The onslaught of the swine flu continued unabated with three persons, including a middle-aged woman, succumbing to the virus, pushing the countrywide death toll to 77 as 186 more contracted the infection since last evening.

The new fatalities occurred in Delhi, Bangalore and Pune as 41 more tested positive for A (HINI) influenze in the national capital where the number of cases climbed to 519.

In all, 186 fresh laboratory confirmed cases surfaced in various states as the number of those afflicted with the illness climbed to 3,095.

Usha Jain, who had tested positive for the flu and was on ventilator, passed away this morning in government-run RML Hospital in Delhi, Medical Superintendent N K Chaturvedi said.

Fortyfour-year-old Usha was a resident of Faridabad in Haryana.

In Bangalore, Siddarraju, admitted to the Rajiv Gandhi Institute of Chest Diseases on August 21, died of the virus, health officials said adding he had also tested positive for chikungunya.

Swine flu fatalities rose to 24 in Pune, the worst-hit, with a 56-year-old man succumbing in a private hospital, Dr Ashok Laddha, Additional Director, Health, said.

Of the 77 deaths from the pandemic, Maharashtra accounts for 41 -- 24 in Pune, eight in Mumbai, five in Nashik, two in Aurangabad and one each in Dhule and Latur.

Fifteen people have died in Karnataka, seven in Gujarat, three each in Tamil Nadu, Chhattisgarh and Delhi and one each in Kerala, Goa, Rajasthan, Uttarakhand and Haryana.

We ask a lot of our feet, we take them for granted and scarcely give a thought to how best to keep them healthy until something goes wrong. In this month's Harvard Health Letter, there is a four page article about how feet work and "three steps" on how to look after them from Dr. James Ioli, chief of podiatry at Harvard-affiliated Brigham and Women's Hospital in Boston and colleagues.

Our feet provide us with a steady base on which to stand or walk, they act as levers for forward and backward and sideways moves, and they absorb shock, for instance when we run and jump the impact of landing is a force equal to many times our body weight.

Our feet do all this with just 26 bones (one less than in our hands) and 33 joints all lashed together by an intricate architecture of 100 ligaments and extrinsic and intrinsic muscles and tendons that orchestrate the movement of the feet.

The extrinsic muscles start in the lower leg, wrap in a crisscross fashion around the ankle and finish in the foot, like a kind of sock, and enables the foot to articulate in several directions.

The intrinsic muscles, which start and end in the foot itself, comprise several layers across the sole and help to form an elegant and graceful arch along the length of the foot.

When a person walks normally, the weight starts in the heel and moves to the front of the foot. The heel hits the ground first and the shock of impact is absorbed by the heel or calcaneus bones and a layer of fatty tissue beneath. Then the foot rolls forward on its outside edge and causes the plantar fascia, a band of tissue along the bottom of the foot, to stretch out.

All this happens without thinking about it, and it's only when something goes wrong, and there is plenty that can, that we become aware of how much we rely on our feet.

Some people are born with foot problems like high arches (pes cavus) or clubfoot (talipes equinovarus) and in many cases these problems can be surgically treated.

Others are born with minor defects that can become more serious as we get older and especially if we put on weight.

One problem is overpronation, where the person walks or runs on the inside of their feet. This is not uncommon and for the most part people aren't bother by it, but some can end up with a range of problems like sore knees, sore ankles, fallen arches, or inflamed and worn out foot tissue.

The opposite of overpronation, called oversupination, or walking too far onto the outside edge of the foot, can also lead to similar problems.

Another problem is flexible flat feet, which affects around 1 in 5 adults. This is when the arches in the feet flatten out under weight but then return to their normal arched shape when the weight is taken off. Again, this does not usually affect many people who have it, but it can get worse as they age, and especially if they put on weight.

Then there is a range of problems that can be described as "self inflicted" because they arise from doing things like wearing high heels and badly fitting shoes. These include hammertoes and bunions which result from squeezing toes into too-narrow shoes, and we can also damage metatarsals (the long bones of the foot before the toes) and Achilles' tendons by over use of high heels.

Many people don't realize that as they age, the ligaments and tendons in their feet stretch out, causing them to grow by a half size or even more.

Also we tend to wear shoes far beyond their replacement stage, by which time the heel is no longer held firmly in place at the back, and the sole no longer absorbs shock effectively.

The authors recommend a three step approach to keeping feet healthy:

1. WEAR GOOD SHOES: Buy low-heeled shoes that fit well and make sure there is plenty of room for your toes. Replace them regularly.
2. STAY TRIM: Too much weight on your feet wears them out, and keeping to a healthy weight will benefit the rest of your body too.
3. WALK: Not only is walking good general exercise, it strengthens and stretches the feet (and remember to change your shoes regularly).

Chandigarh: Even as suspected cases of swine flu continue to be reported, experts say it will be several months before the virus stabilises. It is likely, they add, that the virus continues to affect people in the coming winters.

According to Prof Rajesh Kumar, Head of Department of Community Medicine at PGI, cooler weather of the monsoons flares up flu and other respiratory diseases. This could be the reason, he says, for the sudden surge of cases in August.

But he is quick to add that the H1N1 virus has not shown any adherence to weather so far and is expected to continue in winters.

“At this moment it is difficult to predict how the virus will behave. But traditionally, common flu rises in autumn, spring and winters. Going by that logic, the H1N1 virus should be active in winters and stabilise only by next summers,” Prof Kumar says.

Every new virus causes epidemics. It takes time before human beings develop resistance to it, he says. “Take the case of common flu. It is also a virus but not that harmful as human beings have developed resistance to it. Once the same happens in case of H1N1, it will be like any other flu,” Prof Kumar adds.

Chandigarh’s count of cases has been 11 so far. The eight samples sent to NICD last week were tested negative and no fresh suspected cases were reported on Monday.

Central Nodal Officer satisfied with hospital arrangements

Arun Kumar, Joint Secretary-cum-Central Nodal Officer (Swine Flu), Ministry of Health and Family Welfare, visited the city hospitals on Monday for assessment of their preparedness. He expressed satisfaction over the arrangements after he was apprised of the facilities being provided in the isolation wards of PGIMER-12, GMCH-32 and GMSH-16.

Countries are warned to expect further cases and deaths as the spread of pandemic H1N1 swine flu virus speeds up, and there will come a point when case numbers will seem to explode, a World Health Organization director said on Friday.

Shin Young-soo, Director of the WHO Western Pacific region, told an assembly of health delegates meeting in Beijing that we can be certain there will be more cases and more deaths, reported the Associated Press, who quoted the director as saying:

"At a certain point, there will seem to be an explosion in case numbers."

Shin said governments must prepare their health systems, educate the public and protect the most vulnerable and they must act quickly because "we only have a short time period" to ensure that communities are made aware of how to reduce spread and how to get early treatment for severe cases.

He said developing countries are under the greatest threat because they don't have enough resources.

According to the latest WHO figures, as of 13 August, nearly 1,800 people have died from the 2009 swine flu, which reached pandemic status in June this year.

Individual cases are no longer tracked, so the total number of lab-confirmed infections, which has reached over 182,000 worldwide is likely to be a gross underestimate, said the WHO.

The Americas have reported 105,882 cases and 1,579 deaths; Europe 32,000 cases and 53 deaths; Western Pacific 27,111 cases and 50 deaths; South East Asia 13,172 cases and 106 deaths; Eastern Mediterranean 2,532 cases and 8 deaths; and Africa 1,469 cases and 3 deaths.

The WHO predicts that nearly one third of the world's population will be infected over the next two years, that is around 2 billion people.

The vast majority of cases are expected to be mild, but because of the large numbers involved, where cases are severe they are likely to overwhelm hospitals and health infrastructures, especially in poorer nations.

Experts are watching the pattern that the virus is following in the southern hemisphere in the hope of being able to anticipate how it might spread in the northern hemisphere when the flu season starts.

Unlike seasonal flu, where cases drop significantly during the summer and then resurge in the winter, the novel H1N1 swine flu has proved more resilient and is still spreading in the northern hemisphere.

However, northern countries are gearing up for a significant resurge as students and workers return from summer vacations. Vaccine makers are fast tracking production in an effort to get people vaccinated in time. Some are saying the first batches will be ready in October, but it is not clear how many doses will be available.

WHO Director-General Dr Margaret Chan said earlier this year that pregnant women and people with underlying medical conditions are two of the groups at higher risk of severe infection.

One study, by researchers in the US and Japan, has suggested that the novel H1N1 pandemic strain is more virulent than previously thought. It found that the virus infects cells deep inside the lungs, which can lead to pneumonia and in more severe cases, death, whereas seasonal flu viruses tend only to infect cells in the upper respiratory tract.

They found that the new pandemic swine flu strain spreads much more efficiently in the respiratory system than the seasonal flu virus, causing severe lesions in the lungs, more like the damage caused by other pandemic strains.

WHO and other experts have warned that the virus might also change quite suddenly, as Chan explained in June, when she announced the virus had reached pandemic status:

"The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time."

The last flu pandemic was the Hong Kong flu which globally killed around 1 million people in 1968 and 1969. It was the first known outbreak of the H3N2 strain. Seasonal flu kills around 250,000 to 500,000 people every year worldwide.

WASHINGTON — Early indications are a new swine flu vaccine is safe and is on track to be made available to the public by mid-October, US health officials said Friday.

"There are no red flags regarding safety," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, noting that a series of clinical trials were being conducted on the vaccine with results due out between mid September and late October.

Adult volunteers participated in the first of five trials starting on August 7, and only reported arm swelling or redness where they received the injection.

Encouraged by the results, health officials went ahead this week with vaccine trials on children aged six months to 17 years, Fauci told reporters.

Additional experiments on about 120 pregnant women -- who are particularly at risk of infection from the influenza A(H1N1) virus and are high on the federal government's priority list for vaccines -- are to begin in September.

Officials expect that between 4,500 and 4,600 people will eventually take part in the vaccine studies.

Between 45 and 52 million doses of the vaccine are expected to be available by mid-October, said Jay Butler, who heads the H1N1 Vaccine Task Force of the US Centers for Disease Control and Prevention (CDC).

The CDC, which had made plans to distribute the vaccine once available, has issued its final recommendations for which groups of people should receive the shot.

The priority groups include "pregnant women, children, and young adults aged 6 months through 24 years, as well as persons aged 25 through 64, who have medical conditions that put them at higher risk for influenza-related complications," he said.

Health care workers, emergency medical service workers and people who take care of infants younger than six months -- too young to be administered a vaccine, should be vaccinated, Butler said.

The novel flu strain, which the CDC says has killed 522 people and caused 7,963 hospitalizations so far in the United States, has generally continued to spread, albeit at a slower speed.

Most of the cases occurred in people under the age of 49.

New infection cases have also decreased in South America and Australia during their seasonal flu season.