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Global Update

Indian Pediatrics 2000;37:461-462

News in Brief

Drug Watch

Lateral thinking: Scientists have come up with a delightful new strategy to beat an old disease. In hemophilia the deficiency of factors VIII or IX is overcome with plasma products or infusions of the recombinant protein factor. The drawbacks are need for frequent transfusions and development of antibodies against the foreign protein. An ingenious solution would be to introduce activated factor VII which directly activates factor X obviating the need for factor VIII and IX. But factor VII has a short half life. The answer would be to infuse factor XIIa or Xa. But these would also activate fibrinogen and cause disseminated intravascular coagulation. So Pollard et al. from Bethseda, Maryland, fixed factor XIIa directly, onto a solid matrix and placed it in a capsule with pores. This capsule was surgically implanted into the peritoneum of rhesus monkeys. This allowed factor VII to diffuse in, get activated and hence activate factor X without activating fibrinogen. This produced therapeutically effective levels of activation of the coagulation system (Nature Biotechnology 2000; 18: 289-295, eBMJ 11 March 2000).

Woman Watch

Real life heroes: There are probably many unsung heroes in war torn countries all around the world. One of them is Florina Brovina a pediatrician in Kosovo who had started a center for rehabilitation of displaced women and children. Last year she was imprisoned and given a 12 year sentence for having medically assisted Albanian combatants and patients. Her response was that she had dedicated her life to the care of children who did not know their ethnicity and would not know it unless their parents taught them of it.

Their are many other Kosovo Albanian physicians who are being targeted to destroy the health system in Kososvo. All this in flagrant defiance of the Geneva Convention of which Yugoslavia is a signatory, which states that patients, no matter whether combatant or civilian, "shall receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. Under no circumstances shall any person be punished for having carried out medical activities compatible with medical ethics, regardless of the person benefiting therefrom." (The Lancet Interactive 4 March 2000).

Bug Watch

Changing colors: A new mutant of the hepatitis B virus with the mutation in the "a" determinant of the surface antigen was recently reported by Locarnini from Melbourne, Australia and Oon from Singapore. This is not picked up by the standard immunobased assays for diagnosing HBV nor does routine vaccina-tion against hepatitis B protects against it. It has been found in vaccinated individuals and carriers of hepatitis B after receiving antiviral drugs and is probably transmitted both horizontally and vertically. Scientists working in this field warn of a need for epidemiological surveillance of new hepatitis B mutants (The Lancet Interactive 4 March 2000).


Budget blues: In the area of health, the biggest economic boost (an increase of Rs. 600 crore) in this years national budget was to family welfare, to translate into action the plans in the newly announced population policy. The pulse polio program was not ignored and was granted Rs. 46 crore. An attempt is being made to promote the Indian system of medicine, to standardize itís drugs, modernize itís college and improve quality control of laboratories and formulation, by doubling itís budget to Rs. 100 crore. Tuberculosis and AIDS control is emphasized in this budget though the grants for malaria have gone down. A national illness assistance fund for hospital expenses of the poor is also in the pipeline. In a budget where the most massive increase is for defence, the health of the people is low down in the priorities (The Times of India 2 March 2000).

Public Health

A time to act: Alarm bells should be ringing in the corridors of the Ministries of Health and Family Welfare. For the first time after several years of progressive decline, infant mortality rates in several states in India has shown a rise. The data for 1998 was recently released from the Sample Registration System from the Registrar Generalís office. The national IMR was 72/1000 live birth in 1996, 71 in 1997 and again 72 in 1998. The worst news is from Kerala where it has risen from a low of 12 in 1997 to 16 in 1998. Karnataka, Andhra Pradesh, Assam, Gujarat, Haryana, Madhya Pradesh, Maharashtra, Himachal Pradesh, Orissa and Punjab are other states where this dangerous trend is being copied (The Times of India 6 March 2000).

Gouri Rao Passi,
Consultant, Pediatrics,
Department of Pediatrics,

Choithram Hospital and Research Center,



Kids Health at AMA - www.ama-assn.org/insight/h_focus/nemours/index.htm. The Kids Health at the AMA was developed by the American Medical Association and the Nemours Foundation, and is one of the reliable sources of childrenís health information. This site is well designed with ease of navigation. Though mainly meant for parents and care-givers, pediatricians would find this site of use for parent education. This site contains sections on child development where milestones and infant and child nutrition are clearly explained. The other sections include material on common childhood illnesses, emergencies and first aid, safety and accident prevention and child behavior.

National Attention Deficit Disorder Association (USA) - www.add.org/ This site provides information on research, treatment, and legal issues in Attention Deficit Disorder (ADD). It includes an extensive bibliography on ADD and a listing of support groups. Material for professionals includes guidelines for management of ADD, family issues, legal issues and schooling in ADD. There are pages devoted to kids and teens with ADD. Links to ADD resources on the internet are also listed.

British Pediatric Surveillance Unit - http://bpsu.rcpch.ac.uk. This site, a part of Royal College of Pediatrics and Child Health of UK contains information about uncommon and new childhood diseases. Details about ongoing and past research on uncommon diseases are given here. In addition their newsletter is also accessible from this site. Though the websiteís design is not flashy, it is easy to peruse, and a site of this calibre should raise the profile of the organization within the medical community.

Internet Resources for Special Children - www.irsc.org/ The IRSC web site is dedicated to communicating information relating to the needs of children with disabilities on a global basis in order to enhance public awareness and knowledge on children with disabilities.

Publist - www.publist.com/indexes/health.html. This site is one of the most exhaustive listing of medical and other scientific journals. It contains useful information for doctors hoping to get papers published. It lists publications (both conventional print and online) and provides data about the names of the journals, editors, contact details, etc. Over 15000 medical titles are listed, conveninently divided into specialities, and there is an in-house search engine. Information about 15,000 scientific journals can be accessed from their home page - www.publist.com.

Genetics Education Center - www.kumc.edu/gec/ The Genetic Web Site at the University of Kansas Medical Center contains a variety of clinical, research and educational resources on genetics. The site consists of three main home pages which are linked: Information for Genetic Professionals - www.kumc.edu/gec/geneinfo.html. For genetic counselors, clinical geneticists, and medical geneticists; Genetic Conditions and Support Groups - www.kumc.edu/gec/support/ For individuals and families with genetic conditions or birth defects, genetic counselors, clinical geneticists, and medical geneticists; and Genetic Educational Information - www.kumc.edu/gec/ For science teachers.

Birth defects Foundation - www.birthdefects. org/MAIN.HTM. The Association of Birth Defect Children (ABDC) is a charitable organization that provides information, written materials, special reports and newsletters to parents and professionals about all kinds of birth defects, resources, support groups and environ-mental exposures that may cause birth defects. ABDC also sponsors the National Birth Defect Registry which is an independent research and birth defect prevention project. Their website has a download access section with information on the most frequently reported birth defects, environmental exposures and special research reports.

American Academy of Child and Adolescent Psychiatry (AACAP) - www.aacap.org. The website of this organization includes summaries of the AACAP practice parameters, and the full text of over fifty "Facts for Families," fact sheets that provide concise and up-to-date information on issues that affect children, teenagers, and their families. The abstracts and table of contents from Journal of the American Academy of Child and Adolescent Psychiatry are also available from this site - www.aacap.org/journal/journal.htm.

Note: These websites have been verified on 10th, March 2000. In case of any change in the URLís, readers are requested to check the online version or contact the author.

C. Vidyashankar,
Department of Pediatrics,
Base Hospital, Delhi Cantonment.
Delhi 110 010, India
E-mail: vidyashankarc@hotmail.com.


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