This case report deserves wider publicity

A case report in the latest issue of  The British Medical Journal (THE BMJ) describing a serious injury to a 36 year old male patient deserves wider publicity as we can prevent such instances by imparting correct information.

Physicians from the Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, India authored the case report

The link:      http://casereports.bmj.com/content/2018/bcr-2018-226562.full.pdf

(The photographs which The BMJ carried may shock some readers).

Dr Jamie Well  wrote a news story based on it in one of the dispatches of the American Council on Science and Health (ACSH)

Here is the link:

https://www.acsh.org/news/2018/08/15/yes-you-can-%E2%80%98break%E2%80%99-your-penis-13314.

I feel that the case report must be published in popular dailies and other contemporary publications. I made this suggestion to the concerned physicians. Drugs such as Viagra are reportedly available on line. Patients may come to grief if they consume the drugs  without medical supervision

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Some controversies in radiological protection

The uses of radiation in industry, medicine, agriculture and research have increased many times over the past few decades. Radiation is also present in nuclear installations such as nuclear power plants.In 1960-1961, the radiation dose measuring programme in India covered over 3000 persons. In 2016, the workers covered were 1,43,149.

The science of radiation protection grew and formed the basis for various. recommendations. Most countries  enforce the recommendations of the International Commission on Radiological Protection (ICRP). There were a few controversies in the basic concepts. I had occasions to share , understand appreciate these controversies.

I covered some of them in an article I published in The Wire.

Here is the link: https://thewire.in/science/radiation-lnt-hypothesis-phobia

Another article I wrote in Eurasia Review may be also of interest.

https://www.eurasiareview.com/17052018-radiation-doses-their-limits-related-issues-of-public-perception-analysis/

I had an opportunity to be in the company of Prof Roger Clarke while attending the XIX Annual Conference of the Association of Medical Physicists of India at Delhi. He was then the  Chairman of the ICRP. Our discussions over a few days covered many of  the controversies in radiation protection. Please read the transcript of the interview given below:

EXTRACT OF THE INTERVIEW GIVEN BY Prof. Roger Clarke, chairman, International Commission on Radiological protection to Dr. K.S. Parthasarathy, Secretary, AERB during his visit to India to participate in the International Conference on Medical Physics and the XIXth annual Conference of Association of Medical Physicists of India

Dr. KSP : I remember that it is not your first visit to India

Prof. Roger Clarke : I cam to India a few years ago. But I am attending the Medical Physics Conference for the first time.

KSP : In your last visit you addressed the officers of the Atomic energy Regulatory Board (AERB).

RC : I know a few colleagues from India who worked with me in the Committees of the International Commission on Radiological protection.

KSP: How did you get into the field of radiological protection? What was the incentive to enter this field? The career of a radiation physicist may not have been lucrative. Is it not?

RC : I was a reactor physicist working for the Central Electricity Generating Board (CEGB). One day my head of Division came to me. He wanted an answer for the question, with how many failed fuel plus pins you can operate an Advanced Gas Cooled Reactor (AGCR). It was in the Sixties. AGCR fuel was more expensive. Primarily the emphasis was on the basis of those to the public. I collected relevant data. In the process, I calculated the inventory of the fission products. I got introduced to health physics. I did some environmental modeling, got interest in radiobiology. Later I joined the National Radiological Protection Board to establish close assessment capability after gathering inputs on the environmental concentration of radionuclide. There was a group working on the movement of radionuclide in the biosphere. This was 20 years ago. This group was primarily interested in the study of radiation doses due to releases of radionuclide.

KSP: Historically, the International Commission on Radiological Protection (ICRP) was setup to make recommendations on the safe use of ionizing  radiation in medicine. But it took a few decades for ICRP to bring out comprehensive recommendations on the protection of patients in diagnostic radiology. What was the reasons for this? Was it because  ICRP did not want any control on medical radiation proactive?

RC : In the early years, therapeutic treatment was given more emphasis. The forerunner of the ICRP originated from the recommendations of the British X-ray and Radium Protection Committee. Then the major concern was protection of the workers. This was because deterministic effects such as extensive skin damage was seen among the x-ray workers who handled x-ray units. After the Second World War more penetrating radiations came to be used in medicine. Artificial radioisotopes appeared on the scene. More and More public were exposed. The emphasis shifted to public exposure. It coincided with more developments in fifties the emphasis was on therapy. Later more and more diagnostic technologies were developed.

KSP: Is it true that after the Second World War, many technically qualified people entered the job market. Many of them were electrical engineers. Apparently, this gave a boost to the development of newer technologies, which included manufacture of x-ray generations of higher and higher voltages.

RC : That is true. Radiation generators emitting more penetrating radiation began to appear in medical practice. Leukemia was identified among medical practitioners. The work by an American Physician Mr. Shields Warren is notable. He reported that Leukemia among radiologists was higher than that among general medical practitioners. It was obvious that ICRP, in this background, started giving more emphasis to patient protection. I would like to mention one recent development. Deterministic effects are coming out into focus now. Some of the interventional procedure, if carried out without care, can give substantial does to patients.

KSP: So it is not true that ICRP was somewhat biased in favour of radiologists over the years. What was the type of representation radiologists had in the ICRP?

RC: That ICRP charter states that only one radiologist need be there in ICRP though it was set up by the International Congress of Radiology – a professional association of radiologist – It is often not known that there are two more organizations to be considered, the International Commission on Radiation Units (ICRUs) and the International Committee for Education in Radiation and Radiology. The latter organization was established a few years back, but was not very active. It was re-established around five years back.

KSP: What are the new concerns?

RC: The concern of the radiologists shifted to finding out what is a better image. Future is in imaging, in medical imaging. For instance, digital imaging in interventional radiology, electronic manipulation of images, fluoroscopy with computer software. These technologies are likely to appear. More and more computer will start controlling x-ray imaging. Surgeons will turn round and expect computers to control the imaging procedure. With the newer techniques being used a dose reduction of a factor of about 10 is possible to the patient. The workers are also benefited by the dose reduction.

KSP: Do you agree that the scholarly discussion on the Linear-Non Threshold (L-NT)hypothesis has contributed to the notion that there is no safe level of radiation. Has it not sensitized the large public to greater and unreasonable levels?.

RC : I agree. When experts disagree, the credibility of specialists suffers. If experts do not agree, how can people decide which side of the argument is believable? I cannot deny that the arguments on L-NT has created some difficulties. The situation could be bad because there is an increasing possibility that decisions in science may be made by judges and juries in court rooms and not by professional association or by Royal Societies. The judiciary system may not be able to convince itself about the increased possibilities of radiation effects.

KSP: Don’t you thing that it is futile to try to get a deterministic answer to a purely probabilistic question?

RC: Yes. But I do not understand why some people wanted to establish that there is a threshold does below which there will not be any radiation effect. One of the major difficulties is in tackling the problem of old contaminated sites. Small radiation doses due to residual radio activities left behind at certain sites an cause very tiny amount of radiation doses. But when these doses are integrated over several thousand years. One may end up with getting significant amount of doses. We ill be left with the estimates of a few hundreds of probable deaths due to these collective doses accumulated over a long period of time. But I believe that we must have started dialogue on acceptable risks.

KSP : I am sure we must exclude voluntary risks such as risk due to smoking while we consider acceptable risks.

RC : Yes, I agree. Only involuntary risks are to be considered. In general, I am worried that the philosophy of protection has become somewhat complex.

KSP :Even for the professional …….. 

RC : You said that and I agree. We must develop simpler concepts. ICRP must start consultations with other groups and collect ideas for reviewing and consolidating the system of protection. We have started to do that already. It explains why some of our recent documents are better than earlier ones. Consultation with others will help to improve the documents. The document on radon is an instance in point.

KSP: Everyone was keen on the on-going L-NT controversy. While the ICRP and the NRPB supported the argument that there is no threshold for the effects of ionizing radiation, the US Health Physics Society was unconvinced. The NRPB bulletin went to town with the suggestion that the attitude of the Health Physics Society is in tune with the liberalized attitude of US Administration to nuclear power. Can you comment on this development?

RC : Yes, certainly different professional groups looked at this issue very differently. American Health Physics Society has its own stated view. I have been to Health Physicists Society. Lots of people were interested in the controversy. The arguments put forth by the Health Physics Society are outdated with respect to the recent findings on the Japanese survivors of the atomic weapons. They did not then have  the occasion to see the data. The recent data indicated that there could be significant risk at doses as low as 50 mSv, of course with much uncertainty. I do not still understand why they are looking for a threshold. There are many unknown cellular phenomena to be understood. Genomic instability, for instance.

KSP: You have become an unquestionable proponent of the linear non threshold theory. Certainly you didn’t ask for such a position. Do you really think that this controversy when uncontrolled?

RC: Yes. In my view, there is no need to search for a threshold. Nobody denies that there is evidence for the repair of cellular damage. But we cannot ignore that the repair mechanisms are also statistical in nature.

KSP:  Biological effects of radiation has been studied for the past 100 years. The stochastic effects such as cancer world not have even been through about, but for the long an expensive epidemiological studies. Is it not unfair to spend too much of resources, in fact, vast sums of money to carry out studies about an agent which is now known to be much less hazardous than hundreds of toxic chemicals about which practically nothing is known.

RC:  I may say that physicists should take the blame for it. The study of nuclear physics progressed rapidly. Some of the best brains entered the profession. The study of physics was intellectually satisfying and scientifically stimulating. Unfortunately, the same was not true for chemicals. Of late, biologists are also stating to use more and more mathematical formulations. Probably natural sciences are getting ready to make quantitative estimate.

The biggest injustice done is to attach a speaker to a Geiger counter, You must remember that nobody attaches a speaker to a gas chromatograph. In case higher values of hazardous chemicals are detected, the speaker howling is more dramatic and will definitely arrest the attention and create a problem.

There are several aspects to the understanding of the risks from chemical compared to the risks from chemical radiation. Natural radiation is present everywhere. There is no such analogue in the case of hazardous chemicals. Releasing genetically modified plants without control is probably in my view a higher problem. No doubt of course, this area getting more attention now.

KSP When the French Academy if Sciences published a report critical of ICRP for lowering dose it as French Government policy. To many, it was not surprising as France has a stake in nuclear power. They feel that lower dose limit is probably not in this interest. What is the current position of the French Government?

RC: The French Government has signed the European Directive. The French Electric Power Industry is committed to ICRP recommendations.

KSP: Release form a nuclear facility can be controlled by appropriate methods. It may cause increase in the collective doses to workers. In some instances the collective doses to workers may be far more than those to public. Which option will be acceptable in your opinion?

RC: Both occupational and public exposures are being reduced by optimization procedures. Storage of waste on-site may actually cause a potential for accidental exposure of the public as well as exposing workers. As long as individual doses – workers and public – are acceptably low, the situation is optimized.

KSP: The recommendation of ICRP are universally respected. I remember that the National Radiological Protection Board recommended a dose limit of 15 mSv/year even before ICRP recommendation were issued. NRPB faced some amount of criticism. What is the status of implementation in the UK and USA?

RC: The European directive was issued in May1996. These directives are legally binding on all states and the directives were to be implemented by 2000. In UK, the Health and Safety Executive has to make appropriate already been started. There is a need for harmonizing different documents. For instance different exemption levels are given under different contexts in Europe.

KSP:  why are there such differences in exemption levels in Europe?

RC:  In UK, the Radioactive Substances Act is one of the regulations which is different from The lionizing Radiation Regulation 1985. Health and Safety Executive is reviewing both these. The disposal of radioactive substances comes under the Radioactive Substances Act. The harmonizing of values and concepts and making them consistent is taking some time.

KSP: Was it not because there are some differences in opinions and views?

RC: That is not the reason. Certainly different agencies are at work. Most of the values of exemption levels are given in the European Directives.

KSP: Based on the impression that ICRP may revise the dose limits downward, AERB had its first comprehensive review of occupational exposures in 1989, a year before ICRP 60 was issued. We have implemented the recommendations are similar to those of ICRP except that the maximum dose limit in any year recommended by AERB is 30 mSv instead of 50 mSv recommended by ICRP.

Our experience is that among the various groups using ionizing radiation, industrial radiography is the most important.  In India this field is probably one of the most regulated. The Regulatory Board issue authorization only if certified radiographers, a site-in-charge and appropriate radiation measuring instruments and protective accessories are available at every site.

RC: Industrial radiography has certain peculiarities. In this field, the workers are likely to be exposed to high radiation doses. The field has more potential for accidental exposures. I understand that ionizing radiation occurred in the field of industrial radiography. A man whose film badges did not record any reading but did due to radiation exposure related symptoms.

KSP: He must have been totally careless. I remember that the dose to this worker was evaluated by very advanced dosimeter method using his teeth as sample. What do you propose to make this field safer?

RC: This field is such that it is impossible to supervise them well, as their place of work is distributed in various work environments. For instance, often they work alone in the field while laying gas pipelines. So the only way we can improve the safety status in by imparting appropriate training to the workers. The regulatory organisation should ensure that such dedicated training programme is extended to all the workers.

KSP: Since reducing dose in medical X-ray practice is easier and less expensive, is it not more appropriate to allocate resources more prudently to achieve substantial reduction in collective doses in diagnostic radiology? If I say that there should be more efforts to reduce needless medical exposures, it may be looked upon as an attempt to divert public opinion from exposures in nuclear installation. ICRP should come out with such clear statements on avoiding needless exposure.

RC: We have gone a long way. The International Basic Safety for Protection against Radiation and safety of Radiation Sources has given certain guidance values. The United Kingdom also accepted certain guidelines. With these precautions, the collective dose can be reduced by about 40% But this was more than offset by the predominant use of CT scan units.

KSP: When many States in the US brought out guidelines for typical X-ray examination based on the National X-ray Trend Programmes, UK was less enthusiastic about the concept. Now Basic Safety Standards came out with guidance. What is your general view on this? Can you include the guidance levels in regulation?

RC: I believe that prescribing guidance levels similar to the one stated in BSS is in the right direction. The experience in the UK has been that there has been substantial reduction in collective doses to population at large over the year.

KSP: In your lecture at the International Conference on Medical Physics you spoke about carrying out appropriate evaluation of dose to commercial airline workers under the category of occupational workers. How many countries in Europe have done this?

RC: Cosmic rays obviously come under natural radiation. Under the European law, the member states shall undertake surveys to estimate the magnitude of the radiation exposure due to natural radiation. Currently large groups of persons journey by commercially operated airlines. Because of this, exposure to sensitive groups such as pregnant women may also have to be considered. There is a general thinking that dose contribution to the crew of commercial airline should be quantified by appropriate methods. This cab be done by on-board instrumentation and by considering the number of hours of flying by the airline. The intention is not that all the crew must wear dosimeters but the measurement of exposure will have to be carried out systematically.

KSP: At such high altitudes, the primary component of cosmic rays are high energy protons and neutrons. This is probably one area where we cannot do much about source control. What we can do is that regulated the exposure and the altitude in which the airline flies. The probability of radiation hitting the embryo or foetus will be miniscule. What is your thinking?

RC: I must say that currently the air crew are not subject to dose limits. But the radiation dose should be measured reasonably accurately by asking the number of hours the crew has flown and also by ascertaining the route of travel.

KSP: I understand that the Concord has appropriate monitoring equipment on board way back in 1970. When I was attending the Congress of international Radiation Protection Association at Brighton, I was at the dinner table with a group of scientist from UK who were actually making measurements in the Concord. Have you carried out systematic measurements? Is there anything new published since the special issue of “Radiation Protection Dosimetry” journal was published?

RC: Yes. Radiation measurements have been done and date are available.

KSP: I thought that the exposure is significant only during solar flares.

RC: According to my information the radiation levels on no occasion has increased to such an extent during the past 20 years which led to reducing the altitude of the aircraft to get the benefit of atmospheric shielding.

KSP: ICRP recommendation on pregnant women is known to be too conservative. What was the background information? Was there any re-thinking on this? As the dose limit recommended is different to measure, many institution may decide to withdraw pregnant women from radiation work. I understand that the topic is widely discussed in countries such as Canada where a great proportion of medical radiation workers are women.

RC: ICRP considers that the basis for the control of occupational exposure of women who are not pregnant is the same as that for men. On the other hand if a women is or may pregnant there is a need for additional controls to be considered to protect the unborn child. The considered is at times more prone than the post-natal individual to deterministic injuries caused by radiation and may be more sensitive to the induction of later deterministic effects in the live-born child including significant mental retardation will not happen if the exposure of the mother dose not exceed the dose limits now recommended for occupation exposure regardless of the distribution of the exposure over time.

Accidental high exposure of the mother may be more damaging to the concepts than to the mother.

The commission’s policy us that the methods of protection at work for women who may be pregnant should provide a standard of protection for any concepts broadly comparable with that provided for members of the general public. The commission considers that its policy will be adequately applied if the mother is exposed prior to the declaration of pregnancy under the system of protection recommended by the commission including the recommended dose limits for occupational exposure. This is the basis on which the commission recommended that no special occupational dose limits is needed for women in general.

The ICRP thought the recommendation of 2 mSv measured over the abdomen of a pregnant woman for the entire gestation period is very helpful. But there is some feeling that it is very restrictive.

KSP: In fact in Canada Atomic Energy Control Board (AECB) arranged discussion with woman workers in eight cities and asked for views.  A few hundred women participated.  Many of them argued that there is no reason to change the earlier limit of 10mSv.

RC: The Commission no longer recommends a dose limit of 2 mSv during the gestation period as measured on the abdomen of the pregnant women. The ICRP publication number 75 describes the current ICRP recommendation. Overall risks associated with radiation exposure of men and women are broadly similar. ICRP now sees no need to make any distinction between the two sexes in the control of occupational exposure. But once a worked is known to be pregnant, ICRP recommends higher standard of protection for the concepts.

The advice given in publication No.60 has been interpreted too rigidly. ICRP now recommends that the working conditions of a pregnant worker after the declaration of pregnancy, should be such as to make it unlikely that the addition equivalent dose to the concepts will exceed about one mSv during the remainder of the pregnancy.

It is important to highlight the responsibility of the worker and employer to meet the Commission’s objective. The pregnant worker should declare her pregnancy promptly to the management. The management should then organize the working conditions to make it unlikely that the additional equivalent dose to the concepts will exceed about one mSv during the remainder of the pregnancy.

KSP: Atomic Energy Control Board of Canada had detailed consultations with women groups on the reco0mmendation. I understand they may now recommend an external dose limit of 4 mSv on the abdomen or an intake of 20 percent of the annual limit if intake. ACEB had compared the general risks to the foetus during pregnancy and showed that at 4 mSv it is very low indeed. What is your view on this approach? I feel that if ICRP’s view expressed in publication No.75 is accepted, many employers will discriminate against women being employed in radiation work.

RC: The ICRP position is essentially as it was in publication 60 and elaborated in publication 75. The foetus  to be protected broadly as though it were a member of the public.

KSP: Though conceptually it is clear that exposure at the dose limit is just tolerable, exposing everyone to the dose limit all the tome is not acceptable. Was it not more appropriate for ICRP to recommend a range of values rather than a single value?

RC: The current dose limit of 20 mSv per year average for 5 years offers this operational flexibility. A single number is administratively convenient. It is obvious that the body dies not known whether the exposure occurred in one calendar year or another. Biology does not identify this.

KSP: The recommendations of ICRP are scientifically the best available. But you will agree with me that these recommendation have enormous social impact. Is it justifiable for over a dozen specialists in purely scientific disciplines to take such decisions which have enormous social impact? Don’t you think that the representation in ICRP should be broadened to include social scientists and economists?

RC: There are various components to this question. ICRP recommendations reflect the best scientific information. We do not say what is acceptable to society or not. There is one recent development. ICRP is currently engaged in more and more consultations with specialists by providing drafts of their recommendations to other specialists and concerned people for review. It would certainly reveal whether there is any inconsistency in the concept and approach put forward by ICRP. It will help to find out whether there is any fallacy in our approach. I believe the recent ICRP document bear testimony to this.

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Alcohol at any Level Is Injurious to Health

I  secured my Ph.D from the University of Leeds, UK in 1972. I lived in Leeds from September 1969 to July 1972 as a Colombo Plan study fellow.  Some of my friends developed the habit of  drinking alcoholic beverages regularly. I did not.

A case in point  was that of  a professor of electrical engineering. He was  in the end addicted to alcohol. He used to say that he might find it difficult on return as there was strict prohibition in the district in Tamil Nadu where his college was located. His consolation was  that his residence was close to the border with Kerala where there was no prohibition.

The second case was that of a senior officer from the Food Corporation of India. He  was on deputation and was attending some training programme. He was always seen with a king size mug of beer. He used to drink as early as 7 AM.  He claimed that he cannot weather the weather without some alcoholic drink in his belly!

A third case was that of a very senior officer from the Government of India. He was also on deputation. He was home sick and miserable. He was a strict disciplinarian. He did not start alcohol consumption. He was  concerned about the need for adequate nutrition to survive in the cold weather. He started drinking large quantities of cold milk. His perennial complaint was about loose motion!

This long introduction was to show how people develop certain habits. In the 50s and the 60s people in Kerala used to stand in queues for collecting essential items such as ration and books. Now also many stand in queues patiently. This is primarily to collect their daily quota of drinks!

I believe that the results of a landmark study  published on line on August 23, 2018  in The Lancet, a prestigious British medical journal must persuade any one to discontinue his addiction. The study concluded that “alcohol at any level is injurious to health”.

I summarized the conclusions of the study  in The Wire  on August 27, 2018.

Here is the link:

https://thewire.in/health/theres-no-safe-level-for-drinking-alcohol-but-hold-up-before-you-abstain

 

 

 

 

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Nuclear Legacy Trap: Myths and Reality

https://www.thestatesman.com/opinion/nuclear-legacy-trap-myths-reality-1502625735.html

Home / Opinion / Nuclear Legacy Trap: myths and reality
Nuclear Legacy Trap: myths and reality
K S Parthasarathy | April 22, 2018 1:10 am

Nuclear power plant.

 

General Vinod Saighal’s eminently readable, lucid opinion piece (The Statesman April 2) reflects the concerns of vast sections of the public. He argues persuasively against setting up nuclear power plants because he feels that these plants will form a very expensive nuclear legacy trap for future generations because of decommissioning and nuclear waste disposal issues.
His article highlights the seemingly unbridgeable communication gap between public and the nuclear community. Mired in controversy, the myths about decommissioning and nuclear waste management survive; the realities may remain unknown if nuclear community does not come out of their comfort zones and convey information to all sections of the public. Trust deficit of decision makers at higher levels of Government is not a welcome sign.
A book (The Trap) by Sir James Goldsmith reinforced Saighal’s apprehensions. The 1990 vintage book does not contain information on the latest advances on decommissioning of nuclear power plants and management of nuclear wastes.
Indian scientists have adequate experience in decommissioning of research reactors, reprocessing plants and nuclear facilities.
According to an authentic review (World Nuclear Association-WNA-,March 2018), “over 115 commercial power reactors, 48 experimental or prototype reactors, over 250 research reactors and several fuel cycle facilities have been retired from operation. Some of these have been fully dismantled”.
“Most parts of a nuclear power plant do not become radioactive, or are contaminated at only very low levels. Most of the metal can be recycled. Proven techniques and equipment are available to dismantle nuclear facilities safely and these have now been well demonstrated in several parts of the world.,” the WNA report added.
Scientists have developed technology to incorporate high-level nuclear wastes into glass (vitrification) to make them non-dispersible. Glass is least soluble even in hot, salt water. The vitrified waste after suitable capsulation (for instance in copper canisters) can remain safely in deep underground repositories for thousands of years. By 2025, Sweden and France will move high-level waste (HLW) to their permanent underground sites. Finland will move its HLW in 2020.
Other countries can follow these steps or even outsource waste management to France, Finland or Sweden, the real masters of the technology.
India has been operating vitrification plants for many years. The October 2013 issue of Sadhana, a journal published by the Indian Academy of Sciences vividly describes India’s nuclear waste management programme.
General Saighal rightly talks about the huge funding requirements. The Nuclear Power Corporation of India Ltd (NPCIL) collects two paisa per unit of electricity produced towards decommissioning funds. In 2016-17, NPCIL collected Rs 753 million. Evidently, vast sums will be available for decommissioning the reactors one by one after 40-50 years of operation.
Decommissioning nuclear power plants and nuclear waste management are no more insurmountable; we have the technology and the funds. The current generation need not feel guilty about any “Nuclear Legacy Trap” as feared by General Saighal.
Many NGOs and others published grossly exaggerated reports on Chernobyl and Fukushima In 2005, The Chernobyl forum made up of eight specialized agencies such as the WHO, the International Atomic Energy Agency(IAEA), ILO etc of the UN published Chernobyl’s Legacy: Health, Environmental and Socio-Economic Impacts” a landmark report. It is available online and offers the factual position.
Specialists found that “childhood thyroid cancer caused by radioactive iodine fallout is one of the main health impact of the accident. By 2002, more than 4000 thyroid cancer cases had been diagnosed in this group, and it is most likely that a large fraction of these thyroid cancers is attributable to radioiodine.”
Apart from this, “there is no clearly demonstrated increase in the incidence of solid cancers or leukaemia due to radiation in the most affected populations. There was, however, an increase in psychological problems among the affected population” the report added.
After a comprehensive assessment, “experts on the health risks associated with the Fukushima Daiichi nuclear power plant (NPP) disaster in Japan has concluded that, for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.” ( WHO Press Release,28 February 2013)
“The estimated risk for specific cancers in certain subsets of the population in Fukushima Prefecture has increased and, as such, it calls for long term continued monitoring and health screening for those people”, the experts cautioned. NGOs spread conspiracy theories (such as WHO is under the thumb of IAEA, the promoter of nuclear energy!). It enhances the trust deficit between public and the UN agencies. Radiation specialists know the truth.
Regrettably, General Saighal copied five paragraphs (373 out of 955 words in his article) from Robert Hunziker, who regularly writes in COUNTERPUNCH (claims to do fearless muckracking!) and Professor Bernard Lowen, one of the founders of the International Physicians for the Prevention of Nuclear War (IPPNW) without any attribution. Hunziker’s article is Saighal’s major resource. (Note: General Saighal did attribute the words in question to Hunziker; the attribution was accidentally omitted during editing. – Ed.S.)
The paragraphs quoted by Saighal deal mainly with Chernoyl and Fukushima. Robert Hunziker extensively quotes from Professor Adam Broinoski, another prolific writer whose claims on the plight of “liquidators” at Chernobyl are unfounded. Chernobyl accident was devastating; the site is slowly recovering.
Fukushima site continues to be a challenge. Realizing that this need not be a disincentive against nuclear power, the Japanese started seven nuclear power reactors. They know that Fukushima was preventable. Survival of Onagawa nuclear power plant which faced the same earthquake and 14.3-metre tsunami as against 13.1 meters at Fukushima, because of “safety culture” gives them confidence.
If General Saighal and others for whom anti nuclear sentiment seems to be an article of faith read about Onagawa (The Bulletin of Atomic Scientists,10 March 2014) and appreciate the technological developments in decommissioning of nuclear power plants and waste management, they may change their views or may at least look at nuclear power more benignly.
The writer is a former Secretary, Atomic Energy Regulatory Board.

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Researchers find undiscovered genetic contributors to stroke; study could lead to better treatment of this fatal disease

In the largest-ever genetic study of stroke, an international research group which included scientists at the University of Maryland School of Medicine, studied about 520,000 people from around the world and identified 22 new genetic risk factors for stroke, tripling the number of gene regions known to affect stroke risk.

The study reveals that stroke shares genetic influences with other vascular conditions, such as blood pressure, but also coronary artery disease and others. The new clues on stroke mechanisms could help scientists identify drug targets for treatment.

Wikipedia describes stroke thus: “Stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly”
Stroke is a very complex and debilitating condition. We do not know the cause of stroke though it is the second most common cause of death.

Researchers based the present study, published in the journal Nature Genetics, on DNA samples of 520,000 people from Europe, North and South America, Asia, Africa and Australia; of this group, 67,000 had a stroke. The study compiled data from 29 other large genetic studies.

Researchers from Germany, France, the UK, Japan, USA, Iceland, Spain, Switzerland, Italy, Belgium, the Netherlands, Denmark, Sweden, Norway, Finland, Estonia, Poland, Singapore, Australia, and Canada who are the members of MEGASTROKE, a large international collaboration launched by the International Stroke Genetics Consortium have been working together for the past 10 years to carry out the study.

Dr Steven Kittner, professor of neurology at the University of Maryland School of Medicine (UMSOM) and the Baltimore VA Medical Center and a co-author of the study asserted that this study really advances what we know about the genetics of stroke. “With this new information we can help researchers work to develop new treatments and new therapies.”, he added

After analyzing millions of genetic variants, the scientists found 22 never before discovered genomic regions that were associated with stroke. By mining this enormous trove of data, the researchers obtained important new insights into the specific genes, molecular pathways, and cell and tissue types through which the new genetic risk factors cause stroke.

This study provides extensive new insight on the molecular biology and pathways leading to the disease. It is unique as it includes people of many different ethnic and genetic backgrounds. As a result, researchers can be more confident that the results apply widely.

Stroke can originate from changes in various parts of the vasculature, including large arteries, small arteries, the heart, and the venous system. The researchers found genetic risk factors implicated in each of these mechanisms. While some genetic risk factors contribute to specific mechanisms, others contributed to stroke susceptibility at large.

Researchers further found shared genetic influences between stroke caused by blood vessel blockage, the most common cause of stroke, and stroke caused by blood vessel rupture , a less common cause, but more catastrophic.

On a closer look on the genomic areas uncovered by the study, the scientists noticed that several of them overlap with genomic areas that have been implicated in related vascular conditions such as atrial fibrillation, coronary artery disease, venous thrombosis, or vascular risk factors, especially elevated blood pressure, and, to a lesser extent, high cholesterol.

The implicated genes have potential as new drug targets to treat and prevent stroke. This study raises the possibility of to develop personalized, evidence-based treatments for this complex disease.

“This work provides evidence for several novel biological pathways involved in stroke that may lead to the discovery of novel drug targets,” said John Cole, MD, an associate professor of neurology at UMSOM and the Baltimore VA Medical Center and another co-author of the study,

“These findings, which link stroke with multiple other diseases, and with dysregulation of genes, proteins, and molecular pathways in specific cell types and organs, were generated using novel bioinformatics approaches that use information from many international biological databases. This work underscores the vital importance of data sharing,” Dr Braxton Mitchell, a professor of medicine at UMSOM and a co-author of the paper highlighted the uniqueness of the study.

In a paper titled “Incidence & prevalence of stroke in India: A systematic review” published in Indian Journal of Med Research (August 2017), researchers from the International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London and South Asia Centre for Disability, Inclusive development and Research, Indian Institute of Public Health, Hyderabad showed that the cumulative incidence of stroke ranged from 105 to 152/100,000 persons per year, in different parts of India during the past decade. These values were higher than those of high-income countries were.

Any effective treatment for stroke will play a crucial role in the management of stroke in India, if such treatment is inexpensive for mass scale implementation. The present analysis is only a maiden step, which could lead to the development of appropriate treatment in the coming decades.

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Dr A K Ganguly

The Indian Association for Radiation Protection (IARP) an affiliate of the International Radiation Protection Association (IRPA)  has held a special session to mark the Birth Centenary year celebration of Dr A K Ganguly . I wrote an article on him on that occasion.

Here is the link:

https://www.eurasiareview.com/18012018-dr-a-k-ganguly-outstanding-scientist-erudite-scholar-and-dedicated-teacher-oped/

 

 

 

 

 

 

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Reducing antibiotics use not enough to reverse resistance

Antibiotics resistance is presently a major health issue. Its ramifications are scary. Researchers have discovered how drug resistant bacteria travel from country to country without any passport or visa. The war between the bacteria and humans is going on for the past several decades all over the world.

A new finding from Duke University, Durham is notable. Researchers have discovered that reducing the use of antibiotics will not be enough to reverse the growing prevalence of antibiotic resistance for some types of bacteria.

Many bacteria pass on their  antibiotic resistance genes directly to their offspring.  Scientists found that they can also swap genes among-st  themselves through a process called conjugation. Whether this process occurs fast enough to spread through a population that is not under attack by antibiotics was not clear.

Recently  researchers from Duke University believe they have found a definitive answer to that question. Through a series of experiments with bacteria capable of conjugation, they show that all of the bacteria tested share genes fast enough to maintain resistance. Fortunately, They could also show, however, that there are ways to disrupt the process and reverse antibiotic resistance.

This study  appears online on Nov. 22 in the journal Nature Communications.

“The results came as a surprise to me when I first saw the data,” said Lingchong You, the Paul Ruffin Scarborough Associate Professor of Engineering at Duke University and corresponding author on the paper. “For all of the bacteria we tested, their conjugation rate is sufficiently fast that, even if you don’t use antibiotics, the resistance can be maintained –even if the genes carry a high cost.”

Most resistance to antibiotics arises and spreads through natural selection. If a few lucky bacteria have genes that help them survive a round of antibiotics, they quickly parent the next generation and pass on those genes.

Many of these genes, however, come at a cost. For example, a mutation may allow a bacterium to build a thicker membrane to survive a particular antibiotic, but that mutation might also make it more difficult for the cell to reproduce. Without the selective pressure of antibiotics killing off the competition, bacteria with this mutation should disappear over time.

But when the genes responsible for resistance can also be swapped between cells, the equation gets more complicated. In favor of maintaining the resistance is the rate at which the genes are shared. Working against it is the previously mentioned biological cost of the genes, and the natural error rate in genes when they are passed on.

“There have been some studies on how critical conjugation is to maintaining resistance despite its cost, but there has been a lack of careful and well-defined experiments to come to definitive conclusions,” said You. “That’s where Allison has made a central contribution. Her incredibly thorough measurements allow us to draw our conclusions with high confidence.”

Allison Lopatkin, a doctoral student in You’s laboratory and first author of the paper,  measured the rate of conjugation and antibiotic resistance in pathogens for more than a month. The strains were obtained through a parallel project with Duke Health, in which You is trying to determine just how common conjugation is amongst pathogens.

So far, You  found that more than 30 percent of the bacterial pathogens he has tested spread resistance through conjugation. And of those, nine were further tested by Lopatkin to see how well they would maintain their resistance in the absence of antibiotics.

“Every single clinical strain we tested maintained its resistance through conjugation even without the selective pressure of antibiotics,” said Lopatkin.

The results indicate that — at least for bacteria that swap resistance genes — simply managing the amount of antibiotics being used will not turn the tide on the growing problem of resistance. To make any headway, according to You and Lopatkin, drugs will also be needed that both stop the sharing of genes and decrease the rate at which they are passed on through reproduction.

Luckily, such drugs already exist, and there may be many more out there waiting to be discovered.

“We did the same experiments with one drug that is known to inhibit conjugation and another that encourages resistance genes to be lost,” Lopatkin said. “We found that without the presence of antibiotics we could reverse the bacteria’s resistance in four of the pathogens we tested and could stop it from spreading in the rest.”

One of the drugs is a benign natural product and the second is an FDA-approved antipsychotic. While the team has filed a provisional patent for the use of the combination to reverse antibiotic resistance, they hope future work will reveal even better options.

“As a next step, we’re interested in identifying additional chemicals that can fill these roles more effectively,” said You. “Historically, when researchers screened huge libraries for medicines, they focused on drugs that can kill the bacteria. But what our studies suggest is that there is a whole new universe where you can now screen for other functions, like the ability to block conjugation or to induce the loss of resistance genes. These chemicals, once proven safe, can serve as adjuvants of the standard antibiotic treatment, or they can be applied in an environmental setting as a way of generally managing of the spread of antibiotic resistance.”

Recently, in a new report, researchers from Center for Disease Dynamics, Economics & Policy(CDDEP)  mapped and identified the gaps in current antimicrobial resistance (AMR) research in India. The study was commissioned by the Department for Biotechnology (DBT), Government of India, in partnership with Research Councils United Kingdom (RCUK).

This report found that in 2014, India was the highest consumer of antibiotics, followed by China and the United States.

The study identified the following factors for driving  antibiotic resistance in India: High consumption of broad spectrum antibiotics;  Excess Usage of  Antibiotic fixed-dose combinations ; Social Factors;  Cultural Activities; Antibiotic consumption in Animals; Pharmaceutical industry pollution;  Environmental Sanitation and  Infection Control practices in Healthcare settings.

The paper from Durham which shows that reducing antibiotics alone is not enough to reduce antibiotic resistance adds a new element.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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