NEW DELHI : Doctors have long been using biopsy to diagnose liver fibrosis. A new study says it may be possible to diagnose the liver disease with a blood test in future.

Researchers at the All India Institute of Medical Science (AIIMS), New Delhi, working in collaboration with Justus Liebig University, Giessen in Germany, have identified diagnostic markers for liver fibrosis. With these markers, it will be possible to diagnose liver fibrosis from blood samples. It will make diagnosis easier to perform, non-invasive, and less prone to sampling errors, researchers say in their study published in journal Clinical and Translational Gastroenterology. 

The new study has reported that patients of liver fibrosis have elevated levels of two proteins- Cathepsin L and Cathepsin B – in liver tissues as well as blood plasma, compared to healthy people. The increased levels of these two proteins open the possibility of designing a new and better diagnosis for liver disease. There is progressive increase in concentrations of the two proteins with advancement in the stages of liver cirrhosis, making them potential diagnostic tools. 

The observation was first made in animals and then humans. It was seen that the two proteins are elevated in kidney, heart, and lung fibrosis, which led to the idea of testing their diagnostic relevance in liver disorder. Since the findings are based on blood samples from 51 patients, researchers have recommended studies involving larger group of patients to further validate their work.

However, an expert working in the same field pointed out that “previous studies have also reported biomarkers for liver fibrosis. The challenge is to find a marker that can differentiate between mild and severe stages of the disease in addition to distinguishing between healthy and severely ill conditions.”

Liver fibrosis is caused by several factors including alcohol consumption, viral infection, and metabolic disorders. It is also congenital in some cases. It is marked by the formation of scars and nodules in the liver, which is due to accumulation of specific proteins.

The study team included Mansi Manchanda, Prasenjit Das, Gaurav Gahlot, Ratnakar Singh, Elke Roeb, Martin Roderfeld, Siddhartha Datta Gupta, Anoop Saraya, R M Pandey and Shyam S Chauhan. (India Science Wire) 

The opposition providing some food for thought for the Narendra Modi government having announced its Vice Presidential nominee well in advance. Opposition believes nominating Gopal Gandhi as its Vice Presidential nominee puts the Modi Government in a spot.

If Prime Minister Narendra Modi sent shock waves by choosing barrister and low key Dalit politician Ram Nath Kovind from Uttar Pradesh for the highest Constitutional office of President, the 18-party opposition has given some food for thought to the BJP led NDA by picking former West Bengal Governor Gopal Krishna Gandhi as its Vice Presidential nominee well in advance. 

On its part the NDA is not unduly concerned about the critical arithmetic required as it has the numbers in the electoral college to get its nominee elected as the Vice President despite being in a minority in the Rajya Sabha. 

The Lotus party is expected to enjoy the rare distinction of occupying the highest Constitutional office of President as well as that of the Vice President for the first time since the BJP was formed in 1980. This is on account of the numbers stacked in its favour. 

Going by precedent the ruling party at the Centre has its nominee as President and the opposition invariably occupies the office of Vice President, who is the Chairman of the Rajya Sabha. 

These niceties are the least of Modi’s concerns keen as he is to snuff out the opposition in the country in pursuit of the rather difficult proposition of striving for a “Congress mukt Bharat” in the near future.  

Earlier, Gopal Gandhi was also considered by the Opposition for the office of President. However, that was not to be. The choice of Kovind for the office of the Head of State compelled the opposition to field former Lok Sabha Speaker Meira Kumar, a Dalit and daughter of the late Babu Jagjivan Ram who had served as the Deputy Prime Minister. 

Gopal Gandhi has been described as a worthy successor to outgoing Vice President Hamid Ansari even though the Congress and other 17 parties do not have the required number of MPs in the electoral college to ensure his win.  

As Governor of West Bengal from 2004 to 2009, Gopal Gandhi had won many admirers with his bold criticism of the Left government’s handling of the Nandigram protests. He has spoken out whenever an occasion demanded — be it the partisan role of the CBI, which he has described as “a government hatchet”, or mob violence in the name of cow protection. 

The BJP is bound to be guarded about its Vice Presidential nominee. As the Vice President heads the Rajya Sabha, where the Lotus party still cannot push through crucial legislation in the absence of sufficient numbers, the party may take care not to field a lightweight who could upset political calculations. 

The BJP might be hard put to match the opposition choice. The Left backed Gopal Gandhi wholeheartedly for the post of Vice President. CPM General Secretary Sitaram Yechury “hoped he (Gopal Gandhi) will be elected unanimously”. 

The combined strength of elected members of the Lok Sabha and the Rajya Sabha make up the electoral college for the office of Vice President and the Modi government enjoys a clear majority in the August five elections.   

On the other hand the opposition is essentially banking on Gopal Gandhi’s stature hoping that the fence sitters like BJD’s Naveen Patnaik who has backed the NDA candidate for President would find it difficult to openly oppose him. 

Accepting the nomination, Gopal Gandhi said “I accept the nomination and applaud the unity and conviction with which the opposition parties have asked me to be their candidate for the vice-presidentship.”  

He viewed himself as a citizen weighed down by anxieties and even fears about “out collective future in these violent and retributive times but who nevertheless refuses to give up hope, faith, trust in our Republican Constitution, independent judiciary, free press, the institutions of parliamentary democracy and above all the robust good sense of the people of India”. Interestingly, as the Tamil Nadu’s ruling party the AIADMK will find it difficult to oppose Gopal Gandhi as he is half Tamil and made Chennai his home after demitting public office. The opposition feels it has outsmarted the BJP by announcing Gopal Gandhi’s candidature well in advance besides denying the JD (U) the elbow room to rethink. 

( T R Ramachandran is senior journalist and commentator. The views are personal.) 

NEW DELHI: Indian kids have reasonable knowledge about lifestyle diseases and their risk factors, but this knowledge does not translate into preventive action, a new study has revealed.
For instance, adolescent children know that unhealthy food is a risk factor for cardiovascular diseases (CVDs) yet they indulge in eating junk food and unhealthy snacks.
In spite of better awareness, there is huge knowledge-practice gap among teenagers, the study done among school children in Kolkata has found. Most of these teenagers (who are aware) showed poor and unhealthy eating lifestyles like more than three major meals a day, frequent snacking (more than four times in a day) and consumption of street food. The trend of poor eating habits was visible more in older students and those belonging to affluent families as compared to students from low or middle-class socio-economic status. 
The study, published in journal BMC Public Health recently, was conducted jointly by hospitals in Kolkata along with Mission Arogya Health and Information Technology Research Foundation and the University of California. It was led by Dr. Tanmay Mahapatra. It included over 1600 ninth grade students in urban Kolkata.
Researchers collected data on knowledge about lifestyle diseases, physical activity, and eating patterns from these adolescents. They found that about 20% of the participants reported a family history of CVDs while a majority had little information about heart disorders. Boys tended more to be involved in physical activity (adequate physical activity as one hour every day) along with those who had better knowledge about risk factors. 
About 82% of the adolescents did not perceive themselves to be at risk for future CVDs and even those who perceived the risk showed poor dietary practices. One of the probable explanations might be that adolescents considered CVDs to be problem of the aged, and underestimated their own future risks, researchers said. “Promotion of school-based cardiovascular health programs might be crucial in dispelling myths and misconceptions with eventual prevention of early onset atherosclerotic changes in arterial walls,” the study has suggested.
“Compared to the West, in India, the transition from predominantly infectious disease to non-communicable diseases has happened over a rather brief period of time. Solutions require strategies such as emphasis on prevention, early detection, treatment using both conventional and innovative techniques along with effective implementation of evidence-based policy” suggested Amjad Husain, professor of life sciences at Glocal University. He is not connected with the study.
“Healthy eating habits and lifestyle behaviour inculcated at adolescent age can prevent a lot of diseases like obesity, hypertension, early onset of diabetes, cardiovascular diseases, metabolic syndrome, diseases of spine and joints etc.” says Dr. Vijay Malhotra, President, Delhi Medical Association. He suggests that relevant information and knowledge about lifestyle diseases should be made a part of the curriculum in secondary classes. (India Science Wire)

Centre needs to act fast in seizing control before it too late. Coordinated security and civil response needed for peace to return to the Valley. 
 The terrorist attack on unarmed Amarnath yatris in the Valley in Jammu and Kashmir last Monday might well be indicative of a bigger flare up in the country. It has shattered the deceptive calm in the wake of the first death anniversary of Kashmir’s poster boy Burhan Wani, a local militant leader killed last year. 
Shockingly this attack on Shiva bhakts has broken the unwritten rule followed over the last 15 years with terrorists steering clear of aiming their guns at unarmed pilgrims. That was the critical difference this time. 
There is no doubt a coordinated security and civil response is required to help peace return to the Valley. There are indications of 2017 being the deadliest year in the last decade in J&K. The latest attack specifically targets the innocent aimed at sparking a wider conflagration. 
Impartial observers believe Kashmir’s militancy appears to have taken on religious sentiments at least on this occasion by masterminds from across the border. It also showed an increasing desperation on the part of the militants amid indications that militancy in Kashmir might have taken a drastic turn. 
There has been an inexplicable and inevitable drift in the efforts by the Centre to find a solution to the protracted and complex Kashmir problem. At the same time there could not have been a bigger rebuff to the terrorist attack on the Amarnath yatris than the determination of the pilgrims to visit the shrine in the face of violence seeking to target them. 
The way ahead is to go by Kashmiriyat and its emphasis on social harmony. At the same time civil society played a positive role in checking the spillover of emotions. It was upfront in condemning the death of the innocent including women. 
Even as J&K chief minister Mehbooba Mufti rushed to Anantnag to meet the survivors of the ambush, she felt the attack was a blot on Kashmir. 
The unthinkable coming together of the PDP and the BJP in forming a coalition government in the only Muslim majority state in the country needs to live up to its promise when it assumed office in 2015 : to bridge the chasms in the sensitive border state among its regions, communities and aspirations. 
As the mentor of the BJP the Rashtriya Swayamsewak Sangh has made some noises before its meeting in Jammu that the saffron brigade should break its alliance with the PDP. However, party general secretary incharge of J&K Ram Mahdav is hopeful of the BJP ironing out its differences with the PDP. 
The holy pilgrimage of the Amarnath yatra is not only related to the faith of the Hindu community but plays a key role in the survival of the local economy. From time immemorial Kashmir is linked with its Shaivite traditions and syncretic roots. 
The terrorists aided and abetted by neighbouring Pakistan are trying to provoke communal riots in this country by driving a wedge between Hindus and Muslims.   
The decision to continue the yatra till August four sends a significant message: the people will not give in to terror. The top most priority for the Centre is to ensure security for the pilgrims. This was not a spur of the moment attack as there were specific intelligence inputs and warning about such an assault. The bus from Gujarat that was attacked by terrorists had not followed proper security protocol. It was neither registeredwith the Amarnath Shrine Board not did it adhere to the security detail compulsory for pilgrims because of the security threat. 
With militants targetting Amarnath pilgrims, the entire paradigm has changed. They have given cause to the security forces to step up the fight. 
There is a strong section of opinion calling for Governor’s rule in J&K. It would serve two purposes of cooling frayed tempers in the Valley and lead to better coordination as well as tightening the administration.  
Maintaining status quo and a policy of merely reacting to events will have dangerous consequences in the Valley along with jeopardising peace across the country. This assumes importance with the terrorists signalling their intent to target Hindus. 
The Centre needs to act fast in a determined and effective manner for seizing control before it is too late. Neutralisation of a larger violent radical Islamic movement requires reaching out to the locals to reduce the support to insurgency in Kashmir. 
Meanwhile, Union Home minister Rajnath Singh and External Affairs minister Sushma Swaraj will be apprising opposition leaders today about the situation in J&K and the stand off in Doklam sector between India and China in an effort to soften the attack against the Modi government during the winter session of Parliament beginning Monday, July 17. 

( T R Ramachandran is senior journalist and commentator. The views are personal.) 

NEW DELHI: A team of Indian astronomers has identified a cosmic behemoth – a supercluster of galaxies – about 4 billion light-years away from us. The new discovery has been named Saraswati – which in Sanskrit literally means ‘ever-flowing stream with many pools’. 
The supercluster spans over 650 million light years in its expanse, containing over 10,000 galaxies in 42 clusters. Its total mass equals 20 million billion suns. The team of astronomers was led by Joydeep Bagchi of Inter-University Center for Astronomy and Astrophysics (IUCAA), Pune, which used data from the Sloan Digital Sky Survey. The discovery is forcing astronomers to rethink about early stages of the evolution of the universe and it provides vital clues about mysterious dark matter and dark energy. The results of the study were published in The Astrophysical Journal on Thursday. 
The megacluster has been named Saraswati – the goddess of knowledge, music and art. Saraswati, in Sanskrit also means ‘ever-flowing stream with many pools.’ “This supercluster located in the constellation of Pisces has many clusters and groups moving and merging like the mythological Saraswati river, which prompted us to give this name,” say the researchers. “There are hundreds of superclusters in size range of less than 100 million light years, Saraswati supercluster clearly stands out in the sky as an especially rare, and possibly among the mega superclusters exceeding 500 million light years in size,” said Somak Raychaudhury, one of the co-authors and the Director of IUCAA, Pune.
 Â“A large-scale structure this massive evolves very slowly, and therefore it may reflect the whole history of galaxy formation and the primordial initial conditions that have seeded it,” said Joydeep Bagchi. Our Sun is one among billion stars in a vast cosmic structure called Milky Way galaxy. However, Milky Way extending 120,000 light-years across is just a pin-head in cosmic scales. Gravitational interaction between galaxies results in a much larger structure called “galaxy clusters”. Our Milky Way is part of “Local Group”, a cluster containing around 50 galaxies and  measures more than 10 million light-years across. Recent surveys have shown even larger cosmological structure, ‘cluster of clusters’, superclusters.
Interestingly, Somak Raychaudhury, co-author of this study, discovered the first massive supercluster of galaxies of this scale during his PhD research at the University of Cambridge in 1989 and named it “Shapley Concentration” after an American astronomer, Harlow Shapley, in recognition of his pioneering survey of galaxies. 
The supercluster Laniakea – of which our sun, our Milky Way and “Local Group” are a part – consists of about 100,000 galaxies. Was the Universe built from the ‘bottom up’, with galaxies condensing first, then aggregating into clusters, superclusters and other large-scale cosmic structures? Or did it happen the other way round, with vast gas clouds that fragmented into smaller clouds; each of the smaller clouds then evolving into a galaxy. Which model is correct? Cosmologists are split. The long-popular “Cold dark matter” model of evolution of Universe predicts that small structures like galaxies form first, which congregate into larger structures. 
The existence of large structures such as the “Saraswati Supercluster” evolved as early as 10 billion years since the Big Bang is a challenge to this model. The time elapsed since the Big Bang is not adequate for the slow process of gravitational attraction to have created such a large scale structure. “The discovery of these extremely large structures thus forces astronomers into rethinking popular theories of how the Universe got its current form, starting from a more-or-less uniform distribution of energy after the Big Bang,” says Prof Raychaudhury. 
In the large-scale cosmos, gravity is not the only force to reckon with. While the mutual attraction of gravity tries to bind the ordinary and still elusive dark matter together creating lumps like galaxies, clusters and so on, the still unknown dark energy repulsive in nature causes expansion of the Universe to accelerate, hampering the growth of large-scale structures. 

“Our work will help to shed light on the perplexing question; how such extreme large scale, prominent matter-density enhancements had formed billions of years in the past when the mysterious Dark Energy had just started to dominate structure formation’’ said Bagchi. “This paper is unique because it is a direct product of IUCAA’s associateship programme, under which a faculty member of an Indian university or a post-graduate department in a college can visit IUCAA for periods of short and long durations over a span of three years to develop his or her interest and expertise in astronomy and astrophysics” added Prof Raychaudhury. 
The research was funded by the University Grants Commission and Indo-French CEFIPRA programme of the Department of Science and Technology (DST). While the lead author Bagchi and co-author Raychaudhury are from IUCAA, other researchers are Dr Prakash Sarkar (National Institute of Technology, Jamshedpur postdoctoral fellow at IUCAA), Shishir Sankhyayan (undergraduate student at Indian Institute of Science Education and Research, Pune), Pratik Dabhade (Research Fellow at IUCAA) and Dr Joe Jacob (Newman College, Thodupuzha, Kerala). (India Science Wire) 

Expanding the basket of contraceptive choices, India launched a new injectable contraceptive under its public health system. To mark the World Population Day, India also launched a new programme Mission Parivar Vikas which will focus on 146 high fertility districts in 7 States with high Total Fertility Rates.

Speaking at the function, Union Health and Family Welfare Minister, J.P.Nadda said the injectable had been launched under the `Antara’ programme which also includes new software – Family Planning Logistics Management Information System designed to provide robust information on demand and distribution of contraceptives to health facilities and ASHAs to strengthen supply chain management.     

 
“Under Mission Parivar Vikas, specific targeted initiatives shall be taken for population stabilisation through better services delivery,” Mr Nadda said adding that the new initiative had been conceived by the Ministry with a strategic focus on improving access through provision of services, promotional schemes, commodity security, capacity building, enabling environment and intensive monitoring.

The Health Minister also advised the officials to undertake half yearly review of the programme and correlate the achievements with time to gauge whether the programme is moving in the right direction or not. He stated that “We have enhanced the basket of contraceptive choices to meet the changing needs of people and have taken steps to ensure quality assured services and commodities are delivered to the last-mile consumers in both rural and urban areas.” 

As part of the new communications campaign linked to the roll-out, the Minister also launched a new consumer friendly website on family planning and a 52-week radio show for couples to discuss issues related to marriage and family planning, which will be aired across the country. He stressed upon the life cycle approach of the Ministry and said that a continuum of care approach has been adopted with the articulation of `Strategic approach to Reproductive Maternal, Newborn, Child and Adolescent Health.

Over at the Family Planning Summit in London, C.K. Mishra, Secretary, Ministry of Health and Family Welfare announced that India will overarch FP2020 goals to drive access, choice and quality of Family Planning (FP) services so as to increase the modern contraceptive usage from 53.1% to 54.3% and ensure that 74% of the demand for modern contraceptives is satisfied by 2020. The country will be expanding range and reach of contraceptive options by 2020 through rolling out new contraceptives.

The country will increase FP awareness and generate demand through the 360-degree media campaign in all States and continue to provide FP services and supplies free of cost to all eligible couples and adolescents through the public health system, Non-Government organizations, and accredited private sector. The social marketing scheme will be revitalized, and social franchising schemes would be initiated to rope in the private sector, Mr Mishra said.

India’s commitment will go a long way in reaching thousands of women and girls with critical reproductive health information. For example, India has over 9.2 million married and sexually active adolescents (ages 15-19) of whom 26% have an unmet need for contraception. If India was to increase its focus on adolescents, enabling an additional 1.5 million adolescent girls to use modern contraception by 2020, then we would see a 17% reduction in its adolescent birth rate.

Melinda Gates, Co-Chair of the Bill & Melinda Gates Foundation, said access to contraceptives changes everything. “Women are freer to work outside the home, earn an income, and contribute to the economy. Mothers and fathers can devote more resources to their kids health and education—setting them up for a more productive future. Multiply that by millions of families, and you see why contraceptives are one of the greatest antipoverty innovations the world has ever known—and one of the smartest investments countries can make. Through the new commitments expected today at the Family Planning Summit, we have made a bold statement that investing in family planning is crucial to building the healthier and more prosperous future we are all working towards,’’ she said.

Ten women die every day in India as a result of unsafe abortion. Approximately 30,200 abortions are expected to take place daily, of which 15,000 are estimated to be unsafe. This is primarily due to low levels of awareness about abortion legality, availability, and access to services. Rough estimates suggest that of these, 3,600 develop complications resulting in morbidity and mortality. 

Unsafe abortion is the third leading cause of maternal deaths in India, contributing to eight percent of all maternal deaths annually. To facilitate faster decline in the overall maternal mortality in India, it is imperative that access to safe abortion services is made available at all levels of health facilities.

Studies reveal that 90% of maternal mortality related to unsafe abortions could be averted by use of contraceptives in the post-abortion period. Also, the unmet need for family planning in the post-abortion period is very high which, if bridged, can save many young mothers.

Keeping this scenario in mind, participants at a two-day Conclave on `Expanding the Discourse on Comprehensive Care (CAC) in India’ that concluded here reiterated that there was an urgent need to strengthen safe abortion services by increasing the provider base and creating awareness on availability of comprehensive abortion care services across the country.

Organised by Ipas Development Foundation (IDF), participants said women’s ability to exercise their reproductive choices is integral to the success of maternal health and family planning interventions at the national and state level. However, the challenges of repeated unintended pregnancies and unwanted births or abortions remain largely unattended due to lack of services coupled with myths and misconceptions associated with abortion.

Mr. Vinoj Manning, Executive Director, IDF said that close to 10,000 doctors in the public sector in 13 States have been trained for providing safe abortion services to women. He said that the first CAC guidelines issued in 2010 was a significant landmark in national commitment to making abortion safer. This has been followed by other progressive policy moves including a mass media campaign. However, delay in the passage of amendments to the Medical Termination of Pregnancy Act, 1971 that would allow mid-level health workers to provide safe abortion services, and implementation challenges in light of laws such as Pre-Conception and Pre- Natal Diagnostic Techniques Act, 1994 and the Protection of Children from Sexual Offences (POCSO) Act, 2012 need to be addressed on priority.

Dr Atul Ganatra of the Federation of Obstetrics and Gynaecological Society of India (FOGSI) said that conflict in laws and lack of clarity about laws have resulted in denial of safe abortion services to girls below the age of 18 for fear of prosecution. He asserted that there was an urgent need to educate everyone, including the law makers and law implementers, about existing abortion laws. According to him, the 20-week deadline for medical termination of pregnancy needs to be changed since not all women can rush to the Supreme Court when faced with such situations. There have been numerous instances where providers have refused services and seekers have had to approach the apex court.

Expressing concern over the inconsistencies in the sale of medical abortion drugs in Maharashtra and Uttar Pradesh, Mr Shanker Narayan, PSI India Private Limited, said that the price control of the drugs has impacted the availability of the drugs used for abortion since many pharmaceutical companies have stopped manufacturing these drugs due to reduced profitability.

The two-day Conclave was part of a series of events aimed at creating a favorable environment for making comprehensive abortion care services available to women in India. The purpose of this event was to create a wider community of advocates for CAC in India.

KANKER (Chhattisgarh): Doctors Kiran Lata Thakur, Hemlata Sahu and Ujjwala Devangan have more than one thing in common. Other than being doctors at the Komal Dev Government District Hospital in Kanker, the three are Master Trainers who have the responsibility of training the doctors for providing safe abortion services.

Chhattisgarh is predominantly tribal-dominated State with 35% of its population being Scheduled Tribe with high a maternal mortality ratio (MMR) of 221/100000 live births in 2011-2013 and an unofficial rough estimate suggests that anywhere between 10,000 to 60,000 abortions are conducted in the State every year. In India, unsafe abortions cause 8 to 10% maternal deaths.

The Master Trainers conduct the trainings for other doctors at the Comprehensive Abortion Care (CAC) Training Center developed by in collaborations with Ipas Development Foundation (IDF) – a non-government organization working on safe abortions. Ipas began its operations in the State in 2014 and chose Kanker District Hospital as one of the 6 Training Centres.  

Before 2014 there was no separate facility for training on safe abortions as it was not a priority in the health sector. But now with safe abortions being an integral part of the National Health Mission (NHM) and Ipas being a critical partner, Kanker District Hospital has a dedicated training room where doctors from the health facilities in Northern Bastar are trained in the batches of twos.  The training room has posters, relevant literature on safe abortion, a chart with the course outline and dummy pelvic model for training.

“During training if there is an abortion case, we take the doctors to the theatre for a hand-on training as well,’’ explains Dr Kiran Lata Thakur.

While the training of trainers (ToT) is 3-4 day programme for Registered Medical Practitioners mostly obstetricians and gynecologists who are adept at this procedure, the focus in the ToT is to orient them on new technologies and methodology for facilitating training. This programme is run by IDF staff in the States that IDF works in but also facilitated in other States on request. The certification training of MBBS doctors is for 15 days and is executed by the State trainers trained in the ToT. The IDF teams are involved at various stages in planning and execution of these trainings which are budgeted under the NHM.

Once the doctors are selected for the training, mainly depending on the caseload in their respective facilities and preferably from delivery points, they come to Kanker District Hospital where they are made to undergo a pre-qualification test to assess the trainees on their knowledge of the subject. They have to undergo the same test post-training for evaluation.  

“Our experience shows that young doctors are more knowledgeable with a fair understanding of the Reproductive, Maternal, Newborn, Child Health and Adolescent (RMNCH+A) programme of which safe abortion is a part,’’ says Dr Thakur.

The training includes sessions on laws such as Medical Termination of Pregnancy Act, 1971; Protection of Children from Sexual Offences Act, 2012, Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994, human rights, health rights infection prevention and reproductive rights of individuals in addition to theory and hands-on trainings on conducting safe abortions.

Once trained, each certified doctor is given a Manual Vacuum Aspiration (MVA) kit and the facility is provided IEC material to educate and inform the community about the availability of services.

After the training, IDF and Master Trainers provide all kind of support to the trained doctors. There is a proper schedule which is followed for this. The trained doctors receive a call from IDF within 28 days after they go back to their respective facilities to check on the progress. This is followed by a visit to the facility within 60 days. Calls and visits are also conducted based on the needs of the provider as well including for clinical support.

“As many as 88 doctors have been trained at Kanker since 2014 and all of these have been providing safe abortion services at their facilities. However, there are occasions where the doctors have some reservations on conducting abortion which could either be personal or religious or even hesitate to perform the procedure. In such cases, we just ask them to use Medical Methods of Abortion (MMA) wherein drugs are given and ask them to perform vacuum aspiration in case of an incomplete abortion. This helps them get over hesitation/resistance and even gives them experience,’’ says Dr Thakur.

Ipas Development Foundation has developed six training centres across Chhattisgarh. These were selected on the basis of a baseline survey conducted at 236 public health facilities done at District Hospitals, Community Health Centres and Primary Health Centres. An assessment was done for availability of human strength, skill, training requirement, availability of basic minimum infrastructure necessary for providing CAC services, and availability of instruments and consumables. Also taken into consideration is the current awareness, knowledge and attitude of the providers towards the legal aspects of abortion and related services.

“Kanker has banned over-the-counter sale of abortion drugs within the city that has greatly reduced cases of incomplete abortions. Women have also given up adopting traditional methods of abortion which are unsafe and this has happened because of awareness created by frontline health workers and IEC material provided by the government.  However, the coverage of CAC services should be complete but there are several areas where we are yet to reach,’’ says Dr. R.C. Thakur, Civil Surgeon at the Kanker District Hospital.

Comprehensive Abortion Care training is being rolled out in phased manner in Chhattisgarh with District Hospitals and First Referral Units to be covered in the first phase followed by Community Health Centres in the second phase and finally the 24X7 Primary Health Centres. Six District Hospitals at Kanker, Surguja, Bilaspur, Durg, Rajnandgaon and Raigarh have been developed as CAC Training Centres where doctors are imparted training on safe abortion and the nursing staff on counselling and MTP supporting services. And, the progress so far has been outstanding with the District Hospitals providing CAC services going up from 16 in 2009 to 23 in 2016; CHCs providing safe abortion services going up from 19 to 127 and PHCs from 1 to 48 during the same time. Kanker has four Master Trainers, three posted at the District Hospital and the fourth at the Bhanupratappur CHC. 

“Much has changed now. We have very few cases of perforated uterus and very few women come here in critical condition now as a result of unsafe or incomplete abortions. Mitanins have had a role to play in creating awareness about the safe abortion services in the hospital. Those who come here are mainly those of accidental pregnancies due to contraception failure or incomplete abortions,’’ explains Dr Ujjwala Devangan. Teenage pregnancy is also an issue and the doctors can only counsel the young women to use contraceptives by educating them on the adverse impact of repeated abortions. “At times, women who come here have very low haemoglobin levels and most of them are referred here from nearby areas because this hospital has a Blood Bank facility,’’ Dr Devangan says.

Zoliflodacin, a new oral antibiotic and one of the only treatments in development to address the rapidly-growing threat of drug-resistant gonorrhoea will enter pivotal trials soon. The drug is being developed in partnership between the not-for-profit Global Antibiotic Research and Development Partnership (GARDP) and Entasis Therapeutics. The announcement comes as the World Health Organization (WHO) released an alarming new data showing that of 77 countries surveyed across the world, more than 60% report resistance to the last-resort treatment for gonorrhoea.

Entasis and GARDP will co-develop the first-in-class antibiotic, zoliflodacin, in a global Phase III clinical trial to be carried out in countries including South Africa, the United States of America, and Thailand. The US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), plans to support pharmacological studies on the drug as part of the development programme.

In parallel with the Phase III trial, which is sponsored by GARDP/DNDi (Drugs for Neglected Diseases initiative), GARDP will work with Entasis scientists to carry out non-clinical activities – including microbiology surveys to ensure that the product is effective against recent and geographically diverse strains of gonorrhoea. If zoliflodacin receives regulatory approval, Entasis will grant GARDP an exclusive license with sublicensing rights in most low- and middle-income countries, while retaining commercial rights in high-income markets. Both GARDP and Entasis are committed to affordable and equitable pricing in their respective territories, a joint statement issued by the collaborators has said..

There are about 78 million new cases of gonorrhoea every year. The Neisseria gonorrhoea pathogen creates a potentially serious infection in the genitals, rectum, and throat and can result in infertility, ectopic pregnancy, increased risk of HIV, and pelvic inflammatory disease amongst others. Currently, the main recommended treatment is an injection of ceftriaxone and an oral dose of azithromycin.

“Antibiotic resistance is a serious public health issue, driving an unmet need within many communities around the world. Gonorrhoea causes significant harm to patients who suffer from it, as well as accelerating the spread of other sexually transmitted infections,’’ said Dr Manos Perros, CEO of Entasis Therapeutics.

Entasis’ zoliflodacin is the first in a new class of antibiotics and the only new clinical candidate developed specifically to treat gonorrhoea, which is important for stewardship. Zoliflodacin demonstrated potent in vitro activity against Neisseria gonorrhoea, including isolates resistant to fluoroquinolones and extended spectrum cephalosporins, achieving promising efficacy after a single oral dose in a recent Phase II clinical study sponsored by NIAID. Zoliflodacin has been designated a Qualified Infectious Disease Product (QIDP) by the US Food and Drug Administration and awarded Fast Track status.

Antimicrobial resistance is recognized as a global crisis by the WHO and the G20, with calls for new mechanisms to develop new treatments. In June, the G20 held the first ever Health Ministers’ meeting which called for “broadening the voluntary financial support’’ for initiatives, including GARDP, which reinvigorate research and development in science and research for antimicrobials.’’

Launched in May 2016 by the World Health Organization (WHO) and the Drugs for Neglected Diseases initiative (DNDi), GARDP aims to develop and deliver new treatments for bacterial infections where drug resistance is present or emerging, or for which inadequate treatment exists. Zoliflodacin is one of GARDP’s first research and development projects and its first licensing deal with a company. GARDP is currently operating within DNDi, which provides GARDP’s governance.  Entasis Therapeutics is developing a portfolio of innovative cures for serious drug-resistant bacterial infections, a global health crisis affecting the lives of millions of patients.

Antibiotic resistance is making gonorrhoea—a common sexually-transmitted infection—much harder, and sometimes impossible, to treat, the World Health Organisation has said based on data collected from 77 countries.  

The WHO has reported widespread resistance to older and cheaper antibiotics. Some countries—particularly high-income ones, where surveillance is best—are finding cases of the infection that are untreatable by all known antibiotics.

Each year, an estimated 78 million people are infected with gonorrhoea. Gonorrhoea can infect the genitals, rectum, and throat. Complications of gonorrhoea disproportionally affect women, including pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV.

Decreasing condom use, increased urbanization and travel, poor infection detection rates, and inadequate or failed treatment all contribute to this increase. 

“The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them,” said Dr Teodora Wi, Medical Officer, Human Reproduction, at the WHO.

“These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common,” adds Dr Wi.

The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), monitors trends in drug-resistant gonorrhoea. The WHO GASP data from 2009 to 2014 find widespread resistance to ciprofloxacin [97% of countries that reported data in that period found drug-resistant strains]; increasing resistance to azithromycin [81%]; and the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone [66%].

Currently, in most countries, ESCs are the only single antibiotics that remain effective for treating gonorrhoea. But resistance to cefixime—and more rarely to ceftriaxone—has now been reported in more than 50 countries. As a result, WHO issued updated global treatment recommendations in 2016 advising doctors to give 2 antibiotics: ceftriaxone and azithromycin.

The R&D pipeline for gonorrhoea is relatively empty, with only 3 new candidate drugs in various stages of clinical development: solithromycin, for which a phase III trial has recently been completed; zoliflodacin, which has completed a phase II trial; and gepotidacin, which has also completed a phase II trial, according to the WHO.

The development of new antibiotics is not very attractive for commercial pharmaceutical companies. Treatments are taken only for short periods of time (unlike medicines for chronic diseases) and they become less effective as resistance develops, meaning that the supply of new drugs constantly needs to be replenished.

The Drugs for Neglected Diseases initiative (DNDi) and WHO have launched the Global Antibiotic Research and Development Partnership (GARDP), a not-for-profit research and development organization, hosted by DNDi, to address this issue. The GARDP’s mission is to develop new antibiotic treatments and promote appropriate use, so that they remain effective for as long as possible, while ensuring access for all in need. One of the GARDP’s key priorities is the development of new antibiotic treatments for gonorrhoea.

“To address the pressing need for new treatments for gonorrhoea, we urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline. In the short term, we aim to accelerate the development and introduction of at least one of these pipeline drugs, and will evaluate the possible development of combination treatments for public health use,” said Dr Manica Balasegaram, GARDP Director. “Any new treatment developed should be accessible to everyone who needs it, while ensuring it’s used appropriately, so that drug resistance is slowed as much as possible.”

Gonorrhoea can be prevented through safer sexual behaviour, in particular consistent and correct condom use. Information, education and communication can promote and enable safer sex practices, improve people’s ability to recognize the symptoms of gonorrhoea and other sexually transmitted infections and increase the likelihood they will seek care. At present, lack of public awareness, lack of training of health workers, and stigma around sexually transmitted infections remain barriers to greater and more effective use of these interventions, the WHO has said.

There are no affordable, rapid, point-of-care diagnostic tests for gonorrhoea. Many people who are infected with gonorrhoea do not have any symptoms, so they go undiagnosed and untreated. On the other hand, however, when patients do have symptoms, such as discharge from the urethra or the vagina, doctors often assume it is gonorrhoea and prescribe antibiotics – even though people may be suffering from another kind of infection. The overall inappropriate use of antibiotics increases the development of antibiotic resistance in gonorrhoea as well as other bacterial diseases.