Bhopal gas victims may not have got adequate compensation, but they will help scientists on toxicity research

2010

Syed Akbar

Hyderabad, June 26: Bhopal gas victims may not have got adequate compensation, but they will soon help groups of Indian scientists to understand the mechanisms of toxicity in humans and evolve biological markers for the killer gas methyl isocyanate.

The Indian Council of Medical Research will take up research work to find out whether there are any long term effects of MIC or methyl isocyanate gas on the Bhopal population either exposed to or affected in the gas tragedy in December 1984. The research will cover three successive generations of the victims.

Now that 26 years have passed since the gas tragedy, the ICMR wants to know if the MIC had really triggered any genetic disorders, growth and development disorders, congenital malformation including low birth weight in the subsequent generations.

The investigations will centre around recorded cases of congenital malformations and/or low birth weights, and delayed developmental disorders, including delayed milestones of the affected members of the family and their sibling.

Other developmental issues like retardation of genitalia and reproductive functions will also be assessed. The study gains significance in the backdrop of reports that initially high incidence of congenital malformations in the wake of the Bhopal disaster was found to be well within the national average.

"Soon after the tragedy health experts and researches were divided in their views. While one group felt that chromosomal alterations and damage in the victims was one-time toxic manifestation, others were of the view that it could be the fore-runner of chromosomal abnormalities. The ICMR work will clarify on this," said senior geneticist Dr MN Khaja.

World anaesthesia day – October 16: Wrong dosage of anaesthesia may prove fatal

2010
By Syed Akbar
Hyderabad: Little did the family of Raghavendra Rao, 44 realise that he would not return home when he was admitted to NIMS for a minor ankle problem. Raghavendra Rao slipped into coma and finally death after he was administered anaesthesia for a simple surgical procedure. Though Raghavendra Rao is an extremely rare case study for doctors, the incident has nevertheless raised several issues including the expertise of our anaesthetists and how well trained they are to handle critical cases.
As the world remembers Boston dentist William Thomas Green Morton, who on October 16, 1846 assisted surgeon John Collins Warren in removing a tumour from the neck of a patient in what has become the first known case of surgery without pain (an, without; aesthesia, sensation), city doctors emphasise the importance of quality training for anaesthetists and updation of knowledge and skills at regular intervals. In memory of Morton’s assistance in painless surgery, October 16 is observed as World Anaesthesia Day.
Not many patients or their attendants know that an anaesthetist is one of the most important persons in any surgical team. Often the role of an anaesthetist becomes more important than that of a surgeon. It is no wonder then that after Raghavendra Rao’s sad episode, many patients are insisting on well-qualified and well-trained anaesthetists to be part of their surgical team. After all, it’s a matter of life and death for the 
patient.
“An anaesthetist has a crucial role to play both at the time of surgery and during recovery post surgery,” points out Dr N Somasekhar Reddy, senior orthopaedics surgeon. “The role of an anaesthetist doesn't end with surgery but is crucial for controlling pain after surgery”.
Dr Somasekhar however argues that with modern equipment and anaesthetic drugs, especially the regional anaesthetic techniques, have cut down complications associated with anaesthesia.
The State, for that matter the country, has an acute shortage of well-trained and well-qualified anaesthetists. The shortage is such acute that an anaesthetist has to often run across hospitals to administer anaesthesia to surgical patients. This leaves a little time for the anaesthetist to tend more time to any of his patients. Lack of proper monitoring of patients post surgery often leads to severe complications associated with 
anaesthesia.
As Dr Ratnam Naidu, consultant anaesthetist of Apollo Hospitals, says an anaesthetist has a “significant role in defining the patient care” in terms of pre-operative assessment peri-operative and post-operative management.
The role of an anaesthetist is not restricted to operating rooms any more. “His services are important in emergency rooms to cath labs. Anaesthetists play significant role in pain management in cancer wards and in Obstetrics wards too,” he clarifies.
But what becomes important for an anaesthetist is “better understanding of patho-physiology of disease process, fluid and blood transfusion therapy”, as Dr Ratnam says. He, however, does not want to attribute anaesthesia complications to doctors. “Unsuccessful outcomes do occur, not due to negligence, but due to expected risk of anaesthesia and surgery and the fact that humans practice medicine, not computers”.
On the other hand, Dr Aftab Ahmed, specialist in internal medicine, argues that “anaesthesia, given appropriately after proper assessment of patient, in a right dose is the most effective method in conducting painful procedures including surgery.”
However, if given without considering the patient’s over all medical condition, anaesthesia can sometimes cause life threatening complications affecting heart, lungs and brain. “It’s a double edged sword, to be used very cautiously by an anaesthetist,” cautions Dr Aftab.

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Anaesthesia complications
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Serious complications associated with anaesthesia are generally rare, though often they may lead to even death. Doctors classify complications as normal, rare and extremely rare. It is the extremely rare complications that create major trouble to patients as well as doctors attending them.
Here are some of the broad complications associated with anaesthesia:
1. Nausea and dizziness
2. Back ache
3. Short term loss of memory
4. Respiratory problems
5. Damage to nervous system
6. Muscle pain and blurred vision


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Types of anaesthesia
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Anaesthesia is generally of three types. A qualified anaesthetist decides which type of  anaesthesia should be administered to the patient concerned. A lot of thought and consultation with physician and surgeon goes before the anaesthesia is administered. The physician certifies whether a patient is fit for surgery. He also writes a note of caution if the patient has existing health complications like heart and kidney problems. 
The age of the patient is also important.
1. General anaesthesia: In general anaesthesia the patient becomes unconscious and needs external breathing support. It is used in major surgeries.
2. Regional anaesthesia: A large part of the body is made senseless in regional anaesthesia.
3. Local anaesthesia: Only a smaller area is covered under local anaesthesia. Broadly speaking, local and regional anaesthesia do not cause any major complications.

India ranks 10th in terms of scientific research

Syed Akbar

Hyderabad, Oct 18: India ranks 10th in the world in terms of scientific research but it has to work harder to achieve its past glory of 1970s when it stood eight, according to a report of the Academy of Sciences for the Developing World (TWAS).

The TWAS, which is holding its 21st general meeting in the city for three days from Tuesday, pointed out that nevertheless, "India by any measure, is on a roll". Prime Minister Manmohan Singh will inaugurate the general meeting which will be attended by around 350 scientists and researchers from 50 developing countries.

According to TWAS editor Daniel Schaffer, "what’s true for India's economy is also true for science. The government spending on research and development has grown by 15 per cent or more each year over the past several years. While India has recently approached the one per cent threshold of expenditures in R&D as proportion of GDP, it still lags far behind other

countries." In India the percentage inched forward from 2.5 per cent to 2.6 per cent.

"Today, India ranks 10th in the world in internationally peer-reviewed scientific publications. That’s up from 12th in 2003. While India’s publication output has accelerated over the past several years, it

still falls short of its ranking in the 1970s, when it was eighth," TWAS said in its report ahead of the city's general meeting.

According to the report, the disparity in patents between China and India is even more glaring. In 2006, China received 2,452 patents while India received just 648.  The report, however, added that the good news is that the number of patents has increased with the rise of high-technology companies focusing on R&D.

On the environment front, India is not a polluting nation. India, which has some 18 per cent of the world’s population, produces just 4.5 per cent of the

world’s greenhouse gases. Approximately, six per cent of India’s energy is produced by renewables, largely traditional biomass.

Stating that India has some five million people working in S&T, TWAS report said yet, its ratio of S&T workers to the overall workforce is

about 120 per one million workers. In China, it’s 715. In South Korea,

3,700. And in the US, 4,600.

 "When observers look at where India has been and where it is heading, they see a rapidly emerging economic and scientific powerhouse that is successfully drawing on its expanding capabilities to build a vibrant

society characterised by prosperity and confidence.  India has a complex web

of S&T organisations that are moving ahead at a breakneck speed," Daniel said.

The opening ceremony will include the announcement of the 2010 winner of the Ernesto llly Trieste Science Prize and the official presentation of TWAS prizes, medals and certificates to the 2010 winners. Dr CR Rao, world renowned statistician and professor emeritus at Pennyslvania Sate University, will be given the India Science Prize.

Parkinson's disease - Part one: Take coffee to put off parkinson's

By Syed Akbar
With Parkinson's disease increasingly posing a major challenge to researchers and health planners world wide, the World Parkinson Congress comes out with good news. Take coffee regularly and avoid
or delay Parkinson's disease. Caffeine present in coffee plays a crucial role in people, who are genetically or otherwise susceptible to Parkinson's.
One can now find out whether one's genetic make-up helps in preventing the onset of Parkinson's when he or she becomes old. If their genetic set up carries a particular version of gene called GRIN2A,
they can benefit the most from sipping coffee.
Scientists at the World Parkinson Congress, which concluded early this week in  Scotland, reported that the genetic makeup of a person with Parkinson’s may determine how well he or she will respond to drugs
such as caffeine. This is one of the first genome wide association studies that looked at genetic and environmental interactions.
The investigators scanned the complete genetic code or genome of 4000 people, about half of whom had Parkinson’s disease, for nearly a million markers. They then collected data on the amount of caffeinated
coffee the subjects drank over their lifetimes.
Studies have shown that caffeine may decrease a person’s risk of developing Parkinson’s. Preliminary findings from this new study suggest that subjects who carry a version of the gene GRIN2A benefited the most from coffee.
According to Dr Haydeh Payami, an investigator at New York State Department of Health, the new findings may help researchers identify patients, who are likely to respond to drugs that target the same
physiological pathways as caffeine. Such drugs are currently being investigated as new treatments for Parkinson’s.
Concurring with the research finding, Dr Margaret Sutherland of National Institute of Neurological Disorders and Stroke, USA, said "the next challenge will be to validate that the coffee and GRIN2A
association can be replicated in a larger group of patients."
Dr Kieran Breen, Director of Research and Development at Parkinson’s UK, is hopeful that new drugs, without caffeine’s stimulant and diuretic effects, will prove helpful to patients.
"The new results suggest the possibility of screening patients for their genetic makeup to determine if they are likely to benefit from drugs that target the brain cells affected by caffeine. Such screening could be
done at the outset of clinical trials, and could also become part of routine practice," said Dr Haydeh Payami.
Parkinson’s disease attacks parts of the brain that are needed to control movement. Common symptoms include involuntary shaking, slow movement, stiff muscles and impaired balance, all which worsen as the
disease progresses.  A drug called L-dopa can control symptoms, but causes troubling side effects and does not slow progression of the disease, the researchers said.

Parkinson's - part two: Hunt on for early predictors

By Syed Akbar
Parkinson's disease can be identified at an early stage with the help of biomarkers or early predictors. This helps in early diagnosis and treatment for this neurological problem that affects mostly the old. But
the major task before researchers is how to identify those biomarkers or early predictors.
Health researchers world wide are now busy in finding out those molecules or substances inside cells or body fluids that tell us how severe is the problem.
If researchers succeed in identifying those biomarkers, it will be easier to predict whether a person may get Parkinson’s disease. In case of those already suffering from the problem, the biomarkers will help in
monitoring the progression of the condition. The other important therapeutic use of biomarkers is to test drugs that can slow or stop the development of Parkinson’s.
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What is Parkinson's disease ?
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Parkinson’s disease is a neurological disorder that affects the central nervous system. It is a degenerative disorder and progresses with time. Parkinson's or PD is the most common movement disorder with a
median age of onset of about 55 years. The symptoms include impaired ability to adjust the body position, rigidity and tremor. Some of the patients also suffer from non-motor symptoms like cognitive (thinking
ability) decline and disturbances of autonomic nervous functions.
About 40 lakh people in India suffer from Parkinson's disease. It is not clear what triggers Parkinson's in a person. And scientists are yet to understand the cause and pathogenic mechanisms behind Parkinson's
disease, though some vital information on the problem has been obtained in the last two decades. Some attribute it to genetic factors.
Researchers are now moving to the next step after finding genes that influence the risk for a condition. Work is now on to piece together the picture of what those genes do, and how variations in these genes may
lead to a process which causes the disease.

Parkinson's disease - part three: Parkinson's Disease leads to loss of memory

By Syed AkbarAt least one in three people with Parkinson’s will develop some form of dementia (memory loss). Each person experiences dementia in his or her own way and the symptoms usually come on gradually and get
worse over several years.
According to Prof David Burn of New Castle University, the problems associated with dementia linked to Parkinson's disease include trouble with memory, thinking and language, such as forgetting words for
things or people, or not understanding what's being said.
"Memory problems can lead to confusion. For example, someone with dementia might get lost in a familiar place. Or they might forget they've done something, or keep asking the same questions again and again.
Problems with doing day-to-day things, such as getting dressed, eating and going to the toilet. People with dementia can find it difficult to follow instructions and they can have problems using money," he said.
People with dementia can become agitated, irritable and restless. They may start pacing the room or wandering. They may shout at their family or lash out physically. They might also feel anxious or
depressed. Or they may laugh out loud or start crying at the wrong times.
He said some people get delusions (imagining that something is happening when it isn't). For example, they might think somebody is trying to steal their belongings. Some may get hallucinations (seeing or
hearing things that aren't there).
"We still don’t fully understand why some people with Parkinson’s get dementia or why others don’t, but there are some risk factors. Dementia usually affects older people so it’s rare that someone with Parkinson’s
under the age of 65 will develop the condition," Prof Burn said.
Prof Burn's team is testing whether it is possible to identify people with Parkinson’s who have a high risk of developing dementia. Over five years, they will follow around 300 people who are newly diagnosed
with Parkinson’s and carry out different studies. The research team will keep track of which people develop the symptoms of dementia.
"We will find out if getting dementia can be predicted by brain scans, genetic tests and the presence of certain proteins in a person’s blood or cerebrospinal fluid. Identifying which people with Parkinson’s are at
risk of developing dementia would allow doctors to prescribe anti-dementia drugs earlier. We will also understand more about dementia and this knowledge can help develop new treatments that ultimately
slow down, stop or even reverse dementia," he said.