Sensitivity, specificity for both infections are comparable to ELISA
A palm-sized dongle connected to a smartphone will soon be able to diagnose HIV and syphilis with good accuracy. The device, which was recently field-tested on 96 patients in Rwanda, had high sensitivity and specificity for both HIV and syphilis. The results are published today (February 5) in the journal
Science Translational Medicine.
Sensitivity and specificity for both the infections are comparable to the lab-based ELISA. In the case of HIV, the sensitivity was 100 per cent and specificity was 87 per cent. For syphilis, the sensitivity was 92-100 per cent and specificity was 79-92 per cent. “Two types of syphilis antibodies are looked for to confirm infection and prevent over-treatment,” Dr. Tiffany W. Guo of the Department of Biomedical Engineering, Columbia University said in an email to this Correspondent. He is one of the authors of the paper.
“By increasing detection of syphilis infections, we might be able to reduce deaths by 10-fold. And for large-scale screening where the dongle's high sensitivity with few false negatives is critical, we might be able to scale up HIV testing at the community level with immediate antiretroviral therapy that could nearly stop HIV transmissions and approach elimination of this devastating disease,” Dr. Tassaneewan Laksanasopin of the Department of Biomedical Engineering, Columbia University and the corresponding author noted in a release.
The device has several highlights. For instance, both HIV and syphilis can be diagnosed in about 15 minutes and at a fraction of the cost of a lab-based ELISA test. The dongle cost under $34 compared with an astronomical $18,450 for ELISA equipment. Also, the material and reagent required for testing HIV and syphilis cost no more than $1.44; in the case of conventional lab-based equipment the cost for testing these infections is $8.50.
What makes the device particularly interesting is the very low power consumed to run it. This would be of immense value when the device is used in the field where power may not be available 24x7.
This became possible as the device does not use a power-consuming electrical pump to generate vacuum but a rubber bulb (as in the case of the manual blood pressure measuring instrument — sphygmomanometer) which when pressed creates a negative pressure. The negative pressure, in turn, moves a sequence of reagents that are already stored in a cassette. Other electrical components used consume very little power.
The total power consumed by the device for a test is 1.6 mW. By comparison, a smartphone uses 751 mW on a 3G network; even in a standby mode, a smartphone consumes as much as 17.5 mW.
The researchers came out with a second innovation to power the device using a smartphone. The audio jack of iPhone sends a 19-kHz audio signal that is converted into a stable DC 3 volt. This innovation made the use of a battery redundant. Since audio jacks are standardized among smartphones, the dongle can be attached to any compatible smart device.
“We designed our device to minimize power consumption (e.g. get rid of the electrical pump) and the only component that requires power (which is very little) is the optics. So the power converted from the audio signal is sufficient to run the device,”said Dr. Guo.
It is very easy to operate the dongle. Health workers needed all of 30 minutes of training before they started using the device.
Fingerprick whole-blood specimen was sufficient to diagnose both the infections. During the trial, the freshly collected whole-blood was diluted before testing the sample. “This field testing was a first time performance on freshly collected whole blood, which our cassettes [where the reagents are preloaded] were not best optimised for. Subsequent to the trial, we changed the amount of antigens coated on plastic cassettes which can detect undiluted whole blood,” Dr. Guo said.
There are five detection zones on the microfluidic cassette. Each zone is coated with antigens/antibodies specific to diseases plus internal negative and positive controls. Blood sample is flowed through the microfluidic channel, passing through each detection zone in sequence.
The dongle detects the presence of antibodies against HIV and syphilis from blood samples by capturing these antibodies using specific antigens in the microfluidic channel.
“The dongle is used as an analyser to quantify the amount of antibodies from blood samples and display results as positive or negative,” said Dr. Guo.
A compound found in litchi seeds might be responsible for a mysterious brain disease that strikes many young children in Muzaffarpur district of Bihar each summer, according to two independent groups of researchers.
“Eating litchis is absolutely not dangerous for adults or well-nourished children,” said T. Jacob John, who is a paediatrician but is better known as a leading virologist. He was with the Christian Medical College at Vellore in Tamil Nadu.
Along with colleagues, Dr. Jacob John had published two papers last year in Current Science suggesting that ‘methylenecyclopropylglycine’ (MCPG), a substance that exists in litchi seeds, could be behind the yearly outbreaks in Muzaffarpur, a major cultivation centre for this fruit.
The symptoms
In these annual outbreaks, which peak in June, young children would be healthy in the evening but early next morning have convulsions and even become unconscious.
A large proportion of those affected died and many of those who survived continued to suffer from mental retardation, muscle paralysis or movement disorders.
It was under-nourished children who were affected by the disease, Dr. Jacob John told this correspondent. Children in poor rural families, typically of labourers working in litchi orchards, were the ones at risk.
In work just published in the Morbidity and Mortality Weekly Report (MMWR), a large team of Indian and U.S. researchers, including from the National Centre for Disease Control in New Delhi and the Centers for Disease Control and Prevention in the U.S., ruled out bacterial and viral infections as causative factors.
“One specific hypothesis” to explain the disease was that exposure to MCPG might cause very low blood sugar levels and brain problems in some children, noted Aakash Shrivastava and others in the MMWRpaper.
In tests carried out in animals, MCPG has been shown to lower blood sugar levels and produce brain problems. It was found to interfere with a biochemical pathway in cells that turns fatty acids into glucose, which also resulted in the accumulation of toxic molecules.
In under-nourished children, who had little glucose reserves in their body, MCPG could be blocking their cells' ability to utilise fatty acids when blood sugar levels dropped early in the morning, remarked Dr. Jacob John.
As a result, the brain could then be deprived of the glucose it needed. The toxic substances that MCPG produced could also be taking their toll on brain cells.
MCPG’s mechanism of action is thought to be similar to the one produced by a toxin found in unripe ackee, a fruit found in West Indies and West Africa.
The clinical symptoms of ackee poisoning are similar to those displayed by affected Muzaffarpur children.
However, it has still to be conclusively established that MCPG in litchi is indeed the cause of the disease seen in children.
During the forthcoming litchi season, the MCPG levels in unripe and ripe litchi fruit as well as seeds would be examined, said Mukul Das of the CSIR-Indian Institute of Toxicology Research at Lucknow, a co-author of one of the Current Science papers published last year.
The published literature indicated that the compound was present in litchi seeds. The unripe fruit might be having more of it than the ripe fruit. “These things need to be tested,” he remarked.
In the MMWR paper, Dr. Shrivastava and colleagues said that laboratory investigations to assess the possibility of MCPG in litchis being the cause and to understand why only some children were affected are ongoing.
Beneficial algal species discovered
Two new bloom-forming algal species were discovered recently off the west coast of India. These two species have excellent carbon capture properties — ability to absorb carbon dioxide from the atmosphere and reduce global warming — and are also promising candidates for use as bio fuels.
Currently, a number of research groups are working on using algae as a potential candidate for carbon sequestration because they grow at very high rates and can absorb atmospheric CO.
Both of the newly discovered species are endemic and bloom-forming.
As they are endemic, their cultivation is not going to cause any environmental harm; had it been a species of Atlantic or Mediterranean origin, it might overgrow local flora and might wreak havoc on the local habitats — the so-called bio invasion.
Bloom forming indicates spontaneous growth. There is no need for fertilizers/pesticides or any expensive cultivation systems such as photobioreactors for their cultivation. These can grow sporadically at shorelines and can sequester CO.
The algae species named Ulva paschima Bast, and Cladophora goensis Bast were discovered by Dr. Felix Bast and two research students working with him, Mr. Satej Bhushan and Mr. Aijaz Ahmad John, from the Central University of Punjab, Bhatinda. The findings were reported in the journals PLoS ONE and Indian Journal of Marine Sciences.
The main criteria used for determining these species as newly discovered is a mix of morphological as well as molecular characteristics. Molecular evidence is especially strong; as nearest match is less than 90 per cent sequence identity.
For example, Cladophora goensis Vs. Cladophora glomerata — its nearest match — is 17.7 per cent differences.
“Compare it with human Vs. chimp. Our sequence identity is 98 per cent and 2 per cent difference makes us what we are. These newly discovered algae have profound sequence differences from previously discovered algae. Morphology is not reliable; as algae can change its morphology to suit its environment. Ours is the first molecular study on Indian algae, and first algal species discovery for last 40 years,” notes Dr. Bast in an email to this correspondent.
Pharmaceutical products from algae are under the realms of another project by Dr. Bast.
A number of active substances are isolated from algae including some algae of genera Cladophora andUlva. Probably most famous is Kahalalide-F, which is now being used in clinical trials against prostate and breast cancers.
Kahalalide-F is isolated from Bryopsis — a closely related green algae to Cladophora as well as Ulvaand it is very probable that same or related chemical is present in newly discovered endemic algae.
He intends to work on this. Cladophora goensis and Ulva paschima — recently discovered species — have had no chemical/pharmaceutical studies conducted on them yet.
New findings on cellular functions of cancer-linked gene
Sometime between 1661 and 1665, an undergraduate Isaac Newton took an unlikely academic diversion from his pursuits of mathematics, optics and physics. A neat black-ink notebook jotting, sourced back to his Cambridge University days, reveals that Newton in fact briefly pondered plants too.
Titled quite simply ‘Vegetables’ (and entered between his notes on ‘Philosophy’ and ‘Attraction Electricall & Filtration’) Newton hypothesizes how plants transpire — or how water rises from roots to leaves — against the pull of gravity. Most intriguingly, “His ideas came over 200 years before botanists suggested an extraordinary and now widely accepted theory that explains how plants, from herbs and grasses to the Earth’s tallest trees, transport water from roots to leaves,” says a comment in the latest edition of the journal Nature Plants.
In distinct Early Modern English, Newton describes the process by which fluid matter “continually arise up from the roots of trees upward leaving dreggs in the pores.” This “makes the plant bigger untill the pores are too narow for the juice to arise through the pores & then the plant ceaseth to grow any more.”
What appears to be described here “is the evaporative escape of water from a shoot — transpiration — driven by energy from the Sun,” says the Comment.
It does indeed come as a surprise that Newton dwelt on plant physiology in the middle of his math pursuits at Trinity, author of the Comment David Beerling FRS, Sorby Professor of Natural Sciences, University of Sheffield, told this Correspondent by email.
While there is very little known about the context of his jottings on plant fluids, it could be that he had the note book with him when he retreated from Cambridge to Woolsthorpe Manor (Lincolnshire) in the summer of 1665 to avoid the plague. “Conceivably, it may have been his sojourn in the English countryside that inspired it. But really this is pure speculation.”
The notebook was first judged “not fit to be printed” by Newton’s executor, but later in 1872, it was later presented to Cambridge University Library by the fifth Earl of Portsmouth.
“In the minds of most, Newton’s association with plants begins and ends with the famous apple falling incident and his discovery of gravity. But notes buried within one of Newton’s undergraduate notebooks suggest otherwise,” says the Comment.
NASA spacecraft sends historic Pluto images
In what can be seen as a stride for citizen science, participants of the Milky Way project have identified new structures which can be a stage in the formation of stars, be studying photographs taken by the Spitzer space telescope. Scanning through a huge number of photographs sent down to earth by NASA’s Spitzer space telescope, the participants noticed this class of objects that had been previously unnoticed: yellow balls.
This is the name they gave to these rounded yellow-coloured structures seen in the photographs. These are not yellow in reality, but appear yellow in the infrared, colour-coded images. “The volunteers started chatting about the yellow balls they kept seeing in the images of our galaxy, and this brought the features to our attention,” said Grace Wolf-Chase of the Adler Planetarium in Chicago, in a press release given out by the Jet Propulsion Lab, Pasadena.
“With prompting by the volunteers, we analysed the yellow balls and figured out that they are a new way to detect the early stages of massive star formation,” said Charles Kerton of Iowa State University, Ames. Kerton is lead author, and Wolf-Chase a co-author, of a new study on the findings in theAstrophysical Journal.
Spitzer images
In the Milky Way Project, volunteers scan through images that Spitzer took of the thick plane of our galaxy, where newborn stars are igniting in swathes of dust.
The infrared wavelengths detected by Spitzer have been assigned visible colours which we can see with our eyes.
According to the release, in addition to the yellow balls, there are many green bubbles with red centres, populating a landscape of swirling gas and dust. These bubbles are the result of massive newborn stars blowing out cavities in their surroundings.
The green bubble rims are made largely of organic molecules called polycyclic aromatic hydrocarbons (PAHs), cleared away by blasts of radiation and winds from the central star.
Dust warmed by the star appears red in the centre of the bubbles.
It is remarkable how a simple curiosity about the strange features observed in the photographs led the volunteers to think about it, talk about it and draw the attention of professionals, too.
Why some galaxies die young
Some galaxies die young because they expel the gas needed to make new stars early, suggests a study.
There are two main types of galaxies, ‘blue’ galaxies that are still actively making new stars and ‘red’ galaxies that have stopped growing, said astrophysicist Ivy Wong from the University of Western Australia.
Most galaxies transition from blue to ‘red and dead’ slowly after two billion years or more, but some transition after less than a billion years — young in cosmic terms.
The researchers looked for the first time at four galaxies on the cusp of their star formation shutting down, each at a different stage in the transition. Galaxies approaching the end of their star formation phase had expelled most of their gas, the findings showed.
It is unclear why the gas was being expelled. “One possibility is that it could be blown out by the galaxy’s supermassive black hole,” Ms. Wong noted. Another possibility is that the gas could be ripped out by a neighbouring galaxy. The study appeared in the journal Monthly Notices of the Royal Astronomical Society. — IANS
Rural technology park promotes indigenous technologies
Government of India is setting up such parks in five African countries
Not many would be aware that the National Institute of Rural Development (NIRD), Hyderabad has a well established Rural Technology Park (RTP). Here, several relevant and user-friendly technologies are showcased which are useful for improving rural livelihoods.
Training is given to interested budding entrepreneurs for their skill up-gradation. After training, they are also assisted, so that they can start their enterprises.
The Institute has adopted more than 100 villages across the country where innovative ideas are implemented.
Current focus
“We are also focusing on “Make in India” theme. The idea is to identify critical gaps and address them by enhancing the quality and marketability of the products having an eye on market demand.
“As the Indian market itself is so huge, rural producers can tap it and in the process, create enormous value for their enterprises. This is a very important step, especially in creating opportunities for the rural youth across the country and also addressing the current unemployment scenario,” says Dr. M.V.Rao, Director General, NIRD.
For example, the Institute is promoting the concept of harnessing solar energy at a big level. Solar street lights have become very popular in all the villages adopted by the Institute.
Lights have been installed in all these villages with community involvement.
“Earlier a solar street light used to cost more than Rs.20,000, but thanks to innovative designs, the cost is now reduced to less than Rs.4,000 and several such lights have been installed in remote villages in Madhya Pradesh, Chattisgarh and Maharashtra,” says Dr. Rao.
Preserving food stuff
Tee Wave, a technology partner with the Institute is working on this concept for preserving vegetables, fruits and fish.
Unlike traditional motors and appliances which run on high electricity, these appliances run on very low power DC motors. Hence, these are very useful in remote areas where electricity is a problem. For crops like soya, Saraswathi Mahila Gruha Udyog, a sort of self help group, has been created which is manufacturing a lot of products like soya milk, papad and soya powder.
Honey bee
Those interested in honey bee rearing can visit the honey house to learn how to set up bee boxes, honey extraction and value addition. NIRD has been training hundreds of entrepreneurs in bee-keeping as well as honey collection and preservation.
Another component is the training programmes in bio-fertilizers and bio-pesticides. This is fast finding a lot of popularity among the farmers from several states.
Emphasis is placed on how to manufacture bio inputs because sourcing inputs is a big problem for growers on time.
The institute conducts training on neem based enterprises and vermi-composting as these are eco-friendly and are preferred in organic farming.
Cooking gas is not available easily in villages. Rural women need to go to nearby forest areas to collect firewood for cooking.
The institute has developed various models and efficient technologies for cooking. These include models developed by Centre for Science & Villages (CSV), Wardha and Appropriate Rural Technologies Institute, Maharashtra.
Cooking stove
NIRD has tied up with both these organisations to popularise these cooking stoves and various innovative models so that cooking happens faster with fuel efficiency. In some of these models, as a by-product, cooking coal is also produced. This is used again as fuel.
“We invite farmers, rural youth, women self help groups and NGOs across the country to come and visit our technology park so that they can get a better idea as to how it can help them,” says Dr. Rao.
Success
The success of the technology park has encouraged the Government of India to commit setting up such parks in five African countries including Malawi and Zimbabwe to start with, as part of India-Africa partnership.
Ground-breaking MRT procedure gets Parliamentary approval
Mitochondrial Replacement Therapy, a ground-breaking technique that uses genetic material from three different people to prevent certain inherited -- and hitherto untreatable -- genetic diseases from passing from the mother to her offspring, received a resounding mandate on Tursday in the House of Commons.
Parliament voted 382 to 128 for an amendment to the Human Fertilisation and Embryology Act, 2008, which will clear the path for licenses to be given to clinics to perform the procedure.
First country to approve this
Britain thus becomes the first country in the world to approve such a procedure, considered the only hope for women who carry defective mitochondria to have healthy children. It puts to rest a controversy that was opposed by the Church and faith groups for its potential to create three-parent designer babies.
The issue was sharply debated in the House, on grounds of ethics, medical safety, and regulatory parametres. Members voted according to conscience. The motion was moved by Jane Ellison, health minister, who said that the technique allows women with mitochondrial disorder to avert the “devastating and often fatal consequences” of the disease when passed on to their children.
The technique involves an IVF procedure in which the egg's defective mitochondrial DNA is replaced with healthy DNA from a female donor.
Countering criticism of the technique as a form of genetic modification and a leap into the unknown, the Minister said that mitochondrial DNA is made up of 0.054 per cent of a person’s overall DNA and had none of the nuclear DNA that determined personal characteristics and traits.
Professor Doug Turnbull, who led the team that developed the technique at the University of Newcastle said he was “delighted” with the vote, adding “I’m told it’s unusual to hear a genuine spontaneous whoop of joy from the public gallery when something’s voted through. That reflects how much this means for the patients.” (EOM)
In next two decades, cancer cases may rise by about 70 pc: WHO
Around one third of cancer deaths are due to the five leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use.
The number of new cancer cases world over is expected to rise by about 70 per cent over the next two decades, the World Health Organisation has cautioned. Putting out data on the prevalence of the deadly disease, on World Cancer Day on Wednesday, the WHO said there are 14 million new cases of cancer and over eight million people die from cancer, with 60 per cent of these deaths in Africa, Asia, Central and South America.
In 2012, cancer was among the leading causes of morbidity and mortality globally and as per India's Cancer Incidence Report (2009-2011) from 10,57,204 cases in 2012, the numbers went up to 10,867,83 in 2013 and further to 11,17269 in 2014. According to Union Ministry of Health and Family Welfare the estimated mortality on account of cancer every year is 5 lakh in the country.
WHO which has launched a global drive to prevent premature deaths from non communicable diseases by 25 per cent by 2025 has stressed on vaccination against human papilloma virus (HPV) and hepatitis B virus (HBV), reducing exposure to non-ionizing radiation by sunlight and ionizing radiation (occupational or medical diagnostic imaging) and early detection as steps towards prevention.
“Around one third of cancer deaths are due to the five leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use. Tobacco use is the most important risk factor for cancer causing around 20 per cent of global cancer deaths and around 70 per cent of global lung cancer deaths,” the WHO said in a statement.
No of cancer deaths in the world in 2012 Lung : 1.59 million deaths
Liver : 745 000 deaths
Stomach : 723 000 deaths
Colorectal : 694 000 deaths
Breast : 521 000 deaths
Oesophageal cancer : 400 000 deaths
It also said more than 30 per cent of cancer deaths could be prevented by modifying or avoiding key risk factors, which include tobacco use, obesity, unhealthy diet, urban air pollution and indoor smoke from household use of solid fuels.
Owing to the increasing cancer cases and the burden that it puts on health budget, in India, the Ministry of Health has rolled out cancer screening programmes, stressing on early diagnosis to save lives and increase life expectancy.
While tobacco has been identified as one of the leading causes of cancer in India and steps are being mooted to control the consumption and sale of tobacco products, the Ministry is also going all out to give preventive care a big boost.
A comprehensive National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) was rolled out in 2010 covering 100 districts in 21 States with focus on three types of cancer-- breast, cervical and oral cancer. A scheme for enhancing the Tertiary Care Cancer facilities in the country has also been approved, under which the Centre will assist 20 State Cancer Institutes (SCI) and 50 Tertiary Care Cancer Centres (TCCC) in different parts of the country.
The Minister of State for AYUSH, Shripad Yesso Naik has also urged scientists and researchers to study remedies and practices offered by traditional methods for cancer care.
FDA invites Indian regulators to join inspections
The US Food and Drug Administration (FDA) India Office has invited officials of drug regulatory body, both at Central and State Government levels, to accompany its team inspecting pharmaceutical units in the country.
This is subsequent to a memorandum of understanding that the two countries inked during the visit of US FDA Commissioner to India in February 2014, according to Soloman Yimam, Assistant Country Director, US FDA India Office.
“Based on that MoU whenever we do GMP (Good Manufacturing Practice) inspections we invite DCGI (Drug Controller General of India) officials and State regulators to accompany us on the inspections,” he said on Wednesday. Mr. Yimam, speaking on the sidelines of the BioAsia 2015 event here, was responding to a query on whether Indian government had made requests to allow its officials to be present during inspections by the FDA. Many in the pharmaceutical industry also favour this.
On whether the agreement was being practiced, Mr. Yimam said: “There might be some glitches here and there, but it is something we always strive for - to bring them [Indian officials] on board. We want them to come with us, do the inspection, observe so that they can learn from our processes.”
Mr. Yimam, who addressed sessions at the Bio Asia on Tuesday as well as Wednesday, said that the US FDA in India operates out of New Delhi and Mumbai. It was looking to increase the headcount to 19. On what is the number now, he said probably 9-10 officials, but did not reply on whether more officials would mean more inspections.
The number of inspections, he added, was based on the marketing applications filed by pharma companies seeking to take its products to the US. On whether it pursues a target regarding the number of inspections, he said it was dependent on how many companies produce products meant for sale in the US.
Cancer: Not beyond us
On World Cancer Day today, The Union for International Cancer Control calls the doctors, institutions and the community at large to come together and unite in the fight against cancer
It is estimated that in the next year, nine million people will die of cancer and these numbers will unfortunately only rise, if steps towards cancer prevention and control are not put in place now. This year’s World Cancer day programme focuses on taking a proactive role in the fight against cancer under the tagline “Cancer- Not Beyond Us”.
Adopt a healthy lifestyle
Recent research has shown that physical activity brings down the incidence of cancers as well. About 50 per cent of common cancers can be prevented by reducing alcohol consumption, giving up smoking, a healthy diet and regular physical exercise and that is a pretty good incentive to help in making the right lifestyle choices.
Get regular check ups
Very commonly, people are not aware of the importance of seeking care when symptoms are present, nor are they aware about recommended screening tests such as pap smears, HPV tests for cervical cancers and mammograms for breast cancers. This holds true for women across the socio-economic strata and varied educational backgrounds.There is now clear evidence that deaths due to cervical cancer can be reduced by 80 per cent in screened women. In fact, even a single screening for cervical cancer in women between the ages of 30 -40 years can bring down a woman’s risk of cervical cancer by 25 to 36 per cent. Cervical cancer can be easily prevented by a combination of HPV vaccination and regular screening. The question is how do we get women to access health care and who pays for it? Cancer is a complex disease and often needs a lot of psycho-social input apart from a multidisciplinary medical treatment.
Spread awareness
In spite of improving levels of education and economy, discussion about cancer is often considered taboo. While people would not hesitate to talk about their symptoms and the various medications they are on for their hypertension and diabetes, a diagnosis of cancer is one topic they do not feel they can talk about.
There are a lot of myths and misconceptions that surround a diagnosis of cancer – a common one is that cancer is contagious which it is not. There is still a huge stigma attached to a cancer diagnosis especially in rural areas, very often leading to the person being ostracised from society.
Get involved
As a priority, levels of public and professional awareness about cancer screening and early cancer warning signs should be improved and we would like the health sector, government and the media to be part of this important initiative.
Cancer control has to begin with cancer awareness amongst the community at large. Understanding local cultural beliefs and practices is important and screening programmes will have to factor this into their programmes to succeed.
It is ‘Not Beyond Us’ to meet the challenge of cancer control, if communities and governments realise that prevention of cancer is better and definitely cheaper than cure, if cancer awareness is given priority and screening programmes are integrated in to existing health systems. On the occasion of World Cancer Day, let us all take a pledge to fight against cancer.
