that helped improve access to immunization, antenatal care services and skilled birth attendance in the most vulnerable populations - the poor, the remote and isolated communities where hygienic obstetric, postnatal practices and other health services were suboptimal or not accessible," Khetrapal said. She said the government's innovative approach of utilizing elements of existing and new programmes provided the synergistic lift-off to make maternal and neonatal tetanus elimination a reality.

The government also promoted institutional deliveries in India through its flagship social sector scheme National Rural Health Mission, which is mainly focused on the poor.

WHO, however, pointed that efforts cannot stop here. "Unlike smallpox and polio, tetanus cannot be eradicated as tetanus spores remain stubbornly present in the environment worldwide. As the risk of tetanus persists, we need to continue our efforts to ensure that MNTE is maintained - women and children are immunized and clean deliveries and proper cord care activities get a further boost," Khetrapal said.

With India's achievement, almost the entire South East Asian region, barring a few districts in Indonesia, has eliminated maternal and neonatal tetanus.
Non-medical items may soon disappear from chemist shops
Himani Chandna, Hindustan Times, New Delhi Updated: Aug 28, 2015 01:29 IS

Baby food, soaps and health supplements could soon disappear from your friendly neighbourhood chemist’s shelves if the government decides to turn this proposal into a regulation. According to minister of state for chemicals and fertilisers Hansraj Gangaram Ahir, “Companies buy consumer trust by selling products at pharmacies. Products like Nestle Cerelac and Johnson & Johnson’s baby soaps, or health supplements are not meant for sale at medical stores.”

“We are considering a proposal to restrict pharmacies from selling categories apart from drugs and medical devices, where over 7 lakh pharmacies would only sell approved products,” Ahir told HT.

And there’s a Maggi element in this plan. The recent controversy over instant noodles made by Nestle India had also featured the company’s baby food supplement, Nan Pro, coming under the safety scanner. The noodle row saw the government expanding its vision to think of banning the sale of baby food, cosmetics, health supplements and similar other non-medical products at pharmacies.

“These products are not medicines and people should not buy them under the impression that they are safe, effective and good for health because medical stores sell them,” Ahir said.

Consumer activists and chemists’ organisations don’t agree. “We strongly oppose the move. It would impact the volume of sales at medical stores and drastically impact the availability of non-medical products across the country,” said JS Shinde, president, All-India Organisation of Chemists and Druggists.

There is no clause at present under the Drugs and Cosmetics Act, 1940 to regulate the list of products that can be sold at pharmacies.

One is allowed to open a medical store after seeking a licence from the Food and Drug Administration (FDA). Bejon Misra, a consumer activist, trashed the move. “The government should encourage more competition and choice. If consumers would not get a product from a medical store, they would buy it from some other shop but after facing inconvenience.”

Control of pharmacies comes under state governments, and that means a central proposal can be rejected. “Medical stores get licence under the D&C Act which is governed by the central government but implemented by state governments and state drug controllers,” Shinde said. Mails sent to companies that are likely to be affected by such regulation did not get any response till late on Thursday.
Vaccinated British man found shedding live polio virus for 30 years
A news that comes as a warning for India, a British man with an immune deficiency has been found to be shedding a highly virulent, mutant strain of polio virus for nearly 30 years, as reported in TOI, dated Aug 28, 2015.

UK's National Institute for Biological Standards and Control analyzed more than 100 stool samples collected between 1995 and 2015 from a British white male who had received a full course of childhood immunizations, including the highly effective oral polio vaccine at 5, 7, and 12 months, with a booster at about seven years of age. Scientists have now confirmed that the subject has been suffering from an immunodeficiency, which affects the ability of the immune system to kill viruses in the digestive tract. To their horror, the researchers found high levels of type 2 poliovirus in all the stool samples analyzed - each sample able to cause paralysis in transgenic mice that had a human poliovirus receptor. This strain of poliovirus 2 was eradicated from the wild way back in 1999.

Further analysis of the RNA of these iVDPV strains (strains of vaccine-derived polio virus from immune-deficient individuals) by Javier Martin and colleagues showed that the excreted viruses were different from the weakened vaccine strain, and that they had started to diverge from it an estimated 28 years ago, around the subject's last known vaccination with OPV.

All iVDPV strains had mutations that reversed the features of the vaccine strain and over time they also acquired a range of other mutations, many affecting the antigenic structure of the virus.

At present, all but two countries worldwide, Pakistan and Afghanistan have been declared polio free.

Louis Georges Arsenault, Unicef representative to India told TOI at the side-lines of the Call to Action Summit: "Let's understand one thing for sure - till there is one child infected with polio in this world, every other child is at risk of getting infected. The virus is still at large in India's neighbouring countries. Pakistan is doing better than Afghanistan however in controlling the spread of the virus this year."

Anuradha Gupta, deputy CEO of GAVI Alliance for Vaccines, who spearheaded India's fight to eradicate polio told TOI, "This is a shocking finding and highlights that the world needs to have zero tolerance for a single missed child who hasn't received the full range of vaccinations. The world is closest to wiping out the disease than ever before and we can't have the virus lurking anywhere if we are looking to eradicate it. We therefore need to see vaccination rates go up across the world. Presently we are missing 15 million children globally for a basic vaccine like DTP 3."

The good news however is that despite the extensive changes found in the iVDPV strains compared with the vaccine strain, the researchers found that human sera readily neutralized even the most divergent strain.

"This indicates that vaccinated humans are well protected against infection with these highly drifted iVDPV strains," they said.

However, they also state that "because the sera tested correspond to a selected group of UK healthy adults between 28-65 years of age who had been vaccinated with a full course of four OPV doses plus at least one dose of Injected Polio Vaccine (IPV), whereas the UK switched from OPV to IPV for polio immunization in 2004, it would be helpful to test sera from cohorts that have only received IPV."

The finding has worried experts globally who say that patients like this one could start new polio outbreaks.

There are three strains of wild polio virus (1, 2, and 3) and two different types of polio vaccine.

The authors of the study say that IPV is safe and effective in inducing neutralizing antibodies that protect against paralytic polio. It does not, however, induce substantial mucosal immunity and so prevent excretion of virus. OPV which contains weakened or attenuated live virus is effective, and besides neutralizing antibodies induces mucosal immunity, thereby killing viruses in the gastro-intestinal tract and reducing excretion.

Putting the research into context of other studies on iVDPV, the researchers emphasize that "of the total of 73 iVDPV cases that have been described between 1962 and 2014, only seven involved infections lasting more than five years. The case described here represents by far the longest period of excretion described from such a patient and the only identified individual known to be excreting highly evolved vaccine-derived poliovirus at present".

However, the researchers also mention that several highly mutated VDPV strains that showed molecular properties typical of iVDPVs have recently been isolated from sewage samples in Slovakia, Finland, Estonia, and Israel, suggesting that an unknown number of chronic excreters exist elsewhere.

The researchers conclude that "enhanced surveillance including sewage sampling and stool surveys to search for the presence of iVDPV strains and the development of efficient anti-viral treatments to interrupt virus replication in immune-deficient individuals are needed to be able to identify and manage the possible risks of iVDPV strains spreading and causing disease in patients and the general population, particularly in the light of changes in vaccination strategies as part of the polio eradication endgame and the absence of an established outbreak response strategy. (Source: Times of India, Kounteya Sinha, TNN | Aug 28, 2015)
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Wellness Blog
Fish Medicine for asthma

The Bathini Goud family, living in Hyderabad, claim that they can cure asthma by making people swallow a 2–inch live fish filled with medicine. They claim that they have been using this treatment for over 160 years.

As per their claim the medicine is stuffed inside the mouth of a live murrel fish, 5–6 cm in size. This fish with medicine is slipped into the mouth of the asthmatic patient, which can easily be swallowed as the fish is slippery. This needs to be taken for three consecutive years.

The medicine is administered on a specific day Mrigashira Kanthi Nakshatra, which normally coincides with arrival of monsoon rains in the first or second week of June. Three doses are given to the patients after every 15 days.

The family never discloses ingredients of their drug. They provide the medicine free of cost. Some people went to the Court of the Andhra Pradesh on 27.01.2013 but the court declined to interfere and pass any orders regarding the administration of substances popularly known as Fish Medicine. They reasoned that although the treatment had no medicinal value, analysis had shown the samples to not be harmful. They said that "if people flock to have a substance out of faith the courts cannot interfere".

My opinion

Asthma is classified as mild intermittent asthma, moderate persistent asthma and severe persistent asthma. The distinction between intermittent and mild persistent asthma is important because current guidelines for moderate persistent asthma call for initiation of daily control medicine. For moderate persistent asthma, the preferred long-term controller is low–dose inhaled steroid.

Mild intermittent asthma is the largest segment of asthmatic patients and they do not require long term treatment. These are the people who may never require steroid inhalers. Over a period of time, these asthmatics may show improvement. Many mild intermittent asthmatics who are allergic to a particular protein may improve over a period of time.

Homeopaths, Ayurveda physicians, naturopaths and others who claim that they can cure asthma, they work only on patients with mild intermittent asthma. If they can demonstrate their results in severe asthma, then their methods can be believed to be of use.

The very fact that somebody has claimed does not mean that it is not scientific or scientifically validated. If they can prove their claim, there is no reason why they should not get Noble Prize. We have seen a similar claim by a person who gives a medicine for jaundice in Chandni Chowk and another person in Agra who claims that he can cure any type of cancer with a herb mixed with goat milk.
Reader Response
Dear Sir, Thanks for the useful information. Regards: Dr Kanak
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