Bronchial Asthma

The scale of the problem

Between 100 and 150 million people around the globe -- roughly the equivalent of the population of the Russian Federation -- suffer from asthma and this number is rising. World-wide, deaths from this condition have reached over 180,000 annually.

• Around 8% of the Swiss population suffers from asthma as against only 2% some 25-30 years ago.
• In Germany, there are an estimated 4 million asthmatics.
• In Western Europe as a whole, asthma has doubled in ten years, according to the UCB Institute of Allergy in Belgium.
• In the United States, the number of asthmatics has leapt by over 60% since the early 1980s and deaths have doubled to 5,000 a year.
• There are about 3 million asthmatics in Japan of whom 7% have severe and 30% have moderate asthma.
• In Australia, one child in six under the age of 16 is affected.

Asthma is not just a public health problem for developed countries. In developing countries, however, the incidence of the disease varies greatly.

• India has an estimated 15-20 million asthmatics.
• In the Western Pacific Region of WHO, the incidence varies from over 50% among children in the Caroline Islands to virtually zero in Papua New Guinea.
• In Brazil, Costa Rica, Panama, Peru and Uruguay, prevalence of asthma symptoms in children varies from 20% to 30%.
• In Kenya, it approaches 20%.
• In India, rough estimates indicate a prevalence of between 10% and 15% in 5-11 year old children.

The human and economic burden

Mortality due to asthma is not comparable in size to the day-to-day effects of the disease. Although largely avoidable, asthma tends to occur in epidemics and affects young people. The human and economic burden associated with this condition is severe. The costs of asthma to society could be reduced to a large extent through concerted international and national action.

• World-wide, the economic costs associated with asthma are estimated to exceed those of TB and HIV/AIDS combined.
• In the United States, for example, annual asthma care costs (direct and indirect) exceed US$6 billion.
• At present Britain spends about US$1.8 billion on health care for asthma and because of days lost through illness.
• In Australia, annual direct and indirect medical costs associated with asthma reach almost US$460 million.

What is asthma?

Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day.

This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs.

Causes

Asthma cannot be cured, but could be controlled. The strongest risk factors for developing asthma are exposure, especially in infancy, to indoor allergens (such as domestic mites in bedding, carpets and stuffed furniture, cats and cockroaches) and a family history of asthma or allergy. A study in the South Atlantic Island of Tristan da Cunha, where one in three of the 300 inhabitants has asthma, found children with asthmatic parents were much more likely to develop the condition.

Exposure to tobacco smoke and exposure to chemical irritants in the workplace are additional risk factors. Other risk factors include certain drugs (aspirin and other non-steroid anti-inflammatory drugs), low birth weight and respiratory infection. The weather (cold air), extreme emotional expression and physical exercise can exacerbate asthma.

Urbanization appears to be correlated with an increase in asthma. The nature of the risk is unclear because studies have not taken into account indoor allergens although these have been identified as significant risk factors.

Experts are struggling to understand why rates world-wide are, on average, rising by 50% every decade. And they are baffled by isolated incidents involving hundreds of people in a city, who suffer from allergies such as hay fever but who had never had asthma, suddenly being struck down by asthma attacks so severe they needed emergency hospital treatment.

• One such incident in London, UK, in June 1994 saw 640 people rushed to emergency departments in the throes of full-blown asthma attacks. A similar incident happened in Melbourne, Australia. Many experts have blamed climatic conditions such as thunderstorms, which break up pollen grains, releasing starch granules that trigger attacks. But they do not know why ordinary hay-fever sufferers developed a life-threatening condition without warning.

Treatment

Because asthma is a chronic condition, it usually requires continuous medical care. Patients with moderate to severe asthma have to take long-term medication daily (for example, anti-inflammatory drugs) to control the underlying inflammation and prevent symptoms and attacks. If symptoms occur, short-term medications (inhaled short-acting beta2-agonists) are used to relieve them.

Medication is not the only way to control asthma. It is also important to avoid asthma triggers -- stimuli that irritate and inflame the airways. Each person must learn what triggers he or she should avoid.

Although asthma does not kill on the scale of chronic obstructive pulmonary diseases (COPD), failure to use appropriate drugs or comply with treatment, coupled with an under-recognition of the severity of the problem, can lead to unnecessary deaths, most of which occur outside hospital.

The way forward and the role of the WHO

WHO recognizes asthma as a disease of major public health importance and plays a unique role in the co-ordination of international efforts against the disease. International action is needed to:

• increase public awareness of the disease to make sure patients and health professionals recognize the disease and are aware of the severity of associated problems;
• organize and co-ordinate global epidemiological surveillance to monitor global and regional trends in asthma;
• develop and implement an optimal strategy for its management and prevention (many studies have shown that this will result in the control of asthma in most patients); and
• stimulate research into the causes of asthma to develop new control strategies and treatment techniques.

WHO activities

International Study of Asthma and Allergies in Childhood (ISAAC) : WHO collaborates in ISAAC and, more particularly, in the implementation of the study in developing countries with areas of severe air pollution. A preliminary objective is to obtain information on the association between childhood asthma and air pollution. The first results of this study have shown the prevalence of asthma symptoms to vary from 1.6% to 36.8%.

Global Initiative for Asthma (GINA): In 1992, WHO and the US-based National Heart, Lung and Blood Institute jointly formed GINA to cut deaths and disability by developing and implementing an optimal strategy for asthma management and prevention. Since its inception GINA has:

• produced a report covering a range of information detailing all the latest knowledge on causes, the mechanism of the disease, risk factors, management, education and socio-economic factors;
• developed guidelines on asthma management for doctors, nurses, public health officials, patients and their families;
• held workshops to introduce the GINA programme to public health officials and medical professionals in more than 80 countries, leading to implementation of the guidelines;
• been active in disseminating information in 20 languages and bringing together organizations devoted to improving asthma care;
• backed research efforts to improve asthma management.

GINA's goal is to build an active network with multiple organizations concerned with asthma to ensure better patient care world-wide.

WHO Initiative on Allergic Rhinitis and its Impact on Asthma (ARIA): WHO is developing a strategy for the prevention of bronchial asthma through the management of allergic rhinitis. The strategy was conceived by specialists from all over the world at a December 1999 meeting on ARIA.

Allergic rhinitis is defined as an allergen-induced inflammation of the membranes lining the nose. Based on the time of exposure to the allergen, allergic rhinitis can be subdivided into perennial, seasonal or occupational disease.

Three statements must be taken into account for the successful prevention of bronchial asthma:

• Among the broad spectrum of allergic diseases, bronchial asthma is the most prevalent, dangerous and life-threatening.
• Underestimated up to now, allergic rhinitis is an important risk factor for asthma.
• One efficient way to prevent bronchial asthma is to control and treat allergic rhinitis from the very beginning of its inception.

Generally speaking, ARIA will broaden the perspectives for primary prevention of bronchial asthma and will promote better understanding of bronchial asthma among physicians and patients.

The specific goals of ARIA are defined as follows:

• To increase awareness of allergy and allergic diseases as a preventable public health problem among the medical community, public health officials, and the general public;
• To prepare evidence-based guidelines for the prevention and management of allergic rhinitis as a key element of primary prevention of bronchial asthma;
• To educate physicians and other health care professionals about the relevance of allergic rhinitis to bronchial asthma; and
• To educate the public about the potentially fatal risks of allergy (anaphylaxis) and asthma, especially in children, and to encourage greater dialogue with their physicians. Better education and increased dialogue could avoid approximately 25,000 childhood deaths due to asthma each year

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Protect Your Car from Rough Weather Conditions with Garage Doors

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Fortis Healthcare to buy sister overseas arm

Hospital chain Fortis Healthcare (India) Ltd will buy Singapore-based sister firm Fortis Healthcare International in a move to bring all of the group's health businesses under one company, boosting the listed firm's shares.

Terms of the all-cash deal will be set by an independent valuer and the transaction will be closed by December, Chairman Malvinder Singh told Reuters. The board of Fortis Healthcare on Monday approved the buyout.

Both companies expect revenue of about $500 million each in the current fiscal year, including the listed firm's recently-acquired Super Religare Laboratories, according to the company.

"The deal presents both risk and opportunity for Fortis India," said Rashesh Shah, an analyst with brokerage ICICI Securities, who has a 'buy' rating on the stock with a target price of 185 rupees.

Shah said the move was a surprise, and said the valuation would determine whether or not it's a good deal for the listed firm's shareholders.

Shares in Fortis Healthcare, valued at about $1.3 billion, were up 1.2 percent at 148.90 rupees at 0753 GMT, having risen as much as 5.1 percent after the news.

The billionaire Singh brothers, Malvinder and Shivinder, last year set up Fortis Global, later renamed Fortis Healthcare International, to pursue overseas business after losing out to Malaysian state investor Khazanah in a battle for Singapore's Parkway Holdings, then Asia's biggest listed hospital operator.

Since then, Fortis International has made seven acquisitions across the Asia-Pacific region, making it the size of the Indian operation, and Group Chairman Singh said the group plans to invest about $1 billion in the combined businesses over three years.

Fortis was planning to list two of its health care entities in Singapore in public offers worth up to $1.5 billion, IFR, a unit of Thomson Reuters reported in April.

"Equity markets are not in good shape. That could be a reason that they have decided to combine it to fund further acquisition," ICICI's Shah said.

Malvinder Singh did not comment on the group's plans to list Fortis International or a property trust holding Indian hospital buildings.

INTERNATIONAL FOCUS

Last year, Fortis Healthcare International agreed to buy the healthcare assets of Hong Kong-based Quality HealthCare Asia Ltd.

It has also bought Australia's Dental Corporation Holdings, Sri Lanka's Lanka Hospitals Corp Plc, Vietnam's Hoan My Medical Corp and a Singapore hospital bought from First Real Estate Investment Trust.

"In another six months, international will be bigger than India," Malvinder Singh said.

"If you are to club the two entities together you really double the business and the size and scale, the capability. The infrastructure, the management depth and the medical talent that you end up creating is absolutely phenomenal."

The Singh brothers set up a privately-owned firm to make overseas forays because of jitters among the Indian firm's shareholders after the Parkway bid.

"Internationally, we said as a family, we will seed the businesses, seed the investments because if you put all of that into the Indian entity there might be diffusion of focus, a higher degree of risk," Malvinder Singh said.

He said investors are now more comfortable with Fortis' international ambition.

After the buyout, Fortis International will become a wholly-owned unit of Fortis Healthcare (India), which will be named Fortis Healthcare. Vishal Bali, currently the head of Fortis International, will be the group's global CEO.

"Acquisitions will continue to happen. As we continue to go through that route, we will continuously evaluate various capital raising opportunities in different markets," Singh said.

After the merger, Fortis Healthcare would have over 12,000 beds across 74 hospitals in 10 countries.

Religare Capital markets, part of financial services firm Religare Enterprises that is also controlled by the Singh brothers, advised Fortis Healthcare International.

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July industrial growth falls to 2-year-low

India's industrial output growth slumped to its lowest in nearly two years in July as high interest rates crimped Asia's third largest economy, putting pressure on the Reserve Bank of India (RBI) to pause its monetary tightening even with a stubbornly high inflation.

The RBI is still expected to raise rates at its Friday policy review, especially if August inflation data due on Wednesday touches double-digits, as expected by some analysts.

"Inflation is going to be very close to 10 percent (for the month of August)," the chief economic adviser to the finance ministry, Kaushik Basu, said on Monday. "We are expecting inflation to remain very difficult till the month of November, maybe December and then begin to slow down."

Basu said the country was balancing between two very difficult problems - high inflation and slowdown in growth. "The RBI will have to balance these out and take a decision on it."

The data adds pressure on the RBI to end its monetary tightening that began in March 2010 after recent indicators showed slower factory output and a sharp drop in car sales.

Renewed woes about the weakening global economy and risks to growth, combined with euro zone's debt hurdles and the grim outlook in the U.S., have added to domestic concerns for Indian policymakers.

"For the RBI's monetary policy stance, inflation for August due on Sept. 14 will carry more weight than today's IIP numbers," said Rupa Rege Nitsure, Chief Economist of Bank Of Baroda in Mumbai. "I think inflation will be close to double digits."

India's headline inflation was 9.22 percent in July.

"Our base view is for a 25 bps rate hike by the RBI this week. But the probability of a pause has increased due to global uncertainty," said Kumar Rachapudi, fixed income strategist at Barclays Capital in Singapore.

Industrial output rose just 3.3 percent in July, dragged down by a 15 percent annual decline in capital goods production from a 38 percent growth a month earlier, government data showed.

The factory output figure was well below a median forecast of 6.2 percent in a Reuters poll.

The BSE Sensex extended losses to more than 2 percent and the rupee weakened to its lowest in more than a year on Monday after the data was published.

India's 5-year swap rate fell 6 bps to 6.59 percent from before the data and 1-year rate fell 4 bps to 7.51 percent. The 10-year benchmark bond yield fell 1bp to 8.26 percent.

For a graph on IIP, click link.reuters.com/waw63s

Production of consumer goods and consumer durables rose compared to June, indicating consumer demand is still holding up somewhat in the face of rising interest rates.

Some cautioned that such high volatility raised doubts about the reliability of the data.

"We think that this data cannot be a credible guide to RBI policy. Inflation will continue to hold the key for the September rate decision," said A. Prasanna, an economist with ICICI Securities Primary Dealership in Mumbai.

Manufacturing output, which constitutes about 76 percent of the industrial production index, rose an annual 2.3 percent, the federal statistics office said in a statement.

Weakness in the west is taking a global toll on manufacturing. South Korea's manufacturing sector shrank in August for the first time in 10 months as new export orders decreased, while China's manufacturing contracted slightly for the second consecutive month.

[source]

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Profits elude bankers to the rich in booming India

With businesses from healthcare to glass and property, the 56-year old Piramal has a net worth of $1.4 billion, according to Forbes, good for 39th on its India rich list.

The problem, at least for the swelling ranks of wealth managers in India, is that Piramal doesn't need them, putting his millions instead in his own companies and real estate ventures.

"These are only two areas I invest in, and therefore we don't need any advisor," said Piramal, who is approached by private bankers "all the time".

India may be minting millionaires, but that is failing to translate to profits for the banks that have set up teams of well-dressed, well-paid bankers to help manage those riches.

A narrow product range, rising competition, falling advisory fees and billions of dollars in wealth hidden from tax officials has stifled profits for private banks, which have aggressively ramped up operations in India.

At the same time, expenses -- mostly salaries -- are growing by as much as 20 percent a year, some in the industry say, meaning many private banks must absorb potentially heavy running costs for years before they are profitable.

The industry's difficulties in India come as more established wealth management centres in Hong Kong, Singapore and elsewhere are buffeted by poor markets.

Profit margin pressure on the sector that serves the wealthy is "partly driven by a plain vanilla product platform available for clients," said Atul Singh, head of global wealth and investment management for India at Bank of America Merrill Lynch, among the biggest players in the country.

The challenge is made greater by poor market performance, with Indian shares sliding about 17 percent this year. A spate of scandals embroiling the country's business and political elite has also soured sentiment among the rich.

The tough conditions are exacting a toll, even as many banks such as Morgan Stanley, Royal Bank of Scotland, Barclays and Bank of America Merrill Lynch continue to add staff, with an eye to the long-term potential of the fast-growing economy.

Credit Suisse, one of the largest global private banks and a player in India since 2008, is cutting its India wealth management staff by 12 people, or 20 percent, as part of a global reduction, sources said last month.

Credit Suisse is unlikely to be the last to trim staff over the medium term, industry players said.

For graphic on global wealthy population, India ranking, click link.reuters.com/ber43s

A dearth of fee-spinning alternate investment vehicles such as hedge funds and private equity, a $200,000 cap on overseas investments by onshore Indians, and an underdeveloped corporate bond market means most investments are channelled into run-of-the-mill equity products, bank deposits, and government bonds.

Investments in exotic assets such as art and wine are rare in India. Instead, the homegrown rich keep their money in real estate and gold, which doesn't require the services of polished bankers of the sort that cater to the rich in places like London, New York, Zurich and Singapore.

"When product platforms are largely undifferentiated, then prices get driven down," Singh told Reuters. "Making money is certainly tough for players in the sector, especially ones without scale."

Many tycoons like Azim Premji, chairman of No. 3 IT services exporter Wipro and the third-richest person in India, with net worth estimated by Forbes at $16.8 billion, thus prefer to use in-house staff to manage personal wealth.

In neighbouring China, wealth managers also contend with tight regulations and limited product offerings, but they also face less domestic competition. Many rich mainland Chinese invest in real estate or stash their wealth in Hong Hong or Singapore, which are thriving private banking centres.

Many of the richest Indians also have substantial wealth overseas and do their private banking in Singapore, Zurich, London or Dubai, where there are more investment options and where some banks cater specifically to non-resident Indians.

FEE AND COST PRESSURE

Private banks in India charge between zero and 0.5 percent advisory fees to wealthy clients, which barely covers costs for smaller players, compared to about 0.5 percent to 2 percent in more developed markets, industry insiders say.

Pressure on fees and rising costs have dragged down most wealth management firms' margins to 40-50 basis points now from 1-2 percent a few years back, they said.

The gradual shift from charging transaction-based fees to an advisory fee model, amid a global move to discourage selling of risky exotic instruments, has added to margin pressure.

"No one is making money in private banking in India," said the head of India wealth management at a U.S. bank. "Margins are so very low here because very few people want to pay money for advice and your cost of operations is going up."

To woo clients, some banks will send the adult children of entreprenuers for short training courses at U.S. universities on preserving and growing family wealth, giving them an opportunity to rub shoulders with the sons and daughters of rich Americans.

Closer to home, private banks coddle prospective and would-be customers with wine tastings and live music and dance performances by Bollywood stars.

In 2010, the population of high net worth individuals -- those with more than $1 million in investable assets -- rose nearly 21 percent in India to 153,000 -- making it the 12th largest such market, ahead of Spain and just behind Brazil, according to a report by Capgemini and Merrill Lynch.

BLACK MONEY

A large chunk of Indian wealth goes undeclared. Tax authorities say billions of dollars in funds have been deposited by Indians in Swiss bank accounts and other tax havens.

A government panel in 2009 found Indian illicit funds to range between $500 billion and $1.4 trillion, which is now nearly the size of India's economy. Global Financial Integrity, a Washington-based think-tank, estimated illicit outflows of about $16 billion a year from 2002-2006.

Technology consultancy firm Cognizant said in a report that the Indian wealth management sector in the short-term would remain fragmented with a large number of brokers, financial advisors, insurance agents and tax consultants offering services.

Bank of America-Merrill Lynch, Kotak Mahindra, and HSBC were cited by Cognizant as strong players in the sector in India because of their reach, potential for cross-selling banking products and focus on domestic equities.

Big banks that have yet to take the full plunge on Indian private banking may end up looking prescient, or lucky.

UBS, a global leader in private banking, is in the early stages of providing onshore wealth management services in India.

Goldman Sachs' private wealth management arm serves high net worth Indians from Singapore but does not have an onshore presence in India, while JPMorgan has pushed back plans to launch onshore services to late 2012, according to a source with knowledge of the situation.

Rising salaries, poaching of talent and wafer-thin margins have made it tougher for smaller home-grown wealth managers to compete with the global rivals.

However, while Western banks bring brand cachet and global expertise, they also tend to be saddled with higher costs.

"Some level of consolidation will have to happen in the next year or so. Pure broking businesses will find it difficult to continue because costs are rising and margins are under pressure," said Tashwinder Singh, head of Citi's private bank in India.

[Source]

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Health plans from Apollo Munich, ICICI Lombard, Max Bupa now come with 'returns' assurance

In an advertisement being aired on TV, an apparently healthy man desperately tries to injure himself. The reason? He wishes to make a claim before the end of the policy year. The ad seeks to highlight a commonly-known fact: Indians' fixation for 'returns'.

The reluctance to pay premiums without securing anything in return is the sole reason why insurance-cum-investment plans are popular in the market despite the availability of cheaper alternatives like term cover.

Like term insurance, health covers, too, don't find many takers, since many mistakenly believe that buying a health cover while maintaining perfect health makes little sense. What's more, the health cover premium seldom helps an individual to exhaust the Rs 15,000 deductions that can be claimed for health insurance under section 80D of the Income-Tax Act. This, again, works against such policies. This is the reason why some health insurers have been designing products to make such insurance-seekers happy.

Health 'plus'

These include unit-linked health covers as well as OPD (outpatient department) products that extend cover to treatments not requiring 24-hour hospitalisation or not included under 'daycare' procedures. Companies like ICICI Lombard, Apollo Munich and Max Bupa offer OPD covers.

Unit-linked health plans look to address another source of consternation among policyholders - 'spending' on policies that don't yield 'returns'. The OPD policies cover consultation, dental and maternity expenses, subject to limits, which constitute key exclusions in the standard indemnity-based mediclaim policies for individuals. Such plans also appeal to individuals who want to maximise tax breaks on health insurance premium.

Under the standard policies, a 30-year-old opting for a sum assured of Rs 3 lakh would have to pay an annual premium of around Rs 3,000, way below the Rs 15,000 cap eligible for tax break. "With OPD expenses going northwards steeplyand majority of health insurance policies not covering OPD expenses, such covers have become immensely useful for an individual. Comprehensiveness is the proposition of such policies. Clubbed with the benefit of saving tax, such policies have become popular amongst customers," says Sanjay Datta, head, customer service - health and motor, ICICI Lombard.

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Al Qaeda affiliate HuJI suspected in Delhi blast

A powerful bomb placed in a briefcase outside the High Court in New Delhi killed at least 11 people and wounded 76 on Wednesday in an attack authorities said was claimed by a South Asian militant group linked to al Qaeda.

The 2-kg bomb dug a crater three to four feet deep near the main reception counter where passes are issued for lawyers and visitors to enter the sprawling sandstone building before the main security checkpoint.

Authorities said they are investigating a claim of responsibility allegedly made by the Harkat-ul-Jihad Islami (HuJI) militant group -- an al Qaeda affiliate with bases in Pakistan and Bangladesh. Ilyas Kashmiri, who U.S. authorities believe was recently killed in Pakistan, was the head of the group and senior al Qaeda member.

An attack in broad daylight at such a high-profile location, which lacked CCTV cameras and had faulty security scanners, quickly led critics to question the authorities readiness especially as it came ahead of the Sept. 11, 2001 anniversary of attacks in the United States.

"Notice that this comes just days before 9/11, so the government should have expected something like this," said independent strategic analyst Maj. Gen. Ashok Mehta.

In an email to the National Investigation Agency (NIA), the South Asian militant group called on India to repeal the death sentence of a man convicted in connection with an attack on the Indian parliament in 2001 and warned it would otherwise target major courts in the country.

In May, a low-intensity blast outside the same High Court in Delhi triggered panic but injured no one.

"That mail has to be looked at very seriously because HUJI is a very prominent terrorist group among whose targets India is one," NIA chief S.C. Sinha told reporters.

Prime Minister Manmohan Singh is currently on an official visit to Bangladesh, the first by an Indian premier in 12 years. The militant group has bases in that country.

"I have heard the sad news from Delhi. This is a cowardly act of a terrorist nature, but we will deal with it. We will never succumb to the pressure of terrorism," Singh told reporters in Dhaka.

Forensic evidence initially showing nitrate based explosives with possible traces of pentaerythritol tetranitrate (PETN), a powerful high explosive, a senior home ministry official said.

Sketches of two suspects have been released to the public.

LAWYERS IN SHOCK

Lawyers in black suits and starched white collars stood around shocked on one of the busiest days of the week when the court hears public interest petitions.

About 120 soldiers, police and bomb squad specialists were at the scene, with ambulances whisking the injured away to hospitals.

"I was near the gate at that time," said lawyer K.K. Gautam. "There was an orderly queue when a loud blast occurred. I saw many injured and dead. I saw 20-25 injured and around 10 dead."

The court building compound is in a leafy, usually tranquil and upscale part of the city. The outside gate is usually manned by a handful of policemen armed with automatic rifles and hand-held scanners.

Television images showed scores of lawyers running from one of the main gates of the building just after the explosion amid rubble and chaotic scenes. Police cordoned off the area, not far from parliament and the prime minister's office.

"I think I saw this guy (suspect). He was in white, aged 34 or 35, carrying a briefcase and jumping the long queue," an unnamed middle-aged man told Indian television channels.

"There must have been some 80 people at that time when the bomb went off. I crouched immediately but the man behind me, he did not and was hit (by shrapnel) to his right arm."

SECURITY QUESTIONS

The blast will renew concern about the ability of authorities to prevent attacks, particularly in sensitive, high-risk areas.

It comes as security has been stepped up as parliament is in session and ahead of the 10th anniversary of the Sept. 11 attacks and less than two months after near-simultaneous triple bomb attacks in India's financial hub Mumbai killed 24.

No one has claimed responsibility for those attacks.

"This is a glaring example of the shortage of intelligence, both human and technical -- something if we had we could have prevented these attacks," said Ajai Sahni, executive director at the Institute for Conflict Management in New Delhi.

Two lawyers at the court, Namita Roy, 48, and Hargovind Jha, 40, told Reuters the scanner and metal detector at Gate 5 of the court where the blast occurred were not working.

"This is definitely a big security lapse on the part of the police. For example, yesterday even the (body) scanner was not working. The security, more or less, is very weak, especially in view of the blast that happened a few months ago," said Roy.

Several bomb attacks in large Indian cities in recent years have been tied to the Indian Mujahideen, said to have support from Pakistan-based militants fighting Indian rule in Kashmir.

Pakistan-based militants attacked Mumbai in coordinated assaults that killed 166 people in 2008, raising tensions with nuclear-armed arch rival Pakistan.

Singh and his government came under intense criticism over the handling of those attacks. The government promised a radical overhaul of the security apparatus in India but critics say the reforms have been inadequate and in some cases abandoned.

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Sonia Gandhi To Return Soon

Indian media said Gandhi, 64, India's most powerful politician who has been absent for a month with an undisclosed illness, could be back in Delhi by Tuesday night. The Congress party denied this.

"We can say she is coming back soon," spokesman Janardhan Dwivedi told Reuters.

Gandhi's illness added to an already long list of problems besieging Prime Minister Manmohan Singh, who has fallen behind schedule with a reform agenda he himself considers vital to bring India's economic growth closer to double-digits.

Broadcaster NDTV, citing Congress party sources, said the Italian-born Gandhi was expected to return to the capital on Tuesday, but it was not clear when she would return to work.

The Times of India, without citing any sources, said: "She is likely to need at least another couple of months for a full recovery."

The party has declined to comment on the nature of her illness. However, several media outlets have said she was treated for cancer at the Sloan-Kettering Cancer Center in New York.

SCION RAHUL STEPS UP

After leaving for surgery, Gandhi promoted her son Rahul, still seen as inexperienced, to help manage the party in her absence. He is widely expected to be the next prime minister if the Congress party returns to power in 2014 elections.

The government looked indecisive during recent anti-corruption protests led by 74-year-old activist Anna Hazare who forced the prime minister to back down and agree to tougher anti-corruption legislation.

Recent opinion polls show support for the centre-left Congress party sharply falling behind the opposition Hindu nationalist Bharatiya Janata Party.

Congress is still expected to hobble along until 2014 elections as the opposition feels a snap election will not yet be an automatic return to power.

In an attempt to regain the political initiative, the government plans to present to parliament this week a reform to India's century-old land acquisition laws, aimed at streamlining factory and home-building.

The Gandhi family, descended from India's first Prime Minister Jawaharlal Nehru, enjoys a status similar to royalty in the country of 1.2 billion. They are not related to independence hero Mahatma Gandhi, a close ally of Nehru.

Out of respect, normally clamorous 24-hour news stations have been almost silent on Sonia Gandhi's condition or what her absence meant for running the world's largest democracy.

India's main political parties have also largely shied away from commenting on Sonia's absence.

Sonia was married to Rajiv Gandhi, Nehru's grandson and a former prime minister, who was killed by a suicide bomber in 1991 while campaigning for elections.

His mother, Indira Gandhi, was also prime minister when she was assassinated by her Sikh bodyguards in 1984.

Sonia Gandhi is seen as the main driver for massive welfare and back-to-work schemes for the rural poor, a counterbalance to Singh's more reform minded agenda.

Often seen as the power behind the throne, after driving Congress to election victory in 2009 but declining to become prime minister, critics say Gandhi has been an ineffective leader who failed to halt corruption on her watch.

For over a year, the government has been on the defensive over graft, particularly charges former Telecoms Minister Andimuthu Raja accepted bribes to favour some firms when the sought lucrative 2G mobile phone licences.

Raja, who is now in jail pending trial, is a member of a party in coalition with Gandhi's Congress party.

On Monday, federal police arrested a powerful mining tycoon linked to the opposition BJP in a move the government hopes will show it is getting tough on corruption. The arrest also weakens the BJP's attacks on the government over graft.

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BCCI worried by "government interference"

The National Sports Development Bill, which seeks to limit the tenure of all sports administrators and bring the federations under the scope of the country's Right to Information (RTI) act, has already been rejected by the Indian Olympic Association (IOA).

"While we are happy with the accountability factor, we are not really happy with the interference of the government in sports bodies," BCCI chief administrative officer Ratnakar Shetty told reporters in Mumbai.

"We feel there is no reason for the government to interfere in the affairs of the BCCI."

In June the International Cricket Council (ICC) ordered its members to free themselves from government interference or face sanctions and the bill, if passed, could become a headache for the world's richest cricket board.

The BCCI remains a rare Indian federation that does not take government grants and holds regular elections and Sports Minister Ajay Maken said the government was not seeking to exert any control over its affairs, merely make it more accountable.

"How bringing a Sports Body under RTI is tantamount to controlling it, I fail to understand," Maken wrote on his Twitter page.

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