Archives for 2019

Optimal treatment and new drugs expected to save more lives

By David Bodapati

Bengaluru, 14 Oct 2019: A diminutive middle-aged woman, Pari Yusuf, woke up in the middle of the night and sat down on her bed. Frightening dreams and illusions are not new to her. “Suddenly, I was sweating and found myself in the middle of a huge raging fire. I was shouting for help and had no where to go. I woke up abruptly, and then everything seemed ok in a few minutes,” she said.

“Long back, I used to get these kind of illusions but the intensity seems to be more with the TB drugs,” she recalled. Pari (name changed) is living with HIV for over 15 years and survived drug-resistant Tuberculosis (TB). Later on due to side effects and other opportunistic infections, she literally recovered from her days on the death bed at the government Victoria hospital in Bengaluru, four years back. “These illusions and dreams are a part of the side effects of the drugs I had to take. I used to get these when I started ART (antiretroviral therapy) a decade ago. But now some of the TB drugs too have such side effects,” she explained. “Some of the injected DR-TB durgs can be brutal and can cause complete hearing loss,” she added.

Now Pari, who hails from a rural district in Karnataka, is an activist fighting for the cause of people living with HIV and TB. She fully supports the `TB Harega, Desh Jeetega’ campaign which was launched on Septemeber 25 by the Union Health Minister Harsh Vardhan, who also released the TB India Report 2019 and introduced the all-important, all-oral treatment regimen for Multi-drug resistant TB. But she feels that more needs to be done in terms of providing care after initiation of new drugs and providing access in rural and remote areas.

The Minister announced the roll out of an all-oral MDR regimen across the country based on providing access to one of the two new drugs – Bedaquiline or Delamanid  to replace  the injectable in the treatment regimen. The new all-oral treatment for drug-resistant TB is a welcome development as India. According to WHO’s Global TB Report 2018, the estimated number of DR-TB in India is 135,000, accounting for one-fourth of the global burden.

The all-oral treatment represents hope for people with DR-TB and their caregivers because they offer better cure rates and a fewer side effects. The World Health Organisation’s treatment guidelines prioritise the use of newer drugs as part of all-oral regimens for the treatment of MDR-TB and XDR-TB.

MSF urges more countries to make the switch from older, toxic treatments that need to be injected to all-oral regimens that contain the newer drugs, including bedaquiline and delamanid. “These newer drugs are critical to improving the otherwise abysmal cure rates of 55% and 34% for MDR-TB and XDR-TB, respectively. “Use of the newer TB drugs is also urgently needed for children with MDR-TB in order to improve treatment outcomes and reduce the risks of side effects,” Ms Yusuf says.

Treatment regimens for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) and  extremely drug-resistant TB (XDR-TB) have long consisted of toxic drugs, including those that cause psychosis and hearing loss. Treatment outcomes for people with MDR-TB and XDR-TB have remained unacceptably low for many years for numerous reasons, including drug toxicity, lack of new effective drugs, long treatment durations, and failure to put people at the centre of their care. Such treatments had a high pill burden, long treatment duration (of up to two years), painful daily injections (for up to eight months), and severe side effects (due to toxic drugs). The treatment success rates were only 55% for people with MDR TB) and 34% for people with XDR-TB.

A group of people affected by DR TB, and from different health organisation and People Living with HIV have made a representation to the Health Ministry last December to minimise injectible drugs and scale up all-oral new drugs for DR TB. They are happy that finally the government announced the switch to all-oral treatment which can save more lives with optimal treatment. But they feel that scaling up only Bedaquiline will not help and call for including access to Delamanid too, particularly for patients who have pre-XDR and XDR TB. In addition they call for adequate Drug Sensitivity Testing (DST) facilities throughout the country.

The new all-oral DR-TB regimens are a strong step in the right direction but they should be followed up to provide people with safer and more tolerable treatment, improve treatment outcomes and prevent unnecessary deaths. Importantly, the new all-oral regimens can also facilitate an evolution to a model of care that empowers people and supports them to complete treatment with less disruption to their lives. The benefits of implementing the new all-oral long regimen is very clear but having launched the switch, now the government must make a political commitment for sufficient financing, adequate healthcare worker training, policy updates and multi-sectoral engagement. The National programme should also keep in mind the access to treatment and drugs in rural and remote regions as well as guard against stock-outs which have become frequent in many states like Jharkhand and even in cities like Mumbai.

Now that the programme makes a shift to the all-oral treatment regimen to progress to the MDG goal by 2025, two things that need urgent attention are issuing a circular for minimising and removal of injectable from the Programmatic Managment of drug-resistant TB (PMDT), and making greater efforts to scale up universal Drug Susceptibility Testing (DST) as lack of quality assured testing facilities is a major barrier for DR-TB patients to access safer, effective and rational DR-TB regimens. As per CTD India Report 2018, only  257 of the 712 districts undertake DST on TB samples (2018).

Dr Vardhan says, “We are on track to achieve our target of a TB-free India by 2025, much ahead of the global target of 2030.” For that to happen our programme implementation should be made more robust without allowing any complacency to creep in. But the need of the hour is to attack DR TB with full force.

Kolkata: The police on Tuesday arrested the main accused in the Murshidabad triple murder case for his alleged involvement in the crime, a senior police officer said.

Utpal Behra, a mason by profession, was arrested from Sagardighi’s Sahapur area of the district on Tuesday morning, Murshidabad Superintendent of Police Mukesh Kumar said.

Bandhu Prakash Pal, a 35-year-old teacher, his pregnant wife Beauty and 8-year-old son Angan were found dead in their house at Jiaganj in Murshidabad district on October 8, when Durga Puja festivities were on.

According to police, Behra had paid money to Pal for two life insurance policies.

“Although Pal gave money receipt for the first policy, but he did not give him the receipt for the second policy. For the last few weeks, Pal and Behra used to quarrel over this matter. Pal had even insulted him, following which Behra decided to kill him,” police said.

Behra has confessed to the crime, the police claimed.

Mumbai: A 51-year-old man, whose family has a deposit of over Rs 90 lakh with the troubled Punjab and Maharashtra Bank Cooperative (PMC) Bank, died due to a heart attack, sources said on Tuesday.

Sanjay Gulati, a resident of suburban Oshiwara, went to a protest march held outside a city court on Monday morning and had been under stress because of his deposit being stuck, said Manali Narkar, who was among the agitating depositors.

Gulati was there at the protest along with his 80- year-old father, Narkar said. In a video made at the protest site, Gulati’s father claimed that the family has a deposit of over Rs 90 lakh with the bank, she said.

Gulati died due to a heart attack while having dinner on Monday, a senior official at Oshiwara police station said.

Narkar said a few of the depositors will be attending Gulati’s last rites to be held here around noon, and added that they will also be holding a peaceful candle light march in the evening.

According to reports in a section of media, Gulati lost his job after the grounding of Jet Airways and is survived by a specially-abled son, who requires regular medical treatment.

The PMC Bank has been placed under “directions” by the RBI since last month, wherein depositors’ withdrawals have been capped.

The limits were increased to Rs 40,000 by the RBI on Monday, and the central bank said 77 per cent of the customers will be able to fully withdraw their deposits with this move.

The limits were earlier capped at Rs 1,000, and subsequently raised to Rs 10,000 and Rs 25,000 as the bank’s liquidity position improved.

Harried depositors of the bank, which has deposits of over Rs 11,000 crore, have been protesting across the city, and also forced Finance Minister Nirmala Sitharaman to meet them last week when she was out to address a pre-election media conference here.

Sitharaman then urged RBI Governor Shaktikanta Das to urgently look into the woes of the depositors, after which the deposit withdrawal limits were hiked to Rs 40,000.

Four people, including promoters of realty firm HDIL to which the bank made the sour loans, and the lender’s former chairman and ex-managing director have so far been arrested in connection with the alleged Rs 4,355 crore scam.

A five-judge Constitution bench directed the UP government to provide security to Farooqui.

NEW DELHI: With just a few days left for the verdict in the decade-old Ayodhya land dispute case, the Supreme Court Monday directed the Uttar Pradesh government to provide security “forthwith” to the UP Sunni Central Board of Waqf chairperson Zufar Ahmad Farooqui as he apprehended threat to his life. Through mediator Sriram Panchu, Farooqui informed the court about the threat to his life.

A five-judge Constitution bench directed the UP government to provide security to Farooqui. The development comes a day after Section 144 of the CrPC, banning the assembly of four or more people, has been imposed in Ayodhya district and surrounding areas in Uttar Pradesh till December 10, in anticipation of the judgment in the case.

The statement came at a time when the hearing in the case has reached its final leg and is likely to be concluded this week, senior advocate Rajeev Dhavan appearing for Muslim parties told the bench that, “Your Lordship didn’t ask question to the other side.

All the questions have been asked to us only. Of course, we are answering them.” Opposing the statement by Dhavan, senior advocate C S Vaidyanathan, representing deity Ram Lalla, said, “This is unwarranted.” Dhavan’s remark came when the bench said that the idea behind erecting iron railing at the disputed site was to separate the inner courtyard from the outer courtyard.

He targeted Rahul Gandhi and said when a ship sinks, the captain evacuates everyone safely but Gandhi is a captain who himself left on seeing Congress ship sink.

BHIWANDI (Maharashtra): Ahead of the Maharashtra elections, AIMIM chief Asaduddin Owaisi slammed Congress and asked it to stop pretending to be the saviour of Indian Muslims.

“If for more than 70 years, the Muslims have continued living in India it is not because of your (Congress) grace, but due to the Constitution and the one above (God),” Owaisi said addressing an election rally for his party’s candidate from the Bhiwandi West seat on Monday.

In the same rally, Owaisi had also targeted Congress leader Rahul Gandhi and said when a ship sinks, the captain evacuates everyone safely but Gandhi is a captain who himself left on seeing Congress ship sink.

“When a ship sinks in the middle of a sea, the captain evacuates everyone safely but Gandhi is a captain who himself left after seeing the Congress sinking. Muslims are not alive due to Congress’ mercy on us for 70 years, rather we are alive because of the Constitution and by the grace of God,” said Owaisi.

The AIMIM leader, however, also slammed RSS chief Mohan Bhagwat at the same rally, by stating that India never had been a ‘Hindu Rashtra’ nor will he and AIMIM let it become one.

“India is not a Hindu Rashtra and we will never let it become one, we are strongly against it,” Owaisi said in response to Bhagwat where the RSS chief referred to India as a country of Hindus.

Addressing a meeting of intellectuals in Bhubaneswar on Saturday, Bhagwat had said: “We are a country of Hindus. Hindu is not the name of a language, province or country but a culture, which is the legacy of all people living in India.”

Owaisi did not spare Prime Minister Narendra Modi and the anti-triple talaq law passed by his government too as he went ahead to add, “Our Prime Minister speaks a lot on the issue of Triple Talaq, I am in anguish because of one wife, while the ones who have none, they are happy.”

AIMIM is likely to contest on 44 out of the 288 seats in Maharashtra. The elections in the state will be held on October 21. The counting of votes is scheduled to begin on October 24.