Chandigarh: In booth round of pulse polio campaign, 38,466 children immunised

A total of 38,466 children were immunised with Oral Polio Drops during the booth round of pulse polio activity conducted by the UT health department on Sunday, officials said.

According to the officials, the pulse polio campaign’s April round started with inauguration by Maheshinder Singh Sidhu, advocate and councillor, Sector 8, Chandigarh, by immunising the children with oral polio drops at a polio booth at Sukhna Lake, Sector 1. A statement said Dr Rakesh Kashyap, UT director of health and family welfare, along with Dr Anu Chopra Dosajh, district immunisation officer, were present at the inaugural session and that director Kashyap also observed the activities at various booths installed in Chandigarh and guided the teams to conduct the activities more effectively.

“The Day 1 of pulse polio campaign was completely dedicated for booth activities and door to door activities will be done in the next two days of the campaign. Children who are left on day one through booth activity will be covered by door to door activities on the second and third days i.e. April 3 and 4,” it said.

Health department officials said that a series of awareness generation activities through advertisements in leading Hindi and English newspapers, radio jingles on FM channels, AIR, posters, banners and announcements through FM channels are being conducted to cover maximum number of children for polio drops. “Department of health, police, social welfare, transport and NCC volunteers from different colleges of Chandigarh joined hands together in the mission to eradicate polio from society,” the officials said.

“Four zonal teams are monitoring the polio-related activities. Children are also getting immunised at all the prominent places and transit points like bus stands, railway stations, etc. Supervisors are having checklists to observe the activities at booths and all the reports from the field have been collected,” said the statement.

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Year after assurance, govt yet to move on request to ban 37 ‘harmful drugs’

The drugs could be injected into the middle ear, from which they would diffuse across a membrane into the inner ear. )Source: Thinkstock Images) The drugs could be injected into the middle ear, from which they would diffuse across a membrane into the inner ear. )Source: Thinkstock Images)

OVER 16 months after the secretary, Department of Health Research (DHR), Soumya Swaminathan, wrote to the Drug Controller General of India (DCGI) and senior health ministry officials with a request to ban 37 drugs that she termed “very harmful”, these drugs continue to be freely available in the market. The DCGI had acted on Swaminathan’s email, which was sent on November 12, 2015, seven days later with a suggestion to the health ministry that a committee should be formed to look into this “complex” matter. But the ministry, in response to an RTI filed by The Indian Express, has stated that no such panel had been formed till January 27, 2017.

The 37 fixed-dose combinations (FDCs) listed by Swaminathan in her email are commonly used antibiotics. For example, one drug listed by Swaminathan is Cefpodoxime + Clavulanate, which is used to treat diseases like pharyngitis, urinary tract infection, gonorrhea and pneumonia.

When contacted, Swaminathan, who is also the director-general of Indian Council of Medical Research (ICMR), told The Indian Express: “The DCGI has to take further action. ICMR can only bring to their notice. In fact, they had taken action on many FDCs but much more is needed on irrational combinations. The pharma companies should cooperate.”

According to IMS Health, a global market research company, this drug is sold by more than 70 companies — including Sun Pharma, Pfizer, Wockhardt, Mankind Pharma, Alkem Laboratories, Lupin, Zydus Cadila, Glenmark Pharma, Cipla and Dr Reddy’s Laboratories — in India under different brand names.

In her 2015 email, Swaminathan had stated: ‘’I am attaching a list of irrational antibiotic combinations that need to be banned. The list has been prepared by a group of ID physicians from the Clinical Infectious Disease Society of India (CIDSCON). I agree with them that these are very harmful and will spur additional antibiotic resistance in the community. I hope some action can be taken by DCGI. Am happy to assist in any way possible.’’

This email was sent to B P Sharma, the then health secretary; G N Singh, DCGI, who heads the Central Drugs Standard Control Organization (CDSCO); K L Sharma, joint secretary, health ministry; Jagdish Prasad, director-general of Health Services (DGHS) and S Venkatesh, director, National Centre for Disease Control (NCDC). None of these officials responded to queries sent by The Indian Express seeking comment.

The present health secretary C K Mishra also did not respond to queries sent by The Indian Express. Sun Pharma, Glenmark Pharma and Cipla said they are not aware of Swaminathan’s email and therefore can’t comment on it.

A Pfizer spokesperson told The Indian Express: “We currently market two out of these combinations listed by you and have not been informed of any concerns on either of these. We place utmost emphasis on patient safety and will continue to remain committed to ensuring the safety and quality of our medicines.”

Wockhardt, Mankind Pharma, Alkem Laboratories, Lupin, Zydus Cadila and Dr Reddy’s Laboratories did not respond to requests by The Indian Express seeking comment.

On November 19, 2015, G N Singh, DCGI, wrote a note to the health ministry, stating: “Considering the complexity involved in the issue, examination of each of the antibiotic combinations included in the list forwarded by secretary (DHR) needs to be examined separately considering all aspects of safety, efficacy and present status.”

Singh proposed that a committee of experts under the chairmanship of Swaminathan, comprising experts from institutes like All India Institute of Medical Sciences (AIIMS), New Delhi, “may be constituted for detailed examination and recommendations”.

Singh stated that the proposed committee’s recommendations will enable top health ministry body Drug Technical Advisory Board (DTAB) “to take final decisions through deliberation”.

On January 27, 2017, the health ministry told The Indian Express — in response to an application filed under Right to Information (RTI) Act, 2005 — that no such committee “has been constituted so far by this ministry to examine 37 antibiotic combinations”.

The ministry stated that “three irrational antibiotic combinations (Cefixime + Azithromycin, Ofloxacin + Ornidazole Suspension, and Metronidazole + Norfloxacin) out of 37 mentioned in e-mail of Dr Soumya Swaminathan were banned by the Government vide notifications dated 10.3.2016. However, the Delhi High Court has struck down the said notifications.”

These three drugs were part of the 344 FDCs that were banned on March 10, 2016, by the central government on the recommendation of committee formed under the chairmanship of Professor C K Kokate. This committee, which studied the irrationality of various FDCs, recommended the ban on 344 of them, citing the rising “antibiotic resistance” in the country as one of the reasons. Antibiotic resistance is the ability of a microorganism, which is causing the disease, to withstand the effects of an antibiotic medicine.

On December 1, 2016, Delhi High Court struck down the ban stating that the government had acted in a “haphazard manner”. This January, The Indian Express had also asked the health ministry if there was any committee or any other government department that is currently examining the issue of banning 37 drugs mentioned in Swaminathan’s email. The ministry replied that it has “no such information”.

CIDSCON and Indian Drug Manufacturers Association (IDMA) did not reply to the queries sent by The Indian Express.

The Organisation of Pharmaceutical Producers of India (OPPI) declined to answer queries on behalf of member-companies. D G Shah, secretary-general, Indian Pharmaceutical Alliance (IPA), told The Indian Express: “We are not aware of any communication from the government specific to these 37 FDCs. Some general notices have been put on the website of the Central Drugs Standard Control Organization (CDSCO) and the ministry of health & family welfare about the FDCs from time to time.”

Swaminathan’s email stated that these 37 specific drugs “will spur additional antibiotic resistance in the community”.

On February 1 this year, the DCGI wrote a letter to associations of doctors and pharmacists on the subject of “rational use of antibiotics for limiting antimicrobial resistance”.

The DCGI stated in the letter: “Antibiotic resistance is the result of environmental and behavioural causes. Indiscriminate prescription of antibiotics and laxity of enforcement laws are the main causes of antimicrobial resistance. This may be due to injudicious use of antibiotics in hospitals as well as in private practice apart from easy availability of prescription drugs in the country. In this regard, it is requested that you may kindly sensitise your members by raising awareness for rational use of antibiotics so as to curb antimicrobial resistance in the interest of patient safety.”

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A prescription for the doctor

Last week, as I studied communication theories and patient-centred communication frameworks for shared decision-making in healthcare in a classroom in Harvard University on a rainy Boston afternoon, doctors in Maharashtra went on strike over alleged assaults in emergency rooms. Based on reports I read from here, the attacks were said to be particularly violent, and the strike and protests from doctors that followed were also longer and more momentous. But apart from that, it was a story that plays out repeatedly in India, and one that I worked on at some length in Delhi as a reporter.

When politicians or the judiciary insinuate, or articulate directly, as they did this time, that doctors should not strike like other professionals, basing their argument on some higher moral obligation, the blame for triggering these reactions is put on news reports. I saw this repeatedly in my interactions with doctors as a journalist and now I see it in the classroom.

Communication is linked with public health, and doctors, programme managers and researchers involved in the myriad sectors of the field across the world, often find their paths crossing those of journalists. As someone who covered public health in India for a while, and now donning the student hat on the statistics, epidemiology and implementation science of it all, I find myself torn, trying to be “fair” in my reactions and assessments in these classroom debates.

It is hard to explain to anyone outside of journalism, the sheer doggedness it takes for journalists to go out every day in fields we learn about almost entirely just through telling stories about them, how we navigate systems and forces in specialised and super specialised fields, with no learning tools, making our own mistakes. Identifying stories that are worth telling, and the multiple stakeholders involved in each story, and chasing them to get that utopian “balance” is no mean feat. As an academic, a practitioner, a “source” of news, it is equally painful to see one’s narrative, one’s years of blood and sweat, being “twisted” for what has come to be everyone’s pet peeve about journalism — “sensational headlines”.

An argument that was brought up time and again in class discussions had to do with news stories on hospital-based deaths shooting up after the strike, with no effort to collate the average mortality or morbidity rates in the weeks or months prior to the strike. And even if the deaths did go up, the doctors in my class(es) argued, what was the evidence to relate them to the strike? Co-relation, as they teach you in any introductory statistics course, does not imply causation.

But what does a journalist reporting a story do when the counsel for a state agency (in this case, the Brihanmumbai Municipal Corporation) makes this argument in court? Taking state agencies at their word is not journalism, but not reporting an official statement made in court is also arguably not journalism either. Ideally, such a story should be followed with data analysis on mortality over, say, the last six months in the same hospitals.

Though this would still not establish whether or not the deaths over the last week were due to the strike, without eliminating confounders and a dozen other statistical nuances, it would demonstrate some effort at fact checking. But in a developing story, how many newsrooms would allow a journalist that freedom of time and space? And even if they did, how many journalists have the skill set to do that kind of analysis? Is this even the mandate of journalists or something academics must do and share their results with journalists? Before making official statements about these figures, should state agencies be engaging in this fact-checking themselves?

But antagonising those who are trying to tell their stories may not be very sound strategy for doctors. This is especially so at a time when public opinion seems crucial to achieving their rightful demands to workplace security. Patients’ kin engaging in violence in ERs is not a problem unique to India. Learning from communication strategies in other countries across the developing world, might be a good starting point. Doctors, particularly resident doctors, are the frontline face of public hospitals in India. As unfair as it may seem, the truth is that patients’ kin in public hospital emergencies do not understand who makes decisions on purchases of ventilators or medicines. To achieve that level of health literacy in patients in government hospitals will take some time.

Till then, the choice to not communicate and stay restricted in the silos of surgery rooms and research laboratories does not really exist for medical practitioners. As this strike underlined, physicians, administrators and public health professionals need to recognise communication as a skill that needs learning as any other.

As the world debates best practices for shared decision-making in healthcare, the images of doctors wearing helmets in workplaces, as creative as they may be as token protests, are not those that India’s public healthcare system should be associated with. There has to be a middle ground somewhere, for doctors and patients to communicate better, despite the resource constraints.

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Chandigarh health department starts screening for non-communicable diseases

The Chandigarh health department has started screening the residents in the age group of 30 and above for non-communicable diseases including cancer and diabetes in the city. Health officials said they have starting the programme on a pilot basis from Behlana area in the city.

The screening is under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS).

“It is at an initial stage and in the future the entire population will be covered in the screening programme,” said a senior health official. “We have already sent a proposal regarding the budget for the programme. The department will also provide training to those who will screen the residents.”

The health department has been saying it is hopeful about completing the screening programme in 2-3 years. “Under the programme, the UT health department will screen the entire population in the age group of 30 plus in the city for NCDs,” the official said. Dr Anil Garg, nodal officer for the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in Chandigarh told Chandigarh Newsline that Behlana has been chosen on a pilot basis and the program will be extended further.

The programme, which was launched by the central government is aimed to prevent and control major NCDs, with focus on “strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral.”

Under the programme, NCD clinics too have been set up at district and CHC levels, so that services for early diagnosis, treatment and follow-up for common NCDs are provided. For the screening programme, health officials said Asha workers and ANMS would be roped in and will conduct a house to house survey.

“If they will find symptoms in any of the residents, they will be referred to NCD clinics,” said the health officials. Other than the house to house survey, clinics at civil hospital Sector 45, Manimajra and Sector 22 hospital have been set up, from where doctors from the medical OPD would refer any patient with symptoms of these diseases to the doctors deployed in the NCDs clinics.

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Eat Drink Munch With Sonnalli Seygall

In this new fitness series, we explore simple health to do’s that are not only easy but also accessible, and most importantly affordable. We have found mantras with which you can get super fit, and only with a few lifestyle changes.


Violation of norms: Mohali administration reseals drug de-addiction centre at Kharar

Officials seal a private drug de-addiction centre in Kharar on Friday. Express Officials seal a private drug de-addiction centre in Kharar on Friday. Express

Following the directions of the Punjab and Haryana High Court, the district administration re-sealed a private drug de-addiction centre in Kharar on Friday. The High Court found that the owners of drug de-addiction centre were not following the norms set up by the state government. The court had also directed the district health authorities not to renew the licence of the owners of the centre. Talking to Chandigarh Newsline, additional deputy commissioner Nayan Bhullar said a case was going on in the High Court, which had formed a committee of two doctors to submit a report after the centre was sealed by the health authorities last year.

She added that the division bench the High Court, after going through the details of the report submitted by Dr Sukhwinder Kaur and Avnash Kaushik, ordered on March 27 that the centre should be sealed. “The court has also ordered us not to renew the licence of the owners of the centre. I along with my team comprising health and police officers sealed the centre on Friday evening,” Bhullar said.

Bhullar said the health authorities first received complaints against the centre in October last year that more than 150 inmates were kept there by flouting the norms. Only 50 inmates could be kept in the centre at a time. Regular check-ups of patients were also not conducted and the administration also received complaints that the people who were running the centres allegedly used to beat the inmates and were not providing proper food to the inmates.

After receiving the complaints, the health authorities carried out a raid on the centre on October 9 last year and sealed it. The police also registered a case under sections 341 ( wrongful restrain ), 342 (wrongful confinement), 465(forgery ) and 120B (criminal conspiracy) of the Indian Penal Code (IPC). The case was registered at a local police station against the three owners of the centre.

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WHO estimates suggest 300 million people suffer from depression

(Representational) (Representational)

More than 300 million people are living with depression, according to the latest estimates from the World Health Organisation (WHO). The UN agency released the estimates on Thursday ahead of World Health Day. “These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves,” Xinhua news agency quoted a WHO news release as saying. With the number of people with depression increasing more than 18 per cent from 2005 to 2015, WHO is carrying out a year-long campaign, Depression: Let’s Talk, the focus of April 7’s World Health Day, with the aim of encouraging more people with depression to get help.

Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives. Depression is an important risk factor for suicide, which claims hundreds of thousands of lives each year, says the report. One of the first steps is to address issues around prejudice and discrimination.

“The continuing stigma associated with mental illness was the reason why we decided to name our campaign Depression: let’s talk,” said Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO. “For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”

Increased investment is also needed. In many countries, there is no, or very little, support available for people with mental health disorders. Even in high-income countries, nearly 50 per cent of people with depression do not get treatment. On average, just three per cent of government health budgets is invested in mental health, varying from less than one percent in low-income countries to five percent in high-income countries, says the report.

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CAG reports: Education and health spending dropped 11 per cent

The money spent by the Gujarat government on social services like education and health and family welfare dropped by nearly 11 per cent in 2015-16, stated the Comptroller and Auditor General of India (CAG) in its latest report. “Capital expenditure on the social services decreased by 10.70 per cent in absolute terms from Rs 7,186 crore in 2014-15 to Rs 6,417 crore in 2015-16,” stated the CAG in a report on “State Finances” that was tabled in the Assembly on Friday. Education that held 7.5 per cent share of the capital expenditure in social services in 2014-15 declined to 6.65 per cent the next year.

Similarly, the percentage share of expenditure on the healthcare sector fell from 30.93 per cent to 26.61 per cent during the same period. “In education, the capital expenditure decreased mainly due to less expenditure on projects related to elementary education. In health and family welfare, there was less expenditure on Primary and Community Health Centres,” observed the auditor in the report.

Other social services like water supply, sanitation, housing and urban development also saw the Gujarat government spending less. “In water supply, sanitation, housing and urban development, the capital expenditure decreased on account of lower expenditure on water supply and urban development compared to the previous year,” stated the CAG.

However, during the same period, the state government spent 5 per cent more on providing economic services like power, irrigation and agriculture. The capital expenditure on economic services increased from Rs 16,084 crore in 2014-15 to Rs 16,944 crore in 2015-16. During the 2015-16, the Gujarat government imposed a cut on subsidies given to power sector, farmers and the GSRTC. The government’s expenditure on subsidies during the year stood at Rs 9,045 crore. The subsidies provided to power sector — that accounted for 49 per cent of the total subsidies — declined to Rs 4,452 crore against Rs 5347 crore in 2014-15.

The subsidies for agriculture and allied activities dropped to Rs 711 crore compared to Rs 945 crore in 2014-15. Subsidy to the GSRTC on account of uneconomic routes, student concessions and others decreased to Rs 301 crore from Rs 714 crore in 2014-15.

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Why TB is still with us

It kills an estimated 4,80,000 Indians each year — more than 1,400 every day, almost one Indian per minute. It kills an estimated 4,80,000 Indians each year — more than 1,400 every day, almost one Indian per minute.

Having worked in community health for over two decades in Bihar and Madhya Pradesh, I am well aware of the power of the slogan. Especially of one so simple and telling: TB Harega, Desh Jeetega. And yet, this rang hollow as we marked another TB Day on March 24. The disease is far from being vanquished. It kills an estimated 4,80,000 Indians each year — more than 1,400 every day, almost one Indian per minute.

The startling fact is that this number creates little panic in the public. It doesn’t get any headline attention at a time when everything is a headline — when was the last time you heard a debate in Parliament or on prime time TV on TB? The toll hasn’t reached this figure overnight or in a month or even in a year. India has continued to account for one fourth of the global TB burden for more than a decade despite implementing the WHO-backed Directly Observed Treatment, Short-Course (DOTS) programme nationwide.

Indeed, India is the largest DOTS implementing country and the Revised National Tuberculosis Control Programme (RNTCP) under the leadership of Central Tuberculosis Division, a wing of the Union Ministry of Health and Family Welfare, has been praised internationally.

Recently, the government made three significant important policy decisions to improve disease surveillance: Making TB a notifiable disease (May 2012); including anti-TB drugs under Schedule-H1 (August 2013); and developing a case-based, web-based TB surveillance system.

So why is the disease still with us despite the above and the fact that its causative organism is known, effective drugs are available and key locations of the vulnerable population are well mapped? There are many reasons but let’s focus on one that doesn’t get discussed much: The public-private trust deficit.

Over 80 per cent of people with TB first knock on the doors of the private health sector where the standard of diagnosis and quality of TB care have always been contentious issues. As per norms, a private doctor or hospital has to inform the government about each TB case but this hardly happens. There is a deep trust deficit between the public and the private sector but it’s deeper when it comes to TB. It would be unfair to pass the entire blame for not notifying on private doctors. There is an undue expectation from private providers that they will follow the DOTS administration to ensure treatment adherence. There is no institutionalised mechanism to help them update their knowledge and skills about changing diagnostic algorithms, even the use of anti-TB drugs in appropriate doses for the correct duration.

A study by Zarir F. Udwadia and others to understand the prescribing practices of private practitioners in Mumbai found that the practitioners were never approached or oriented by the local TB programme. Only six of the 106 respondents wrote a prescription with a correct drug regimen. And the 106 doctors prescribed 63 different drug regimens. Wherever those barriers have been addressed, the notification has significantly improved. For example, in Patna, where private doctors have been engaged through a private-provider interface agency, notification has increased fourfold.

Although there have always been provisions for the involvement of NGOs and private practitioners in the government’s anti-TB programmes, the state and district-level programme managers themselves were never adequately oriented towards facilitating the partnership.

RNTCP has an “intermittent drug regimen” (three days of drugs a week). Outside RNTCP, the most common treatment method is the daily drug regimen. Healthcare providers, particularly in the private sector, have always had reservations in engaging with the RNTCP due to a lack of confidence in an intermittent regimen.

That’s changing. The treatment of TB with a daily regimen, under RNTCP, is being implemented for all HIV-infected TB patients across the country and for all TB patients in Kerala, Maharashtara, Bihar, Himachal Pradesh and Sikkim. It is likely to be made available across the country in the near future. This will likely to enhance notification from private sector.

One reason why notification is so important is because TB comes wrapped in silence and invisibility. Anyone, rich or poor, can get infected with the TB bacteria and already more than 40 per cent of the Indian population is said to harbour it. But over 90 per cent of such people (infected) may not fall ill because of TB or spread the disease. This will depend on their immune system, standard of nutrition, the condition of their overall health and their habitat. So, in cases where the patient is well-placed, the bacteria may remain alive inside the body for a lifetime without producing any symptoms. It is the poor and the marginalised who are the first victims.

That’s why the key to the fight against TB is how ministries other than the health ministry respond to the Sustainable Development Goals.

Prevention, care and support to TB-affected people will contribute to other SDGs and will help all, particularly the poor and the vulnerable who have to pay a catastrophic cost due to the disease — debt, loss of wages and death. At the rate of almost one a minute.

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Why Good Old Desi Ghee Is The Best Thing To Have For Good Health

Ghee is the most misunderstood food India Today, all thanks to the new olive oil fad! The biggest misconception around ghee goes is that it is fattening. Most of us don’t know that ghee by nature is lipolytic, which breaks down fat. And this is due to its unique short-chain fatty acid structure. Here we have busted few myths and have given you enough reasons to not shun this good old golden fat:

1.Ghee has antibacterial and antiviral properties. If eaten regularly it can help you recover from sickness and helps boost your immune system.

2. Ghee can be your best beauty potion ever! The anti-oxidants in ghee makes it the incredible anti-wrinkle and anti-ageing therapy you have been searching forever.

3. Ghee is brilliant for joint health as it lubricates and oxygenates them.

4. Ghee takes nutrients from your food and delivers them through fat permeable membranes like in the brain.

5. It also helps to improve your satiety signal and ensures you eat the right amount of food.

6. The significant levels of vitamin A in ghee make it ideal for protecting eye health. Carotenoids are antioxidants that help in removing and neutralising the free radicals that attack the macular cells, thereby stopping macular degeneration and the development of cataracts.

7. According to the doctors, ghee is a great medium for cooking, especially when it comes to frying foods. This is because of its high smoke point. Unlike other cooking oils, it does not break down into harmful free radicals or generate toxic fumes under high temperatures.

8. Ghee is one of the most popular natural remedies for the treatment of burns. It is also widely used for treating swelling in different parts of the body. Apart from this, it can also be used to reduce inflammation on the skin by applying it to the affected area.

9. Ghee is a good remedy for those who suffer from constipation. So many doctors suggest pregnant women to have a glass of milk every night with a teaspoon of ghee. This can ease up constipation and also boost metabolism.

10. Ghee is rich in vitamins A, D, E and K, which are fat-soluble vitamins. They play an important role in the immune system functioning of the heart, brain, and bones.