Cigarette, bidi and other tobacco packets including gutka and zarda would, from June 1, have to portray disturbingly gory pictorial health warnings in order to make tobacco control measures more effective. The pictures would be of a repelling blood-oozing cancerous mouth, that too in colour. They would replace the existing ones like a scorpion or a diseased lung in black and white.

The Health and Family Welfare Ministry has issued a notification on the amendments to the Cigarettes and other Tobacco Products (Packaging and Labelling) Rules 2008 for specifying the new mandatory pictorial health warnings on both smoking and smokeless forms of tobaccos in the market. They would come into force from June 1 this year.

The necessity to change the pictorial warnings was felt as the conventional warnings like the scorpion and the lung were perceived to have not yielded the desired results. The pictures were soft and thereby ineffective in weaning people away from tobacco or preventing new addictions. The new picture of a cancer-stricken mouth is very strong to the point of being repulsive.

The warning has been put into paper after a vigorous field testing conducted by Voluntary Health Association of India and Healis Sanskaria Institute in both rural and urban settings across eight states. More than 98 per cent people said the notified warning instilled deep fear and would be effective in conveying the dangers of tobacco consumption. "Both smokers and non-smokers in Orissa said that this picture will have a lasting impact on the viewers' mind and discourage people from developing the habit of tobacco consumption," Itishree Kanungo of VHAI said.

By selecting an evidence based graphic health warning, the Union Government has taken a right step since it will effectively communicate the risks and dangers of tobacco use, especially to users with low literacy levels and children, VHAI chief executive Alok Mukhopadhyay said.

Successful treatment for gum disease cuts the risk of pregnant women giving birth early, US research suggests.

The preliminary research showed those whose gum disease was not treated successfully were three times more likely to give birth before 35 weeks.

The study of 160 women was presented to the annual conference of the American Association for Dental Research.

UK experts said the finding was "controversial" but advised pregnant women to take care of teeth and gums.

Doctors have previously established that severe gum infections cause an increase in the production of prostaglandin and tumour necrosis factor, chemicals which induce labour, to be produced.

The study by researchers at the University of Pennsylvania enrolled women who were between six and 20 weeks' pregnant.

All of the volunteers had gum disease. These women were given treatment, which was successful in one third of the cases.

The researchers found a "strong and significant association" between successful treatment and full-term births.

Those whose treatment did not work were "significantly more likely" to give birth before 35 weeks.

'Controversial area'

UK experts warned that this was a small study and further research was needed.

Professor Iain Chapple, from Birmingham Dental School, said this was a "controversial area", and that while some previous studies had shown an association between gum disease and early births, others had shown no association.

He said the results "could reflect behavioural differences in the successfully treated group versus the unsuccessfully treated group" such as "poorer diets, smoking status, alcohol intake and many other issues".

But Dr Nigel Carter, chief executive of the British Dental Health Foundation, said: "This paper adds to the growing evidence around links between gum disease and pre-term babies.

"It is further strong evidence that pregnant women should take care of their periodontal health and receive appropriate treatment during their pregnancy to reduce as far as possible their chance of a pre-term birth."

'Only one clue'

This advice was echoed by the pregnancy research charity Tommy's.

Its consultant midwife, Annette Briley, said: "Women in the UK do get free dental care during pregnancy and for a year after the baby's birth.

"It is therefore good to go to the dentist early in pregnancy and ensure that your mouth, teeth and gums are as healthy as they can be.

"However, the causes of preterm birth are multifactorial and many women with no periodontal disease may still have their babies early, this is only one clue to one cause."

As the world observes World Kidney day, it is shocking to know that upto 80 percent of critically ill newborns in our country suffer from Acute Kidney Injury (AKI), commonly known as Acute Renal Failure.

As many as 30 - 50 % of patients in the ICU and about 5% of hospitalized children overall have this condition.

Again, Chronic Kidney disease (CKD) together with End stage renal disease (ESRD) has a worldwide incidence of 75 - 350/million population.

Approx. 3,00,000 ESRD children exist in India with fewer than 5% receiving renal replacement therapy.

Acute Kidney Injury (AKI) is commonly precipitated by -Acute Gastro Enteritis, blood loss, shock, inflammation of the Liver (Known as Fulminant Hepatitis), heart failure etc. In this background, assessing Kidney function precisely assumes particular significance.

Early detection of a functional abnormality leading to a prompt intervention can prevent significant kidney damage. Unfortunately, as of now we don't have many diagnostic methods or tests in place, which could help us detect these abnormalities early especially before the disease has become clinically manifest.

Kidney function so far is gauged by creatinine & its small rise increases risk of mortality. Creatinine tends to be an unreliable indicator of AKI (Variations with age, gender, muscle mass & metabolism, hydration status) & does not change until 50% of Kidney function is lost.

In the near future there would be novel biomarkers for early detection & management of kidney injury including Urine panel of NGAL, IL-18, KIM-1, & Plasma panel of NGAL & cystatin C. These biomarkers are sensitive much before rise in Sr. creatinine.

Various drugs & agents including painkillers & anti-inflammatory drugs, antibiotics, herbal & alternative medicines also cause kidney injury.

The Symptoms & Signs are often Subtle & hidden! Laboratory investigations include detailed blood and urine analysis with radio imaging. Management of AKI (Accute Kidney Injury) is treating the basic causes, management of complications e.g. Fluid overload, Hypertension, etc. Occasionally dialysis is required to sustain kidney function.

Urinary Tract Infection (UTI) is a common cause of chronic kidney damage. 150 million people per year become infected. 5% of general practitioner visits are for UTIs. Prevalence - In girls <1 year is 6.5%, boys is 3.3%, in girls >1 year is 8.1%, boys is 1.9%, <1 year, uncircumcised boys have a 10 fold increase in risk.

Urinary Stone Disease: "Renal stone disease in children is not uncommon, and can present in classical or atypical manner. It is more common in children < 5 years, with 90% of infective causes. Stones have to be removed; Antibiotics are an important treatment modality. The Long-term outcome is Good, with < 10% recurrence. A metabolic cause can be identified in 50% of the cases", says Dr. P.P. Singh, Sr. Consultant Urologist, Batra Hospital.

Overall, formulating strategies for controlling CKD is of the utmost importance. Control of CKD is with managing fluid electrolyte disturbances, hypertension, protein in urine, obstructive changes etc., Medication for hypertension, control blood sugar levels in diabetics, lifestyle changes especially in adolescents, including physical exercise, avoiding smoking and alcohol intake, restricting sodium intake etc. are all important. CKD must be detected early, regular screening of children in "at risk" category & Nation wide school screening programmes are crucial for detection of Proteineuria, Haematuria, Hypertension etc.

Disproving the beliefs that only the close ones, family members and relatives can give away their kidneys, professor Susan Hou, an internationally renowned renal expert from Chicago had created history seven-and-a-half years back when she donated her kidney to her own patient.

On Monday, she was in the city to give a talk on renal disorders in pregnant women ahead of the World Kidney Day on March 11.

It is believed to be the first time when a physician had donated an organ to an unrelated patient since living unrelated transplants don't happen too often.

The lady doctor changed the relationship between a doctor and patient and took organ donation to a higher level. Susan Hou is an expert on renal disorders in pregnancy and a humanitarian and her husband professor Mark Moli is an expert on prolactin, endocrine testing during pregnancy and management of many endocrine problems during pregnancy.

In an interview, Susan said, "If we believe in the brotherhood of men, then there should be no second thought in donating your kidneys to anybody as no donation is unrelated." Speaking about her donation experience, she just said, "It felt great." In fact every nephrologists should donate his kidney for the cause of healthcare, she noted. Though her husband Mark was worried the day before the surgery, post that he was fine, said Susan. She said that donors should be sensitised too and they should be aware that health complications can crop up after donation.

It is an irony that at the time when she donated her kidneys, there was a lot of criticism from India stating that in countries where women's rights are not recognised, this kind of practice will force them to donate their kidneys for their husbands.

But today, times have changed, says Susan.

Women who eat a full breakfast and a high fat diet at the time of conception are more likely to have a boy, scientists claim.

A low fat diet with periods of long fasts favours girls, the researchers have found.

The findings seem to give some credence to to old wives' tales such as eat "bacon for boys".

Dr Cheryl Rosenfeld, of the University of Missouri, and colleagues said: "High calorie diets generally favour birth of males over females, whereas low calorie diets tend to favour females over males.

"In humans and mice, food restriction and a suboptimal diet during the period around conception and early pregnancy also lead to a surfeit of daughters, most probably due to selective loss of male foetuses, the most vulnerable sex in the womb."

Researchers analysed the genes in placentas of pregnant mice fed diets high in fat or carbohydrates and low calorie diets and found each one had a distinctive effect compared with a third group given normal soybean meal-based food.

As well as the changes in sex, female foetuses were more sensitive to their mother's diet and their genes were more likely to be affected or altered, it was found.

After 12 days - just over half the animals' pregnancy term - there were differences in almost 2,000 genes including those involved in kidney function and smell.

They concluded gene expression in the mouse placenta is "adaptive and shaped by maternal diet" with the biggest effect on the placentas of females.

The research, published in Proceedings of the National Academy of Sciences, follows a study two years ago that found a woman's diet around the time of conception may influence the gender of her baby.

A high-calorie diet at this time - and regular breakfasts - might increase the odds of a boy while women with a lower energy intake were likelier to give birth to a girl.

The research shows a higher calorie intake around the time of conception can shift the odds of having a son from ten to 11 boys in every 20 births.

Sons and daughters are also at different risk for diseases later in life, apparently related to either the mother's diet or body condition while pregnant.

For instance, sons of obese mothers are more likely than daughters to become obese and develop diabetes as they get older, even though no differences in birth weight may be evident.

The researchers added: "The reason why a maternal high fat, low carbohydrate diet favours survival of sons and a maternal low fat, high carbohydrate diet results in more daughters continues to elude us.

"The effect was such that the more women ate the more likely she was to have a boy.

"Women who had sons were also more likely to have eaten a higher quantity and wider range of nutrients including potassium, calcium and vitamins C, E and B12. They were also more likely to have eaten breakfast cereals."

There has been a small but consistent decline of about one per 1,000 births annually in the proportion of boys being born in industrialised countries, including the UK, over the last 40 years.

It could be because women have been consuming low fat foods and skipping breakfast, among other things.