Re: Gulran / camel belly/ charmak disease in Afghanistan

[Guest guest]

Hi master,

You could have corrected the subject matter since you are the

moderator. See if now it is correct so we all stick to it.

Vijay

> > > > >

> > > > > Dear Dr. Bashaar:

> > > > > We all are fortunate and delighted enough to have a

learned

> > > > scholar like you as moderator for the ongoing discussion at

> > NETRUM.

> > > > I wholeheartedly welcome you and wish you success and a

great

> > time

> > > > for your topic of discussion. To set the ball rolling I am

> > > > reproducing here an article on Hepato veno-occlusive disease

> > (VOD) -

> > > > also known as camel belly disease for information of all

> > members. It

> > > > is self-explanatory in nature.

> > > > > AFGHANISTAN: WHO confirms `charmak’ disease in

Herat

> > Province

> > > > > Photo: Khalid Nahez/IRIN

> > > > > Charmak disease †" also known as camel belly - is

caused

> > by

> > > > exposure to pyrrolizidine alkaloids found in Charmak weed

> which

> > > > grows in grain fields, WHO says

> > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic

veno-

> > > > occlusive disease (VOD) - also known as  " camel bellyâ

> > €� or

> > > > `charmak’ disease - in Gulran District of Herat

> Province,

> > western

> > > > Afghanistan, have surpassed 190, and 17 people have died so

> far,

> > > > provincial health officials said. Citing the result of tests

> at

> > the

> > > > National Institute for Public Health in the Netherlands, the

> UN

> > > > World Health Organization (WHO) said the disease was caused

by

> > > > exposure to pyrrolizidine alkaloids found in `charmakâ

€™,

> a

> > > > poisonous weed believed to be growing mostly in grain fields

> in

> > > > Gulran District, and which often finds its way into locally

> > produced

> > > > wheat flour.

> > > > >

> > > > > According to WHO, regular consumption of bread

contaminated

> by

> > > > alkaloids contained in the weed can cause rapidly filling

> > ascites

> > > > (also known as peritoneal cavity fluid, peritoneal fluid

> excess,

> > > > hydroperitoneum or abdominal dropsy), severe abdominal pain,

> > > > vomiting and jaundice.  " VOD of the liver is a form of

> > toxic liver

> > > > damage caused by pyrrolizidine alkaloids,� WHO said.

> The

> > outbreak

> > > > of `charmak’ disease was first reported in November

> 2007.

> > Of the

> > > > 17 deaths six were men, six were women and five children,

> > according

> > > > to Herat’s public health department.  " Thirty

> eight

> > other

> > > > patients are currently under medical testing which will

> > determine

> > > > whether or not they have `charmak’ disease,�

> Aziz

> > Noorzai, the

> > > > head of Gulran hospital, told IRIN on the phone on 14 May.

> > > > >

> > > > >  " No magic pill�

> > > > >

> > > > > Until early May local health officials did not know what

> > > > medication should be given to `charmak’ patients to

> cure

> > their

> > > > illness. Medical experts now say - based on the Netherlands

> test

> > > > results - that two grams of sodium in the daily diet, the

use

> of

> > > > vitamin and mineral supplements, and the extraction of

> > unnecessary

> > > > liquids from a patient’s swollen belly in serious

> cases,

> > can save

> > > > lives and treat the disease, according to Rana Graber Kakar,

a

> > WHO

> > > > expert in Kabul.  " There is no magic pill for it,â

€�

> > said Kakar,

> > > > adding that technical research and studies were under way to

> > > > illuminate characteristics of the disease and help the

> Ministry

> > of

> > > > Public Health (MoPH) to overcome similar challenges in

future.

> > Rest

> > > > is also recommended for long-term recovery, she said.

> > > > >

> > > > >

> > > > > Photo: Khalid Nahez/IRIN

> > > > > A father and his son are suffering " charmak " disease in

the

> > Gulran

> > > > district of Herat

> > > > > Food aid distributed

> > > > > WITH REGARDS

> > > > >

> > > > > In an effort to curb the outbreak, the MoPH has launched a

> > public

> > > > awareness campaign in Gulran District through which people

are

> > > > encouraged to stop consuming locally produced flour. But the

> > drive

> > > > has been received coldly by most of Gulran’s poor

> > populace.

> > > >  " When we tell them not to eat Gulran flour, they ask

> what

> > they

> > > > should eat instead,� said Noorzai. The UN World Food

> > Programme

> > > > (WFP) said it had distributed 700 tones of mixed food items

to

> > about

> > > > 55,000 people in Gulran under food-for-work and education

> > incentive

> > > > schemes, and a further 860 tonnes would be distributed to

> 24,000

> > > > people in the near future. An Italian Provincial

> Reconstruction

> > Team

> > > > has also delivered food and non-food relief items to

> vulnerable

> > > > families, the NATO-led International Security Assistance

Force

> > said

> > > > in a statement on 28 April.

> > > > >

> > > > > Improved wheat cultivation needed

> > > > >

> > > > > `Charmak’ has appeared at least three times in the

> past

> > 50

> > > > years - always in Herat Province - and had affected hundreds

> of

> > > > people each time, according to local officials. Health

experts

> > said

> > > > the disease cannot be prevented through medical measures

only,

> > but

> > > > that improvements in wheat cultivation, harvesting,

threshing

> > and

> > > > milling - and enabling farmers to eliminate poisonous weeds

in

> > their

> > > > fields - would help avert future outbreaks.  " In the

long-

> > term, the

> > > > government needs to focus on agricultural policies that will

> > reduce

> > > > contamination of grain with Heliotropium [`charmac’]

> > weeds,� the

> > > > WHO said in a weekly epidemiological monitor on 11 May.

> > > > >  

> > > > > Dr. Geer M. Ishaq

> > > > > Sr. Lecturer

> > > > > Dept. of Pharmaceutical Sciences

> > > > > University of Kashmir

> > > > > Srinagar-190006 (J & K)

> > > > > Ph: 9419970971, 9906673100

> > > > > E-mail: ishaq@

> > > > > Website: http://ishaqgeer. googlepages. com

> > > > >

> > > > >

> > > > > Forgot the famous last words? Access your message archive

> > > > online at http://in.messenger ./ webmessengerprom

> o.php

> > > > >

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Share files, take polls, and make new friends - all under

> > one roof. Go to http://in.promos. / groups/

> > >

> >

>

[Guest guest]

Thanks Geer,

For mentioning the 1976 classic article. It is available full text (along with pictures of patients) in this link:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1411218

Strange that not much work has been done on this later although here in my practice I often come across isolated incidences of large liver cirrhosis with ascites in some patients where the cause remains obscure. Sometimes USG shows partial effacement of hepatic veins (not enough to call it budd chiari)

VOD is something I would definitely like to rule out in some of these patients and also look for possible sources of PA exposure in them. I guess it only comes to focus when there is an epidemic such as that in Gulran (which is the subject of the present discussion and where it perhaps is still not clear if VOD is the underlying pathology).

Ultrasonography is a powerful tool for confirming diagnosis of VOD, but typical findings often manifest late in the course or are not always apparent. Thus, ultrasonography should not be relied on to rule out the diagnosis of VOD in the face of other evidence that would support it.

The diagnostic ultrasonography finding is a reversal of flow in the portal and hepatic veins.

rakesh

On 7/1/08, Geer M. Ishaq <ishaqgeer@...> wrote:

Dear Dr. Santosh:

There is a mention of Pyrrolizidine alkaloids as one of the causes of VOD in the very first para of the review article attached. I don't think there is any difference between VOD, Gulran, Charmak and Camel Belly disease. Gulran is the local term used for the disease in the Gulran village/district of the Herat Province in Afghanistan, Charmak is the name of the poisonous weed also called Heliotropium containing the alkaloid substance, whereas camel belly is the term used as a result of accumulation of ascitic fluid giving the abdomen of such a patient a " camel belly " like appearance. Dr. Bashaar may please enlighten us in the event of any difference in these terms used to describe the disease. This disease also referred as Sinusoidal Obstruction Syndrome was first described in South Africa and was linked to the ingestion of pyrrolizidine alkaloids contained in Senecio tea, very popular in that region. Stem Cell/Bone marrow transplantation is just one of the causes of this disease responsible for about 25 % of cases. Apart from the alkaloid Pyrrolizidine, VOD has also been associated with chemotherapeutic agents such as actinomycin D, mithramycin, cytosine, arabinoside at conventional doses and with long-term use of the immunosuppressive agent azathioprine. One of the most promising agents tried as therapy for VOD is defibrotide, a novel polydeoxyribonucleotide with adenosine receptor agonist activity. One more interesting fact about this disease has been that there has been an epidemic of VOD in INDIA also way back in 1976. Other details of this epidemic are available in the paper by Tandon RK et al, titled, " Study of an epidemic of veno-occlusive disease in India " , published in vol.17, page 849-855 of the journal GUT in the year 1976. More details about this epidemic can be searched and presented.

WITH REGARDS

Dr. Geer M. Ishaq

Gulran / camel belly/ charmak /VOD disease

> netrumgroups (DOT) com> Date: Tuesday, July 1, 2008, 4:32 AM> > > Hi,> > I tried to search on the subject and admit my ignorance. Please see > http://www.foodstan dards.gov. au/_srcfiles/ TR2.pdf for details.

> The weed Heliotropium (Greek = leaves turn to sunlight) has been > existing in many parts of the world since long.It is there in USA, > Australia, Africa, Asia. Many types are there. Epidemics have

> occured due to consumption of this. The first such epidemic was > reported in 1920 from South Africa.> > The plant is also nursed indoors and outdoor because of its fragrant > flowers. The fragrance is closer to vanilla. It contains

> pyrolizidine alkaloids which if ingested, are responsible for VOD. > > It is reported that apart from accidental exposure, intentional > adulteration may be there because it imparts the flavour to cereal

> flour like wheat.> > Vijay >

> > > >> > > > Dear Dr. Bashaar:> > > > We all are fortunate and delighted enough to have a learned > > > scholar like you as moderator for the ongoing discussion at

> NETRUM. > > > I wholeheartedly welcome you and wish you success and a great > time > > > for your topic of discussion. To set the ball rolling I am > > > reproducing here an article on Hepato veno-occlusive disease

> (VOD) - > > > also known as camel belly disease for information of all > members. It > > > is self-explanatory in nature.> > > > AFGHANISTAN: WHO confirms `charmak’ disease

in Herat > Province > > > > Photo: Khalid Nahez/IRIN > > > > Charmak disease †" also known as camel belly - is caused > by > > > exposure to pyrrolizidine alkaloids found in Charmak weed

which > > > grows in grain fields, WHO says > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic veno-> > > occlusive disease (VOD) - also known as  " camel

bellyâ> €� or > > > `charmak’ disease - in Gulran District of Herat Province, > western > > > Afghanistan, have surpassed 190, and 17 people have died so

far, > > > provincial health officials said. Citing the result of tests at > the > > > National Institute for Public Health in the Netherlands, the UN > > > World Health Organization (WHO) said the disease was caused by

> > > exposure to pyrrolizidine alkaloids found in `charmak’, a > > > poisonous weed believed to be growing mostly in grain fields in > > > Gulran District, and which often finds its way into locally

> produced > > > wheat flour. > > > > > > > > According to WHO, regular consumption of bread contaminated by > > > alkaloids contained in the weed can cause rapidly filling

> ascites > > > (also known as peritoneal cavity fluid, peritoneal fluid excess, > > > hydroperitoneum or abdominal dropsy), severe abdominal pain, > > > vomiting and jaundice.  " VOD of the liver is a

form of > toxic liver > > > damage caused by pyrrolizidine alkaloids,� WHO said. The > outbreak > > > of `charmak’ disease was first reported in

November 2007. > Of the > > > 17 deaths six were men, six were women and five children, > according > > > to Herat’s public health department.  " Thirty eight

> other > > > patients are currently under medical testing which will > determine > > > whether or not they have `charmak’ disease,� Aziz > Noorzai, the

> > > head of Gulran hospital, told IRIN on the phone on 14 May. > > > > > > > >  " No magic pill� > > > > > > > > Until early May local health officials did not know what

> > > medication should be given to `charmak’ patients to cure > their > > > illness. Medical experts now say - based on the Netherlands test > > > results - that two grams of sodium in the daily diet, the use

of > > > vitamin and mineral supplements, and the extraction of > unnecessary > > > liquids from a patient’s swollen belly in serious cases, > can save > > > lives and treat the disease, according to Rana Graber Kakar, a

> WHO > > > expert in Kabul.  " There is no magic pill for it,� > said Kakar, > > > adding that technical research and studies were under way to

> > > illuminate characteristics of the disease and help the Ministry > of > > > Public Health (MoPH) to overcome similar challenges in future. > Rest > > > is also recommended for long-term recovery, she said.

> > > > > > > > > > > > Photo: Khalid Nahez/IRIN > > > > A father and his son are suffering " charmak " disease in the > Gulran > > > district of Herat

> > > > Food aid distributed > > > > WITH REGARDS> > > > > > > > In an effort to curb the outbreak, the MoPH has launched a > public > > > awareness campaign in Gulran District through which people are

> > > encouraged to stop consuming locally produced flour. But the > drive > > > has been received coldly by most of Gulran’s poor > populace. > > >  " When we tell them not to eat Gulran flour, they

ask what > they > > > should eat instead,� said Noorzai. The UN World Food > Programme > > > (WFP) said it had distributed 700 tones of mixed food items to > about

> > > 55,000 people in Gulran under food-for-work and education > incentive > > > schemes, and a further 860 tonnes would be distributed to 24,000 > > > people in the near future. An Italian Provincial

Reconstruction > Team > > > has also delivered food and non-food relief items to vulnerable > > > families, the NATO-led International Security Assistance Force > said > > > in a statement on 28 April.

> > > > > > > > Improved wheat cultivation needed > > > > > > > > `Charmak’ has appeared at least three times in the past > 50 > > > years - always in Herat Province - and had affected hundreds

of > > > people each time, according to local officials. Health experts > said > > > the disease cannot be prevented through medical measures only, > but > > > that improvements in wheat cultivation, harvesting, threshing

> and > > > milling - and enabling farmers to eliminate poisonous weeds in > their > > > fields - would help avert future outbreaks.  " In the long-> term, the

> > > government needs to focus on agricultural policies that will > reduce > > > contamination of grain with Heliotropium [`charmac’] > weeds,� the

> > > WHO said in a weekly epidemiological monitor on 11 May.> > > >  > > > > Dr. Geer M. Ishaq> > > > Sr. Lecturer> > > > Dept. of Pharmaceutical Sciences

> > > > University of Kashmir> > > > Srinagar-190006 (J & K)> > > > Ph: 9419970971, 9906673100> > > > E-mail: ishaq@> > > > Website: http://ishaqgeer. googlepages. com

> > > > > > > > > > > > Forgot the famous last words? Access your message archive > > > online at http://in.messenger ./ webmessengerprom

o.php> > > >> > >> > > > > > > > > > > > > > > > > > > > > > > > > >

> > > > > > > > Share files, take polls, and make new friends - all under > one roof. Go to http://in.promos.. / groups/

> >> > > > > > Meet people who discuss and share your passions. Go to http://in.promos. / groups/bestofyah oo/

>

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[Guest guest]

Dear Dr Bashaar, Dr Geer,

Is this Senetio tea same as bush tea which also causes liver damage? Wild Mushrooms could also cause liver damage.

It is sad to hear of the casualities due to Charmak/ camel belly disease (the same disease seems to have different names at different locations). Rather than blaming the wheat alone for the disease, we should investigate the possible reasons for the disease.

The source could be:

-Weeds which grow along with the crop. Animal studies can also be done with the weed to rule out hepatotoxic potential

- Colouring/ flavouring agents of wheat flour can similarly be tested for hepatotoxicity.

- Packing material of wheat bags/ flour should be checked for.

-Any contamination in transportation can be checked

-The milk of goats, cows which feed on these plants can also have some percentage of contamination.

-Interaction with alcohol cannot be ruled out

-Human errors

With regards

-Anupama> > From: Vijay <drvijaythawani@ .co. in>> Subject: Gulran / camel belly/ charmak /VOD disease> netrumgroups (DOT) com> Date: Tuesday, July 1, 2008, 4:32 AM> > >

Hi,> > I tried to search on the subject and admit my ignorance. Please see > http://www.foodstan dards.gov. au/_srcfiles/ TR2.pdf for details.> The weed Heliotropium (Greek = leaves turn to sunlight) has been > existing in many parts of the world since long.It is there in USA, > Australia, Africa, Asia. Many types are there. Epidemics have > occured due to consumption of this. The first such epidemic was > reported in 1920 from South Africa.> > The plant is also nursed indoors and outdoor because of its fragrant > flowers. The fragrance is closer to vanilla. It contains > pyrolizidine alkaloids which if ingested, are responsible for VOD. > > It is reported that apart from accidental exposure, intentional > adulteration may be there because it imparts the flavour to cereal >

flour like wheat.> > Vijay > > > > >> > > > Dear Dr. Bashaar:> > > > We all are fortunate and delighted enough to have a learned > > > scholar like you as moderator for the ongoing discussion at > NETRUM. > > > I wholeheartedly welcome you and wish you success and a great > time > > > for your topic of discussion. To set the ball rolling I am > > > reproducing here an article on Hepato veno-occlusive disease > (VOD) - > > > also known as camel belly disease for information of all > members. It > > > is self-explanatory in nature.> > > > AFGHANISTAN: WHO confirms `charmak’ disease in Herat

> Province > > > > Photo: Khalid Nahez/IRIN > > > > Charmak disease â€" also known as camel belly - is caused > by > > > exposure to pyrrolizidine alkaloids found in Charmak weed which > > > grows in grain fields, WHO says > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic veno-> > > occlusive disease (VOD) - also known as â€Å"camel bellyâ> €� or > > > `charmak’ disease - in Gulran District of Herat Province, > western > > > Afghanistan, have surpassed 190, and 17 people have died so far, > > > provincial health officials said. Citing the result of tests at > the > > > National Institute for Public Health in the Netherlands, the

UN > > > World Health Organization (WHO) said the disease was caused by > > > exposure to pyrrolizidine alkaloids found in `charmak’, a > > > poisonous weed believed to be growing mostly in grain fields in > > > Gulran District, and which often finds its way into locally > produced > > > wheat flour. > > > > > > > > According to WHO, regular consumption of bread contaminated by > > > alkaloids contained in the weed can cause rapidly filling > ascites > > > (also known as peritoneal cavity fluid, peritoneal fluid excess, > > > hydroperitoneum or abdominal dropsy), severe abdominal pain, > > > vomiting and jaundice. â€Å"VOD of the liver is a form of > toxic liver > > > damage caused by

pyrrolizidine alkaloids,� WHO said. The > outbreak > > > of `charmak’ disease was first reported in November 2007. > Of the > > > 17 deaths six were men, six were women and five children, > according > > > to Herat’s public health department. â€Å"Thirty eight > other > > > patients are currently under medical testing which will > determine > > > whether or not they have `charmak’ disease,� Aziz > Noorzai, the > > > head of Gulran hospital, told IRIN on the phone on 14 May. > > > > > > > > â€Å"No magic pill� > > > >

> > > > Until early May local health officials did not know what > > > medication should be given to `charmak’ patients to cure > their > > > illness. Medical experts now say - based on the Netherlands test > > > results - that two grams of sodium in the daily diet, the use of > > > vitamin and mineral supplements, and the extraction of > unnecessary > > > liquids from a patient’s swollen belly in serious cases, > can save > > > lives and treat the disease, according to Rana Graber Kakar, a > WHO > > > expert in Kabul. â€Å"There is no magic pill for it,� > said Kakar, > > > adding that technical research and studies were under way to > >

> illuminate characteristics of the disease and help the Ministry > of > > > Public Health (MoPH) to overcome similar challenges in future. > Rest > > > is also recommended for long-term recovery, she said. > > > > > > > > > > > > Photo: Khalid Nahez/IRIN > > > > A father and his son are suffering "charmak" disease in the > Gulran > > > district of Herat > > > > Food aid distributed > > > > WITH REGARDS> > > > > > > > In an effort to curb the outbreak, the MoPH has launched a > public > > > awareness campaign in Gulran District through which people are > > > encouraged to stop consuming locally produced flour. But the > drive > > > has been received coldly by most of

Gulran’s poor > populace. > > > â€Å"When we tell them not to eat Gulran flour, they ask what > they > > > should eat instead,� said Noorzai. The UN World Food > Programme > > > (WFP) said it had distributed 700 tones of mixed food items to > about > > > 55,000 people in Gulran under food-for-work and education > incentive > > > schemes, and a further 860 tonnes would be distributed to 24,000 > > > people in the near future. An Italian Provincial Reconstruction > Team > > > has also delivered food and non-food relief items to vulnerable > > > families, the NATO-led International Security Assistance Force > said > > > in a statement on 28 April. > > > >

> > > > Improved wheat cultivation needed > > > > > > > > `Charmak’ has appeared at least three times in the past > 50 > > > years - always in Herat Province - and had affected hundreds of > > > people each time, according to local officials. Health experts > said > > > the disease cannot be prevented through medical measures only, > but > > > that improvements in wheat cultivation, harvesting, threshing > and > > > milling - and enabling farmers to eliminate poisonous weeds in > their > > > fields - would help avert future outbreaks. â€Å"In the long-> term, the > > > government needs to focus on agricultural policies that will > reduce > > > contamination of grain with Heliotropium

[`charmac’] > weeds,� the > > > WHO said in a weekly epidemiological monitor on 11 May.> > > >  > > > > Dr. Geer M. Ishaq> > > > Sr. Lecturer> > > > Dept. of Pharmaceutical Sciences> > > > University of Kashmir> > > > Srinagar-190006 (J & K)> > > > Ph: 9419970971, 9906673100> > > > E-mail: ishaq@> > > > Website: http://ishaqgeer. googlepages. com > > > > > > > > > > > > Forgot the famous last words? Access your message archive > > > online at http://in.messenger ./ webmessengerprom

o.php> > > >> > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Share files, take polls, and make new friends - all under > one roof. Go to http://in.promos. . / groups/> >> > > > > > Meet people who discuss and share your passions. Go to http://in.promos. / groups/bestofyah oo/>

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[Guest guest]

Dear Dr. Geer M Ishaq,

Thanks for the detailed information, I do agree with what you have stated, Gulran is the district name situated in Hirat Province of Afghanistan and so on.

Best Regards

Mohammad Bashaar> > From: Vijay <drvijaythawani@ .co. in>> Subject: Gulran / camel belly/ charmak /VOD disease> netrumgroups (DOT) com> Date: Tuesday, July 1, 2008, 4:32 AM> > >

Hi,> > I tried to search on the subject and admit my ignorance. Please see > http://www.foodstan dards.gov. au/_srcfiles/ TR2.pdf for details.> The weed Heliotropium (Greek = leaves turn to sunlight) has been > existing in many parts of the world since long.It is there in USA, > Australia, Africa, Asia. Many types are there. Epidemics have > occured due to consumption of this. The first such epidemic was > reported in 1920 from South Africa.> > The plant is also nursed indoors and outdoor because of its fragrant > flowers. The fragrance is closer to vanilla. It contains > pyrolizidine alkaloids which if ingested, are responsible for VOD. > > It is reported that apart from accidental exposure, intentional > adulteration may be there because it imparts the flavour to cereal >

flour like wheat.> > Vijay > > > > >> > > > Dear Dr. Bashaar:> > > > We all are fortunate and delighted enough to have a learned > > > scholar like you as moderator for the ongoing discussion at > NETRUM. > > > I wholeheartedly welcome you and wish you success and a great > time > > > for your topic of discussion. To set the ball rolling I am > > > reproducing here an article on Hepato veno-occlusive disease > (VOD) - > > > also known as camel belly disease for information of all > members. It > > > is self-explanatory in nature.> > > > AFGHANISTAN: WHO confirms `charmak’ disease in Herat

> Province > > > > Photo: Khalid Nahez/IRIN > > > > Charmak disease â€" also known as camel belly - is caused > by > > > exposure to pyrrolizidine alkaloids found in Charmak weed which > > > grows in grain fields, WHO says > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic veno-> > > occlusive disease (VOD) - also known as â€Å"camel bellyâ> €� or > > > `charmak’ disease - in Gulran District of Herat Province, > western > > > Afghanistan, have surpassed 190, and 17 people have died so far, > > > provincial health officials said. Citing the result of tests at > the > > > National Institute for Public Health in the Netherlands, the

UN > > > World Health Organization (WHO) said the disease was caused by > > > exposure to pyrrolizidine alkaloids found in `charmak’, a > > > poisonous weed believed to be growing mostly in grain fields in > > > Gulran District, and which often finds its way into locally > produced > > > wheat flour. > > > > > > > > According to WHO, regular consumption of bread contaminated by > > > alkaloids contained in the weed can cause rapidly filling > ascites > > > (also known as peritoneal cavity fluid, peritoneal fluid excess, > > > hydroperitoneum or abdominal dropsy), severe abdominal pain, > > > vomiting and jaundice. â€Å"VOD of the liver is a form of > toxic liver > > > damage caused by

pyrrolizidine alkaloids,� WHO said. The > outbreak > > > of `charmak’ disease was first reported in November 2007. > Of the > > > 17 deaths six were men, six were women and five children, > according > > > to Herat’s public health department. â€Å"Thirty eight > other > > > patients are currently under medical testing which will > determine > > > whether or not they have `charmak’ disease,� Aziz > Noorzai, the > > > head of Gulran hospital, told IRIN on the phone on 14 May. > > > > > > > > â€Å"No magic pill� > > > >

> > > > Until early May local health officials did not know what > > > medication should be given to `charmak’ patients to cure > their > > > illness. Medical experts now say - based on the Netherlands test > > > results - that two grams of sodium in the daily diet, the use of > > > vitamin and mineral supplements, and the extraction of > unnecessary > > > liquids from a patient’s swollen belly in serious cases, > can save > > > lives and treat the disease, according to Rana Graber Kakar, a > WHO > > > expert in Kabul. â€Å"There is no magic pill for it,� > said Kakar, > > > adding that technical research and studies were under way to > >

> illuminate characteristics of the disease and help the Ministry > of > > > Public Health (MoPH) to overcome similar challenges in future. > Rest > > > is also recommended for long-term recovery, she said. > > > > > > > > > > > > Photo: Khalid Nahez/IRIN > > > > A father and his son are suffering "charmak" disease in the > Gulran > > > district of Herat > > > > Food aid distributed > > > > WITH REGARDS> > > > > > > > In an effort to curb the outbreak, the MoPH has launched a > public > > > awareness campaign in Gulran District through which people are > > > encouraged to stop consuming locally produced flour. But the > drive > > > has been received coldly by most of

Gulran’s poor > populace. > > > â€Å"When we tell them not to eat Gulran flour, they ask what > they > > > should eat instead,� said Noorzai. The UN World Food > Programme > > > (WFP) said it had distributed 700 tones of mixed food items to > about > > > 55,000 people in Gulran under food-for-work and education > incentive > > > schemes, and a further 860 tonnes would be distributed to 24,000 > > > people in the near future. An Italian Provincial Reconstruction > Team > > > has also delivered food and non-food relief items to vulnerable > > > families, the NATO-led International Security Assistance Force > said > > > in a statement on 28 April. > > > >

> > > > Improved wheat cultivation needed > > > > > > > > `Charmak’ has appeared at least three times in the past > 50 > > > years - always in Herat Province - and had affected hundreds of > > > people each time, according to local officials. Health experts > said > > > the disease cannot be prevented through medical measures only, > but > > > that improvements in wheat cultivation, harvesting, threshing > and > > > milling - and enabling farmers to eliminate poisonous weeds in > their > > > fields - would help avert future outbreaks. â€Å"In the long-> term, the > > > government needs to focus on agricultural policies that will > reduce > > > contamination of grain with Heliotropium

[`charmac’] > weeds,� the > > > WHO said in a weekly epidemiological monitor on 11 May.> > > >  > > > > Dr. Geer M. Ishaq> > > > Sr. Lecturer> > > > Dept. of Pharmaceutical Sciences> > > > University of Kashmir> > > > Srinagar-190006 (J & K)> > > > Ph: 9419970971, 9906673100> > > > E-mail: ishaq@> > > > Website: http://ishaqgeer. googlepages. com > > > > > > > > > > > > Forgot the famous last words? Access your message archive > > > online at http://in.messenger ./ webmessengerprom

o.php> > > >> > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Share files, take polls, and make new friends - all under > one roof. Go to http://in.promos. . / groups/> >> > > > > > Meet people who discuss and share your passions. Go to http://in.promos. / groups/bestofyah oo/>

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[Guest guest]

Dear Dr. Anupama,

Thanks for your concerns regarding charmak and the same diseases. As you said, we cant only blaim wheat, it can be found in any form, since charmak was an extra plant which grew in between wheat.

I am really optimistic of the day, where we can find concrete facts on charmak disease.

I suggest if you could please work more on this topic as our all esteemed scholars are doing their best

Best Regards

Mohammad Bashaar> > From: Vijay <drvijaythawani@ .co. in>> Subject: Gulran / camel belly/ charmak /VOD disease> netrumgroups (DOT) com> Date: Tuesday, July 1, 2008, 4:32 AM> > >

Hi,> > I tried to search on the subject and admit my ignorance. Please see > http://www.foodstan dards.gov. au/_srcfiles/ TR2.pdf for details.> The weed Heliotropium (Greek = leaves turn to sunlight) has been > existing in many parts of the world since long.It is there in USA, > Australia, Africa, Asia. Many types are there. Epidemics have > occured due to consumption of this. The first such epidemic was > reported in 1920 from South Africa.> > The plant is also nursed indoors and outdoor because of its fragrant > flowers. The fragrance is closer to vanilla. It contains > pyrolizidine alkaloids which if ingested, are responsible for VOD. > > It is reported that apart from accidental exposure, intentional > adulteration may be there because it imparts the flavour to cereal >

flour like wheat.> > Vijay > > > > >> > > > Dear Dr. Bashaar:> > > > We all are fortunate and delighted enough to have a learned > > > scholar like you as moderator for the ongoing discussion at > NETRUM. > > > I wholeheartedly welcome you and wish you success and a great > time > > > for your topic of discussion. To set the ball rolling I am > > > reproducing here an article on Hepato veno-occlusive disease > (VOD) - > > > also known as camel belly disease for information of all > members. It > > > is self-explanatory in nature.> > > > AFGHANISTAN: WHO confirms `charmak’ disease in Herat

> Province > > > > Photo: Khalid Nahez/IRIN > > > > Charmak disease â€" also known as camel belly - is caused > by > > > exposure to pyrrolizidine alkaloids found in Charmak weed which > > > grows in grain fields, WHO says > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic veno-> > > occlusive disease (VOD) - also known as â€Å"camel bellyâ> €� or > > > `charmak’ disease - in Gulran District of Herat Province, > western > > > Afghanistan, have surpassed 190, and 17 people have died so far, > > > provincial health officials said. Citing the result of tests at > the > > > National Institute for Public Health in the Netherlands, the

UN > > > World Health Organization (WHO) said the disease was caused by > > > exposure to pyrrolizidine alkaloids found in `charmak’, a > > > poisonous weed believed to be growing mostly in grain fields in > > > Gulran District, and which often finds its way into locally > produced > > > wheat flour. > > > > > > > > According to WHO, regular consumption of bread contaminated by > > > alkaloids contained in the weed can cause rapidly filling > ascites > > > (also known as peritoneal cavity fluid, peritoneal fluid excess, > > > hydroperitoneum or abdominal dropsy), severe abdominal pain, > > > vomiting and jaundice. â€Å"VOD of the liver is a form of > toxic liver > > > damage caused by

pyrrolizidine alkaloids,� WHO said. The > outbreak > > > of `charmak’ disease was first reported in November 2007. > Of the > > > 17 deaths six were men, six were women and five children, > according > > > to Herat’s public health department. â€Å"Thirty eight > other > > > patients are currently under medical testing which will > determine > > > whether or not they have `charmak’ disease,� Aziz > Noorzai, the > > > head of Gulran hospital, told IRIN on the phone on 14 May. > > > > > > > > â€Å"No magic pill� > > > >

> > > > Until early May local health officials did not know what > > > medication should be given to `charmak’ patients to cure > their > > > illness. Medical experts now say - based on the Netherlands test > > > results - that two grams of sodium in the daily diet, the use of > > > vitamin and mineral supplements, and the extraction of > unnecessary > > > liquids from a patient’s swollen belly in serious cases, > can save > > > lives and treat the disease, according to Rana Graber Kakar, a > WHO > > > expert in Kabul. â€Å"There is no magic pill for it,� > said Kakar, > > > adding that technical research and studies were under way to > >

> illuminate characteristics of the disease and help the Ministry > of > > > Public Health (MoPH) to overcome similar challenges in future. > Rest > > > is also recommended for long-term recovery, she said. > > > > > > > > > > > > Photo: Khalid Nahez/IRIN > > > > A father and his son are suffering "charmak" disease in the > Gulran > > > district of Herat > > > > Food aid distributed > > > > WITH REGARDS> > > > > > > > In an effort to curb the outbreak, the MoPH has launched a > public > > > awareness campaign in Gulran District through which people are > > > encouraged to stop consuming locally produced flour. But the > drive > > > has been received coldly by most of

Gulran’s poor > populace. > > > â€Å"When we tell them not to eat Gulran flour, they ask what > they > > > should eat instead,� said Noorzai. The UN World Food > Programme > > > (WFP) said it had distributed 700 tones of mixed food items to > about > > > 55,000 people in Gulran under food-for-work and education > incentive > > > schemes, and a further 860 tonnes would be distributed to 24,000 > > > people in the near future. An Italian Provincial Reconstruction > Team > > > has also delivered food and non-food relief items to vulnerable > > > families, the NATO-led International Security Assistance Force > said > > > in a statement on 28 April. > > > >

> > > > Improved wheat cultivation needed > > > > > > > > `Charmak’ has appeared at least three times in the past > 50 > > > years - always in Herat Province - and had affected hundreds of > > > people each time, according to local officials. Health experts > said > > > the disease cannot be prevented through medical measures only, > but > > > that improvements in wheat cultivation, harvesting, threshing > and > > > milling - and enabling farmers to eliminate poisonous weeds in > their > > > fields - would help avert future outbreaks. â€Å"In the long-> term, the > > > government needs to focus on agricultural policies that will > reduce > > > contamination of grain with Heliotropium

[`charmac’] > weeds,� the > > > WHO said in a weekly epidemiological monitor on 11 May.> > > >  > > > > Dr. Geer M. Ishaq> > > > Sr. Lecturer> > > > Dept. of Pharmaceutical Sciences> > > > University of Kashmir> > > > Srinagar-190006 (J & K)> > > > Ph: 9419970971, 9906673100> > > > E-mail: ishaq@> > > > Website: http://ishaqgeer. googlepages. com > > > > > > > > > > > > Forgot the famous last words? Access your message archive > > > online at http://in.messenger ./ webmessengerprom

o.php> > > >> > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Share files, take polls, and make new friends - all under > one roof. Go to http://in.promos. . / groups/> >> > > > > > Meet people who discuss and share your passions. Go to http://in.promos. / groups/bestofyah oo/>

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[Guest guest]

Dear Dr. Anupama,

As you pointed out that Animal studies can also be done with the weed to rule out hepatotoxic potential.

Animal studies has been done as it is stated:

The target organ for PA toxicity in both experimental animals and humans is the liver.

In animals, this toxicity is manifested as anti-mitotic activity leading to extensive fibrosis, nodular regeneration, parenchyma and cancer, while in humans; the major effects are hepatocellular injury, cirrhosis and veno-occlusive disease. There is no evidence from the significant human epidemics which have occurred that PAs cause liver cancer in humans. Further research on the mechanisms of PA-induced hepatotoxicity may clarify the apparent differences in species specificity. At this time, the major toxicological endpoint for humans is considered to be veno-occlusive disease.

Best Regards

Mohammad Bashaar> > From: Vijay <drvijaythawani@ .co. in>> Subject: Gulran / camel belly/ charmak /VOD disease> netrumgroups (DOT) com> Date: Tuesday, July 1, 2008, 4:32 AM> > >

Hi,> > I tried to search on the subject and admit my ignorance. Please see > http://www.foodstan dards.gov. au/_srcfiles/ TR2.pdf for details.> The weed Heliotropium (Greek = leaves turn to sunlight) has been > existing in many parts of the world since long.It is there in USA, > Australia, Africa, Asia. Many types are there. Epidemics have > occured due to consumption of this. The first such epidemic was > reported in 1920 from South Africa.> > The plant is also nursed indoors and outdoor because of its fragrant > flowers. The fragrance is closer to vanilla. It contains > pyrolizidine alkaloids which if ingested, are responsible for VOD. > > It is reported that apart from accidental exposure, intentional > adulteration may be there because it imparts the flavour to cereal >

flour like wheat.> > Vijay > > > > >> > > > Dear Dr. Bashaar:> > > > We all are fortunate and delighted enough to have a learned > > > scholar like you as moderator for the ongoing discussion at > NETRUM. > > > I wholeheartedly welcome you and wish you success and a great > time > > > for your topic of discussion. To set the ball rolling I am > > > reproducing here an article on Hepato veno-occlusive disease > (VOD) - > > > also known as camel belly disease for information of all > members. It > > > is self-explanatory in nature.> > > > AFGHANISTAN: WHO confirms `charmak’ disease in Herat

> Province > > > > Photo: Khalid Nahez/IRIN > > > > Charmak disease â€" also known as camel belly - is caused > by > > > exposure to pyrrolizidine alkaloids found in Charmak weed which > > > grows in grain fields, WHO says > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic veno-> > > occlusive disease (VOD) - also known as â€Å"camel bellyâ> €� or > > > `charmak’ disease - in Gulran District of Herat Province, > western > > > Afghanistan, have surpassed 190, and 17 people have died so far, > > > provincial health officials said. Citing the result of tests at > the > > > National Institute for Public Health in the Netherlands, the

UN > > > World Health Organization (WHO) said the disease was caused by > > > exposure to pyrrolizidine alkaloids found in `charmak’, a > > > poisonous weed believed to be growing mostly in grain fields in > > > Gulran District, and which often finds its way into locally > produced > > > wheat flour. > > > > > > > > According to WHO, regular consumption of bread contaminated by > > > alkaloids contained in the weed can cause rapidly filling > ascites > > > (also known as peritoneal cavity fluid, peritoneal fluid excess, > > > hydroperitoneum or abdominal dropsy), severe abdominal pain, > > > vomiting and jaundice. â€Å"VOD of the liver is a form of > toxic liver > > > damage caused by

pyrrolizidine alkaloids,� WHO said. The > outbreak > > > of `charmak’ disease was first reported in November 2007. > Of the > > > 17 deaths six were men, six were women and five children, > according > > > to Herat’s public health department. â€Å"Thirty eight > other > > > patients are currently under medical testing which will > determine > > > whether or not they have `charmak’ disease,� Aziz > Noorzai, the > > > head of Gulran hospital, told IRIN on the phone on 14 May. > > > > > > > > â€Å"No magic pill� > > > >

> > > > Until early May local health officials did not know what > > > medication should be given to `charmak’ patients to cure > their > > > illness. Medical experts now say - based on the Netherlands test > > > results - that two grams of sodium in the daily diet, the use of > > > vitamin and mineral supplements, and the extraction of > unnecessary > > > liquids from a patient’s swollen belly in serious cases, > can save > > > lives and treat the disease, according to Rana Graber Kakar, a > WHO > > > expert in Kabul. â€Å"There is no magic pill for it,� > said Kakar, > > > adding that technical research and studies were under way to > >

> illuminate characteristics of the disease and help the Ministry > of > > > Public Health (MoPH) to overcome similar challenges in future. > Rest > > > is also recommended for long-term recovery, she said. > > > > > > > > > > > > Photo: Khalid Nahez/IRIN > > > > A father and his son are suffering "charmak" disease in the > Gulran > > > district of Herat > > > > Food aid distributed > > > > WITH REGARDS> > > > > > > > In an effort to curb the outbreak, the MoPH has launched a > public > > > awareness campaign in Gulran District through which people are > > > encouraged to stop consuming locally produced flour. But the > drive > > > has been received coldly by most of

Gulran’s poor > populace. > > > â€Å"When we tell them not to eat Gulran flour, they ask what > they > > > should eat instead,� said Noorzai. The UN World Food > Programme > > > (WFP) said it had distributed 700 tones of mixed food items to > about > > > 55,000 people in Gulran under food-for-work and education > incentive > > > schemes, and a further 860 tonnes would be distributed to 24,000 > > > people in the near future. An Italian Provincial Reconstruction > Team > > > has also delivered food and non-food relief items to vulnerable > > > families, the NATO-led International Security Assistance Force > said > > > in a statement on 28 April. > > > >

> > > > Improved wheat cultivation needed > > > > > > > > `Charmak’ has appeared at least three times in the past > 50 > > > years - always in Herat Province - and had affected hundreds of > > > people each time, according to local officials. Health experts > said > > > the disease cannot be prevented through medical measures only, > but > > > that improvements in wheat cultivation, harvesting, threshing > and > > > milling - and enabling farmers to eliminate poisonous weeds in > their > > > fields - would help avert future outbreaks. â€Å"In the long-> term, the > > > government needs to focus on agricultural policies that will > reduce > > > contamination of grain with Heliotropium

[`charmac’] > weeds,� the > > > WHO said in a weekly epidemiological monitor on 11 May.> > > >  > > > > Dr. Geer M. Ishaq> > > > Sr. Lecturer> > > > Dept. of Pharmaceutical Sciences> > > > University of Kashmir> > > > Srinagar-190006 (J & K)> > > > Ph: 9419970971, 9906673100> > > > E-mail: ishaq@> > > > Website: http://ishaqgeer. googlepages. com > > > > > > > > > > > > Forgot the famous last words? Access your message archive > > > online at http://in.messenger ./ webmessengerprom

o.php> > > >> > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Share files, take polls, and make new friends - all under > one roof. Go to http://in.promos. . / groups/> >> > > > > > Meet people who discuss and share your passions. Go to http://in.promos. / groups/bestofyah oo/>

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[Guest guest]

Dear Netrumians,

Reports of human toxic reactions to PAs are mostly limited to cases where grain has been contaminated by seeds of PA-containing plants, causing acute reactions in a substantial number of people. This has occurred, for example, in Uzbekistan and Afghanistan in 1948 and again in 1976, in Jamaica in 1954, and in India in 1975

for more info find the attached article or click on the link http://www.itmonline.org/arts/pas.htm

Best Regards

Mohammad Bashaar> > From: Vijay <drvijaythawani@ .co. in>> Subject: Gulran / camel belly/ charmak /VOD disease> netrumgroups (DOT) com> Date: Tuesday, July 1, 2008, 4:32 AM> > >

Hi,> > I tried to search on the subject and admit my ignorance. Please see > http://www.foodstan dards.gov. au/_srcfiles/ TR2.pdf for details.> The weed Heliotropium (Greek = leaves turn to sunlight) has been > existing in many parts of the world since long.It is there in USA, > Australia, Africa, Asia. Many types are there. Epidemics have > occured due to consumption of this. The first such epidemic was > reported in 1920 from South Africa.> > The plant is also nursed indoors and outdoor because of its fragrant > flowers. The fragrance is closer to vanilla. It contains > pyrolizidine alkaloids which if ingested, are responsible for VOD. > > It is reported that apart from accidental exposure, intentional > adulteration may be there because it imparts the flavour to cereal >

flour like wheat.> > Vijay > > > > >> > > > Dear Dr. Bashaar:> > > > We all are fortunate and delighted enough to have a learned > > > scholar like you as moderator for the ongoing discussion at > NETRUM. > > > I wholeheartedly welcome you and wish you success and a great > time > > > for your topic of discussion. To set the ball rolling I am > > > reproducing here an article on Hepato veno-occlusive disease > (VOD) - > > > also known as camel belly disease for information of all > members. It > > > is self-explanatory in nature.> > > > AFGHANISTAN: WHO confirms `charmak’ disease in Herat

> Province > > > > Photo: Khalid Nahez/IRIN > > > > Charmak disease â€" also known as camel belly - is caused > by > > > exposure to pyrrolizidine alkaloids found in Charmak weed which > > > grows in grain fields, WHO says > > > > KABUL, 15 May 2008 (IRIN) - Confirmed cases of hepatic veno-> > > occlusive disease (VOD) - also known as â€Å"camel bellyâ> €� or > > > `charmak’ disease - in Gulran District of Herat Province, > western > > > Afghanistan, have surpassed 190, and 17 people have died so far, > > > provincial health officials said. Citing the result of tests at > the > > > National Institute for Public Health in the Netherlands, the

UN > > > World Health Organization (WHO) said the disease was caused by > > > exposure to pyrrolizidine alkaloids found in `charmak’, a > > > poisonous weed believed to be growing mostly in grain fields in > > > Gulran District, and which often finds its way into locally > produced > > > wheat flour. > > > > > > > > According to WHO, regular consumption of bread contaminated by > > > alkaloids contained in the weed can cause rapidly filling > ascites > > > (also known as peritoneal cavity fluid, peritoneal fluid excess, > > > hydroperitoneum or abdominal dropsy), severe abdominal pain, > > > vomiting and jaundice. â€Å"VOD of the liver is a form of > toxic liver > > > damage caused by

pyrrolizidine alkaloids,� WHO said. The > outbreak > > > of `charmak’ disease was first reported in November 2007. > Of the > > > 17 deaths six were men, six were women and five children, > according > > > to Herat’s public health department. â€Å"Thirty eight > other > > > patients are currently under medical testing which will > determine > > > whether or not they have `charmak’ disease,� Aziz > Noorzai, the > > > head of Gulran hospital, told IRIN on the phone on 14 May. > > > > > > > > â€Å"No magic pill� > > > >

> > > > Until early May local health officials did not know what > > > medication should be given to `charmak’ patients to cure > their > > > illness. Medical experts now say - based on the Netherlands test > > > results - that two grams of sodium in the daily diet, the use of > > > vitamin and mineral supplements, and the extraction of > unnecessary > > > liquids from a patient’s swollen belly in serious cases, > can save > > > lives and treat the disease, according to Rana Graber Kakar, a > WHO > > > expert in Kabul. â€Å"There is no magic pill for it,� > said Kakar, > > > adding that technical research and studies were under way to > >

> illuminate characteristics of the disease and help the Ministry > of > > > Public Health (MoPH) to overcome similar challenges in future. > Rest > > > is also recommended for long-term recovery, she said. > > > > > > > > > > > > Photo: Khalid Nahez/IRIN > > > > A father and his son are suffering "charmak" disease in the > Gulran > > > district of Herat > > > > Food aid distributed > > > > WITH REGARDS> > > > > > > > In an effort to curb the outbreak, the MoPH has launched a > public > > > awareness campaign in Gulran District through which people are > > > encouraged to stop consuming locally produced flour. But the > drive > > > has been received coldly by most of

Gulran’s poor > populace. > > > â€Å"When we tell them not to eat Gulran flour, they ask what > they > > > should eat instead,� said Noorzai. The UN World Food > Programme > > > (WFP) said it had distributed 700 tones of mixed food items to > about > > > 55,000 people in Gulran under food-for-work and education > incentive > > > schemes, and a further 860 tonnes would be distributed to 24,000 > > > people in the near future. An Italian Provincial Reconstruction > Team > > > has also delivered food and non-food relief items to vulnerable > > > families, the NATO-led International Security Assistance Force > said > > > in a statement on 28 April. > > > >

> > > > Improved wheat cultivation needed > > > > > > > > `Charmak’ has appeared at least three times in the past > 50 > > > years - always in Herat Province - and had affected hundreds of > > > people each time, according to local officials. Health experts > said > > > the disease cannot be prevented through medical measures only, > but > > > that improvements in wheat cultivation, harvesting, threshing > and > > > milling - and enabling farmers to eliminate poisonous weeds in > their > > > fields - would help avert future outbreaks. â€Å"In the long-> term, the > > > government needs to focus on agricultural policies that will > reduce > > > contamination of grain with Heliotropium

[`charmac’] > weeds,� the > > > WHO said in a weekly epidemiological monitor on 11 May.> > > >  > > > > Dr. Geer M. Ishaq> > > > Sr. Lecturer> > > > Dept. of Pharmaceutical Sciences> > > > University of Kashmir> > > > Srinagar-190006 (J & K)> > > > Ph: 9419970971, 9906673100> > > > E-mail: ishaq@> > > > Website: http://ishaqgeer. googlepages. com > > > > > > > > > > > > Forgot the famous last words? Access your message archive > > > online at http://in.messenger ./ webmessengerprom

o.php> > > >> > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Share files, take polls, and make new friends - all under > one roof. Go to http://in.promos. . / groups/> >> > > > > > Meet people who discuss and share your passions. Go to http://in.promos. / groups/bestofyah oo/>

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