Falak Jahan

World Asthma Day is organized annually by the Global Initiative for Asthma to boost the global asthama awareness. Along with the health care professionals and public health officials round the globe, the Global Initiative for Asthma (GINA) is working to reduce asthma prevalence, morbidity, and mortality through evidence based strategies for asthma management, projects, and events such as the annual celebration of World Asthma Day. World Asthma Day takes place on the first Tuesday of may. the theme of this year’s event is “You can Control your Asthma”.

the serious global health disease that affects all age groups, when left uncontrolled, can prove fatal. With an estimated 300 million affected individuals worldwide the prevalence of asthama is increasing because of rapid urbanisation. in Kashmir the number of asthama patients is increasing with gradual industrialisation like cement manufacturing plants and the increase in transportation.

Asthma is the chronic inflammatory disorder of respiratory airways. during an asthama attack the lining of the airways swells, muscles around the airways tighten and mucus clogs the tiny airways in the lungs making breathing difficult. Asthma is characterised by the symptoms like breathlessness, wheezing, chest tightness and coughing. usually the symptoms worsen during the night hours and in the early morning, the severity of asthma also varies from person to person. Asthama is the disease caused by some environmental factors in genetically predisposed allergic patients. now asthama is a fully reversible disease with appropriate treatment.

Asthma can be extrinsic (Allergic) or intrinsic (non allergic), of the two the extrinsic asthama is more common. Asthama is triggered by the host factors and environmental factors. the host factors include genetic makeup, obesity, and gender. Environmental factors include allergens, infections (predominantly viral), occupational sensitizers, tobacco smoke (both active and passive), diet. both indoor allergens (Domestic mites; furred animals like dogs, cats, mice; cockroach allergen, fungi; molds; yeasts) and outdoor allergens (Pollens, fungi, molds, and yeasts) are accountable for the disease. in Kashmir the diet allergens usually constitute tomato, cabbage, cauliflower, milk, eggs, bananas etc. the other triggers include cold air, extreme emotional provocation such as anger or fear, and physical exercise. Even the medications like aspirin and other non-steroid anti inflammatory drugs, and beta-blockers (used to treat high blood pressure, coronary disorders and migraine) can trigger asthma.

While obesity plays its role everywhere, it has also been shown to be a risk factor for asthma. as far as gender is concerned, prior to the age of 14, boys are more susceptible to the disease than the girls. by adulthood the occurrence of asthma is more common in females than in males.

The best way to stay away from the agony of asthma is to avoid exposure to specific allergens one is susceptible to. appropriate management can control the disease and enable people to enjoy a good quality of life. Short-term medications are used to relieve symptoms. People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms. in J&K the immunotherapy is under the focus of intensive research and by the end of this year the treatment will be available. till such therapy is developed for the specific allergens found in Kashmir like the pollen of poplar, prevention efforts along with the medications must be ruled out.

Once a diagnosis of occupational asthma is established, complete avoidance of the relevant exposure is ideally an important component of management. Occupational asthma may persist even several years after removal from exposure to the causative agent, especially when the patient has had symptoms for a long time before termination of exposure. Continued exposure may lead to increasingly severe and potentially fatal asthma exacerbation

The prevention involves prevention of the allergic sensitization or the prevention of asthma in the sensitized people. as sensitization can occur prenatally the antigen avoidance diet is prescribed to the high risk women during the pregnancy. Infants fed with the milk other than breast feeding like the cow milk, soya milk etc., are found more susceptible to the disease. Pure breast feeding during the first months after the birth is associated with lower rates of asthma during childhood.

The persons who is suffering from Rhinites, Sinusites, sleep Apnia,  Gastro Eosophigal Reflux disease are prone to asthama or in other words these diseases lead to asthma soonser or later.

Patients having the history or evidence of rhinitis are more prone to asthma. up to 30% of patients with persistent rhinitis have or develop asthma.

Rhinitis frequently precedes asthma, and shares several common risk factors with asthama like common indoor and outdoor allergens such as house dust mites, animal dander, and, less commonly, pollen affecting the nose and bronchi, occupational sensitizers, and non-specific factors like aspirin. the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative recommends that the presence of asthma must be considered in all patients with rhinitis, and that in planning treatment, both should be considered together.

Sinusitis is a complication of upper respiratory infections, allergic rhinitis, nasal polyps, and other forms of nasal obstruction. both acute and chronic sinusitis can worsen asthma. Nasal polyps associated with asthma and rhinitis, and sometimes with aspirin hypersensitivity, are seen primarily in patients over 40 years old. almost 36% to 96% of aspirin-intolerant patients have polyps, and 29% to 70% of patients with nasal polyps may have asthma.

Gastroesophageal Reflux is also associated with asthama. Medical management should be given for the relief of reflux symptoms as it is often effective. Patients may be advised to eat smaller, more frequent meals; avoid food or drink between meals and especially at bedtime; avoid fatty meals, alcohol, theophylline, and oral beta2-agonists; and elevate the head of the bed.

Although asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.

Enlightened Treatment

To stay away from the allergens that cause asthama and taking the medications for the inflammation of the respiratory airways was the only way out to deal with asthma. But now with the help of immunotherapy you can enjoy your life with no need to control the disease after treatment, as it gets fully cured.

The World Allergy Organisation along with American College of Allergy Asthama, and Applied Immunology and Indian Academy of Allergy Asthama and Applied Immunology has approved the specific therapy for curing asthma. Dr. Ghulam Hassan is the pioneer to start curing asthama patients in J&K with this therapy. Dr.Ghulam Hassan is the consultant at department of medicine, Government medical college and associated SMHS hospitals, Srinagar Kashmir. Recently Dr. Ghulam Hassan completed his fellowship training in “Allergy” and Diploma in “Allergy and Asthama” through American Academy of Allergy Asthama and Immunology at Christian Medical College Vellore India. Besides, he is the member of American College of Allergy Asthama and Immunology as well as Indian Academy of Allergy. he has also published research papers.

Dr. Ghulam Hassan says “America has developed some specific vaccines and drugs which halt or alter the allergic process in the body. in order to develop specific vaccines and drugs for some allergens that are specific to our state like the pollen of poplar, the American College of Allergy Asthama and Applied Immunology and Indian Academy of Allergy Asthma and Applied Immunology are helping out. the vaccines for such Kashmir specific allergens are to be created and I have taken the initiative to introduce this therapy in our state”

Immunotherapy decrease sensitivity to allergens and leads to lasting relief of allergy symptoms even after treatment is stopped. this makes it a cost-effective, beneficial treatment approach. Allergy shots work like a vaccine, the particular allergen is injected into the body and the gradual increase in the dose develops immunity or tolerance to the allergen. “This therapy turns an asthma patient into a normal person within 3-5 years, and with further research this duration will shrink” Dr. Ghulam Hassan said. “When compared with the symptoms and ailments caused by asthama, the risk involved in using this therapy is quit negligible” Dr. Ghulam Hassan added.

January 28, 2012

MARSTONS MILLS — for weeks, Marstons Mills residents wondered about the identity of the Barnstable man suffering from rabies in a Boston hospital.

At the tiny Liberty Hall community center in this picturesque village, people wondered, “Doesn’t anybody know who it is?” said Al Baker of the Marstons Mills Historical Society.

This week they learned the sad truth.

It was one of their own, Kevin A. Galvin, 63.

President of the Marstons Mills Historical Society and owner of a historic home on a pond in the center of the village, Galvin passed away Monday at Massachusetts General Hospital.

His death certificate, obtained at Boston City Hall Friday, said he died of rabies encephalitis after fighting the neurological virus for a month.

His death is the first time since 1935 that a Massachusetts resident has died of rabies acquired in the commonwealth. In 1983, a state resident died of the deadly virus after being exposed in Nigeria.

“It’s shocking,” Baker said Thursday. “Very sad and disheartening.”

The Cape Cod Times reported on Friday about Galvin’s legacy to the village where he had lived for 11 years. It did not mention the cause of death because reporters could not confirm it with state or local public health officials.

But for days it had been an open secret in Marstons Mills.

One woman who did not want to be named said she received an email about Galvin’s passing that said it was rabies.

“I was shocked because I’ve been following the story all along,” she said.

While Galvin was in the Boston hospital fighting for his life with his wife, Judith, by his side, few knew he was the anonymous Cape rabies victim making headlines after being bitten by a small brown bat.

“It was very top secret,” a board member at Liberty Hall, to which Galvin also belonged, said. The hall’s flag is flying at half staff.

“To the best of my knowledge, nobody knew,” Baker said. he said looking back, he now realizes why Galvin didn’t return his phone calls about printing some raffle tickets.

A computer software developer who marketed a product for catalog companies, Galvin was usually ready to help out any time, Baker said.

A man he identified only as an official “who’d be in the know,” told him Galvin was busy, Baker said.

Officials at the state Department of Public Health have maintained a news blackout recently on the rabies case they first publicized late last month.

Phone calls to DPH spokeswoman Jennifer Manley went straight to voice mail Friday, and neither she nor commissioner John Auerbach returned calls or emails.

Asked Thursday if the rabies victim had died, Manley said by phone, “We would never confirm that. At this time we don’t have to confirm it because of privacy.”

DPH officials first announced at the end of December that a Barnstable County man in his 60s was in critical condition with the deadly virus.

Then, a local public health official confirmed the victim was from the town of Barnstable.

Early this month state public health officials confirmed that the disease had been transmitted by the bite of a small brown bat of the Myotis species.

Although rabies is rare in the U.S., in most cases it is caused by bats.

The Centers for Disease Control and Prevention in Atlanta says only six cases were reported last year, of which five were fatal (a victim in California lived).

Galvin apparently was bitten in his Marstons Mills home, but didn’t know it until symptoms started showing.

Usually at that point, it’s too late to recover because the virus has invaded the brain, disrupting signals to vital body parts such as the heart and diaphragm, health officials say.

As of Jan. 14 — the date of the Times’ last published update on the case — the rabies victim remained in stable but critical condition in a comalike state at an unidentified Boston hospital, according to Barnstable Health Director Thomas McKean.

McKean did not return phone calls Friday. He’d said earlier in the week that family members had requested privacy.

Lee Mannillo, of the Cape Cod Rabies Task Force, confirmed recently that Galvin had undergone an innovative treatment called the “Milwaukee protocol.”

The treatment involves administering a cocktail of sedatives while allowing the body to produce natural antibodies to fight off the infection.

The protocol, developed by Dr. Rodney E. Willoughby at the Medical College of Wisconsin in Milwaukee, is credited for saving six lives since 2004.

But it is far more effective to give people bitten by rabid or suspicious animals a series of rabies shots before symptoms ever appear, health officials say.

Galvins’ siblings said they did not want to talk to the press about their brother’s death, and his wife indicated the same through a friend.

Galvin, who ran Galvin Associates software development company in Hingham for years, threw himself into the community life of Marstons Mills after moving there a little more than a decade ago.

He and Judith purchased the William Marston House, which dates from 1780 and is on the National Register of Historic Places.

They turned it from an inn back into a private residence, but still allowed civic celebrations and an Easter church service to be held on the grounds.

Galvin served on the board of the Barnstable Land Trust until a few years ago and put his computer expertise to work digitizing records for the Marstons Mills Historical Society.

He kept a blog on the Marstons Mills River Herring Counting Project.

His funeral is being held today in South Weymouth. Burial will be at Mosswood Cemetery in Cotuit.

Michaela Harrington, Michelle Ng and Lian Parsons contributed to this story.

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Friday January 27, 2012

ASHLEY FALLS — A local herd of cattle was not actually infected with a rare bacteria as previously suspected, according to state regulators who have lifted a ban on milk sales at Twin Rivers Farm in Ashley Falls.

The state Department of Public Health acknowledged in a terse statement Thursday that the initial diagnosis of the farm’s owner as having contracted brucellosis, which is what prompted the farm’s initial quarantine, was incorrect.

Neither the DPH nor the state Department of Agricultural Resources have any further health concerns at this time, according to the statement.

As to what led health officials to diagnose brucellosis in the first place, officials were silent. The statement acknowledging negative test results from the farm contained no other information and a spokeswoman didn’t return calls for further comment.

Twin Rivers Farm made news across the state on Sunday after officials distributed an alarming consumer alert linking raw milk sold at the farm to brucilla, a bacteria that hasn’t been seen in this state in over two decades.

Only about 22 of the 680 gallons of milk Twin Rivers sells a week are raw; the rest are taken off site and pasteurized, a process that eradicates the bacteria.

Public health officials said the germ’s appearance in the state would have “significant implications” for the state’s livestock. according to the Centers for Disease Control and Prevention, brucellosis can cause fever, sweats, headaches, back pains and physical weakness in humans, leaving chronic, long-lasting symptoms in some cases.

Although the state’s initial release didn’t indicate who had contracted brucilla, the farm’s owner, Robert Kilmer, told The Eagle last week that he was the case referenced by the health officials.

Kilmer, who wasn’t available for comment Thursday, previously told The Eagle he strongly doubted his milk was to blame for his sickness. He said his herd of about 270 was vaccinated for the germ and that no one else exposed to the milk had gotten ill.

Advocates for raw milk, who are currently pushing legislators to ease restrictions on sales of the product, also were critical of the state’s focus on unpasteurized milk as the cause of Kilmer’s illness.

“It seemed like they jumped to a conclusion too quickly,” said Winton Pitcoff, the coordinator of the Raw Milk Network of the Northeast Organic Farming Association’s Massachusetts chapter. “And now they aren’t doing enough to acknowledge that the end result is good news.”

A spokesman for the Department of Agricultural Resources said the agency “just wanted to take the necessary precautions.”

To reach Ned Oliver:,or (413) 496-6240.On Twitter: @BE_NedOliver

Gonorrhea cases are up significantly in Erie County, ending a three-year decline for the sexually transmitted disease.

Two hundred and four gonorrhea cases were reported to the Erie County Department of Health during the first six months of 2011. That’s nearly three times more cases than were found during the first half of 2010.

Still, public-health officials aren’t ready to panic.

“The numbers so far in 2011 are not alarming,” said Charlotte Berringer, R.N., the county Health Department’s director of community health, pointing out that 2010 was “one of our better years for STDs.”

Gonorrhea cases had been on the decline in Erie County since 2007, when 521 were reported. It also was the year Erie County’s rates for gonorrhea and chlamydia, another common STD, set all-time highs.

Only 168 gonorrhea cases were reported in all of 2010.

Berringer said she doesn’t know why gonorrhea cases have increased in 2011. Cases of chlamydia also are on the rise, with 656 cases reported from January through June 2011, compared to 530 during the same period of 2010.

Three cases of syphilis, a more serious STD that can be life-threatening if not treated, were reported in Erie County in May and June. five cases have been reported in 2011, one more than the same period in 2010.

“We usually see between two and seven cases of syphilis a year, so that number is not unusual,” Berringer said.

Most STDs can be treated with antibiotics, but people often don’t realize they have one because symptoms aren’t always obvious, said Fred Havko, M.D., a Saint Vincent Health Center emergency physician.

“Women in particular might not have any symptoms of gonorrhea or chlamydia until later, when an infection develops in their pelvis,” Havko said. “By that time, it’s a pretty serious disease.”

Untreated chlamydia and gonorrhea can scar a woman’s fallopian tubes, which can cause infertility, Havko said.

Most gonorrhea and chlamydia cases are found in teenagers and young adults, so college health centers are often on the front lines in the battle against STDs.

“We serve a high-risk population of 18- to 25-year-olds, so we act proactively,” said Darla Elder, R.N., director of Edinboro University of Pennsylvania’s Ghering Health & Wellness Center. “We educate students on risk behaviors, we test them when they have a positive risk factor, and we treat anyone with a positive result.”

Both the Ghering center and the STD clinic at the county Health Department will help someone with an STD contact all of their sexual partners.

It’s an important step toward limiting an STD outbreak, Berringer said.

Not having sex is the only foolproof way to avoid getting gonorrhea or chlamydia. But there are ways to reduce your risk of an STD if you are sexually active.

“The best prevention is to use a condom, though those aren’t 100 percent effective,” Berringer said. “That’s why it’s so important to get tested and get treated.”

DAVID BRUCE can be reached at 870-1736 or by e-mail.

NATIONAL CITY, Calif. — County public health officials Wednesday will be testing for tuberculosis at a National City preschool because an individual there was recently diagnosed with it and may have exposed others.the San Diego County Health and Human Services Agency and the National School District Preschool Center are also working together to notify those who have been in close contact with the infected person from Nov. 2 to Dec. 17.”We urge those people who are at risk to get tested, in order to catch early infection before it makes the person ill with TB,” said Dr. Eric McDonald, the county’s Deputy Public Health Officer. “TB can be treated and cured with medication and that’s why it is important to identify.”Symptoms of active TB include persistent cough, fever, night sweats and unexplained weight loss. Most people who are exposed to TB do not develop the disease, as prolonged close contact is needed to pass it to others.This is the 14th case of TB in San Diego County so far this year. There were 222 cases in 2010.

For months, people were told to get flu shots, and it looks like they got the message. So where are they supposed to get them?

“The majority of our offices are completely out of seasonal flu vaccine, and there’s no guarantee they will receive any more,” said Pamela Zemaitis of Heritage Medical Group.

Public health experts knew from the beginning this flu season would pose challenges. The first obstacle was to produce a vaccine against H1N1, also known as swine flu. H1N1 is different than regular “seasonal flu” and requires a separate vaccine.

Then public health officials had to convince people that, in most cases, they needed both the H1N1 vaccine and the regular flu vaccine.

But now there are shortages, or at least delays, involving both vaccines. Many health care providers and state health officials hold out hope a sufficient supply will eventually arrive.

The federal government paid for the H1N1 vaccine. Pennsylvania, like most states, is controlling the supply. Hundreds of doctors, retailers and health-related organizations have signed on to obtain and dispense H1NI vaccine. but the vaccine is arriving slower than expected.

Of the vaccine delivered to Pennsylvania so far, most has gone to the parts of the state with the most H1N1 cases. The vaccine has further been reserved for children and young adults, who have the highest risk of becoming severely sick from H1N1.

Stacy Kriedeman of the state Department of Health said Pennsylvania had distributed 964,100 doses as of Friday and expected more to arrive, although later than originally expected.

Holy Spirit Hospital, for instance, has received a “very limited” supply of H1N1 vaccine, spokeswoman Lori Moran said Friday. It reserved most of those for employees who work with high-risk patients and for patients who are at high risk of flu complications.

Holy Spirit-owned pediatric and family medical practices also have limited supplies of H1N1 vaccine, and are holding them for high-risk patients.

Regular flu vaccine also is in short supply, with little expectation of receiving more, Moran said.

Penn State Milton S. Hershey Medical Center was dealing with similar circumstances, spokeswoman Megan Walde said. Moran and Walde, like other providers interviewed, stressed that doses of both H1N1 and regular flu vaccine would go only to existing patients ” not the public. they said that’s standard policy, not a response to a shortage.

The belief among health care providers is that the shortage of seasonal flu vaccine is the result of production being temporarily cut back to allow greater production of the H1N1 vaccine.

Giant Food Stores received fewer doses of regular flu vaccine than ordered and had to stop offering them as of Oct. 22 instead of November. Spokeswoman Tracy Pawelski said the situation is the result of limited supply as well as higher than usual demand for shots.

Numerous health care providers also cited increased demand for regular flu shots and attributed it to flu-related public health messages of recent months.

Pawelski said Giant has signed on with the state as a distributor of H1N1 vaccine, but hasn’t been told when or if it will get the vaccine.

Rite Aid is dealing with “spot shortages” of seasonal flu vaccine. The Cumberland County-based national chain has flu vaccine in its warehouse and is trying to keep its stores supplied, spokeswoman Cheryl Slavinsky said Friday. Rite Aid didn’t get its full order on time, but continues to receive shipments, she said.

Slavinsky said the only way to find out if a particular store has vaccine is to call the store. Calls to five Harrisburg-region Rite Aid stores Friday found none with vaccine. An employee of one said she was aware of no local retailers with regular flu vaccine. “You might want to call your doctor,” she said.

Kriedeman, the health department spokeswoman, said the department has received most of the 424,200 doses of regular flu vaccine it ordered. but she stressed those are intended for people with no health insurance and others who need flu shots because of health reasons, but are unlikely to obtain one on their own. most are distributed through state health centers and state and federal health clinics.

Kriedeman said that, with seasonal flu vaccine, the state leave it up to the private market to supply the vast majority of vaccine. She added that according to federal officials, 82 million doses of seasonal vaccine had been distributed as of Oct. 8, and officials expect 114 million will eventually be distributed. She noted that regular flu season often doesn’t peak until March, so it makes sense to continue to seek a shot. “Seasonal flu vaccine is out there, but you may have to look for it. We encourage people to be persistent,” she said.

As for H1N1 vaccine, Rite Aid has so far been able to supply only five stores in three states, and none in Pennsylvania. “I expect it will be a little while before it trickles down full force to the drug store chains,” Slavinsky said.

At the end of last week, there were some signs the Harrisburg-area H1N1 vaccine shortage is easing. Carlisle Area and Cumberland Valley school districts announced they had received H1N1 shots and would begin dispensing them on Monday. Harrisburg school officials, who began dispensing doses last week, planned to dispense more on Saturday, and at a succession of future dates. Several other districts said they are expecting doses.

All the while, H1N1 seems to be rapidly spreading in the region. at Holy Spirit, 30-40 people per day have been coming to the ER with the flu, although most didn’t need to remain in the hospital, Moran said.

Health officials have been urging people not to go to a doctor or hospital unless they believe there are dangerously ill. The purpose is to avoid spreading the flu.

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BOSTON—Public health officials say more Massachusetts residents are being diagnosed with Lyme disease, and many of them are picking up the tick-borne ailment in areas of the state where it was relatively rare a decade ago.

State Department of Public Health figures show that the disease, once most common on Cape Cod and the Islands, is now seen more in Middlesex, Norfolk, and Worcester counties.

There were 4,042 Lyme disease cases statewide last year, compared with 1,194 in 2000.

People get the disease from bacteria passed on by ticks that attach themselves to the skin.

Specialists tell The Boston Globe that the disease is spreading as the tick-carrying deer population explodes and housing developments encroach on natural habitats.

The disease causes flulike symptoms and can be treated by antibiotics.

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