Expressing serious doubts over the high estimates of 200,000 malaria deaths in India as reported in the latest edition of The Lancet, the World Health Organisation (WHO) on Thursday questioned the methodology adopted by the authors of the study.

The Lancet uses verbal autopsy method which is suitable only for diseases with distinctive symptoms and not for malaria. Malaria has symptoms similar to many other diseases, and cannot be correctly identified by the local population.

The use of verbal autopsy for malaria may result in many false positives. In this method, deaths due to fever from any cause are likely to be misinterpreted as malaria in areas with high incidence. In areas with low malaria incidence, the symptoms are difficult to distinguish, and would result in overestimates of malaria deaths, a statement issued by the WHO here said.

Independent studies

It said the organisation welcomed independent studies for estimating malaria deaths, provided the method used was appropriate. The limitations of verbal autopsy, and the implausibly high incidence rates implied by the malaria mortality estimates, indicate that the findings of the study cannot be accepted without further validation.

Malaria is endemic in many States of India. Maximum cases are reported from the North Eastern States, Orissa, Jharkhand, Chhattisgarh and a few districts of Maharashtra, Madhya Pradesh and Andhra Pradesh. Approximately 50 per cent of malaria cases reported in the country are due to Plasmodium Falciparum (a type of malaria which causes death), the statement said.

The WHO estimated 10,000 (deaths) - 21,000 malaria deaths in India in 2006 - based on the rate of three deaths per 1000 estimated falciparum cases. Estimates of falciparum cases are made by multiplying total estimated malaria cases by reported falciparum percentage. These estimates make necessary adjustments for under-reporting of malaria data in the countries.

This methodology was universal, it said, admitting that the present malaria estimation procedures had limitations.

Concerns raised

Pointing out that the same authors, in a study in 2005, had warned against the use of verbal autopsy for obtaining malaria death estimates, the statement said, "Given these methodological concerns raised already in the early stages of this new study, the WHO had proactively supported a project to validate the methodology of verbal autopsy used in the study. The findings of the project reconfirmed that verbal autopsy method overestimates malaria deaths.

The method was found to estimate deaths correctly only in 8 per cent fatalities."

Setbacks of the method

"This new study published in The Lancet also has bias, as deaths during 2001-03 have been assessed much later in 2005-06. Any adult member of the family or even a neighbour was interviewed during the verbal autopsy, and it is not clear how well the interviewee was familiar with the case during the period of illness prior to the death," the WHO said.

The limitations of the new study were also exposed when estimates were examined for particular States. The proposed estimate of malaria mortality in Orissa suggests, implausibly, that there are 17-50 million falciparum malaria cases annually in a population of 40 million.

If you are over 45 and find yourself going weak at the knees, don't think that Cupid is shooting its arrow at you! The bones of your legs may have fallen victim to osteoporosis, an unhealthy condition in which the bones become porous.

Osteoporosis is characterised by a decrease in bone density and bone mass which makes the bones of the body fragile and weak.

Nearly 20% of the women and 12 percent of the men aged 50 or above in India suffer from osteoporosis but the disorder remains largely under-diagnosed and undertreated. The prevalence of osteoporosis is even more widespread in rural and semi-urban areas.

Weakening of the bones leads to unexpected fractures that can occur anywhere in the body. Nowadays, more than 80 percent of all spinal fractures are caused by osteoporosis, say experts.

Another area of the body commonly affected by osteoporosis is the hip bone.

Apart from the pain and immobility they cause, the long-term consequences of fractures caused by osteoporosis include debilitating pain, spinal deformity, functional, and psychosocial impairments, poor pulmonary function and risk of fresh fractures.

The contemporary view in medicine is that osteoporosis is something of a lifestyle disease, too, as poor food habits and consumption of alcohol aggravate the condition. With the World Osteoporosis Day falling on October 20, experts have reiterated the need to raise awareness about how osteoporosis can be prevented.

Dr Bharat Dave, a spine surgeon and member of the association of spine surgeons of India (ASSI), said that most major osteoporotic fractures occur in the spine, wrist or the hip bones.
"During puberty and adolescence, the skeleton absorbs calcium avidly and builds up its reserves," Dave said. "The amount of calcium converted into bone is largely dependent on calcium and vitamin D nutrition, as well as exercise."

Bones continue to grow in strength till the age of 30. But from the mid-thirties, there is a gradual bone loss that continues throughout life.

Osteoporosis is not completely curable; hence its prevention is as important as its treatment. The most important prevention measures include quitting smoking, curtailing excessive intake of alcohol, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D content, Dave said.

The number of people affected by osteoporosis in India is higher than those in Western countries,doctors in the city said on the eve of the World Osteoporosis Day.

Osteoporosis, a disease of the bones that leads to an increased risk of fracture, was becoming a lifestyle disease, they said.

Dr Mahesh Bijjawara, spine surgeon at Jain Hospital, said, "The incidence of osteoporotic hip fractures is in the ratio of one woman to one man in India, while in the Western world, it is three women to one man. Also in the West, the peak incidence of osteoporosis occurs only when the person is about 70-80 years of age, while in India it afflicts them even at 50." He also underlined the importance of adequate calcium intake during the growing years to prevent the disease.

There was a gradual progressive bone loss from the mid-30s, which continued throughout life and was accelerated during menopause in women, he added.

Treatment options available for prevention of post-menopausal osteoporosis include estrogens and progesterone hormone replacement therapy, amongst others.

Leading a healthy lifestyle, quitting smoking, curtailing alcohol consumption, regular exercise and a balanced diet will help in keeping the disease at bay.

A drug based on vitamin A could prevent millions from going blind as they get older, say researchers. The treatment was able to stop the most common cause of blindness in old age during trials. Researchers behind the drug, fenretinide, found it halted the advance of age-related
macular degeneration, for which there is currently no cure.

They targeted the most prevalent form of the condition, known as 'dry' AMD, which is caused by the deterioration and death of cells in the macula - the part of the retina used to see straight ahead.

The disease robs sufferers of their sight by creating a blackspot in the centre of their vision, reports the Daily Mail.

It can make it impossible to carry out everyday tasks such as reading, driving and watching television.

While the less common 'wet' form can be treated, nothing can be done to help the bulk of patients.

The US research studied fenretinide, which is derived from vitamin A, the vitamin found in carrots, and which was originally designed to tackle arthritis.

Almost 250 men and women with dry AMD took a fenretinide pill a day or a placebo.

In the highest dose, the drug halted visual deterioration after a year. This suggests that while it was unable to do anything to stop cells that were already damaged from dying, it protected healthy cells.

Although the research is still preliminary, it offers promise of a treatment for the disease.

It affects millions across the world. The number of British sufferers could more than treble to one million within 25 years as the population ages.

Jason Slakter of New York University School of Medicine said: "There are currently no effective treatments for dry AMD and the need for finding one is grave."

New insight into how different types of age-related hearing loss may occur could help lead to the development of drugs to preserve hearing, scientists say.

The team at the University of Minnesota Medical School looked at how two closely related genes affect hearing in mice. Mutations in these genes are associated with deafness in humans, they noted.

The study, published online Oct. 14 in PLoS Genetics, found that proteins produced by the genes play a key role in two important processes that are required to maintain hearing in mice.

"These separate maintenance pathways are likely important for maintaining auditory function during aging and may contribute to future understanding of common forms of age-related hearing loss in humans," study author Ben Perrin said in a news release from the journal's publisher.

Because animal studies frequently fail to produce beneficial results for humans, additional research is needed.

Funding for the study was supplied by the U.S. National Institutes of Health.