Four people, including two in Goa, died due to swine flu today, taking India's total toll to 135, health authorities said here.

Also, 147 fresh cases were reported in the country, taking the number of people affected with the flu to 4,885.

Apart from Goa, one death each was reported from Delhi and Karnataka.

In New Delhi, 69-year-old Durga Prasad Sharma died due to the swine flu Monday afternoon.

"He was admitted to the hospital on Aug 28. He had bronchial asthma for the last 18 years and suffered from renal failure. Though he was not in a critical stage, his condition was bad from the beginning," N.K. Chaturvedi, medical superintendent of the Ram Manohar Lohia (RML) Hospital, told media.

Sharma, who was on ventilator and undergoing dialysis, was the fourth victim of the flu in the national capital.

He had first gone to a private hospital before being shifted to the RML Hospital. "His x-ray report had confirmed pneumonia. He had tested positive for the virus," Chaturvedi said.

A 12-year-old girl, suffering from respiratory problems, was critical and on ventilator at the hospital.

Meanwhile, 34 fresh cases were reported in the city, taking the total affected with the flu to 843 - the second highest in the country.

Three public schools in Delhi were also closed down for a while following detection of the swine flu cases among their students.

While the Vishwa Bharti Public School in Dwarka was closed for two days, the Heritage Grove Public School in Vasant Kunj and Banyan Tree School in Lodhi Colony were closed for a week.

In Bangalore, a 29-year-old woman succumbed to the influenza A (H1N1) virus. She was 20 weeks into her pregnancy.

Karnataka reported 15 fresh cases, taking its total number to 579 - the third highest in the country.

Maharashtra, which tops the list of the states with the maximum deaths and cases, confirmed 32 fresh cases, taking the total number of people affected with the virus to 1,855.

Meanwhile, Health Minister Ghulam Nabi Azad noted that swine flu is here to stay and will spread despite best efforts, but the country is controlling it by early detection, proper treatment and creating mass awareness.

He said authorities have "learnt some lessons" while tackling the spread of the disease that has become a global pandemic.

"The key to control its spread is early detection, complete treatment of confirmed cases and communicating with public at large to create awareness," Azad said at the 27th meeting of Health Ministers of World Health Organisation (WHOs) South East-Asia region and the 62nd Regional Committee Session of the WHO South-East Asia Region in Kathmandu.

"The virus is here to stay and will spread despite our best efforts to prevent its spread," the minister said, according to a statement issued here.

Azad said India focussed on contact tracing of suspect patients and also early diagnosis and treatment.

The minister said they enhanced the laboratory testing capacity and formed rapid response teams of doctors drawn from national, state and district levels.

"The number of labs equipped to test for the influenza-A (H1N1) disease was increased from two to 41 in the public and private sectors within a short span of time," he said, adding that doctors and paramedical staff were trained to build diagnosis and treatment capacity.

"India is taking adequate measures to enhance core capabilities at all levels to contain the spread of infectious diseases through border and community surveillance, early warning and detection systems, enhancing hospital preparedness to provide better healthcare facilities and stockpiling of anti-virals and personal protective equipment," he said in his address to the health ministers from the region and top WHO officials.

Azad offered India's help to countries in the region by "cooperating" with them in dealing with the pandemic. (IANS)

Men and women whose thighs are less than 60cm in circumference have a higher risk of premature death and heart disease, according to research published on bmj.com today. The study also concluded that individuals whose thighs are wider than 60cm have no added protective effect.

Lead author, Professor Berit Heitmann, based at Copenhagen University Hospital, says his research may help GPs identify patients who are at an increased risk of early death and developing heart disease.

While several studies have already demonstrated that being either very overweight or underweight are related to premature death and disease, this is the first to investigate the implications of thigh size on health.

Almost 3000 individuals took part in the study in Denmark - this included 1463 men and 1380 women. Participants were examined in 1987/88 for height, weight, thigh, hip and waist circumference and body composition. They were then followed up for 10 years for incidence of heart disease and 12.5 years for total number of deaths.

During the follow-up period 257 men and 155 women died, also 263 men and 140 women experienced cardiovascular disease and 103 men and 34 women suffered from heart disease. When assessing the results, the authors found that the survivors had higher fat-free thigh circumference levels.

The relationship between thigh size and early death and disease was found after taking body fat and other high risk factors (such as smoking and high cholesterol) into account. The authors therefore suggest that the risk from narrow thighs could be associated with too little muscle mass in the region. This is problematic because it may lead to low insulin sensitivity and type 2 diabetes and, in the long run, heart disease, they explain.

The authors conclude that the study "found that the risk of having small thighs was associated with development of cardiovascular morbidity and early mortality. This increased risk was found independent of abdominal and general obesity, lifestyle and cardiovascular risk factors such as blood pressure and lipids related to early cardio vascular morbidity and mortality".

The authors believe that doctors could use thigh size as an early marker for at risk patients and suggest that individuals increase lower body exercise in order to increase the size of the their thighs if necessary. Further research would be needed, however, to assess whether this approach was worthwhile.

A 24-year-old woman delivered a set of quintuplets in a span of three minutes on Friday at the Kokilaben Ambani Hospital, Andheri. The
first all-male set of quintuplets - incidentally, also the lone survivor set in India - and Sabira Khan, their proud mother, are all doing well.

"The set was conceived naturally. This, apart from being the first survivor set in India, is the eleventh all-male set and the seventeenth set of natural conception in the world," said Dr Suchitra Pandit, the gynaecologist who operated upon Sabira. The average weight of the babies is 800 gram. The first was born at 12:36 pm and the last at 12:39 pm, say the doctors who performed the operation.

Incidentally, this is not the first delivery for Sabira. "Our first son is 10 months old now. It is only by God's grace that I've got five more sons in the month of Ramzan, and on a Friday," said Ubaid Khan, the ecstatic father. He runs a garments business at Naya Bazaar.

The quintuplets did not seem to have caused much of a problem to their mother. "Sabira's case was referred to us by another doctor
. It was a big decision on our hospital's part to take up such a case. We needed a lot of preparation, both mental as well as in terms of equipment,'' said Dr Vinay Joshi, consultant pediatrician.

"When Sabira was referred to us on Monday, we did not know what to do. She was in her 28th week of pregnancy and had a history of a leak (passing water). Plus, one of the babies had less fluid surrounding him. Sabira also had a slightly higher pulse rate," said Dr Pandit, adding that the whole team had practised four drills before the delivery.

"The babies will have to be kept in the ICU for at least two months," said Dr Joshi.

Swine flu has claimed at least 2,840 lives across the world and over 2.5 lakh of confirmed cases of the virus have been reported, the World Health Organisation on Saturday said.

At least 254,000 laboratory confirmed cases of H1N1 virus has been reported from all over the world, which means that actual number could be much more, WHO's Gregory Hartl said at a news conference in Geneva.

"With the virus circulating so widely around the world, it is unfortunately to be expected that there will be deaths as the volume of cases and deaths is increasing," he said.

At the same time, there is no indication that the virus has mutated or changed its behaviour, he said noting that the virus is not causing more severe illness than before.

According to the latest update issued by WHO, tropical regions of South and South-East Asia continue to experience geographically regional or widespread influenza activity in India, Bangladesh, Myanmar, Thailand, Cambodia, Sri Lanka and Indonesia.

Many countries in the region are reporting increasing or sustained high levels of respiratory disease, and a few, including Thailand and Brunei Darussalam, have begun to report a declining trend in the level of respiratory diseases.

As the international pharmaceutical companies announced that they are ready to roll out their H1N1 vaccines between December and February,
the city-based vaccine major Serum Institute of India (SII), which is among the three Indian pharma companies working on the vaccine, said that if everything goes as per plan, they will not wait for the March deadline and will launch the vaccine way ahead keeping pace with the international players.

Moreover, the SII has diverted Rs 1.6 million US dollars given by the World Health
Organisation (WHO) for developing the avian flu vaccine for development of swine flu vaccine, said Rajeev Dhere, senior director of SII.

"With support from the WHO as well as the Government of India, we will be going in for toxicity study in animals in October and then conduct clinical trials on humans at the beginning of December. We will not wait for the March deadline given by the Indian companies. Our attempt is to launch the vaccine way ahead keeping pace with the international players," said Dhere.

Moreover, the SII has veered the WHO's financial assistance granted to develop and manufacture avian flu vaccine for development of H1N1 vaccine. "The WHO has requested the SII to take up the work of H1N1 vaccine on priority and asked us to redirect the funds meant for developing avian flu vaccine to the development of H1N1 vaccine," Dhere said.

Elaborating on the scheduled plan of vaccine development, Dhere said "A month after the animal trials, a detailed report of toxicity as well as the immunogenicity of the vaccine will be submitted to Drugs Controller General of India (DCGI) for carrying out human clinical trials
at the end of October," said Dhere. "After obtaining necessary permission from DCGI, the human clinical trials will begin in December," said Dhere.

"The vaccine has to go through the regular testing process but the DCGI has promised us that they will do their best to fasttrack the process following guidelines of the WHO and European Medicines Agency," said Dhere.

"If these human trials are successful, we have the technology to produce a vaccine that can be pressed into service for commercial production depending upon the scale of requirement after regulatory clearances," said Dhere.

The Serum Institute of India (SII) was part of a teleconference held with over 30 countries by the Director-General of the World Health Organisation (WHO), Dr Margaret Chan, to develop a preventive vaccine against H1N1 flu, hours after the disease was declared a global pandemic.