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).

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).

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 it’s drugs, modernize it’s college and improve quality control of laboratories and formulation, by doubling it’s 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).

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 General’s 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,
Indore, India.
E-mail: [email protected]