Disease Watch

Animalfarm: In several districts of Malaysia pigs are bred in rather unsanitary conditions. Add to that dirty water collections ideal for mosquito breeding. This potential tinderbox for disease has finally lighted up and Malyasia is currently in the grip of an epidemic of Japanese encephalitis. More than fifty deaths and a hundred and fifty odd cases have been reported. Pigs are being slaughtered in large numbers in the ensuing panic. Nearby Singapore has also reported a few cases and banned pig meat from Malaysia (BMJ 3 April 1999).

Technology

Millenium muddle: The Year 2000 (Y2K) problem has been haunting computer programmers for past couple of years. What they fear is that as 1999 gives way to 2000 AD, computers may record it as 1900 AD wherever only the last 2 digits are used for year calculations. In spain, this is called the Effect 2000 and efforts are on, on a war footing to ensure that medical equipment are Y2K com- pliant. Areas where problems may occur are where computer software is used to record and calculate age, expiry dates for drugs and blood and in life support and monitoring equipment. Measures being taken include listing all computerized medical equipment, checking whether they are Y2K complaint and updating those that aren't. Optimists hope there will be no major risk to patients lives and have planned for adequate medical standby's as we usher in the new millenium (Lancet 17 April 99).

War

Kosovo crisis: In Europe's worst humanitarian crisis since the second world war more than 180,000 ethnic Albanians have left Yugoslavia. Health officials of the WHO say that apart from small outbreaks of measles in unorganized camps and several deaths from dysentery among the elderly and children, there have been no major epidemics in sharp contrast to the Rwandan refugees of 1994. The difference is probably due to enormous financial aid pouring in. Reasons cited include that this is not Africa, this is Europe and NATO, in the full glare of media cynosure has an image to maintain (BMJ 10 April, 17 April 1999).

Molecular Mechnanisms

Why folates work: Some more answers to the fascinating puzzle of how folate deficiency causes neural tube defects have been uncovered. The first association to be discovered was that hyperhomocystinuria causes neural tube defects. Now two studies have ex- posed the link between hyperhomocystinuria and folate deficiency. Ologsan and colleagues have documented an inverse relationship between folate levels and homocysteine in 3524 school children. At the molecular level, Ludwig and colleagues have shown that the methyl tetra hydrofolate reductase enzyme (MTHFR) which has flavins as cofactors, is mutant in hyperhomocystenemia. Folates activate this enzyme and increase the attachment of flavins to this enzyme (JAMA 1990; 281: 1189-96, Nat Struct Bioi 1999; 6: 359-65).

Ethics

Objection, Your honour: It takes a thief to catch a thief. This profound yet simple principle is the reason there are 144 complaints against pharmaceutical companies received by the British Prescription Medicines Code of Conduct Authority. Of the 36 complaints against pharmaceutical companies, received in the last quarter, 17 were from other pharmaceutical ocmpanies. For example Astra described it's Oxis Turbohaler "a significant advance in the management of asthma". Glaxo Wellcome objected and it's charge that Astra had overstated it's properties was upheld. Some complaints were also filed by physicians and former royal yatch, Britannia fizzled out in the face of a complaint by a doctor that such extravagance was not in order (BMJ 10 April 99). Pharmaceutical companies in India are not far behind in their assiduous attempts to woo the hand that writes the prescription slip.

 

Gouri Rao Passi,
Associate Consultant,
Choithram Hospital and Research Centre,
 Indore 452 001, India.
E-mail: [email protected]