Archives

JMO downs

Doctor samarasekara

Dr. Amanda Samarasekera. (Consultant JMO Colombo North) and a member of the National Task Force to combat bio-terrorism, describes the current world fear on anthrax being lashed as a bio-weapon a phobia, an irrational fear, created due to ignorance and false propaganda.

We lead the Health Watch today with this new thinking, which Dr. Samarasekera revealed in a postmortemed style lecture on anthrax delivered at the annul scientific sessions of the medico-legal society of Sri Lanka, held on November 10th at the SLFI in Colombo.

Tracing the history of anthrax, its possibilities to be used as a ibo-weapon, and in the current context, whether there is a real danger posed to mankind, he said "No, it is only a phobia created due to a combination of ignorance and false propaganda."

We quote here from his lecture notes.

Anthrax affective in warfare as a biological weapon

For reasons I mentioned earlier anthrax would be difficult to use, and it could hardly kill more than a few hundred people under the most ideal condition and not the hundred of thousand, which are claimed, Furthermore, antibiotics are effective for it during the early sage of the illness. It is not contagious for human and human to human spread do not occur. All in all biological warfare is a followed concept. The only route, which can be considered is airborne spread. Even the airborne disease require close contact with the source bio warfare is exaggerated through a combination of ignorance and false propaganda. The terrorists mage be succeeded in creating a lot of fear, but for casualties guns and explosive are definitely more effective. Other than from deaths due to terrorist attacks in Sri Lanka we have much large number of deaths due to road accidents and poisoning which should be given much more serious consideration.

How effective anthrax as a bio-weapon?

Can anthrax be used successfully as a terrorist weapon or as a military weapon?

To do this anthrax spores has to be converted to spores suspended in air, which is technically very difficult. To use anthrax as a weapon it must be converted to a powder which can be inhaled. It is believed that only the US and Russian military experiments have so far succeeded in doing this. Even Iraq uses anthrax in liquid form, which is more or less in effective.

Is human easily vulnerable?

Anthrax is a livestock pathogen. There are anthrax spores in the soil of rural areas, because they can survive for about 20 yrs. These spores usually have no direct effect upon humans, because few anthrax spores cannot crate an infection, and they do not come up from the ground in large quantities. Anthrax spores has a tendency to settle down on the ground or surface and not to circulate with air or to come up easily once it is settled on the ground. Even in powdered form the spores would fall on to the ground rapidly in the absence of wind. It is not adapted for airborne dissemination. The reason is because wind disperse the agent too lightly and gravity brings them down more rapidly. Anthrax is a "Gram positive" bacterium, usually Gram positive cell walls are less harmful than Gram negative bacteria which readily attack tissues. Therefore anthrax can only attack tissues by producing a special toxin, which it excretes. One cell or spore does not produce enough toxins to start an infection.

It has been theoretically estimated that typically ten thousand anthrax spores must be inhaled to start an infection. That number must be some one's guess, but it is in line with the biology of the disease. Anthrax normally attacks the lungs, because it must lodge in a vulnerable tissue. Livestock eat from the ground where they grace. They could continue to inhale large number spores while gracing. But human who does not grace and therefore cannot easily inhale such a large number or spores. It can invade through other routes such as cuts or a wound in the skin or undercooked meat, but it only so under 3rd world conditions, but those routes are usually not relevant to bio-warfare. Is it easy to weaponize anthrax bacillus?

Naturally occurring anthrax spores are not suitable, as a biological weapon is warfare. These spores are too large to be acrosolized and to enter into lungs. They are usually sticky and there is a tendency for many spores to stick together. (Clumping). Therefore in weaponizing the first requirement would be to acrosolize the spores. The spores would have to be converted to a dry power, because a liquid would create glue, which would fall to the ground rather than staying suspended in the air. To create a powder, the spores would have to be washed several times in air of very large and expensive centrifuges. Then drying apparatus would have to be used and it would require spraying a mist into a vacuum, which is how power is produced from a liquid. Otherwise whole thing will make up into a hard rock. This procedure is technically difficult and costly.

Anthrax spores cannot be used in liquid form as a weapon because the spores would rapidly settle to the bottom of the liquid and strictly debris and tendency to clump will result in production of glue like material. The agriculture spraying demonstrate that a mist drops rapidly fall on the ground since air can only hold small amount of water which will result in precipitation. A chemical mist is different, because chemicals vaporize, while cells do not. Cells in a mist could clump together on the liquid vaporizes.

Anthrax spores cannot weaponize by grinding it to particles of 1x5 micrometer size. It is not possible to grind them because of the glue-like nature of the bacteria it will continue to remain in a glue ever after grinding and the bacteria would not tolerate grinding because it is a fragile like the egg-shell.

Can a plane dust a city?

A scenario is that one can use a plane to dust a large city with anthrax spores during a night is very unrealistic. Even if it is done, it is unlike that the people living inside the building would be affected. The few spores, which may enter the building, would settle on surfaces. Very few people would inhale large quantities. Anthrax spores would not diffuse uniformly through the air like a gas. They will either drop too fast or blow away. A few dozens of persons might get killed, but that is not the expected outcome.

How was the recent anthrax scare begun?

Anxiety about anthrax was spreading in United States after recent exposures to the bacterium in Florida, Nevada, Washington DC and New York were confirmed.

During mid October, on a Monday a letter sent to US senate majority leader Tom Daschle was found to contain anthrax, and a baby boy and a 73 yrs old man were diagnosed with the infection. The baby, the son of an ABC new product is thought to have been exposed to the bacterium in the newsroom of ABC studio in New York, and the elderly man was a work colleague of the first man to die from the disease. Robert Stephens in Florida. Later five more employees of America media, a news agency in Florida, where Robert Stephen worked have tested positive for exposure. This brings the total of those exposed in Florida to eight so far. Mr. Stephen, the index case, contacted the pulmonary form of anthrax from a letter containing dried spores dispersed in a fine powder. Tests of the office disclosed the presence of anthrax spores on the Stephen's computer keyboard and in the post room. anthrax spores were also found in the nasal passages of two workers in the post room. Blood test has also shown antibodies to anthrax in five more employees, and results on 35 more workers are pending. In New York five people are confirmed to have been exposed to bacterium, of whom two developed anthrax. An assistant to the anchorman for the National Broadcasting Corporation (NBC) nightly news contracted cutaneous anthrax after handling an envelope addressed to the anchorman.

Scientific detective worked on samples following the anthrax attack in the US points towards sophisticated amateurs but investigators have so far failed to pinpoint those responsible. It has been said that whoever was responsible was sophisticated enough to use a dangerous strain of the bacterium and to mail it down to a size small enough to enter the small airways in the lungs. But they had not used an antibiotic-resistant strain, nor did they get hold of one that was fully weaponised, as it would have been if it emerged from a military biowar-laboratory. It has been reported that Tom Ridge, the US Director of Homeland Security had confirmed that all the anthrax bacteria used in the attacks were indistinguishable and that they all belong to the 'Ames Strain'. This is because the 'Ames strain', a particular virulent version of the bacteria, has been widely distributed as part of vaccine tests by defensive biowar program around the world. Dr. Frederick Southwick, head of infectious diseases at the University of Florida is reported to have said that the recent findings suggest amateur production of anthrax, but by people with a reasonable degree of sophistication. It has also been reported that so far no evidence has been found which links the attacks to bin Laden's group' and the focus of suspicion has begun to switch to home-grown terrorists exploiting the confusion in the wake of the September 11th attack on twin towers.

The dreaded anthrax scare of biological warfare hit Colombo with the United State and Australian High Commissions, receiving envelopes containing suspicious material on 18th September and thereafter. Since then not only high commissions but also several individual institutions have received "anthrax letters". However according to Medical Research Laboratory sources so far not a single case has been found positive for anthrax from over seventy suspicious letters sent to it for testing. The fear psychosis was so great the Nation Task Force to combat bio-terrorism was established by the Ministry of Health. During that week the leading news in almost all and electronic and print and media were about anthrax scare in Colombo. As a result non-functioning equipment in Medical Research Laboratory was quickly repaired and put into order to deal with the situation. However regarding anthrax phobia the valuable concept that - `an ounce of prevention is worth a pound of cure' cannot be ignored.

Legal aspects

Nationally:
Chapter XIV of the penal code on offenses affecting Public Health, safety, convenience, decency and morals provide legal provisions to deal with such situation as a criminal offence.

Section 262:
Whoever unlawfully or negligently does any act which is, and which he knows or has reasons to believe to be, likely to spread the infections of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine or with both.

Section 263:
Whoever unlawfully or negligently does any act which is and which he knows or has reason to believe to be likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extent to six months or with five or with both. In addition if any person is maliciously made to acquire the infection the perpetrator may be changed for causing hurt, under section 312 or 313 or even for attempted murder section 300 or if death occurs ever for murder under section 294.

To be continued next week

Health Watch organised doctor-patient discussion on heart disease in progress

The first in a series of doctor-patient discussions on common diseases, organised by us in collaboration with Asha Central Hospital and a panel of doctors who are contributing to the Health Watch, was held last Sunday at the Asha Central Hospital. The picture on top shows the medical panel engaged in discussion with the patients. The panel from (left) Dr. Githanjan Mendis (Consultant Neurologist and Head of Sports Medicine Unit, Ministry of Sports), Dr. D. P. Athukorala (Consultant Cardiologist), Dr. Dennis J. Aloysius (Family Physician and visiting lecturer PGIM) Dr. Lakshman Dalpadadu (Consultant Cardiac Surgeon, Suwa Sevana Hospital, Kandy) and Dr. Mohan Jayatilleke (Consultant Cardiologist Asha Central Hospital). In the picture (below) is Dr. Neville Fernando, Managing Director and Chairman Asha Central Hospital inaugurating the discussion. The event was a great success. It's report will be carried next week. Our thanks - We say a big thank you to all who made this event possible. The lay participants first. The medical panel who accepted our invitation, and sacrificed their valuable time to attend the event and make it a success. We are grateful to Dr. Neville Fernando and Dr. Mohan Jayatilleke for making the place available and for making all arrangements and to participating in the event. Dr. Luxman Dalpadadu for coming all the way from Kandy to participate, Dr. D. P. Atukorala for his participation. Dr. Githanjan Mendis for participation and also for getting Baskara Medicals to sponsor the event. Last but not least Dr. Dennis J. Aloysius for conducting the discussion in a very lively and an interesting way. We welcome participants views on the event.

Full report next week - Edward Arambewela, Co-ordinator, Health Watch.

Delays at Osusala Centres

K. D. M. David from Maharagama in a letter to the Health Watch complains of delays in getting drugs from SPC sales outlets - Osusala Centres. He states, in his letter dated 3.11.01 "The other day I went to the Osusala in Nugegoda to get drugs for a prescription. I was in a bit of a hurry as I had to go and see a patient at the Sri Jayawardenepura Hospital also.Believe me I had to wait for nearly 20 minutes to get the drugs. I feel the delay is too much. I always prefer to patronise state sales outlets to the private sectors but this kind of delays puts me off in following my policy.

SPC chairman Prof. Colvin Gooneratne responds - I highly value your principle of patronising the Osusalas. I hope the little delay you experienced will not discourage. You in going to our sales points for your medical needs. Please send me a copy of the prescription you got dispensed at Nugegoda, with a copy of the receipt. I will see if any unnecessary delay has been caused to you. What generally happens in dispensing drugs on prescriptions, we follow a strict procedure, to ensure that no mistake occures at any point in the process of dispensing. This takes a little time. This little delay is in your own interest. Please understand that, and bear with us.

If in our opinion, after inquiry we find that any customer has been put into unnecessary delay, we take action.

Thank you very much for bringing this matter to the notice of the Health Watch.

Health Watch Question Box

RH Factor

We had this letter from Mrs. Kamala Kottegoda in Anuradhapura, where she says "when my second child was born he was deeply jaundiced and died shortly afterwards. I was told that my child died due to the RH factor of my blood being RH - negative and that of my child's being RH - positive". Could the Health Watch enlighten me on this please.

Dr. Ranesh Wijesinghe Replies

Your letter (Mrs. Kottegoda) was referred to me for a reply, and I decided to quote to you from the book - Marriage Problems written by Dr. M. Zakir Molvi of Pakistan on this subject. It is in simple language, and best for the layman.

"Research in UK in 1940 showed that Rhesus monkeys had a substance in their blood, which caused red blood cells to form into clusters when this factor is present in the blood it is called the RH - positive, when it is absent it is called RH - negative.

All of us have this factor in blood. We are either RH - positive or negative. The foetus (child in womb) inherits qualities from both parents. If the father is RH - positive and the mother RH - negative, the child will inherit RH - positive. During pregnancy and specially during labour there is the possibility of the blood of the baby leaking into the system of the mother.

If this happens, the mothers blood being RH - negative, her defence system will go into alert and start producing anti-bodies against the RH - positive blood causing what we medically call haemolysis or the breakdown of the child's red blood cells. This may not be seriously detrimental to the first child. Trouble starts with the second child, as anti-bodies are already present in the mothers blood, and it tends to become more serious with the succeeding pregnancies.

If the father is RH - negative and the mother RH - positive, because of the dominance of the positive the child usually becomes RH - positive, and there is no danger at all. In short we can put it down like this.

Father Mother Child

RH - positive RH - positive safe
RH - negative RH - positive safe
RH - negative RH - negative safe
RH - positive RH - negative possible danger

So in selecting partners it is best to consider this factor also.

Numbness following bypass surgery

N K Rajan from Colombo 3 writes,

I am 63 years old and underwent bypass surgery, with 5 blocks, about 18 months ago and am now relieved of the angina pains I used to get. However, a numbness of the soles, that was very mild prior to surgery, has increased to proportions that trouble me now. The soles are hard and the area near the toes, in particular, appears hide-bound with a numb feeling. This is also associated with excessive sweating of the soles, to the extent that wearing shoes is uncomfortable. I have no problem walking and do so for about 45 minutes for about 5 days a week. I get relief (from the hide-bound feeling) in wetting them frequently, and once in a while I soak my feet in luke-warm salt water for relief. At the time of post-surgery examination, this was said to be mild signs of peripheral Neuropathy, and a Vitamin B1, B6 & B12 tablet, one a day, was prescribed which I take even now. I am not known to be diabetic, even though some times, rarely, my routine FBS tests indicate figures of about 115 mg/dl. My cholesterol level is between 170-200 mg/dl, though triglycerides are around the 300 mark, having been on 5 mg Vastatin for several years. Rheumatoid factor is negative.

My concern is whether the numbness usually associated with the healed wounds on both legs, following vein-harvesting, is aggravating the numbness of the soles? The area above my ankles on both feet, surrounding the wounds, feel numb to the touch yet.

What should do for this?

Dr. D. P. Athukorale, Consultant Cardiologist replies: You appear to have signs of peripheral neuropathy as you had this prior to bypass surgery. I don't think that neuropathy has anything to do with the bypass surgery. As your fasting blood sugar is 115/dl, it is advisable to get a glucose tolerance test done (G.T.T.) as you may be suffering from mild diabetes. Consult a neurologist please. Take all your reports with you including G.T.T.

STAR Letter

Food adulteration business at the expense of our health

For any kind of preparation of food which requires the use of cooking oil I have always been using polyunsatured fatty acid oils such as soya oil, sunflower oil, sesame oil, canola oil. Imagine my shock and dismay when I realised last week quite by coincidence, that our soya oil bottle did not contain soya oil at all, but a saturated fatty acid oil, such as palm oil [commonly labelled vegetable oil], or coconut oil. The oil had turned hard and whitish in colour under refrigeration. Somewhere along the line the soya oil appear to have been substituted with a much cheaper oil. It had a brand name! Though I informed the importer immediately, who are hopefully taking necessary action, I have lost all faith in any kind of food labelling/food safety in Sri Lanka. Fortunately I was able to detect this kind of adulteration, but how many adulterated, impure foods go undetected since they are difficult to identify, recognize.As for YOU making sure of your polyunsaturated fatty acid oil [i.e. soya, sunflower, sesame, canola] or monounsaturated fatty acid oil [olive], please do the FRIDGE TEST: Turn the oilbottle upside down several times [if mixed with saturated fatty acids, this oil will be at the bottom of the bottle], then pour a little oil into a small dish or a saucer and put it overnight into the fridge. In the morning the oil should still be of the same colour [light-yellow] and consistency [smooth liquid] as before.

If you come across adulterated oil the way I did please contact the importer, marketing company or your super market.

Sigrid S. de Silva
Negombo.

News | Business | Features | Editorial | Security
Politics | World | Letters | Sports | Obituaries |

Produced by Lake House
Copyright 2001 The Associated Newspapers of Ceylon Ltd.
Comments and suggestions to :Web Manager