The New Nation - Internet Edition

Medicine at our doorsteps: Angur (Grape)

Jamayet Ali

Juicy and tasty fruit Angur is favourite to all. More than fifty species of this fruit are known. Of these Angur is the most important and universally cultivated grape vine. With only a few exceptions, all modern grapes are direct or hybrid descendants of this species. It is known that cultivation of Angur most probably began in Asia Minor, in the region between and the south of Black and Caspian seas. Many naturalised or possibly wild forms are still known in this area. From Asia Minor, the culture of grape spread both towards west and east. Though Angur is not grown in Bangladesh, it comes from other countries as import item and its availability is satisfactory. It is sold in hats and bazaars and also in the shops of fruit sellers in rural Bangla.

While wine-grapes soon spread throughout the Southern and Central Europe, almost at the same time the cultivation of raisin table grapes was spreading around the eastern end of the Mediterranean sea to the countries of North Africa. Almost coinciding with the westward extension of cultivation, it moved eastwards through Turkey and Iran to Pakistan and India. The leading grape growing countries in different regions are: Italy, France, Russia and Spain in Europe; Turkey, Iran, Afghanistan, Japan and Syria in Asia; Algeria, South Africa and Morocco in Africa; Argentina and Chile in South America and U.S.A. in North America. In our country cultivation of Angur (Grape) are still on experimental stage. Applied Botany Research division of the BCSIR, Rajshahi has undertaken a project for studies on grape production and improvement of its quality.

Angur is a good source of bioflavonoid (vitamin P), which are known to be useful in such conditions as purpura, capillary bleeding in diabetis, odema and inflammation from injury; radiation damage, and atherosclerosis, catechines and anthocyanogenic tannins present in angur possesses bioflavonoid activity. Vine sprouts and leaves are rich sources of bioflavonoid (Watt and Breyer Brandwijk, 1060). Food scientists have proved by analysis that per 100 grams. edible Angur contain: moisture, 75.3; minerals, 0.5, fibre, 2.9; calorie 97 k; protein, 0.5; fat, 0.1; and carbohydrate, 23.6 g . calcium, 22; iron, 0.5; vitamin B-1, 0.10; vitamin B-2, 0.06 and vitamin C 29 mg / 100g. (Food Processes and Analyses, Mohammad Yunus, BARC, Dhaka).

Medicinal Properties: There are five kinds of fruit. The ripe fruit is acrid; cooling, laxative and purgative, fattening, diuretic, aphrodisiac, appetizer; good for the eyes, and the throat; cures thirst, fever, asthma, "vata" and "vatarakta", jaundice, strangury, burning, bad effects of drinking, blood diseases; allays vomiting; difficult to digest, causes gases in the stomach; causes "kapha". The sour fruit causes biliousness (Ayurveda).

The leaves are useful in piles. Their juice cures headache, syphilis, piles, inflammation of the spleen; diuretic; allays vomiting, stops bleeding from the mouth; applied in scabies, produces alopecia. The ashes of the stem are good for pains in the joints, stones in the bladder, swelling of the testicle, and piles. The flower is expectorant, emmenagogue; enriches the blood; tonic of the liver; good in chronic bronchitis; produces constipation. the fruit is sour, sweet; digestive, stomachic, expectorant; purifies and enriches the blood; good for lungs, liver and kidney; fattens the body; useful in old fevers; recommended to weak people. The skin of the fruit should not be eaten. The seeds are cooling, aphrodisiac, astringent to the bowels; their ash is applied to diminish inflammation (Yunani).

The dried fruits are demulcent, laxative, sweet, cooling, agreeable and useful in thirst, heat of body, cough, hoarseness and consumption. The sap of the young branches is a popular remedy for skin diseases, and is still a popular remedy in Europe for ophthalmia. The juice of the unripe grapes is used as an astringent in affections of the throat. Black raisins in combination with other drugs are prescribed for the treatment of snake-bite (Sushruta, Vaghbata) and scorpion sting (Sushruta). The leaves, on account of their astringency, are sometimes used in diarrhoea. In modem native practice, the raisins are considered cool and aperient and given in coughs, catarrh and jaundice (Indian Medicinal Plants, K.R. Kirtikar & B.D. Basu, 608)

Medicine: Angurs both fresh and dried have varied uses in Ayurvedic and Unani system of medicine. Fresh grapes are considered laxative, stomachic, diuretic, demulcent and cooling; raisins are also demulcent, laxative, cooling and expectorant. Grapes are used in the preparation of various medicines. The popular tonic Drakshasava is made from grape juice. Similarly grapes enter in to the preparation of Chyavanaprasa. The juice of the unripe berries is used as an astringent in throat affections. The leaves are astringent are some times used in diarrhoea. The sap of young branches is reported to be used for skin diseases and ophthalmia (Chopra, 1958, 530; Marketing of grapes in India, 1965, 47).

According to U.C. Dutt the dried fruits or raisins have for many centuries been employed medicinally by the Hindus. They are described as "demulcent, laxative, sweet, cooling, agreeable and useful in thirst, heat of body, cough, hoarseness, and consumption. Raisins also enter into the consumption of numerous demulcent and expectorant medicines." Dutt describes the preparation of a medicinal wine known as Draksha arishta of which the chief ingredients are raisins treacle, cinnamon, cardamoms, tejpatra, the flowers of Mesua ferrea, the fruit of Aglaia Roxburghii, black pepper, long pepper; etc. set aside until fermented. This liquor was deemed invigorating and nourishing and was used in consumption, cough, difficult breathing, and hoarseness.

In European Pharmacy raisins are similarly employed in compound tincture of cardamoms, tincture of senna on account of saccharine matter they contain. Noureddeen Mohammad Abdulla Shirazy, Physician to the Emperor Shahjehan in his work Ulfaz Udwich gives the uses of grapes, raisins, and wine among the Mohammadans in his time. A species of black grape known as Asa' ba ul Ghe sa-ri, PERs; Kali-dakh, Hind; and Angur-zeituni, ARAB, was regarded as hot and dry. Wine by the Muhammadan Physicians was a hot and dry cordial. Raisins without seeds, were known as Zebir in ARAB; Kishmish in HIND; Me-wiz in PERS; they were regarded as emollient and suppurative. Abdullah Shirazy adds that the vine plant was in Arabic kerm.

The Muhammadan writers regarded the fruit as one of the most digestible, purifying the blood, and increasing its quantity and quality. Dymock tells us that ''The ashes of the Wood are recommended as a preventive of stone in the bladder, cold swellings of the testes, and piles; in the two last named diseases they are to be applied externally as well as given internally. The juice of unripe grapes, Husrum, ARAB; Ghurch, PERS, is used as an astringent". The sharbat, or syrup of grapes, says Moodeen Sheriff, is a very pleasant and cooling drink, and proves very useful in relieving thirst and other pyrexial symptoms in many forms of fever. I have also used it with advantage in ardorurinae, dysuria, strangury, and some cases of bilious dyspepsia. It is one of the best and most agreeable vehicles for other medicines particularly those used in dyspepsia, dysentery, diarrhoea and dropsical affections. From this combined actions of demulcent, expectorant and laxative, raisins are a frequent ingredient in Muhammadan prescriptions for catarrhal and febrile complaints. The cut branches of vine yield in spring and abundant SAP, which was formerly used as a remedy for skin diseases, and is still a popular remedy in Europe for ophthalmia"

Special Opinions: "Munakka" and 'Kismis' are different species. The former as regarded as cooling and laxative." (Assistant Surgeon Shib Chundra BhattachaIji, Chanda, Central Provinces). Grapes are largely imported from Afghanistan. The fresh fruit is grateful and useful in allaying thirst in febrile condition" (Brigade Surgeon G.A. Watson, Allahabad) (Dictionary of the Economic Products of India).

Dysfunctional American Healthcare System

Adnan Gill

Each year the UN publishes a report, known as the Human Development Index (HDI). It is a report card that grades the standards of life in 177 nations. Three dimensions are used to measure the human development: life expectancy, education, and Purchasing Power Parity (PPP per capita)/income. The United States is one of the richest nations that enjoys the PPP of US$41,890; only second to Luxembourg (PPP US$60,228). Despite its 13+ trillion dollar economy, it is placed at the 12th place on the HDI.

One of the major reasons world's largest economy was placed at the embarrassing 12th place was its commitment to health of its citizens: resources, access and services. According to the 2007/2008 HDI Report, Iceland received the coveted HDI 1st place. Iceland whose PPP is $ 36,510, spent 8.3% of its GDP on the healthcare. Whereas, the US spent a meager 6.9% of its GDP on the healthcare. What really separated the two apart was the disproportional life expectancy rate at birth. In Iceland, the life expectancy at birth is 81.5%, while, the same in the United States is 77.9%. Paradoxically, a country that spends about 50% ($450 billion) of the world's total military spending ($910.6 billion) is awarded a dismal 31st place-out of 177 nations-for the mortality rate.

US is the only industrialized nation in the world that lacks some form of universal healthcare. Roughly 60% Americans have access to health insurance through employers and the workers' contributions. An estimated, 47 million Americans remain uninsured. Health insurance in the US remains very expensive. The ever increasing insurance premiums outpace the inflation rate, which is unduly burdening the employers and consumers. According to a Health Affairs study, half of personal bankruptcies in the US involve medical bills.

The ominous condition of American healthcare system also stands out when compared to its northern neighbor, Canada. In 2000, World Health Organization's ranked the American healthcare system's performance at 72nd and Canadian's at 35th place out of 191 member nations. In 2004, America spent double the amount ($6,096 per-capita) on its health care system than what Canada did ($3,038).

The jury is still out on whose system is better, but it will be hard to overlook certain undeniable facts, like health insurance and drugs are much more expensive in the US as compared to Canada. Supporters of American health care system allege that Americans get bigger bang for their buck; in other words, the medical care in the US is superior to what is available in Canada. However, the critics retort, what good is superior medical care if it's not available to 47 million Americans to begin with?

Critics also allege, that the American system favors the special interests, who are more interested in profits, rather than the patients. These interests include pharmaceutical giants and health insurance companies.

Ironically, Americans find it is much cheaper to re-import prescription drugs from Canada. On average, the Canadian drugs costs as low as one-eighth of US prices. That is why, in an effort to reduce the healthcare costs, some of the American states are also contemplating on re-importing drugs from Canada. The burden of expensive drugs mostly falls on elderly and disabled, many of whom live on fixed incomes and are forced to choose between prescription drugs-that can prolong their lives-and the immediate necessities of life like rent, food, heat, electric power, and telephone service. Consequently, for last decade or more, the Americans have been crossing the Canadian border for lower-cost prescription drugs.

Mere fact that Americans are forced to travel to Canada in busloads to re-import prescription drugs is a sad commentary on the dysfunctional American healthcare system. It should raise red flags to the policymakers that the system is in dire need to be rescued; so every American would have the same chances of surviving an ailment as the citizens of any other industrialized nation do.

Immunization from whooping cough

Pertussis (whooping cough) is one of the leading causes of vaccine-preventable deaths worldwide, and its prevalence in the community is underestimated.

Most deaths occur in young infants who are either unvaccinated or incompletely vaccinated.

A study published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine, has found a high percentage (32%) of staff working in an emergency department had low immunity and were therefore at risk of becoming ill themselves and of spreading the infection if a patient with the disease sought treatment in the department.

The researchers recommend that all ED staff be routinely offered booster immunization for pertussis. The study, led by Dr Omar Faruque from the Emergency Department at St George Hospital in Kogarah NSW (previously at Royal Hobart Hospital), was conducted at two hospitals in Hobart.

"There was evidence that some winter leave in southern Tasmania might be a reason for pertussis infection among unimmunized staff. This results in loss of individual earning and loss of availability of staff during the peak demand periods in the ED. There is evidence in the literature that underdiagnosis and undertreatment of pertussis occurs worldwide," the researchers said. To determine the proportion of ED staff who are susceptible to pertussis, they studied 97people

Ninety-one of them (94%) believed that they had been immunized for pertussis in childhood; six had either not been immunized or were unsure (6%).

Twenty-three (24%) had been immunized as adults.

The researchers found serologic evidence of recent infection for 21 participants (22%), and 31 (32%) were susceptible to pertussis on the basis of low immunoglobulin G titres. The epidemiology of pertussis has changed significantly, and childhood pertussis vaccination does not offer lifelong protection.

The staff working in an emergency department might be at risk of pertussis from patients and vice versa.

"Adult pertussis occurs despite a prior history of childhood immunization and, indeed, in persons with a history of previous pertussis infection. This is further complicated by the fact that underdiagnosis and undertreatment of pertussis occurs worldwide," the researchers said.

Resurgence of pertussis was first observed in 1976 in the USA, despite widespread immunization since 1951. The resurgence might be in part attributed to declining vaccine-induced immunity. The absence of repeated boosters, by either immunization or exposure to infected persons, is the most likely explanation, the researchers suggested.

Pertussis is spread by respiratory droplets to 80% of susceptible household contacts.

Epidemics occur every 3-4 years. The presentation of pertussis is less severe in vaccinated people than it is in unvaccinated people, leading to an underestimation and misdiagnosis of cases.The ED staff are potentially at risk of acquiring this infection from an undiagnosed or asymptomatic patient who presents to the ED for treatment. Once infected, these staff might become a reservoir of disease for patients, colleagues and their own families.

The researchers recommend routine booster immunization of emergency department staff and they also strongly advise the community to check with their doctor about their immunization status for this and other vaccine-preventable diseases.