Outbreak of Zika Virus: How to prevent?


Current outbreak of  Zika  in Rajasthan is a warning for another potential disaster. The Prime Minister’s Office (PMO) has asked the Union health ministry for a report on the localised outbreak of Zika after 22 people tested positive for the mosquito-borne virus, which can cause birth defects in unborn babies, in Rajasthan’s capital Jaipur.

The Union health ministry, in a statement on Monday, confirmed the Zika cases in Jaipur so far through the Indian Council of Medical Research (ICMR) surveillance system.

About Zika Virus- summary

  • Zika virus disease is caused by a virus transmitted by Aedes mosquitoes.
  • People with Zika virus disease usually have a mild fever, skin rash (exanthema) and conjunctivitis. These symptoms normally last for 2-7 days.
  • There is no specific treatment or vaccine currently available.
  • The best form of prevention is protection against mosquito bites.
  • The virus is known to circulate in Africa, Americas, Asia and the Pacific

India needs to be particularly conscious about the spread of the disease since the mosquito that carries the virus actually thrives in the country. The Aedes Aegypti mosquito whose bite transmits the disease is the same as the one that transmits dengue and chikungunya, which is widely prevalent in India. With the temperature rising across India, it becomes more important to take precautions and not let the Aedes Aegypti mosquito breed.

What is Zika?

The virus is transmitted by Aedes aegypti mosquito, the same mosquito that transmits dengue and chikungunya. Its name comes from the Zika Forest of Uganda, where the virus was first isolated in 1947.

In pregnant women, Zika can cause birth defects such as microcephaly – unusually small heads – and other brain abnormalities in babies in the womb. The infection can also cause Guillain-Barre syndrome, a rare neurological disorder that causes paralysis.

There is no treatment or vaccine for the Zika infection.

Symptoms

The virus can show symptoms such as mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or a headache and body ache. But only about 20% of patients show symptoms that usually last up to a week.

Why should  one fear Zika?

It is strongly suspected to cause birth defects and neurological problems in newborns and as birth rate is high in the country special care needs to be taken. Since India provides fertile climate for the aedes egypti mosquito to grow and multiply, there is the potential of an outbreak situation in the country.

How can you avoid the virus?

Check mosquito breeding in and around your house. The mosquito that carries Zika virus – Aedes aegypti – breeds in fresh water so don’t let water collect in birdbaths, planters, non-used bottles, containers, discarded waste, tyres etc.

Use mosquito repellants such as creams, gels, electronic mosquito repellents, patches, incense sticks and bed nets. Grow plants that are known to repel mosquitoes such as citronella, basil, lemon grass, lavender, mint, rosemary etc.

Take special precautions during the day as Aedes aegypti is a day-biting mosquito and dress appropriately that covers most of the body parts.

WHO risk assessment

There has been  evidence on the circulation of the virus in India. Low level transmission of Zika virus and new cases may occur in the future. Efforts to strengthen surveillance should be maintained in order to better characterize the intensity of the viral circulation and geographical spread, and monitor Zika virus related complications. Zika virus is known to be circulating in South East Asia Region. WHO encourages Member states to report similar findings to better understand the global epidemiology of Zika virus.

The risk of further spread of Zika virus to areas where the competent vectors, the Aedes mosquitoes, are present is significant given the wide geographical distribution of these mosquitoes in various regions of the world. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

WHO advice

Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.

 

Loss of cabin pressure caused hypoxia, bleeds in Mumbai: Major tragedy in Greece@ air travel


More than 13 years ago, a Boeing aircraft crashed in a hilly terrain in Greece snuffing out 121 lives. A year later, investigators concluded that omissions in controlling cabin pressure was a key reason for the crash. Extreme case in 2005, a Helios Airline flight crashed into a mountain after the pilots lost consciousness from hypoxia.

One of the pilots said that generally, an aircraft is pressurized to 8,000 feet so that the pressure is adequate for the human body. Normally, a plane flies at an altitude of around 35,000 feet.

De-pressurization could even result in hypoxia for the people on board. Hypoxia or lack of adequate oxygen supply for the human tissues, can cause various problems, including deterioration in a cognitive abilities.

Loss of cabin pressure could result in hypoxia or the deprivation of oxygen. Oxygen deprivation is also the cause of headaches, nausea, and nosebleeds. A sudden drop in air pressure can be fatal for people with pre-existing conditions such as hypertension and cardiac anomalies .  There is a cavity in our oral and nasal passages and sudden change in air pressure of the surroundings negatively impairs the internal air pressure maintained in these cavities, thus causing bleeding through nose, ears or mouth. At the same time, the sudden drop in the pressure and lack of oxygen supply to the brain can also cause strokes, paralysis or convulsions in some people.

Drop in air-pressure in the surrounding affects people differently. While it usually causes heaviness in the head, dizziness and drowsiness in some, it can also be fatal for people with high blood pressure and a history of heart attacks. The five passengers suffered “barotrauma” of ear, which is caused due to a change in air pressure.

Several passengers on a Jet Airways Mumbai-Jaipur flight suffered nose and ear bleeding on Thursday morning as the pilots forgot to switch on the system to maintain cabin pressure, the DGCA said. “The 9W 697 Mumbai-Jaipur flight was turned back to Mumbai after take off as, during the climb, crew forgot to select switch to maintain cabin pressure. This resulted in the oxygen masks dropping. Thirty out of 166 passengers experienced nose and ear bleeding, some also complained of headache,”   deputy director general, Directorate General of Civil Aviation (DGCA), said. The crew has been taken off duty and Aircraft Accident Investigation Bureau (AAIB) has started an investigation, DGCA added. Ministry of Civil Aviation has requested DGCA to file its report immediately on the issue. The passengers are being treated at Mumbai airport. In a statement, Jet Airways said the B737 aircraft landed normally in Mumbai. “All guests were deplaned safely and taken to the terminal. First aid was administered to few guests who complained of ear pain, bleeding nose etc. The flight’s cockpit crew has been taken off scheduled duties pending investigation. The airline is making alternative flight arrangements for guests on this flight. Jet Airways regrets the inconvenience caused to its guests.” Several passengers posted images from inside the plane,  that showed that oxygen masks had been deployed due to the low cabin pressure

Invisible medical harms of carpet-bomb treatments with FDC (fixed dose combination): @ Government prohibits 328 fixed dose combinations


Drug Technical Advisory Board said there is no therapeutic justification for the ingredients contained in the 328 fixed-dose combination or FDC drugs.

A fixed-dose combination or FDC drug contains two or more active ingredients in a fixed dosage ratio. It means it’s not the single drug but a combination of the two or more,  which may be   unnecessary for consumption.

  1. Antibiotic  resistance: Most harmful impact can be because of antibiotics in FDC.

– Logic is simple. If  some one  is  not able to recognize, whether it is a rat, cat, dog or tiger causing trouble, carpet bomb with combination of three or four   bombs.  Is it overuse of  weapons? Yes, it is. Similarly, abuse of multiple antibiotics has potential to cause massive antibiotic resistance, can have global harmful effect.

Quacks or by self medication,  antibiotics may be overused  and abused . Quacks  or alternative medicine doctors often prescribe FDCs as they are unable to pinpoint the exact cause of an illness and carpet-bomb patients with combination doses, in the hope that one of the drugs would work.

  1. Overuse of drugs: where one drug for example a paracetamol is required, patient will take three medicines.
  2. Increase in side effects: instead of one medication, patient will have side effects of all other medicines also.
  3. inadequate doses: If many drugs are combined in one, doses may be inadequate or less. So patient takes more drugs , but in adequate doses.
  4. Increase in cost: instead of one , the patient pays for three drugs, thereby increase in cost.

Government prohibits 328 fixed dose combinations 

     Painkiller Saridon and skin cream Panderm are among 328 fixed-dose combination or FDC drugs banned by the government to stop their “irrational use”. The health ministry says the ingredients in these medicines do not markedly add to the benefits that people can get from taking them. The order immediately bans the manufacture, marketing and sale of several common cough syrups, painkillers, and cold and flu drugs. The country’s drug advisory body, the Drug Technical Advisory Board or DTAB, has said there is no therapeutic justification for the ingredients in these drugs and they must be banned in public interest.

-The government has added restrictions to dosage and use of six more FDCs,  not among the 328 banned ones,  over their ingredients having no therapeutic value and posing a risk to consumers.

-The health ministry took the decision after the country’s top drug advisory body, the Drug Technical Advisory Board or DTAB, in a report said taking the 328 FDCs would be a health risk. India has some 2,000 FDCs as against a little over 500 in USA.

-It is a good move for public health. Individual drugs are approved by the centre, but some manufacturers make combinations of two drugs and get state licences.

-Mixing two drugs create a new medicine. For new medicine , pharma companies should approach the Drugs Controller General of India and apply for a fresh licence, conduct trials and  prove safety.

-In March 2010, the government restricted sales of 344 FDCs, a move that was challenged by pharma firms in court. The Supreme Court last December told the DTAB to ascertain whether FDCs should be banned from the market.

Every one is  calculative about  the loss of millions.  The invisible losses to human kind are still to be calculated.

 

Air pollution, Ultra fine dust causing millions premature deaths by heart attacks, strokes


Globally, 58% of outdoor air pollution-related premature deaths are due to heart disease and strokes, 18% due to chronic obstructive pulmonary disease, 18% from lung infections, and 6% because of lung cancer, said the World Health Organisation’s 2016 estimates.

Outdoor air pollution leads to 4.2 million premature deaths worldwide each year, with close to 60% of the deaths from heart attacks and strokes, according to the World Health Organisation. Finally, scientists appear to have figured out just how fine dust attacks the cardiovascular system.

An analysis of the effect of the different components of polluted air, including ozone, nitrogen dioxide, carbon monoxide and sulfur dioxide, showed that small particulate matter is the most damaging to the body’s vascular system, reported a team of researchers from Germany, England and the US.

Ultrafine dust (particulate matter 2.5 microns or less in diameter, or PM2.5) is the size of a virus and can penetrate the lung barrier to enter the blood system, leading to local inflammation in the blood vessels, the researchers found. This leads to atherosclerosis (plaque or fatty deposits in the side wall of the arteries), which stops blood flow to cause heart attacks, heart failure and irregular heartbeat (arrhythmias), they said.

It was PM2.5 and not nitrogen dioxide (NO2) — both of which are found in diesel exhaust emissions — which affected vascular function and posed a bigger risk to cardiovascular health, found the study published in the European Heart Journal on Thursday.

Heart disease is the leading cause of death in India, which has 14 of the world’s most polluted cities by small particulate matter concentration (see box). According to the Global Burden of Disease report, an estimated 1.1 million deaths in India were linked to PM2.5 air pollution in 2015.

PM2.5 inhalation causes hypertension, insulin resistance, and endothelial dysfunction with impaired vasodilation (stiffening of the arteries), inflammation and clot formation, which can trigger heart attack and stroke. “The fine dust particles are chemically formed mainly in the atmosphere from emissions from traffic, industry, and agriculture. In order to achieve low, harmless concentrations, emissions from all these sources need to be reduced,” said lead author Thomas Münzel, director of cardiology at the Medical Center of Johannes Gutenberg University Mainz, Germany.

Governments need to introduce strong regulatory policies to regulate emissions and invest in clean transport, green power generation and efficient waste management.

source

 

How viruses, germ cross international borders? Toilets cleaner than Airport trays


Airport security trays carry more diseases than toilets.  The plastic trays that passengers put their hand luggage in at airport security checkpoints harbour the highest levels of viruses, even more than toilets, a study warns. Researchers from the University of Nottingham in the UK swabbed a variety of surfaces at Helsinki-Vantaa airport in Finland during the winter of 2016. They set out to identify and quantify the respiratory viruses on frequently touched surfaces in airports. The team found evidence of viruses on 10 per cent of the surfaces tested and most commonly on the plastic trays that are circulated along the passenger queue at the hand luggage X-ray checkpoint. The study, published in the journal BMC Infectious Diseases, concludes that hand washing and careful coughing hygiene are crucial to the control of contagious infections in public areas with high volumes of people passing through. The findings add weight to previous studies showing that microbes are commonly found on surfaces in public transport vehicles and will strengthen public health advice in preparation for future flu pandemics, researchers said. Airport security trays carry more diseases than toilets. The highest concentration of viruses was detected on the security check plastic trays with further viruses detected on shop payment terminals, staircase rails, passport checking counters, children’s play areas and in the air. The most common virus found in the survey was rhinovirus, which causes the common cold but the swabs also picked up the influenza A virus, researchers said. Interestingly, no respiratory viruses were found on toilet surfaces, they said.

Story of Unlabeled drugs and Fraud In name of Ayurvedic treatment


         A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who have been given a “no hope” by scientific medicine, are an easy prey for such fraudsters.

   Another major problem is that medicines and syrups distributed in such manner are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses.  

     Ayurvedic medicines and practitioners  belong to a  stream, also based on a  science. The medicines and treatment has to be  controlled and regulated in the same way, as for allopathic  stream.  So that criminals, who are not trained in ayurvedic stream can not play with lives of gullible people, giving them false hope.  Such acts  are  real crime to society, done with an intention to cheat rather than treating them.

   Any one distributing medicines or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis.

Regulating Ayurvedic medicines and practice will help  not only the genuine  Ayurvedic  doctors but also go a long way  in benefiting the ancient system of medicine and promote research.  

  Following may be just one of the cases, millions may remain unnoticed.

False ayurveda hopes to the hopeless

Tarun Mandal has spent almost all of his savings trying to get his son, suffering from acute jaundice since his birth, treated for the past one and a half years. A desperate Mandal recently paid a youth Rs 65,000 for an ayurvedic cure. However, his wife’s suspicion about the ‘gold ash’ tasting like churan led cops to an inter-state racket cheating terminally ill patients with a promise of cure. Mandal, who sells food items on a cart at the Sarojini Nagar market, was not the only one to fall in the trap. Cops have found at least 40 people who had been duped by the gang. Most of the victims are family members of children from different states getting treated in the capital’s top government hospitals.
“I gave away all my savings to them. They even guaranteed that all my money would be returned if the medicines failed. But when I went back to the same shop, they refused to recognise me,” said Mandal, who has already spent Rs 2 lakh and needs more money for a surgery.
The gang has also duped the grandfather of a seven-year-old thalessemia patient from Uttarakhand.

other incident dangerous chemicals in alternate medicines

The Story of Faulty Johnson & Johnson (J&J) Hip Implant


Govt to track patients with faulty J&J hip implant to ensure compensation

Close to 4,700 people with damaged hip joints in India received the implant before 2010, when it was recalled, of which only 1,080 were tracked and compensated.

   The Union health ministry will establish committees at the Central and state levels to track and compensate patients who received a faulty artificial hip implant that was recalled worldwide by the manufacturer Johnson & Johnson (J&J), in 2010.

Close to 4,700 people with damaged hip joints in India received the implant before 2010, when it was recalled, of which only 1,080 were tracked and compensated. Of them, 275 underwent revision surgeries.

Following complaints from patients, the health ministry set up an 11-member committee on February 7, 2017, to investigate patient complaints of adverse events against J&J’s metal-on-metal Articular Surface Replacement (ASR) hip implant devices — XL Acetabular Hip System and Hip Resurfacing System.

The committee  submitted its report on February 19, 2018. It said specialists must assess cases individually for treatment and compensation of at least Rs 20 lakh.

In November last year, the federal jury in Dallas had ordered J&J and its DePuy Orthopaedics unit to pay $247 million to six patients for not warning patients about the potential risks of the defective design of the metal-on-metal hip implants .

The committee at the state level will be tracking the affected patients. These cases are old and hospitals don’t have data available on them; close to 100 hospitals were approached but there was no data. State governments will be widely advertising the move to see that affected people approach them,” said a senior official, requesting anonymity.

Each case will be physically and clinically assessed by the state government committee to determine the degree of disability and refer to the central government committee to decide on the compensation amount.

In it response J&J said: “DePuy has fully cooperated with the expert committee in their investigation of the ASR matter. However, the Expert Committee Report has not been provided to the company for review to date, so it would be inappropriate for us to comment on it. We would like to reiterate that we have furnished full facts and data available with us to the expert committee.”

Metal on metal implants are rarely used now, say orthopaedic surgeons. “Metal-on-metal hip implants have been largely discontinued because of the associated complications. With other implants, the revision surgery rate would be around 3-5%, but with this particular brand, it was a higher 10-12 percent.

People complain of pain, which is largely due to loosening of the implant and wear and tear of the metal that would cause collection of metal in the body that it would react to. Another  available implant is ceramic cross-linked with plastic polyethylene socket, where head ball is of ceramic and socket of polyethylene.

After years of testing, ASR was imported and marketed in India and in various countries around the world, with all regulatory approval and permissions as were then applicable. After it was on the market, DePuy continued studying and closely watching how the device was performing and in August 2010.  DePuy issued a voluntary recall of the ASR Hip System after receiving new information from the UK National Joint Registry.

It immediately informed the Drugs Controller General of India (DCGI) about the voluntary recall. Since then, we have kept the DCGI informed of all key actions and worked to provide Indian patients and surgeons with the information and support they need, in line with government requirements.”

Report finds hazardous chemicals in crayons: may cause breathing difficulties and cancer in kids


The innocuous looking items of daily use may contain hazardous chemicals. Unless these items are honestly checked and contents known, any of these can be dangerous. Users are usually unaware of the complex risks associated with simple items. Here are examples of crayon and water bottles containing dangerous chemicals.

  • The US Public Interest Research Group has just released its annual back-to-school report 
  • It found trace amounts of asbestos in Dollar Tree’s Playskool crayons
  • Asbestos has been linked to mesothelioma, a potentially deadly cancer of the lungs’ lining
  • Scientists are unsure if the chemical is in the crayons’ wax or paper wrappers
  • Carcinogenic chemicals were also found in one brand of binder and two kinds of dry erase markers 
  • Lead was once again found in two previously recalled water bottles  

 

Researchers found trace amounts of the toxic mineral in Dollar Tree’s Playskool crayons, and toxins in at least three other products.

Asbestos is a well-known carcinogen that has been blamed for thousands of cases of mesothelioma.

Just three years ago, low levels of the harmful substance were found on not one but several major brands of crayons – including Crayola and Rose Art – but one brand still could pose a risk to young children.

The US Public Interest Research Group (PIRG), which just released its report of toys and school supplies, says that finding asbestos in only one crayon brand is progress – but several other back-to-school basics may still be unsafe.

Playschool crayons, were found to contain trace amounts of asbestos, a chemical known to cause mesothelioma, a cancer of the lining of the lungs

Mass production and plastic help to keep back-to-school expenses to a minimum, but parents still need to be cautious of what products end up in their children’s backpacks.

Without fail, a number of products make it onto the PIRG’s naughty list each year.

Crayons are chief among these.

Trace amounts of asbestos fibers frequently find their way into the coloring tools, which are marketed as being made for small children.

Waxy crayons are not sharp and break easily, so they pose a somewhat lesser risk of stabbing, scratching and choking incidents when in the hands of tots.

But somehow, asbestos commonly finds its way into the products, though the US Consumer Product Safety Commission (USPSC) has yet to work out whether that danger comes from the wax itself or crayons’ paper wrappers.

Tiny, fine asbestos fibers can get lodged in the lining of the lungs, where they corrupt cells and can lead to breathing problems and cause a high-fatality cancer, mesothelioma.

The naturally occurring mineral is fire resistant and impervious to damage from many chemicals.

This discovery led to its inclusion in household insulation and many products beginning in the 1850s. But as early as the 1920s, scientists noticed a trend in early cancer deaths among those who were frequently exposed to the material.

By the 1980s and 1990s it was solidly linked to mesothelioma and banned in many countries, including the UK.

The US stopped short of outlawing asbestos, however, and trace amounts of the tightly controlled chemical still appear periodically in certain products and places, though it is now disallowed from school buildings.

But the new report suggest that while the school structures may be certifiably safe, asbestos could be sneaking in with school supplies.

Crayons are in many ways ideal implements for young children because children under-fives who tend to use their entire arm when they color.

Public Interest Research Group also found phthalates – chemicals linked to asthma, obesity and reproduction issues – in Jot Binders and carcinogens in Expo white board markers

And, worst comes to worst, if a child does decide to turn his artistic instrument into a snack, crayons are fairly non-toxic.

That is, when they don’t contain asbestos.

Dollar Tree spokesperson Randy Guiler told Daily Mail Online that the company was ‘aware of the report,’ and has since’re-verified that each of the listed products successfully passed inspection and testing.’

The product safety group also found worrisome chemicals in three ring binders, dry erase markers and two water bottles that had previously been recalled by the USCPS.

Phthalates were found in Jot binders, also sold at Dollar Tree. This set of chemicals helps to give plastic products their flexibility.

There is still some uncertainty surrounding the health effects of phthalates, but scientists have found possible links between the chemicals and everything from asthma to obesity, low IQ to reproduction issues.

Both the LL Bean GSI Outdoors Children’s Water Bottle and the Reduce Hydro Pro Furry Friends bottles, had previously recalled for their high lead contents. The PIRG’s report warned that they still do, and can still be purchased.

The health effects of phthalates are still not entirely clear, and exposure happens when people drink or eat something out of a plastic container that contains the chemicals, so as long as children are not licking their binders, the risk is probably low.

In addition to these products, Expo’s dry erase markers, as well as those made by The Board Dudes were found to contain several carcinogenic chemicals, including benzene, xylene and toluene. 

Two children’s water bottles were found to still be on the market and still contain dangerously lead, even after the USCPS recalled the two products.

Though the notion of toxins in products made specifically to be safe for children is unsettling, this year’s list of dangerous back-to-school products is encouragingly short.

Source

 

Viagra & anaesthetic drug sold as herbal alternative medicines


This news in Times of India  is just an tip of the iceberg, the reality  of alternative medicine  industry. Toxic substances being sold at exorbitant prices  labelled as herbal substances can be unmasked only if checked  and controlled strictly.  Gullible masses consume these substances without knowing the right dose or right drugs thinking them as herbal products . Assumptions that they are free from side effects is another myth, that goes unsaid.

MUMBAI: The Aurangabad division of FDA has found sildenafil citrate, commonly known as Viagra, and a short-acting anaesthetic drug in two alternative  medicines meant to increase sexual desire and potency that were randomly tested for quality recently. The worrying finding has prompted the drug regulatory body to issue a statewide circular asking its officials to seize any available stock of these drugs- Power up capsules and Tiger king cream. The containers of both the alternative medicines didn’t mention the allopathic components sildenafil and anaesthetic drug (lignocaine hydrochloride), giving rise to fear of serious health consequences in people who might consume them unknowingly. Viagra, in particular, which is given for erectile dysfunction, is supposed to be taken only when prescribed by a specialist as it can react with other ongoing medications and give rise to life-threatening complications. In July, FDA officials raided the office of Srishti Unani Medicine Agency in Aurangabad and found stocks worth Rs 16,000 that had arrived from Saharanpur district of Uttar Pradesh. Tests revealed each Power up capsule contained 49.45mg of Viagra, while Tiger king cream had a significant amount of lignocaine hydrochloride, though only the herbal components were mentioned in the packing material.

The spurious drugs were manufactured in violation of the Drugs and Cosmetics Act. “We will lodge an FIR against Naman India, the UP-based manufacturer, that has been selling these drugs in the name of herbal medicine to gullible consumers,”, joint commissioner, FDA, Aurangabad. He said the department is yet to establish where these drugs were supposed to be distributed, but there is demand from across the state. It was during a raid in the city sometime in 2015 when the department woke up to rampant adulteration of so-called alternative  medicines with allopathic drugs. An official said it was an “industry worth millions” that clandestinely ran out of Tier-2 and 3 cities or slums in metros. “Under the Act, manufacturing of alternative  drugs needs a licence, but there are no legal provisions for distribution and supply. So monitoring becomes a challenge,” said an FDA official. Medically, doctors say, such rackets are not just about making spurious drugs and making a quick buck but messing with people’s lives. “It’s a menace that has existed for years unchecked. Alternative  practitioners charge exorbitant sums for these  medicines that illegally contain sildenafil, which otherwise costs just Rs 30-40 when sold as an allopathy drug.

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