Plastic waste found in fish meant for human consumption

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As per a 2015 paper, plastic waste was found in fish from Indonesia and textile fibre in fish from California.

In a first, researchers have found plastic debris in fishes in Indonesia and California, U.S. meant for human consumption, raising a red flag for human health. According to a paper published in September 2015 in the journal Scientific Reports, man-made debris was found in 28% of individual fish and in 55% of all species samples from markets in Makassar, Indonesia. In the case of the U.S., man-made debris was found in 25% of individual fish and in 67% of all species. Anthropogenic debris was also found in 33% of individual shellfish sampled.

While all anthropogenic debris found in the digestive tracts of fish and whole shellfish sampled in Indonesia contained plastic, it was fibre from textiles in the case of fish from California (there was only 20% plastic waste). The difference in the type of man-made found in fish in the two countries reflects the waste-management practices in the two countries.

In Indonesia, of the 76 fish from 11 different species collected from a market, 21 (28%) had anthropogenic debris in the digestive tract. Of the 11 fish species collected, plastic waste was found six species. At 56%, the Indian mackerel had the most amount of debris, followed by herring at 29%.  Totally 105 plastic pieces were removed from the fish. The average size was 3.5 mm in length and up to 4.5 mm in width.

In the case of fish from 64 fish from 12 different species taken from California, 16 (25%) fish and four of 12 shellfish had man-made fibre from textiles waste inside the digestive tract; six fish had plastic waste. Totally, 30 individual fibre pieces were removed from the fish. The number of anthropogenic particles in individual fish was up to 10 pieces. The researchers were unable to know if the textile fibre found inside fish was synthetic or natural. The average length of fibre 5.5 mm and width was up to 0.05 mm.

“As anthropogenic debris is associated with a cocktail of priority pollutants, some of which can transfer to animals upon ingestion, this work supports concern that chemicals from anthropogenic debris may be transferring to humans via diets containing fish and shellfish, raising important questions regarding the bioaccumulation and biomagnification of chemicals and consequences for human health,” notes the paper.

Small-sized man-made debris has been shown to cause “physical damage leading to cellular necrosis, inflammation and lacerations of tissues in the gastrointestinal (GI) tract. As such, anthropogenic marine debris may cause physical harm to humans when debris is ingested via seafood,” the paper says.

Plastic debris is widely present in oceans. According to a February 2015 study published in Science, eight million tonnes of plastic entered the ocean from around the world in 2010. China was the worst offender contributing 8.82 million tonnes of plastic per year; India was ranked 12th with 0.60 million tonnes.

It was always known that of the huge plastic waste that enters the world oceans, certain percentage of degraded plastic in the form of tiny particles would be consumed by fishes and other marine animals and ultimately enter the food chain.

TB diagnosis, treatment sub-optimal in Indian prisons

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Screening, diagnosis and treatment of people with tuberculosis is “sub-optimal” in Indian prisons, says a study published recently. Only 79 prisons (50%) screened new inmates at the time of entry, and 92 prisons (59%) carried out periodic or regular screening. As a result, researchers from the Delhi-based International Union Against Tuberculosis and Lung Disease (The Union) were able to diagnose 80 new TB cases by screening nearly 5,100 prisoners. These people “could have been missed in the existing [TB testing] system” in Indian prisons.

157 prisons studied

The study was conducted in 157 prisons — central, district and sub-district — that housed 0.2 million inmates. There were 342 inmates with TB in 92 prisons when the study was carried out in 2013. The results were published in the International Journal of Infectious Diseases.

The study found an association between periodic screening and TB patients but no such association between the entry-level screening and TB patients.

“Entry-level screening helps in identifying TB patients among those prisoners/inmates who are new in the prison. Regular screening identifies TB patients among those who have been in the prison for certain duration and are at higher risk [owing to prison conditions]. Our study indicates that entry-level screening alone is not sufficient to diagnose all TB patients in prisons and needs to be supplemented with regular screening,” Banuru Muralidhara Prasad from The Union and the first author of the study says in an email.

The WHO and The Union advocate regular screening. “In this study, regular screening was limited to a few central and district prisons,” the paper notes.

Diagnostic facility

Entry-level screening is more in prisons which had a doctor and was the least in sub-district prisons. Though doctors are available in 129 (89%) prisons, only 65% were trained under the national tuberculosis programme.

Though the availability of diagnostic facility in prisons ensures early diagnosis of TB, the study found the availability of diagnostic and treatment services had “no significant” relation to TB diagnosis. Central prisons, where inmates serve more than two years of imprisonment, had better facilities — doctors trained in TB programme (90%), periodic screening (73%) and availability of TB services (65%) — compared with district and sub-district prisons.

India has 0.37 million inmates housed in 1,400 prisons across the country. Overcrowding, malnutrition, lack of infection control, to name a few makes prisons a high-risk environment for spread of TB. “Prisoners very often originate from the most vulnerable sectors of society. They already have an increased risk of diseases such as TB. In prison, these problems are amplified by poor living conditions and overcrowding, poorly ventilated spaces,” a 2001 WHO document says.

“Prisoners disproportionately come from disadvantaged backgrounds. They can, therefore, be at a higher risk of acquiring TB infection even before they arrive in prison, as well as of suffering from comorbidities, such as HIV infection, hepatitis and diabetes. Thus, prisoners are a key population to be covered by the End TB Strategy,” says the WHO’s  Ethics guidance for the implementation of the End TB strategy report.

Published in The Hindu on March 23, 2017

Can health spending of 2.5% of GDP only by 2025 help achieve the goals set by India’s National Health Policy?

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The National Health Policy wants to reduce infant mortality rate to 28 per 1,000 live births by 2019.

The long awaited National Health Policy announced a few days ago proposes to raise public health expenditure as a percentage of GDP from the current 1.15% to 2.5% by 2025. The resource allocation to individual States will be linked with their development indicators, absorptive capacity and financial indicators. “There will be higher weightage given to States with poor health indicators and they will receive more resources. The Policy aims to end inequity between States. But at the same time, States will be incentivised to increase public health expenditure,” says Manoj Jhalani, Joint Secretary — Policy, Ministry of Health and Family Welfare.

The catch

While public health expenditure as a percentage of GDP will reach 2.5% only by 2025, many of the goals listed in the Policy have a deadline of 2025 and some of them even earlier.

The Policy stresses on preventive healthcare by engaging with the private sector to offer healthcare services and drugs that are affordable by all. It wants to reduce out-of-pocket “catastrophic” health expenditure by households by 25% from current levels by 2025.

The focus is on providing free, comprehensive care in primary care for the most prevalent communicable and non-communicable diseases, and increased affordability of care at secondary and tertiary care services by a combination of public and not-for-profit private providers wherever necessary. It wants to increase the utilisation of public health facilities by 50% from the current levels by 2025.

Health card roll out

The Centre is working on introducing a health card — an electronic health record of individuals. “The health card will be for retrieving and sharing health data by lower [PHC] and higher [secondary and tertiary] healthcare facilities. It will be helpful when patients move from primary to secondary or tertiary healthcare facilities,” says Mr. Jhalani. “It will be launched in six months to one year’s time. It will be launched in those States that show interest to roll it out in certain districts or across the State.”

Disease control and elimination

Like the Health Ministry’s National strategic plan for tuberculosis elimination 2017-2025 report, the Policy wants to reduce incidence of new TB cases to reach elimination by 2025. In a similar vein, the policy has set 2017 as the deadline to eliminate kala-azar and lymphatic filariasis in endemic pockets, and 2018 in the case of leprosy. In the case of chronic diseases such as diabetes, cancer, cardiovascular diseases, it envisages a 25% reduction in premature mortality by 2025.

The Policy “aspires” to provide secondary care right at the district level and reduce the number of patients reaching tertiary hospitals. For the first time, there is any mention of public hospitals and facilities being periodically measured and certified for quality.

Pipe dream

The Policy has sharpened its war on tobacco by indicating a 15% relative reduction in tobacco use prevalence by 2020 and 30% by 2025. But the most ambitious target is providing access to safe water and sanitation by all by 2020. As per January 2016 Ministry of Drinking Water and Sanitation country paper, sanitation coverage was only 48%.

Reducing IMR and MMR

Other challenging targets set by the Policy include reducing infant mortality rate to 28 per 1,000 live births by 2019 and under five mortality to 23 per 1,000 live births by 2025. According to the National family Health Survey 4, IMR was 41 in 2015-16; it took 10 years to reduce IMR from 57 to 41. Similarly, under five mortality was 50 in 2015-16 and it took 10 years to reduce it from 74. Over 38% children under five years were stunted according to the NFHS-4 report. The Health Policy wants to reduce this by 40% by 2025.

Increasing immunisation coverage

As against 62% children 12-23 months old who were fully immunised in 2015-16 according to the NFHS-4 data, the Policy has set a target of 90% by 2025. “Going up to 70% coverage is hugely a challenge of reaching the community. But beyond 70% coverage, other factors come in and it becomes a very big challenge,” says Dr. Pradeep Haldar, Deputy Commissioner — Immunisation, Ministry of Health. According to J.P. Nadda, the Union Health Minister, the Mission Indradhanush has increased the annual increase in full immunisation from 1% to 5-7%.

Published in The Hindu on March 19, 2017

Toxins in litchi kill children in Bihar

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Eating litchi during the day  and skipping evening meal lead to very low blood glucose level the next day early morning in some children.

Unexplained illness in children aged 15 years and younger in Muzaffarpur, Bihar, India, which claims many lives during an outbreak that occurs in May-June, has been solved. Scientists from the U.S. and India have found that consumption of litchi fruit and skipping evening meal can result in very low blood glucose level (less than 70 mg/dL) and acute encephalopathy including seizures and coma, and causes death in many cases. The results were published in the journal Lancet Global Health.

Children in Muzaffarpur frequently spend the day eating litchis and some skip the evening meal. Skipping evening meal, by itself results in low blood sugar levels during the night. This is particularly so in the case of young children as they have limited hepatic glycogen reserves. Hypoglycin A and methylenecyclopropylglycine (MCPG), which are naturally present in litchi fruit, make the condition worse. The toxins block enzymes involved in normal glucose metabolism and this results in an inability to synthesis glucose leading to acutely low level of blood sugar. The build-up of other metabolic by-products could also have an adverse effect (encephalopathy) on the child. These two cause death in many children.

The study shows the modifying effect of skipping the evening meal on the impact of these toxins.

In 2013, scientists from Delhi’s National Centre for Disease Control, India (NCDC) and the U.S. Centers for Disease Control and Prevention (CDC) started an investigation. The first focus of the team was to evaluate if the mysterious condition was due to an infectious cause or not. “Most of the children did not have fever. And on testing the spinal fluid we did not find elevated white blood cell count. These two indicated that it was less likely to be to an infectious cause. It gave us a clue that we should look at non-infectious causes,” recalls Dr. Padmini Srikantiah, Global Disease Detection Program – India, CDC, Atlanta and the corresponding author of the paper.

With infectious causes ruled out and most sick children presenting with low blood glucose levels the team started investigating the role of toxins — exposure to pesticide, insecticide and heavy metals to name a few.

“In late 2013, CDC colleagues in Atlanta brought to our attention the well reported case of toxic hypoglycaemic syndrome in West Indies caused by hypoglycin A, a toxin found in ackee fruit, which is in the same family as litchi,” she says. “MCPG, which is a homologue had been detected in the seed of litchis, and was reported to cause low blood glucose in rats. So we started with a hypothesis.”

The 2014 outbreak allowed the scientists to investigate the role of pesticides, herbicides, heavy metals, besides hypoglycin A and MCPG in litchi fruits. “We heard over and over again from parents that their children were healthy and running around the day before, but presented with seizures and loss of consciousness in the early morning. Some people also said their children had skipped the evening meal the previous day [to illness],” says Dr. Srikantiah.

Over 62% sick children had blood glucose level less than 70 mg/dL. The median was 48 mg/dL and it was as low as 8 mg/dL.

Researchers compared 104 children with illness with similar number of controls. They found metabolites of hypoglycin A and MCPG in 66% (48 of 73 cases) of urine samples but none from the 15 controls. About 90% of children with illness showed severe disruption of fatty acid metabolism. In 36 litchi samples tested, hypoglycin A ranged from 12.4-152 microgram per gram and MCPG ranged from 45-220 microgram per gram. The level of hypoglycin A and MCPG was twice in unripe compared with ripe fruits.

“After our field investigation in July 2013, we didn’t know the cause but we recommended dextrose therapy to children who were sick. Mortality fell from 44% in 2013 to 31% in 2014. So administration of dextrose to sick children is very important,” she says. Whether malnourishment and other factors also play a role merits further investigation.

“Our data supports a public health recommendation — minimising litchi consumption, eating evening meal throughout the outbreak period and implementing rapid glucose correction for suspected illness. These recommendations are specific to children in Muzaffarpur. ” she says.

Published in The Hindu on February 1, 2017

Tamil Nadu researchers show chronic exposure to commonly used insecticide causes diabetes

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Degradation of organophosphate pesticide by gut bacteria causes diabetes in humans, says Ganesan Velmurugan.

A study by scientists at Madurai Kamaraj University, Tamil Nadu, India, has found evidence that long-term exposure to organophosphate insecticides induces diabetes and impaired glucose tolerance in both mice and humans. The researchers found that organophosphates-induced diabetes was mediated by gut bacteria. The results were published in the journal Genome Biology.

A survey of around 3,000 people in villages in and around the University found diabetes prevalence in people who were directly exposed to the insecticides was three-fold higher than in people who were not directly exposed to the insecticide. Serum analysis for four organophosphate insecticides revealed a direct correlation between pesticide level and HbA1c. “We saw a linear trend — for every unit increase in insecticide residue there was a corresponding increase in HbA1c level,” says Dr. Ganesan Velmurugan from the Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University and the first author of the paper.

To ascertain if chronic exposure to organophosphates led to diabetes, the researchers treated mice (2.9 microgram per kg bodyweight) with organophosphate for 180 days, which is equivalent to 12-15 years of human life. “We saw an increase in blood sugar level from day 60 in mice treated with the insecticide,” he says. “But we didn’t see any correlation between insecticide and neurotransmitter level in mice treated with the pesticide.” The neurotransmitter is the main target of the pesticide.

So the researchers were confident that the pesticide was inducing diabetes through a new route of action. Studies have already shown that the pesticide is degraded by bacteria present in the gut. To ascertain this, the researchers collected faecal material from mice exposed to the pesticide for 180 days and transplanted it to a new set of mice. “The mice that received the faecal material developed diabetes in just one week, while the control mice did not. We repeated the experiment thrice and got the same result,” Dr. Velmurugan says. “We concluded that organophosphate-induced diabetes was mediated by gut bacteria.”

To understand the molecular mechanism, the researchers did a complete gene profiling of gut bacteria present in mice that were exposed to the pesticide for 180 days. “We found the genes linked to organophosphate degradation were highly expressed,” he says. So they focussed on finding the pathway involved in the degradation of the pesticide.

The gluconeogenesis pathway — where glucose is generated from non-carbohydrate sources such as fat and proteins — was highly expressed. “The pesticide is degraded into short-chain fatty acid, particularly acetic acid. It is well known than acetic acid produces glucose, elevated blood sugar levels and glucose intolerance,” Dr. Velmurugan says.

They ascertained the role of acetic acid in elevating blood sugar level in mice by administering sodium acetate orally and through rectal route; the rectal route led to more blood sugar increase than the oral route.

The role of gut bacteria in mediating pesticide-induced diabetes was confirmed in humans by studying the faeces of diabetics. “The acetate level was higher in people with diabetes,” he says.

“The study clearly shows the prevalence of diabetic conditions mediated by microbial degradation of the pesticide in humans,” says Subbiah Ramasamy from the Department of Molecular Biology, School of Biological Sciences, MKU and the corresponding author of the paper. “So the usage of this pesticide should be seriously reconsidered.”

Published in The Hindu on January 29, 2017

Trump jolts science, gives anti-vax movement a booster dose

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The mid to late 1960s U.S. Public Health Service announcement from the Office of the Surgeon General, William H. Stewart is particularly relevant today.

Anti-vax activists in the U.S. are already cheering. A presidential commission on vaccine safety (read a link between measles-mumps-rubella (MMR) vaccine and autism) is setting the ground for further erosion of the merits of vaccination and instilling more fear and scepticism in the minds of the people.

On January 10, the well-known vaccine denier Robert F. Kennedy Jr. told the media that he has been asked to “chair a commission on vaccine safety and scientific integrity”. Though the Trump team said no invitation has been issued, it did admit that President-elect Donald Trump was “exploring the possibility” of such a commission.

In August last year, Trump met the fraudulent British scientist Andrew Wakefield, who first made up the vaccine-autism connection in 1998 through a paper published in The Lancet.  He has been actively advocating the link despite his work being discredited and retracted in 2010. The BMJ exposed his fraud.

Trump and Kennedy are among a growing number of people who strongly believe in the link between MMR vaccine and autism despite several studies not finding any evidence to support the link.  A study published in 2015 in the Journal of the American Medical Association (JAMA) involving nearly 96,000 children in the U.S. found that “receipt of the MMR vaccine was not associated with increased risk of autism spectrum disorders (ASD), regardless of whether older siblings had autism”.

A 2010 study found “no association of autism with either MMR or a single measles vaccine”. A 2002 study in The New England of Medicine involving more than half a million children found no link between vaccination and autism.  The study concluded: “There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder.”

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According to many, including Kennedy, thimerosal — a mercury-based preservative in multi-dose vial vaccines — was thought to be responsible for causing autism. According to the Centres for Disease Control and Prevention (CDC), thimerosal contains ethylmercury, which is cleared from the human body more quickly than methylmercury, and is therefore less likely to cause any harm. But most anti-vax people think thimerosal metabolises into methylmercury, which is wrong. The most common side-effects of thimerosal are minor reactions like redness and swelling at the site of injection. Although rare, some people may be allergic to thimerosal.

Many studies have failed to find a link between thimerosal and autism. In 2004, the Institute of Medicine said: “The committee concludes that the body of epidemiological evidence favours rejection of a causal relationship between the MMR vaccine and autism. The committee also concludes that the body of epidemiological evidence favours rejection of a causal relationship between thimerosal-containing vaccines and autism.”

Beginning 2001, thimerosal was removed from almost all childhood vaccines. If the link between thimerosal and autism were indeed true there should have been a drop in the number of autism cases. Instead, autism rates continued to increase!

Never mind the evidence disproving the link between MMR vaccine and autism, with Trump and his administration strongly believing in the link, there is only one option left. “Scientists, medics and commentators who have fought vaccine disinformation in the past must take a deep breath and return to the fray. There is no need to wait for this commission to be announced officially. There is no need to wait until it issues its findings. There is no cause to be surprised if it shows little regard for science — or even if it targets scientists who speak out in favour of vaccination. Those who claim a link between vaccines and autism can do so only by discrediting the scientific evidence and, often, the scientists who gathered it. Kennedy’s reference to investigating vaccine safety “and scientific integrity” provides ample warning of what is to come. Scientists should get their retaliation in first. Lives are at stake,” a  Nature Editorial warns.

Here are some of the some of the tweets by Trump on vaccine-derived autism:

 

 

A hand-held, 20 cents paper centrifuge can revolutionise global health

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Images of a rotating paperfuge captured using a high-speed camera.  It shows a succession of wound (top), unwound (middle) and re-wound (bottom) states.

Manu Prakash, Stanford University professor who had earlier built the less than a dollar foldscope — a paper microscope that can be used for diagnosing blood-borne diseases such as malaria, African sleeping sickness and Chagas — has now developed another ultra-low cost device that can revolutionise public health.

The human-powered paper centrifuge, which can attain a maximum speed of up to 1,25,000 revolutions per minute (RPM), could enable simple blood tests for diseases such as malaria for just 20 cents. The paper centrifuge can separate pure plasma from whole blood in less than 90 seconds and isolate malaria parasites in 15 minutes. The power-free centrifuges have the potential to become point-of-care diagnostics in resource-poor settings.

The results were published in the journal Nature Biomedical Engineering. Prof. Prakash is the corresponding author of the paper.

Centrifuges are routinely used for analysing the concentration of pathogens and parasites in blood, urine and stool, and is the first step in detecting diseases such as malaria, tuberculosis and other diseases. Commercially available centrifuges need electricity and are expensive. This prompted Prof. Praksh to look for alternatives.

After trying several other items including the yo-yos and tops, the breakthrough came in early 2016 when Saad Bhamla from the Department of Bioengineering at Stanford University and the first author of the paper tried a button whirligig. He realised the potential of the whirligig as a centrifuge when a high speed camera clocked the speed of the button at 10,000-15,000 rpms. “One night I was playing with a button and string, and out of curiosity, I set up a high-speed camera to see how fast a button whirligig would spin. I couldn’t believe my eyes,” Bhamla says in a press release about the speed at which the button was spinning.

The paper centrifuge or “paperfuge”, as Prof. Prakash calls it, is the improvised whirligig — circular discs spun by pulling the strings passing through two holes in the discs.

img_0415The paperfuge spins at very high rpm by going through winding and unwinding phases. The disc unwinds when the strings are pulled; since there is no force applied during the winding phase it allows the inertia of the disc to rewind the strings. Since the strings are very flexible they wind beyond a point that the string gets into a tightly packed supercoiled state and the spinning stops. At this point when the string is pulled outwards they unwind and spin the disc in the opposite direction.

Though commercial centrifuges spin only in one direction, same results can be achieved when the paperfuge spins in one direction, stops and then spins in the reverse direction. Prof. Prakash is confident that performance-wise the paperfuge can match centrifuges that cost $1,000-5,000. “The simplicity of manufacturing our proposed device will enable immediate mass distribution of a solution urgently needed in the field,” they write. It is yet one more example of frugal science “leveraging the complex physics of a simple toy for global health applications”.

“There are more than a billion people around the world who have no infrastructure, no roads, no electricity. I realized that if we wanted to solve a critical problem like malaria diagnosis, we needed to design a human-powered centrifuge that costs less than a cup of coffee,” Prakash says in the release.

Health-care implications

The paperfuge can separate red blood cells from plasma in about 90 seconds and cost about 20 cents. The paperfuge with two capillaries loaded with blood samples had a maximum speed of 20,000 rpm. The haematocrit (volume percentage of RBCs in blood) value obtained was in “good agreement” with control experiments carried out for 120 seconds on a commercial electric centrifuge. The commercially available centrifuge has a speed of 16,000 rpm.

Prof. Prakash and his team used the paperfuge to test blood samples containing malaria parasites.  The Plasmodium falciparum parasitemia present in 30 microlitre of blood sample could be isolated from blood samples in 15 minutes. They went a step further by using capillaries precoated with acridine orange dye; the malaria parasites glow under fluorescent microscopy making the identification easy and simple.

Prof. Prakash in collaboration with nonprofit health care Pivot based in Boston is all set to test the paperfuge in a region of rural Madagascar in full-scale trials in March. “I would guess that 90 per cent of labs in Madagascar don’t have a working centrifuge. If it works this could be a game changer,” Pivot co-CEO Matthew Bonds told Science.

“The simplicity and robustness of the paperfuge device makes it possible to design and construct devices from materials beyond paper, including wood, plastic and polymers,” they write. The authors printed lightweight prototypes of 3D-fuges using 3D printer.  These with a maximum rpm of 10,000 “opens up opportunities to mas-manufacture millions of centrifuges using injection-moulding techniques”.