The New Nation - Internet Edition

Jamayet Ali

Gulancha is a deciduous climbing shrub found in bushy and fallow lands of rural Bangla. Its stems are rather succulent with long filiform fleshy aerial roots from the branches. Bark grey-brown or creamy white, warty; leaves membranous, cordate with a broad sinus; flowers small, yellow or greenish yellow, appearing when the plant is leafless. The plant is sometimes cultivated for ornament and is propagated by cuttings. The leaves afford a good fodder for cattle. Moreover, the leaves are rich in protein and fairly rich in calcium and phosphorus. The stem and extract of the plant can be obtained in shops and bazaars. The root is not generally available in bazaars, but can be procured without difficulty at the cost of collection. Botanical name of Gulancha is Tinospora cordifolia.

Medicinal Values: The stem is bitter stomachic; stimulates bile secretion; causes constipation; tonic; allays thirst, fever, burning sensation, vomiting; diuretic; enriches the blood; cures jaundice; useful in skin diseases; the juice is useful in diabetes, vaginal and urethral discharges, low fevers, and enlarged spleen (Ayurveda). Stem bitter; appetizer, stomachic, tonic, antipyretic, expectorant; good in cough, jaundice, giddiness, vomiting, piles, anaemia, chronic fever; renews the blood; mixed with sesame oil it is useful for massaging the body (Yunani). The root and stem are prescribed in combination with other drugs as an antidote to snake-bite and scorpion-sting.

An infusion of the powdered stem is used as an alterative and tonic and enjoyed the reputation among ancient Hindu writers of being an aphrodisiac. Among the Mundas of Chota Nagpur the whole plant, well ground, is applied on fractures. In Ceylon the stems are used in fevers, skin diseases, jaundice, and syphilis. The starch obtained from the roots and stems of the plant is similar to Arrow-root in appearance and effect. It answers not only as a remedial medicinal agent in chronic diarrhoea and some forms of obstinate chronic dysentery, but it also a valuable nutrient, when there is intestinal irritability and inability to digest any kind of food. I have myself had experience of the usefulness of this starch. I think this drug is useful where there is an acid-dirrhoea, due to an acidity of the intestinal canal or acid dyspepsia. It is useful in relieving the symptoms of rheumatism. There is another preparation of the plant, the succus (Juice), freshly prepared from the fresh plant. It acts as a powerful diuretic. It is prescribed by ancient Hindu physicians in gonorrhoea with advantage (Kirtikar).

In certain parts of India the plant is regarded as a specific for the bites of poisonous insects and venomous snakes. The juice and decoction of the root are applied to the bitten, poured frequently into the eyes and administered internally by mouth at intervals of half an hour. A tincture was tried in mild cases of malaria and was found to be useless in such cases. The aqueous extract was tried in the low chronic fever of kala-azar and also in diabetes, but it was not found to possess the virtues attributed to it. The drug was given another fair trial in the form of a liquid extract in several cases of malarial fever, both in children and adults. The action was found to be very low. The drug had to be administered for several days before even mild cases were cured. In chronic cases it did not do any good, although it is a reputed medicine in the Hindy Pharmacopoea for all fevers (Koman). The root and stem are useless in the additional treatment of snakebite; the root is also useless as a collyrium or as an external application to the bitten part (Mhaskar and Caius). The root is equally useless in the treatment of scorpion-sting (Caius and Mhaskar). (Indian Medicinal Plants, K.R. Kirtikar and B.D. Basu, 78, 79).

Medicinal Properties: Gulancha is mentioned in Ayurvedic literature as a constituent of several compound preparations, used in general debility, dyspepsia, fevers and urinary diseases. The aqueous and alcoholic extracts caused reduction in the fasting blood-sugar which has been interpreted as indicating some indirect action of the drug on carbohydrate metabolism. Similarly, glucose tolerance was increased but a deterioration in tolerance occurred after one month treatment. It has been suggested that the action of the drug is due to its favourable effect on the endogenous insulin secretion, glucose uptake and inhibition of peripheral glucose release.

A decoction of the leaves is used for the treatment of gout, . and young leaves, bruised in milk, are used as a liniment in erysipelas. The leaves are bitten with honey and applied to ulcers. Dried and powdered fruit mixed with ghee or honey, is used as a tonic and also in the treatment of jaundice and rheumatism. The root is powerful emetic and used for visceral obstructions; its watery extract is used in leprosy. After all, the entire plant including stem, leaves, root is regarded as a valuable alterative and tonic and is used in general debility, fever, jaundice, skin diseases, rheumatism, urinary diseases, dyspepsia etc. It enters into the composition of many elaborate prescriptions Chakradatta and other Sanskrit writers, most of which contain many other more or less powerful medicines. The plant early attracted the notice of European physicians in India. Fleming remarked on its use as a febrifuge, and as a tonic in gout; for snake-bite and Taylor states that the watery extract was, in his time, administered for leprosy. A little later, a paper was published on the subject by Dewan Ramkamal Sen in which he described the method of preparing the extract, also a decoction of the stem, root and leaves. (The Wealth of India, Raw materials)

Medicine: O'Shaughnessy states that the extract was found to be a very useful tonic in several trials made at the Calcutta College Hospital, though decided febrifuge effects could scarcely be attributed to it. The decoction or cold infusion he described as a very great utility in the treatment of several cases of chronic rheumatism, and of secondary syphilis, its action being decidedly diuretic and tonic in a very high degree.

Gulancha was accordingly admitted to the Bengal Pharmacopoeia of 1844 and the Indian Pharmacopoiea of 1886. In the latter a tincture, infusion, and watery extract (which correspond to the palo of the natives) are officinal. Waring corroborates O'Shaughnessy's statements regarding its greater value as a tonic than as an antiperiodic. "The fresh plant is said to be more efficient than the drug; it is taken with milk in rheumatism, acidity of the urine and dyspepsia. The juice with pakhanbed and honey is given in gonorrhoea, and is an ingredient paushtiks given in phthisis. In Guzrat a necklace called kamala-ni-mala (jaundice necklace) made of small pieces of the stem is supposed to cure that disease". Moodeen Sheriff considers the drug alterative tonic and antipyretic, and states that the root and stem, but especially', the extract, are useful in slight cases of fevers, in secondary syphilis and rheumatism, Jaundice, general debility after long standing sickness, and splenic affections. He suggests that one or other of the officinal preparations might be substituted for quinine, James' powder, potassic iodide and sarsaparilla.

Special Opinions: "There is a general belief amongst the Muhammadans of India that the gulancha growing on a Margosa tree is more efficacious as a medicine than that which may be found on other kinds of trees, hedges, etc. and they, therefore, cultivate the plant in their own houses and gardens, and make it run over Melia azadirachta. The watery extract of the plant is greatly used as a remedy in fevers and is called 'Indian Quinine' by some Hakims. This is of course, a great exaggeration of its value but there is no doubt that it is a very useful drug, especially in some very obstinate, low, and longstanding remittent and typhoid fevers. Its action is generally more satisfactory when employed in combination with other drugs of similar medicinal properties. Although it is not costly drug, yet it is generally substituted by, or adulterated with, many cheaper substances in the bazaars, so much that out of the seven specimens I have received from different places, including Calcutta, Hyderabad and Lucknow, none is found to be genuine" (Honorary Surgeon Moodeen Sherif, Khan Bahadur, Triplicane, Madras) "Have used it a little in the shape of decoction of the root, as an antiperiodic but not successfully" (Surgeon D. Picachy, Pumeach).

"Gulancha, which grows on neem trees, is considered most efficacious for remedial purposes" (Surgeon Anund Chunder Mukerji, Noakhally) "Tonic and antiperiodic" (Assistant Surgeon Nehal Singh, Saharanpore). "The bazaar extract is starchy in its nature and does not contain the bitter principle of the plant" (Surgeon Ma-Major Robb, Civil Surgeon, Ahmedabad.) " Bitter tonic and diuretic in the form of decoction" (Civil Surgeon C. M. Russel, Sarnn). " Gulancha is an excellent substitute for Calumba. The starch prepared from the plant is much used, but it is not so efficacious as the infusion" (Surgeon R.L. Dutt, M.D., Pubna). "Tonic useful in chronic rheumatism and fevers" (Asstt. Surgeon S. C. Bhattacharji, Chanda). "Useful in chronic rheumatism and secondary syphilis" (Surgeon-Major H.J. Hazlitt, Ootacamlend). "Is a favourite dispensary remedy as a tonic and alterative in the Behar district" (Surgeon R.D. Murray, M.B. Burdwan). "An extract made nom the stems by crushing and infusion, is much valued by the natives as an antiperiodic. It is given in doses of 5 grains, and commands a high price in the bazaar. It is superior to cinchona febrifuge" (Narain Misser, Khate Bazar Dispensary, Hoshangabad, Central Provinces). (Dictionary of the Economic Products of India)

Steven Reinberg

Women with cardiovascular risk markers are at heightened risk of developing preeclampsia when pregnant, and pregnant women who do develop preeclampsia are at higher risk for developing heart disease later, British and Norwegian researchers report.

Preeclampsia, a condition in which abnormally high blood pressure develops during the second half of pregnancy, affects about 5 percent of all first pregnancies and is dangerous for both mother and child, according to two studies published in the Nov. 2 online edition of the British Medical Journal.

In the first study, Norwegian researchers found that cardiovascular risk factors that show up before pregnancy increase the risk of preeclampsia sevenfold.

"This study is the first that confirms the hypothesis that lipid and blood pressure abnormalities before pregnancy are strong predictors of preeclampsia," said lead author Elisabeth Balstad Magnussen, a research fellow in the Department of Public Health Faculty of Medicine, Norwegian University of Science and Technology, Trondheim.

To assess the risk, the researchers looked at 3,494 women, recording any cardiovascular risk markers, including blood pressure, cholesterol, blood sugar levels, weight and body mass index, before pregnancy. Among the group, 133 developed preeclampsia during pregnancy, the researchers found.

Magnussen's team then found that those women who had high blood pressure, high cholesterol and high blood sugar levels before pregnancy were seven times more likely to develop preeclampsia compare with the others.

In addition, women who had a family history of high blood pressure, heart disease, or diabetes had double the risk of developing preeclampsia. And, being overweight or obese also increased the risk, the researchers found.

However, the research also showed that women who had used oral contraceptives had half the risk of preeclampsia compared with those who never used oral contraceptives.

"The findings suggest that preeclampsia and cardiovascular diseases may share a common origin, and that the increased risk of cardiovascular disease subsequent to preeclampsia, at least partly, is due to an underlying biological trait of the woman," Magnussen said.

In the second study, British researchers reviewed 25 studies that included 3.5 million women worldwide. Almost 200,000 had developed preeclampsia while pregnant. The researchers then calculated the future risk of heart disease, stroke, hypertension and thromboembolism.

"Women who have had preeclampsia are at a roughly twofold increased risk of cardiovascular disease in later life, compared with women who did not have preeclampsia," said lead researcher David Williams, a consultant obstetric physician at the Institute for Women's Health at Elizabeth Garrett Anderson Obstetric Hospital, University College London.

"Specifically, these women have an almost fourfold increased risk of hypertension, and a doubling of the risk of heart disease, stroke, and venous thromboembolism," he added.

Some of the larger studies in the review suggested that this increased risk of heart disease after preeclampsia is independent of other recognized risk factors and, therefore, should become an important factor when assessing a woman's cardiovascular risk, Williams said.

The risk of a cardiovascular disease usually increases with age, the researchers noted. The normal risk for heart disease among women 50 to 59, is about 8 percent, but for women who have a history of preeclampsia, it is 17 percent. At ages 60 to 69, the risk is 14 percent and 30 percent, respectively, Williams' team explained

In their analysis, the researchers didn't find any increased risk of cancer, including breast cancer. This suggests that there is a specific relationship between preeclampsia and heart disease, the researchers said.

One expert agreed with the conclusions of both studies.

"I believe in these findings that preeclampsia is related to cardiovascular disease," said Dr. Richard Levine, a senior investigator at the U.S. National Institute of Child Health and Human Development.

"In women who develop preeclampsia, there are already signs of metabolic syndrome, which is linked to subsequent cardiovascular disease," he said.

Women who develop preeclampsia should be screened for heart disease, diabetes and metabolic syndrome, and women at risk for preeclampsia before becoming pregnant should also try to reduce their cardiovascular risk factors to help prevent the condition, Levine said.

"Get your weight under control," Levine said. "If you have diabetes or chronic hypertension, get that attended to and take medications to lower your cholesterol, exercise, and eat well."

A H M Abdul Hai

(From previous issue)

Here is the situation more fatal as expatriate husbands are maintaining extra-marital sex-practice in those countries and their wives have the same sex-practice here. That is why we see time and again some Bangladeshis are identified as HIV positive in the foreign land and they are forcibly returned home. They are coming back and having sex with their wives and spread it at large. The vulnerable situation of such an extra-marital sex practice does not come to light as these characters always pretend to be honest, pious and chaste.

Though pre-marital and extra-marital sex-practices are in such a risky level in Bangladesh, no bride or bridegroom dare demand HIV test prior to the marriage. So the question easily comes ahead "Who is and how much aware of HIV/AIDS in Bangladesh?" It clarifies that the NGOs and Government programs could reach only limited community members such as brothel-based and hotel-based sex workers, Injecting Drug Users of drug-dens and a few of internal migrants. But a large portion of common people are left unaware and untouched. The Bangladesh Demographic and Health Survey 2004 shows, in last two decades several crores of Taka had been spent on "Awareness Raising and AIDS Prevention". However, only 22/% of the population is aware of HIV/AIDS. In the same survey, it was found, only 60% of women and 42% of men have heard of AIDS. One third of men could not name a single method of avoiding HIV. Only one in ten men knew that limiting to one partner could reduce the risk of HIV transmission. In addition, a large majority of respondents have not heard of STIs at all, which accounted for more than 70% in all categories interviewed. There are known to be significant barriers to condom use in the whole country. These include the perception of men that it reduces sexual pleasures, is barrier to closeness and associated with promiscuity and illicit sex. There is also the embarrassment associated with the purchase of condoms. A survey also found that 18% of sexually active male adolescents had sexual intercourse with sex workers. Among the married male, 36% is reported having pre-marital sex.

While commenting on the 7th National Surveillance Report, former Programme Manager of National AIDS/STD Program (NASP) Dr Abdus Salim says, "HIV prevalence rate in Bangladesh is below 1 percent but risk practices and environment for infection are rampant here." He says that Bangladesh is geographically also at risk of AIDS. Long border area, sex trade, labor migration as links between most at risk population and general people together with gender discrimination, poverty, low level of education, high level of drug addiction among youth, inadequate health service and lack of awareness about HIV/AIDS, which promote infection of this virus, are still prevailing in the country. UNAIDS and World Health Organization, in 2004, expressed their concern that Bangladesh has about 14 - 15 thousand HIV positive people, but NASP estimates the number of HIV positive people in Bangladesh is 7,500. Government did not accept the UNAIDS statistics without any proven ground.

It is very noteworthy in the present national perspective that, while preparing voter ID and national ID card for the people, the Government can easily accomplish all five tests including HIV/AIDS status and mention blood group in the ID cards at the same time. Because, till now Government can not strongly claim any accuracy of their own data of 874 AIDS cases when crores of people are beyond the access of having HIV test. Moreover, it will be a great achievement if Government introduces HIV test in every seaport, airport and land ports just now to combat HIV/AIDS infection through external migrants.

Being afraid of the article to be over-loaded by only a lump of data and figures, it has been limited to the boundary of analyzing root-level and hidden but real situation of sexual vulnerability keeping other vulnerable behaviors left aside. It is with the view to storming the brain and thought of the countrymen and policy makers to address the newly-discovered areas and fill in the loop-holes concerning HIV/AIDS prevention, treatment, care and awareness issues. Otherwise, it will be late when the AIDS bomb is blasted and positive people will be explored in a geometric rate of multiplication.

[Writer is a freelance journalist)

(Concluded)