Our hands are vital for performing tasks throughout our daily lives and must be taken care of and cleaned regularly. They can easily spread germs, bacteria, or viruses such as Covid-19 (Coronavirus). Coronavirus has spread rapidly throughout the entire world in the past few months and health officials are very adamant that hand hygiene can help prevent further escalation of the virus. The reason is simple; viruses can spread from our hands to other objects that we touch, to which other people can touch those same objects and possibly contract the virus by putting their hands on their face. According to the World Health Organization, proper hand sanitation that uses alcohol-based rub or hot water and soap can kill Coronavirus and other viruses [1].

For some people, such as healthcare professionals, there are actually major consequences for neglecting hand hygiene. For example, the dirty hands of these professionals have a negative impact of 40% in the transport and spread of resistant microorganisms among patients. Hospital infections are actually among one of the main catalysts for increased disability and death rates in hospitals, along with additional healthcare costs [2]. In the United States, 1.7 million patients develop health-related infections every year, and 100,000 of them die. This increases the length of hospital stay by 20 times and the cost of treatment by 5 times [3].

It was not until the 19^th century that we began to understand that infectious diseases can be prevented by washing our hands. In the middle of the same century, the pioneer of antiseptic processes, known as the “savior of mothers,” Hungarian physician Ignaz Semmelweis, showed that microorganisms could be transmitted to patients via the hands of medical staff. This discovery began a new era of hygiene and healthcare. It is now well known that microbes reproduce rapidly, and that it is possible to prevent the spread of disease by keeping the hands and body, which is possible by following personal hygiene rules.

Hand hygiene is maintained in different ways in modern medicine. In daily life, washing hands with soap and water to remove dirt is called “social hand washing.” Common examples include washing after a meal and when visiting the toilet. For this purpose, it is sufficient to rub the hands and fingers for 15 seconds with a non-antimicrobial feature soap, rinse, dry with a disposable towel, and turn off the tap with a towel. Cloth towels used by many people in public places are not considered suitable for hygiene.

The more serious and professional form of hand washing is “hygienic hand washing,” where antimicrobial soaps are used in the washing process before and after contact with patients and bodily fluids. Other hand hygiene methods during surgical operations cover applications where alcohol-based 3-5 ml hand-disinfectant is rubbed until dry along with hand disinfection and surgical hand antisepsis, which includes washing the hands, including the forearms, with chemical solutions such as soaps, isopropanol, chlorhexidine specifically produced for this purpose for 2-3 minutes, and later wearing sterile gloves until the end of any procedures.

The World Health Organization published a guide on proper hand hygienics and explained when, how often, and how healthcare providers should wash their hands [4]. Despite the development of various programs and policies, especially hand hygiene, and increasing material expenditures in the fight against infections observed in health services, the control of infections remains well below the desired level.

Today, research also looks at the effects of hand washing on individual psychology. An experiment carried out by two psychologists from the University of Michigan, Spike W.S. Lee and Norbert Schwarz, shows that hand-washing reduces this classic post-decisional dissonance effect:

In individual sessions, 40 undergraduates browsed 30 CD covers as part of an alleged consumer survey as if they were in a music store. They selected 10 CDs they would like to own and ranked them by preference. Later, the experimenter offered them a choice between their 5th and 6th ranked CDs as a token of appreciation from the sponsor. Following the choice, participants completed an ostensibly unrelated product survey that asked for evaluations of a liquid soap; half merely examined the bottle before answering, whereas others tested the soap by washing their hands. After a filler task, participants ranked the 10 CDs again, allegedly because the sponsor wanted to know what people think about the CDs after leaving the store.

For those who merely examined the soap, the preference for the chosen over the rejected alternative increased from before choice to after choice by an average of 1.9 ranks, replicating the standard dissonance effect. In contrast, for those who washed their hands, preferences were unaffected by their decision. Thus, handwashing significantly reduced the need to justify one’s choice by increasing the perceived difference between alternatives. “Washing one’s hands after making a choice eliminates post-decisional dissonance effects, suggesting that hand-washing psychologically removes traces of the past, including concerns about past decisions” [5].

In another study conducted in 2008, Schnall, et. Al. “hypothesized that physical cleanliness reduces the severity of moral judgments. In support of this idea, they found that individuals make less severe judgments when they are primed with the concept of cleanliness and when they wash their hands after experiencing disgust” [6]. This effect of hand washing, which relieves conscience, is called the “Macbeth Effect.”

Washing hands is one of those simple but compulsory practices we tend to take for granted and lose interest in as we progress in science and education. Simple practices like using each of our hands for different purposes and frequent hand-washing will surely contribute to the fight against healthcare infections and infectious diseases that threaten public health.

There are several traditions of Prophet Muhammad, peace be upon him, in which washing hands is strongly emphasized.

“The blessings of food lie in washing hands before and after eating.”

“Wash your hands after you wake up; you do not know where your hands have moved while you were sleeping.”

The Prophet advised using each hand for different tasks. It is narrated that his wife Aisha said: “The right hand of the Messenger of God (peace be upon him) was for his purification and food, and his left hand was for using the restroom and anything that was dirty.”

Notes

1. “Advice for Public.” World Health Organization, World Health Organization, www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.
2. Pittet D, Allegranzi B, Storr J, Donaldson L. Clean care is safer care: the global patient safety challenge 2005-2006. Int J Infect Dis. 2006; 10(6): 419–24.
3. Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The first global patient safety challenge “Clean care is safer care”: from launch to current progress and achievements. J Hosp Infect. 2007; 65(Suppl. 2): 115–23.
4. WHO Guidelines on Hand Hygiene in Health Care, www.who.int/gpsc/5may/tools/9789241597906/en/
5. Lee SW, Schwarz N. Washing away postdecisional dissonance. Science. 2010 May 7;328(5979):709. doi: 10.1126/science.1186799.
6. Schnall S, Benton J, Harvey S. With a clean conscience: cleanliness reduces the severity of moral judgments. Psychol Sci. 2008 Dec;19(12):1219-22. doi: 10.1111/j.1467-9280.2008.02227.x. Also see https://psycnet.apa.org/fulltext/2014-20922-011.html in which Johnson, D. J. et. al. suggest that “researchers investigating the connections between cleanliness and morality should therefore use large sample sizes to have the necessary power to detect subtle effects.”

To this day, natural breast milk is still regarded as the best nutritional choice for babies. Recent research on stem cells, genetics, and epigenetics [1] from the last three decades, along with information obtained from studies about childhood and youth and testimonials from organizations that guide health policies worldwide, all support this claim. Modern medicine agrees that breastfeeding is the healthiest, most inexpensive, highest quality, and most appropriate choice for protecting both a mother and baby’s health [2]. The World Health Organization holds breastfeeding as an essential gold standard for the immunological development of a child, starting from the first six months to two years of age [3].

Breastfeeding has many benefits. It strengthens the emotional bond between the mother and her baby. It helps ensure that the baby grows in a healthy manner, by establishing its first feeling of trust; positively effects the baby’s intelligence level; and helps bolster the baby’s immune system.

One of the most studied issues in recent studies is the effect of breast milk on respiratory diseases such as asthma. The effects of breastfeeding on asthma, allergic diseases, and respiratory infections has been a topic of concern for the medical world for at least the last 80 years. Recent studies agree that breast milk has a preventive role against lower respiratory tract infections in infancy (0–2 years). However, there are some complications in these studies. Given the challenges in patient standardization, only food-allergy studies can be standardized. Due to the complexity of the environmental and genetic factors that trigger allergies, it should be considered normal that the effect of breast milk has not yet been fully established to protect against a wide range of allergic diseases, particularly asthma [4].

Asthma is the most common chronic disease in childhood and has a complex structure. It has been on the rise lately, and scientists are scrambling to figure out what is causing this increase as well as the best ways to combat the disease. Asthma can be caused by a wide variety of sources, such as genetics, smoking, microscopic ticks and mites in house dust, allergenics such as grass or pollen, obesity, urban life, air pollution, synthetic nutrition, and imbalance in intestinal flora [5]. In addition, premature birth, low birth weight, a young mother, and early exposure to respiratory infections are factors that increase the risk of asthma [6]. Consequently, it is difficult to independently measure the effect of a single determinant in asthma. In a significant study on 3,963 children in the Netherlands, children were breastfed for at least four months and then followed for up to eight years after birth. The outcomes of the study revealed that breast milk significantly reduced the risk of asthma, independent of other variables. It has been observed that the rate of chronic asthma development decreases as the breastfeeding duration increases [7].

Today, breast milk’s benefits have been proven in protecting babies from respiratory infections both early on and later in life. Breastfeeding provides an emergency line of defense against infectious diseases by helping infants whose immune systems are not yet developed enough to fight infections.

Breastfeeding facilitates a beneficial germ exchange between mothers and babies and helps to develop a strong immune system. Enzymes, hormones, bioactive molecules, and growth factors in breast milk are all extremely vital for babies. These crucial molecules help develop the baby’s immune system by interacting with the proximate elements. Thanks to numerous features in its ingredients, breast milk has a significant role in supporting the baby’s immune system with the development of appropriate microorganisms in the intestine. The strength of the microbial structure in the baby’s intestine depends on the way of delivery, diet, and the variety of foods consumed by the mother. This healthy structure in the intestines is essential for the development of the immune system and for building an increased tolerance to new foods that will be taken orally. In infancy, beneficial microbiota in the intestines starts to develop healthily by breastfeeding in the first four to six months.

A comparative study between the intestinal flora of infants fed with breast milk and formula milk showed that the diversity and density of the desired microorganisms increased in a shorter time and in sufficient amount in the breastfed infants. Today, increased hygiene standards have changed the intestinal flora of infants, especially in Western societies. This, however, has increased the risk of diseases such as asthma [8].

Cytokines (a group of proteins and peptides that allow cells to communicate with each other) in breast milk also serve the development and smooth functioning of the immune system and play an important role in protecting the baby against bacterial infections, wheezing, and allergies. Human milk, especially “first milk,” was found to contain more than 20 cytokines [9]. First milk arrives in the first few hours after birth as a miraculous gift to babies when they are most vulnerable to illnesses and helps to protect against diseases. Ig A antibodies in the first milk also protect against infectious diseases that are commonly experienced in early life, besides obesity, diabetes, and allergic diseases that may come later [10].

Infants fed with ready-made foods have lower amounts and types of bacteria in their intestines than those fed with breast milk, which can consequently increase the risk of eczema and asthma. The issue of delaying foods with high allergy potential, especially when switching to supplementary foods, is still being debated. Some researchers suggest that complementary foods should not be introduced to infants up to 12 months. However, the common opinion is that positive intestinal bacteria that develops with sustained breastfeeding can reduce the risk of allergies to additional foods. Another consensus is that the transition to supplementary foods should not be earlier than six months [11].

As breast milk is the most important food for newborns, mothers should diligently endeavor to complete the suggested period of breastfeeding. Breastfeeding, if continued until the age of two and especially in the first six months, is accepted by international pediatric authorities as the cornerstone of nutrition.

Character formation and breast milk

We are physically and emotionally affected by what we eat or drink. Based on this assumption, it can be argued that breastfeeding might also have an influence on the character formation of babies [12]. Although it has been determined that intelligence and brain development are influenced by the emergence or inhibition of some genetic characters in the baby by epigenetic means, no research based on long-term observations has been conducted. In any case, it would be wise for parents to provide the best food both for themselves and their babies. Inasmuch as they make sure the food is hygienic and natural, they should also be cautious that it is obtained through legitimate means. If, for any reason, the mother’s milk is not enough or is suspended, a milk-mother with necessary qualities may be contracted.

Breastfeeding for two years is prescribed in the Qur’an: “Mothers are to suckle their children for two complete years” (2:233). “We have enjoined on human in respect with his parents: his mother bore him in strain upon strain, and his weaning was in two years” (31:14). Likewise, the Prophet Muhammad, peace be upon him, speaking about his son Ibrahim, who died before he could turn two, said, “He has a milk-mother in Paradise, she will suckle him for his remaining milk, (will complete the term of two years).” (Muslim, Fadail, 63, 2316)

References

1. The inherited and non-genetic changes which occur in the disclosure of genetic information i.e. gene expression, without any no change to the structure of DNA.
2. Ballard O, Morrow AL: Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am, 2013; 60: 49–74.
3. World Health Organization Recommendations on Postnatal Care of the Mother and Newborn. Geneva, WHO, 2013.
4. Matheson M, Allen KJ, Tang MLK: Understanding the evidence for and against the role of breastfeeding in allergy prevention. Clin Exp Allergy, 2012; 42: 827–851.
5. Ding G, Ji R, Bao Y: Risk and protective factors for the development of childhood asthma. Paediatr Resp Rev, 2015; 16: 133–139.
6. Oddy WH, de Klerk NH, Sly PD, Holt PG: The effects of respiratory infections, atopy and breastfeeding on childhood asthma. Eur Respir J, 2002; 19: 899–905.
7. Scholtens S, Wijga AH, Brunekreef B, Kerkhof M, Hoekstra MO, Gerritsen J et al..: Breastfeeding, parental allergy and asthma in children followed for eight years: the PIAMA
8. birth cohort study. Thorax 2009; 64: 604–609.
9. Adlerberth I, Wold AE: Establishment of the gut microbiota in Western infants. Acta Paediatr, 2009; 98: 229–238.
10. Goldman AS, Rudloff HE: Are cytokines in human milk? Adv Exp Med Biol, 1991; 310: 93–97.
11. World Health Organization Recommendations on Postnatal Care of the Mother and Newborn. Geneva, WHO, 2013.
12. World Health Organization: Global Strategy for Infant and Young Child Feeding. Geneva, 2003.
13. Ibrahim Canan, Peygamber’in Sunnetinde Terbiye, Istanbul: Isik Yayinlari, 2014, pp. 95.

These findings might help researchers to design more effective drugs for various human infections by focusing on the minimization of the inflammation. Moreover, bats are capable of sustained long flights, as some bat species can fly more than 1,000 km in a single night. With such intense physical activity, cells often produce high levels of toxic (free radicals) that would usually damage DNA sequence.

This study also found that bats are equipped with a highly functional set of genes that mediates DNA repair in response to DNA damage, thus bats are protected from toxic cellular waste with this advanced mechanism. Aging, cancer and infectious diseases are the three major issues medicine is facing today and biological abilities granted to bats seem to provide important clues for us to discover new ways to combat these big health problems

In the seventeenth century, nearly seven centuries after Ibn Sina, the Dutch scientist Anton van Leeuwenhoek (also referred to as the “Father of Microbiology”) observed microorganisms under a microscope (van Leeuwenhoek 1980). With his fundamental discovery, he showed that there were living organisms that were not visible to the naked eye. What van Leeuwenhoek did not realize was that these microorganisms (e.g. pathogen: a disease causing microbe) could actually be the cause of infections. This is contrary to the discoveries made by Ibn Sina seven centuries earlier that microorganisms could be the cause of infections despite the extremely limited evidence for the existence of microorganisms at the time. Nearly two centuries after Leeuwenhoek’s first observation of microorganisms, in 1876, Robert Koch, a German physician, postulated that microorganisms could actually be the cause of infection and therefore disease by his fundamental observation that the blood of an infected animal that contained pathogenic bacteria that, when transferred to a healthy animal caused the recipient animal to become sick (Koch 1999).

Let’s take a moment to reflect on Ibn Sina’s life story to encourage readers to learn more about him (McGinnis 2010) and his contributions to modern medicine and science.

Ibn Sina was born in 980 in in the village of Afshana near Bukhara, Uzbekistan (previously known as Khorasan) to a local governor named Abdullah, from Balkh, and his wife Setareh, a local from Afshana. Thanks to his father’s position as a governor as well as his background as a scholar, Ibn Sina had access to an excellent education in Bukhara, which at the time was the capital and intellectual center of the Samanids. Ibn Sina was taught by some of the most famous scholars of the time in the sciences and in Islamic theology. By the age of 18, Ibn Sina had already mastered the sciences of his day and had become a practicing physician. In addition to his expertise in medicine, for which he became world-renown, he was also a well-known philosopher, astrophysicist, mathematician, and theologian. He spent his life educating people, treating patients and writing books that not only enlightened the people of his age but later generations throughout the world as well.

Although Ibn Sina was considered one of the greatest Muslim philosophers of the medieval age he was a widely respected and well-known physician and was known as the “Prince of Physicians” in the West, and al-Sheikh al-Rais (Leader of the Scholars) among his students and colleagues (McGinnis 2010, 227). His gigantic medical encyclopedia al-Qanun fi al-Tibb (The Canon of Medicine), comprising of upwards of a million words, has been used as the standard medical textbook up until the seventeenth century and is still widely considered a valuable resource for the study of medicine. It was printed thirty-six times in the fifteenth and sixteenth centuries alone (Ullman 1978) and is regarded as one of the most influential books in Europe during the Middle Ages and Renaissance (Siraisi 2001).

The Canon of Medicine consists of five books with each book subdivided into various subjects, subsidiary subjects, summaries, and sections. The first book, also called al-Kulliyyat (The Collection), discusses the scientific background of medicine and anatomy such as physiology, symptomatology, and the principles of therapy. The second book has an account of the therapeutic properties of substances used in medicine. The third book is devoted to pathology and specific or localized ailments. Diseases that affect the whole body, such as fever, are discussed in the fourth book. Ibn Sina explained the mixing of drugs in the final volume, which is a book on pharmacology. Ibn Sina, in his Canon, derives his system of medicine from the Greco-Roman physician Galen (Galen of Pergamon, modern day Bergama, Izmir, Turkey, 129-200 CE) who himself based his approach on Hippocrates (460-370 BCE). Ibn Sina also benefited from ar-Razi (Rhazes in Latin, 865-925 CE) and al-Majusi (Haly Abbas in Latin, died circa 990) to present a systematized and comprehensive view of the medical sciences of the time (Prioreschi 2003).

Ibn Sina is only one of many great minds of the Muslim World during the medieval era. There were other great minds such as Ibn Rushd (Averroes in Latin), Ali Kuscu, al-Farabi (Alpharabius), Omar Khayyam and many more whose multifaceted studies encompassed diverse scholarly fields such as exegesis, law, logic, metaphysics, mathematics, astronomy, and medicine. The great Mesopotamia and Andalusia Civilizations – civilizations that were built by these brilliant scientists and philosophers – established the foundations of the science, art and philosophy of our age. The knowledge developed by the Muslim scholars was later transmitted to Europeans and enabled Europe to emerge from the Dark Ages and into the Renaissance.

A Renaissance is also needed for the Muslim world today. This can only be possible when they can raise a new generation of scholars like Ibn Sina who can lead the society with their groundbreaking findings and illuminating interpretations.

References

• Colgan, Richard. 2009. Advice to the Young Physician. Springer, New York.
• Koch, Robert. 1999. A Life in Medicine and Bacteriology. ASM Press, Washington, D.C.
• Life and work of Anton van Leeuwenhoek of Delft in Holland; 1632-1723. Municipal Archives, Delft, 1980.
• McGinnis, Jon. 2010. Avicenna. Oxford University Press, New York.
• Prioreschi, Plinio. 2003. Medieval Medicine vol. 5: Medieval Medicine, Horatius Press, Omaha, Nebraska.
• Siraisi, Nancy. 2001. Medicine and the Italian Universities 1250-1600. Leiden, The Netherlands.
• Ullman, Manfred. 1978. Islamic Medicine. Edinburgh University Press, Edinburgh, United Kingdom.
• United States National Library of Medicine, MS A 53
• http://www.pbs.org/wgbh/globalconnections/mideast/themes/science/index.html

HIV/AIDS is one of the most devastating health issues in modern history. Since the first case was reported in 1981, over 25 million people have died of HIV/AIDSrelated causes. Despite a better understanding of the disease, extensive knowledge about virus-human interaction, improved preventive measures, and medical treatment options, most experts agree that the pandemic is still in its early stages and rapidly spreading. According to the World Health Organization, in 2006 4.3 million people became infected with HIV and a total of 2.9 million people died of HIV/AIDSrelated causes. As of 2007, over 40 million people are living with HIV/ AIDS around the world and nearly half of them are females between the ages of 15 and 24.

With a vaccine still perhaps decades away, the best hope for impeding the spread of this deadly disease lies in effective prevention, early diagnosis, and successful treatment. For more than two decades, thousands of researchers from the most prestigious institutions around the globe have been struggling to discover more effective screening, diagnosis, and treatment options against HIV/AIDS, but a great deal has yet to be accomplished. At the moment, the high cost of the current medical treatment options and limited accessibility to HIV testing worldwide remain as additional obstacles to be overcome. Below is a table showing the spread of HIV/AIDS worldwide, based on the best available information provided by WHO in 2006. Additionally, the map below represents the regional distribution of adult HIV/AIDS cases by region based on UNIAIDS 2006 Report on the global AIDS epidemic.

What is HIV/ AIDS?

Healthy human bodies have a wellprogrammed defense mechanism (the immune system) that fights infections and helps prevent the development of cancer cells. Human immunodeficiency virus (HIV) primarily targets vital elements of the immune system, such as helper-T cells, macrophages, and dendritic cells. Due to the damage and destruction of these cells, the human body loses its ability to fight against infections and cancerous developments. This makes the body more susceptible to certain types of cancers, such as Kaposi sarcoma, and to opportunistic infections that would normally be easily defeated, such as pneumonia (Pneumocystis carinii) and Cryptococcal Meningitis. These infections might result in severe damage or the death of the patients. Therefore, it is not the Human Immunodeficiency Virus that causes death in HIV(+) individuals, but opportunistic infections or cancerous developments that a weakened immune system cannot repel. Hence, the later stages of HIV infection are called Acquired Immunodeficiency Syndrome (AIDS).

In spite of many obstacles, in industrial countries there has been a remarkable improvement in the medical care of HIV/AIDS individuals as a result of testing for HIV on a regular basis, particularly among high risk groups. This facilitates early diagnosis and therefore an early start in medical treatment, which allows HIV(+) individuals to live for decades after diagnosis. However, worldwide, particularly in developing countries, 90% of those carrying HIV have not been tested or do not have access to adequate treatment for the disease. Furthermore, every year a considerable number of HIV(+) individuals in developing countries die without even knowing what HIV is and leave thousands of orphans behind who do not have any idea what took their parents away. The number of people living at critical poverty levels in some of these hardest-hit regions, such as sub- Saharan Africa, has reached over 43 percent in recent years. Women encompass 80 percent of those who are living on less than a dollar a day. For people who live in such abject poverty, neither treatment for an HIV+ /AIDS individual (which normally costs around $25,000 annually) nor routine HIV screening seems realistic. On the other hand, even though testing and medical treatment options are available in developed countries, the economic burden on the health care system is becoming greater with every passing day.

HIV and children

As of 2007, over 2.3 million children are suffering from HIV/AIDS worldwide. A small percentage of these children were exposed to the HIV in medical settings, due to unscreened blood transfusions or reused or insufficiently sterilized equipment. Pediatric HIV outbreaks in Romania in 1989 and in Libya in 1998 are two devastating examples of the consequences of negligent or insufficient precautions taken by medical personnel in hospitals. Currently, health care professionals are required to take strict precautions when cleaning and sterilizing medical equipment, while blood banks are monitored closely to ensure the careful screening of blood. These precautions seem to have led to a significant reduction in the number of HIV infections which are acquired in hospital settings. However, motherto- child transmission still constitutes 90% of pediatric HIV cases. An HIV (+) mother has about a 35% risk of transmitting the virus to her child during her pregnancy, child birth, or nursing. This risk can be reduced by administering AZT (an antiretroviral drug) to the mother during the last trimester of pregnancy, delivering the child by C-section, giving one dose of prophylactic antiretroviral therapy to the baby after birth, and by avoiding breast-feeding the infant. As a result of widespread screening and the use of prophylaxis for mother-to-child transmission, the rapid spread of HIV among the pediatric population in industrial countries is relatively under control.

Sadly, not all nations have benefited uniformly from the recent advances in our knowledge about the prevention of transmission. Mothers and infants in developing countries face a different scenario than those in the “modern world.” In places like sub-Saharan Africa, where the majority of HIV/AIDS cases are due to mother-to-child transmission, the number of new infections is rapidly increasing; it seems that ensuring the abovementioned precautions are in place is extremely difficult due to several limitations. These limitations should be discussed in another paper, however to give a brief idea to the reader, one of these instances can be examined. It is a fact that if an HIV(+) mother avoids breastfeeding her newborn baby the risk of her infecting the child with HIV is dramatically reduced. Although this sounds like a wonderful way to combat HIV infection in infants, it poses many problems to mothers in sub-Saharan Africa. Every year, more than one million babies die in the first 28 days of their life in Sub- Saharan Africa. Most of these deaths are due to malnutrition and infections. In most situations breast-feeding is the only clean source of nutrition a mother can offer her child. It also provides natural immunization against most of the infectious agents to which a newborn can be exposed in the later days of his/her life. Babies who are not breastfed have almost no other alternative source of clean nutrients and stand little chance against infections. An HIV(+) mother in Sub-Saharan Africa has to face this dilemma every single time her baby cries from hunger: either take the risk of infecting your baby with HIV or let your child die of malnutrition or infections which kill approximately 3,000 African children every day.

Another issue concerning children in the hard-hit HIV regions is the loss of one or both parents or primary care-givers at a very early time of their life. So far in Africa, HIV/AIDS related deaths have left 14 million orphans. The United Nations estimates that the number of orphans will reach 25 million by the year 2010. Only in rare cases do these children have access to clean water, food, shelter, and education. Furthermore, the orphans who have been infected with HIV by their parents do not have access to adequate treatment options. The number of orphans is so high and resources are so limited that unfortunately most of these children fall through the cracks of society, succumbing to poverty, abuse and even death. Some of these orphans are relatively lucky and have healthy grandparents to care for them. It is not uncommon to find 75-80 year old grandparents who are already living under the critical poverty level taking care of three or four AIDS orphans, and wondering who will care for their grandchildren when they pass away.

Education

Success against the HIV/AIDS epidemic cannot be accomplished only with scientific and medical means. Preventive education plays a key role in the battle against HIV/ AIDS. The first step in preventive HIV/AIDS education is to inform individuals about the disease and answer their questions, such as, “What causes AIDS?”, “How is HIV/AIDS spread?”, “What are the preventive measures to be taken?” If one is already infected with HIV then one must ask “What are the treatment options?”

Preventive education for risk groups who are not aware of HIV/ AIDS and the consequences of the infection helps to decrease the overall number of new infections, particularly those in developing countries. However, another issue appears as education level increases: according to current studies, the number of people who continue risk-taking behavior is increasing in spite of the knowledge they have about HIV/ AIDS prevention and the consequences of the disease. This suggests overthat effective HIV/AIDS prevention should include not only education about the facts of the illness, but also education that focuses on teaching people to avoid behavior that puts them at high risk. It is also worth noting that the widespread dissemination of information by governmental organizations may not be effective on its own, and that different types of intervention may be necessary by groups with the potential to motivate people on a personal level. In other words, it is important to individually instill a sense of consequence and personal responsibility within those at risk, rather than broadly reminding them of the dangers that they face. As a result of recent thinking along these lines, various institutions, professional groups, and government organizations have realized the need for strong collaborative efforts and have aligned themselves in order to begin taking the steps necessary to effect this type of change.

Working together

Around the globe, government agencies have been initiating and sponsoring several efforts aimedat HIV-prevention. However, the complexity of the HIV epidemic and the involvement of many sociologic and behavioral factors require a shared commitment among government agencies and civil society organizations. For example, the Center for Disease Control (CDC) is the leading federal agency in HIV prevention in the United States. In their strategic plan for HIV prevention in 2005, the CDC admits that the HIV epidemic is not a matter that can be handled by only one agency, group, or organization. Therefore, for success in HIV prevention the CDC recognizes the need for other domestic partners, such as:

~ Other federal agencies;

~ State and local health and education departments;

~ HIV prevention community planning groups;

~ Community-based organizations;

~ Academic institutions;

~ The private sector;

~ Faith-based groups and

~ Foundations and nonprofit groups

(Centers for Disease Control and Prevention HIV Prevention Strategic Plan Through 2005)

In addition to domestic partnership, worldwide cross-cultural and cross-faith collaborations are establishing a strong global response to eradicate HIV/AIDS. People from all over the world should contribute, in whatever capacity and with whatever resources they can, to the solution; their involvement is critical. The World Health Organization, UNICEF, UNESCO, and similar organizations are doing their parts to bring multinational aid to the hardest hit regions. Additionally, many faith-based national and international organizations around the globe have started working in collaboration towards the eradication of HIV/AIDS. Among these faithbased efforts there are recent examples of interfaith partnerships. The Africa HIV/AIDS Faith Initiative, a successful example of this type of collaboration, has been active since 2001 in five African countries: The Ivory Coast, Kenya, Nigeria, Tanzania and Zimbabwe. One of their noticeable accomplishments is promoting interfaith dialogue in these countries where ethnic and religious variations often cause serious clashes. A report from The Global Health Council lays the power of Interfaith partnership before our eyes:

“In Kenya, the Supreme Council of Kenya Muslims, the Anglican Church of Kenya and the Pentecostal Churches of Eastlands, a low socioeconomic community outside Nairobi, have teamed up to reach bishops, pastors, men, women, youth, children and people infected with HIV/AIDS through education and service initiatives. In Tanzania, the national staffs of the Episcopal, Christian and Muslim HIV/AIDS offices meet monthly to exchange ideas and plan together for the effective development, implementation and coordination of HIV education and service interventions.

But it is in Nigeria, with its welldocumented history of religious conflict and recent violence, where the partnering of Christians and Muslims is most remarkable. Observing the establishment of separate offices in each of the four other countries, Nigeria’s religious leadership said “it won’t work here,” and charged The Balm In Gilead to set up the Interfaith HIV/AIDS Coalition of Nigeria. Christian and Muslim clerics going out on the street together can draw curious crowds, and “people will come into the office just to see us working together,” said one reverend.

Nigerian faith institutions involved in this historical decision included the Episcopal Conference of Nigeria, Christian Association of Nigeria, the Christian Health Association of Nigeria and the Supreme Council of Islamic Affairs. This interfaith approach in Nigeria is being seen as a model that can be replicated by other countries. The Kenyan Muslim leaders have already requested that it be presented as a best practice model and replicated in other parts of the continent.” http:// www.globalhealth.org/reports/ text.php3?id=194

Conclusion

We have witnessed many harsh discussions, questions and speculations about HIV/AIDS such as, “How and where did HIV/AIDS start?”, “Whose fault was that?”, “Why don’t people simply stay away from risky behavior and put a stop to it?”, “What are the roles of faith traditions, family values and public wisdom in terms of preventing and fighting against HIV/AIDS?”, “If I am not involved with certain risky behavioral elements am I safe? Are my children safe from HIV?”, “Is contributing to the solution for HIV the same as trying to legitimize the life-style preferences which are the primary cause of the spread of HIV in the first place?”

As a matter of fact, how this epidemic started, whose fault it was, why precautions were not taken on time does not matter that much anymore. What matters is that hundreds of people are dying, thousands of children have been orphaned, and millions of mothers are crying in desperation everyday. We do not have the luxury to sit back in our comfortable seats and be the judge who decides who is right and who is wrong in this drama. We are all human… we are citizens of the earth… we breath the same air, sleep under the same sky. When we cut ourselves, our blood runs red, our tears are salty. Pain is pain… a cry is a cry… desperation is desperation…No matter where we go, what language we speak, or how we live our lives… We are obliged to put the differences to one side and to become a part of the solution…to think about it… to talk about it… to do something about it… or at least with a sore heart cry and pray for our HUMAN sisters and brothers who are suffering from HIV/AIDS… who might not be able to do much for themselves.

When Alexander Fleming first discovered penicillin in 1929, it was touted as a miracle drug, and at the time it was. After antibiotics became common, once-fatal infections became only minor inconveniences. But now it appears that bacteria, the target of antibiotics, are fighting back by developing resistance to the drugs that once killed them. In order to grasp how this has occurred, we need to understand a little more about both antibiotics and bacteria.

Antibiotics and Bacteria

Antibiotic literally means against life. Antibiotics are natural substances, compounds made by living organisms, which either kill or inhibit the growth or production of bacteria. The antibiotics we take when we are ill are manufactured. They have been altered or synthesized in order to enhance their potency or increase the range of the species they affect. Some antibiotics, such as tetracycline, interfere with the production of new bacteria by binding to ribosomes and thereby preventing them from manufacturing proteins. Others, among them penicillin, obstruct the synthesis of cell walls. Whatever their mode of operation, antibiotics hinder the proliferation of bacteria and allow the human immune system to overcome any remaining organisms.

Bacteria are complex one-celled organisms. Contrary to popular belief, most bacteria are necessary and beneficial. Beneficial bacteria aid digestion, decompose dead organisms, and often protect us from an invasion of harmful bacteria.

Genomic or chromosomal DNA in bacteria is in the form of a continuous strand. This circular DNA is located in a nucleoid.¹ A plasmid, another form of DNA, is an extra-chromosomal self-replicating structure found in bacteria cells. Plasmids, which carry genes for a variety of functions not essential for cell growth and normal survival, can be thought of as mini-chromosomes.

Compared with genomic DNA, which may contain 4 million base pairs, plasmids are small -they contain only 1,000 to 25,000 base pairs. A bacterial cell may contain one plasmid, many copies of the same plasmid, several different kinds of plasmids, or no plasmids. It is generally believed that DNA in plasmids helps bacterial cells to overcome the various stresses in their environment. One such survival mechanism is a gene or several genes for antibiotic resistance. Plasmids also may carry genes for virulence. For example, the severe food-borne disease caused by a strain of E. coli is a plasmid-based illness.

Reproducing and Exchanging Genetic Material

As bacteria usually reproduce through binary fission, or splitting to form two identical daughter cells, there is no recombination of DNA. However, many bacteria do exchange and then recombine genetic information through transformation, transduction, or conjugation. All three techniques have been exploited by specialists involved in the genetic engineering revolution.

When a bacterium (donor) dies, the cell ruptures (lyses) and thereby sets the cellular material free in the environment. Fragments of this naked DNA are then absorbed by recipient (host) bacteria, which incorporate and recombine it with their own. This process, known as transformation, has been exploited to produce such transgenic organisms as cows or plants that contain functional human genes.

The second method of recombination is transduction, or the exchange of genetic material by a viral carrier. Viruses that invade bacteria are called bacteriophages, or just phages by most scientists. When a phage infects a bacterium, it injects its own DNA, which then takes over the host’s metabolism and turns it into a small factory capable of assembling more phages. After it has produced a sufficient number of viruses, the cell lyses and the new phages are released and begin to infect more bacteria. If some of the host DNA is incorporated into a phage during the assembly process, an extremely rare occurrence, the defective phage still can bind to and inject its DNA into a host cell. However, it does not carry the virus’ genetic material and so cannot infect the cell. Thus it is no more than a mode of transport for DNA from one bacterium into another. As in transformation, the new DNA can be recombined with that of the host.

In the 1950s, scientists observed a third form of recombination: conjugation. This form of exchange features bacteria that are connected to each other through a tube or bridge. Donor cells carry fertility (or sex) plasmids, which allow the cell to synthesize long, thin hollow tubes called pili. The “sticky” pili bond to the cell walls of the recipient cell, and the two cells become united. A special enzyme then cuts a strand of the donor DNA, which is then transferred. Sometimes an entire chromosome is transferred and then recombined in the recipient cell. Bacteria also exchange plasmids through the conjugation bridge. This exchange is rapid and efficient. Not only do exchanges take place among bacteria of the same species, but they also cross species lines and even occur between bacteria and eukaryotic (plant and animal) cells.

Resistant Genes and Antibiotic Abuse

Resistant genes work in several ways. Certain genes prevent destruction by producing enzymes that either degrade antibiotics or alter them chemically so that they become ineffective. Another gene helps the bacteria replace the receptor site for the antibiotic, thereby preventing it from binding to the bacteria. And yet a third gene can be used to manufacture a pump that removes the antibiotic from the cell.

When antibiotics are taken, the bacterial cells that are susceptible to the drug die. But some cells may survive. Those cells then reproduce and pass on that resistance to the daughter cells. This often happens when too little of a drug is used or if it is not taken over a long-enough period. If patients do not take enough of their prescribed medication or stop taking it after a few days, they are promoting resistance. Another problem is that non-life-threatening illnesses, such as acne and chronic ear infections, often are treated with low doses of antibiotics over a long period of time. This practice also aids the development of resistant genes.

Many patients view antibiotics as a quick cure, and unfortunately doctors succumb to demands to prescribe them even if they are not necessary. Although antibiotics do not kill viruses, they are prescribed for patients who do not want to be told just to go home, rest, and drink plenty of fluid. Unless a culture is done to identify the infection, a doctor can only guess which anti-biotic to use. Increasingly stronger or broader-spectrum antibiotics are employed in cases involving unidentified infections, which can be analogous to killing a fly with a machine gun. Most minor illnesses will succumb to the body’s immune system. Furthermore, we need to remember that the symptoms being treated are the body’s reaction to invasions by pathogens.

In many developing countries, antibiotics are available without prescription and are taken inappropriately. Some pharmaceutical companies offer doctors bonuses and gifts for every prescription they write, and so antibiotics are overprescribed.

The United States Food and Drug Administration (USFDA) reports that over 40 percent of all antibiotics produced in the U.S. are given to animals. Low doses of antibiotics are routinely fed over the lifetime of meat-producing animals to promote growth and improve feed conversion. This practice creates a perfect environment for the development of resistant genes. One example, which already has produced dire consequences, is the emergence of a strain of salmonella that is resistant to several antibiotics commonly used to treat it.

Antibiotics are routinely sprayed on crops to treat and prevent disease. Although bacteria that invade plants are not harmful to people, many are related to those which cause such food-borne illnesses as E. coli, salmonella, and shigella.² If plant bacteria develop resistance, they could pass it on to bacteria that infect humans. There also appears to be evidence that we acquire resistant bacteria from our food. One researcher, Denis E. Corpet of the National Institute of Agricultural Research, has discovered that the amount of resistant bacteria humans obtain from food is quite significant. When his volunteers went on a diet of bacteria-free food, the quantity of resistant bacteria in their feces diminished by 1,000-fold.

Merri Moken, a student in Morristown, NJ, found that bacteria quickly developed resistance to common household disinfectants. The consequences of the proliferation of new anti-bacterial soaps, steering wheels, sponges, toys, and toothbrushes that we have seen in the past few years could be quite serious if it is causing an increase in resistance.

Solutions and Conclusions

The first step in combating resistance should be to reduce the number of antibiotics used for treating illness. When possible, doctors should identify the pathogen before prescribing antibiotics. Patients should complete the full course of antibiotic treatment by taking all of their medication instead of saving some for later. They also should not demand these drugs for colds or minor infections. Second, developing countries should enact legislation to control sales of antibiotics without prescriptions.

Another important step is a drastic reduction in the use of antibiotics in agriculture. Routine feeding of antibiotics to meat-producing animals needs to be prohibited. Some European countries, Sweden for example, have banned the use of these drugs for growth promotion. Consumers should demand antibiotic-free meat. The practice of spraying fruit and vegetable crops, even though they are not infected, also needs to stop, and consumers should be encouraged to wash all produce thoroughly in order to remove bacteria and antibiotic residues.

Consumers need to consider the consequences of overusing disinfectants and anti-bacterial products. Generally, washing your hands with ordinary soap is all that is necessary if we have been exposed bacteria in public places. Perhaps more education on the necessity of bacteria is another solution.

Finally, new antibiotic drugs need to be developed so that we will continue to have a last line of defense against resistance genes. Other research designed to improve our understanding of all of the mechanisms of resistance could perhaps result in a new family of drugs. In our ever-shrinking world, it has become essential for us to consider the significance of our impact on other organisms, including bacteria. Bacteria were created with a purpose and are indispensable. So let’s stop waging war on all of them. We need the susceptible bacteria as our allies against those which are resistant

Footnotes

1. Plasmoid: The part of a bacterium or virus that contains nucleic acid and is analogous in function to the nucleus of a eukaryotic cell.
2. E. coli: A bacillus (Escherichia coli) normally found in the human gastrointestinal tract and existing as numerous strains, some of which are responsible for diarrheal diseases; Salmonella: Any of various rod-shaped bacteria of the genus salmonella, many of which are pathogenic, causing food poisoning, typhoid, and paratyphoid fever in humans and other infectious diseases in domestic animals; Shigella: Any of various nonmotile, rod-shaped bacteria of the genus shigella, which includes some species that cause dysentery.

References

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