East knows some science

New vistas in Prof. Khuroo’s pioneering work

E Virus

DR. JAVID IQBAL

New vistas in the pioneering effort on ‘E’ virus provide room for re-assessing Prof. Khuroo’s work. The study pool of ‘E’ virus is piling up for variety of reasons. Prof. Khuroo’s update keeps the medical community abreast with advances in research. The viral phenomenon of mutation—changing form makes the study dynamic. Lately western studies have multiplied as viral form affecting the advanced west and Japan has changed concepts. The initial skepticism related to Khuroo endevour changing to gradual acceptance may be attributed to western disbelief in anything positive emerging from east. ‘Rome knows no art’ the proverbial belief emerged in an age of Greek ascendance in all realms of knowledge. In modern era, it might translate to mean ‘East knows no science’.
Knowledge, said the ancient Greeks, originates in wonder. Archimedes charged with finding the weight of the gold wondered how to find it. Taking a dip in water, he jumped out with that cry ‘Eureka’ I have found it!  It stands noted in annals of knowledge. Weight equals the water displaced. Khuroo’s interest in Hepatitis [liver inflammation, mainly viral] was stoked by PGI Chandigarh guide Prof DV Datta. Doctoral study [DM] in medicine was studded with the query over daily cups of coffee, “Sultan why do women come with fulminant hepatitis and die”? Datta’s Punjabi intonation added thrust to the scientific query.
‘Mini Tsunami’ as Khuroo called Kamraz [north Kashmir] epidemic of 1978 started providing the answers. It recorded 52,000 cases, loss of 1700 lives in a population group of 600,000 people residing in 200 villages with a single water source ‘Ningal Nallah’ contaminated with fecal matter from latrines build in its course. Pregnant women showed a greater impact of the disease in the population group studied by Khuroo led GMC Srinagar team, aided by 500 health workers. Fulminant form Prof. Datta talked of pertains to severe form of liver ailment resulting in failure, seen in pregnant woman in third trimester [last three months of pregnancy]. The mortality [death] rate has been assessed to be 20% higher in affected pregnant woman. Otherwise in Genotype I and 2, the epidemic viral forms seen in unhygienic states, mortality rate is 1 to 2 %. The disease though incapacitates the ones affected until it lasts, which could be several weeks.
Hepatitis, notes Prof. Khuroo in his masterly essay on the subject entitled, ‘Hepatitis-the untold story’ was known in the era of Greek pioneer of medicine--Hippocrates [460-375 B.C]. Jaundice, its predominant clinical sign, noted Hippocrates, was the decisive factor in victory or defeat in war--depending on the side getting afflicted most. In Hippocratic era, epidemic proportions of Hepatitis though noted had to wait ages before the human race got to grips with it.  Jaundice, the yellowish tinge of sclera in the eye became proverbial--the jaundiced eyes that cannot see anything but yellow--the tainted.
In his latest essays on the subject, Prof. Khuroo notes, three decades of HEV study led to a conference entitled ‘International symposium on Hepatitis E’ held in international vaccine institute Seoul, South Korea on September 15/16, 2010. It was sponsored by Bill & Melinda Gates foundation, center for disease control in Atlanta Georgia-USA and World Health Organization [WHO]. The focus remained on establishment of ‘International consortium for control and prevention of viral hepatitis E’. Turmoil in summer 2010 held back Prof. Khuroo from personal appearance. He addressed the meet through ‘Telemedicine’ from his office in Srinagar. This was followed by drafting the article entitled ‘Discovery of Hepatitis E: The epidemic Non-A, Non-B hepatitis 30 years down the memory lane’.
Neither the sera study [the laboratory tests] nor was clinical evidence conforming to known forms--HAV or HBV [Hepatitis ‘A’ or ‘B’ virus]. Hence it was named Non-A, Non-B. It did not conform to anther known form--Hepatitis ‘C’ virus [HCV]. Prof. Khuroo presented his findings to plenary session of 20th annual meeting of Indian society of Gastroenterology [ISG] on October 12, 1979 at Pune, India. Subsequently it was widely communicated.
Genotype 3 and 4 in sporadic form seen mostly in developed states affects the elderly and could have a mortality rate of up to 5 to 10%. Studies revealed that in sporadic incidences [where the disease does not occur in epidemic form] animal species--domestic swine, wild boar and wild deer could cause the viral disorder, notes Prof. Khuroo in some of his latest essays. These animal species were found to be reservoirs of hepatitis ‘E’ virus. Human infections occurred due to intake of uncooked or undercooked meat of the infected animals, pig livers or sausages made of these livers and sold in supermarkets. 
Efforts to develop vaccine to prevent the occurrence stand covered in Prof. Khuroo’s latest essays. China worst affected over last few decades leads the drive, the promise heightened in 2012. In preventive measures providing clean water in underdeveloped and developing states needs huge funding. International effort is lacking. Apart from lives claimed in hundreds of thousands by other water borne diseases, E virus annually causes 20 million infections, 3 million being acute, and results in 70, 000 deaths. All the talk of advancement, globally knit economy, north—south understanding in economic realm appears bizarre in a world which cannot ensure safe water supply to majority of global inhabitants. 
Yaar Zinda, Sohbat Baqi [Reunion is subordinate to survival]        

Lastupdate on : Tue, 5 Feb 2013 21:30:00 Makkah time
Lastupdate on : Tue, 5 Feb 2013 18:30:00 GMT
Lastupdate on : Wed, 6 Feb 2013 00:00:00 IST




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