|HEALTH TRIBUNE||Wednesday, August 30, 2000, Chandigarh, India|
Uppal formula for Kataria
Tobacco: a life-saver too?
New millennium's surgeons
Uppal formula for Kataria
IN an interesting and informative article on "Rural and slum health care: a multi-organisational achievement", published in Health Tribune on August 2, 2000, Dr (Brig) M. L. Kataria, a tireless and selfless socio-medical worker for several years who has recently been honoured with Dr B. C. Ray Award by the President of India, has indicated his requirements for suitable accommodation for setting up dispensaries and health-care centres in various rural and slum areas. The number of the slums is increasing everyday around the Union Territory of Chandigarh. It is hoped that sarpanches and panches of the areas as well as various social organisations and NRIs will respond favourably and meet the clearly stated requirements by constructing suitable buildings if they cannot be spared from the existing structures available in such areas.
However, since the unhygienic conditions, generally prevailing in the slum areas because of the lack of proper sanitation and shelters for the residents, are responsible for the spread of various diseases, equal if not a greater stress should be laid on providing them with suitable shelters and maintaining the cleanliness of the environment.
This will considerably reduceand also facilitate the task of health-care which can be extended to greater areas with the available resources and funds. It is felt that neither the Government nor any private organisation is paying serious attention to the housing problem of the slums. Stress is disproportionately laid on the construction of multi-storeyed concrete flats and the buildings for affluent people living in cities and big towns. People living in rural areas and slums cannot afford to build or buy such houses. They need much cheaper and equally durable but hygienic shelters for their own living as well as for their cattle.
As a result of extensive research and experimentation, both in the laboratory and on the field scale, it was found that the local soil, normally considered suitable for casting sun-dried-and-brunt clay bricks, can be used for making water-resistant sun-dried bricks by incorporating in it only 1 per cent cutback bitumen prepared by blending the 80:100 penetration bitumen (normally used in road surfacing) with about 15-20 per cent kerosene or creozote oil and only 1 per cent paraffin wax. Thousands of such bricks were produced and used in the construction of compound walls as well as some office store and workshop buildings on the premises of the PWD, B and R Research Laboratories in Sector 19, Chandigarh, during the late sixties. All these structures showed excellent performance and weather-resistance for more than 20 years till they were dismantled owing to the shifting of the labs to Sector 9. One of such structures ( a cottage) is shown in the photo that goes with this article.
The cost of such bricks at the present market rate of the constituents (bitumen, kerosene or creozote oil and wax), works out between Rs 550 and Rs 600 per thousand as against about Rs 2,000 for burnt-clay bricks. By using 0.5 per cent stabiliser (cutback bitumen) which also provides fairly satisfactory resistance to water, the cost can be reduced to about Rs 300 per thousand bricks. While the bricks produced with 1 per cent stabiliser can be used in the external walls of a building, the inner walls can be built with ordinary sun-dried bricks as they are not exposed to rain or any other moist atmosphere; or the bricks stabilised with only 0.5 per cent stabiliser can be used for inner walls.
Structures built with asphalt stabilised bricks have several advantages over the brunt-clay-brick structures as they, being fairly water proof, do not allow the moisture to travel through them to spread on the interior surface. By keeping the buildings dry, they provide better hygienic conditions and resist the growth of bacteria and insects like cockroaches and termites.
These bricks also provide better thermal insulation, thus keeping the buildings warmer in winter and cooler during summer. Above all, their manufacture is simple and independent of coal supplies over long distances, and can be taken up on a self-help basis throughout the year. No special technique or equipment is involved.
Dr M.L. Kataria's requirement of three to four-room accommodation is not likely to cover a more than 500 sq ft area. If the bricks are produced on a self-help basis by the villagers or slum-dwellers (which can be done in their spare time), and the maximum use of soil stabilisation technique is made in floors and the foundation, the cost of construction of a three-to-four-room accommodation with A.C.C. sheet roofing is not likely to exceed Rs 60 per sq ft with fairly good inside finish and neat and clean plinth protection outside.
If any organisation or an N.R.I. or the sarpanch of the area comes forward to meet the requirements of Dr Kataria, the author, with the help of Dr Uppal's Testing & Analytical Laboratory, will be too glad to assist in the successful completion of the job. This lab is located at 168, Industrial Area, Phase II, Chandigarh.
For the high quality of bricks, the soil should be free from organic matter and deleterious soluble sulfates and carbonates which cause efflorescence and high alkalinity. The soil around Chandigarh has been generally found suitable for making asphalt-stabilised bricks of reasonably good quality.
Dr Uppal, Ph.D.,
FIE, of Uppal's Testing and Analytical Laboratory
(Chandigarh) fame has been honoured with the Rashtriya
Ekta Award by the Global Economic Council for his
scientific achievements and distinguished services to the
Tobacco: a life-saver too?
PHARMACEUTICAL companies are sowing the seeds for an alternative type of agriculture where crops are used as biofactories, instead of food. They stand to reap significant financial rewards by manufacturing a wide spectrum of plant-derived products for the health-care industry.
The crop of choice is one renowned for causing medical problems. The tide is turning for tobacco, from health-threat to potential life-saver. It has become the tool of the biotechnologists trade and researchers are capitalising on the hidden potential of this cash crop, developing applications that could redeem it in the eyes of the medical profession. Tobacco plantations soon could be providing a multitude of medically desirable drugs.
These sustainable and renewable solar-driven production plants are an attractive choice for pharmaceutical companies. Tobacco is easy to genetically modify and large quantities of protein can be produced relatively inexpensively. Plants are a safer raw material than blood plasma or mammalian cell cultures as they are free from disease-causing contaminants, thereby reducing the cost of screening drugs for viruses and toxins.
Molecular farming has seen vaccines, mammalian blood constitutes, enzymes, antibodies and low-calorie sweeteners produced in tobacco leaves. Australian scientists have engineered a measles gene into tobacco. They are now modifying rice with the gene as an alternative vehicle for vaccines in the developing world where the refrigeration of traditional vaccines is difficult.
The tiny, toxic yellow scorpion, Tityus serrulatus, is responsible for numerous deaths worldwide, but tobacco is taking the sting out of this tale. Conventional treatment uses a serum derived from horses injected with the venom, but a team at Durham University is producing a version in tobacco.
Human secretory immunoglobulins, SIgSa, are proteins made by our bodies to protect oral and other mucosal surfaces against pathogen attack and toxins. Plants have been engineered to make these antibodies to combat infectious diseases of mucosal surfaces.
The first clinical proof confirming the therapeutic use of these potent proteins in humans was demonstrated by a team at Guys Hospital in London led by Prof Tom Lehner and Dr Julian Ma.
The bacterium, Streptococcus mutans, is notorious for causing infections that lead to tooth decay. Plantibodies against this microbe were made in tobacco by Planet Biotechnology, a company developing SIgA-based therapeutics to treat infectious diseases and toxins affecting oral, respiratory, gastrointestinal, genital and urinary mucosal surfaces and skin. When these plantibodies were applied to the teeth of test subjects, bacteria were not able to recolonise the dental surfaces.
Dr Mich Hein, President of the San Diego-based EPlcyte Pharmaceutical company, believes that there is tremendous scope for plant-made antibodies against a variety of pathogens and for treating cancer or systemic infections.
Ultimately, the products will be safer and cast significantly less than if produced in cell-culture systems: around $20 a gram compared with $200 to $2,000 a gram.
EPlcyte is particularly interested in the production of antibodies which would prevent sperm reaching the egg. They could also fight sexually-transmitted diseases: antibodies against the herpes simplex-2 virus have been made in genetically engineered soybean. When topically applied to the vagina, these plantibodies prevented mice from contracting genital herpes.
The plantibodies were compared with those made by conventional cell culture methods. There were no significant differences in their physical properties, their performance in assays or in protecting mice against HSV-2 infection.
The technology is being transferred to corn to make anti-herpes and anti-sperm plantibodies on a larger scale which ultimately could be incorporated into gels or suppositories. This could revolutionise the sexual health-care market by supplying a product that gives both contraception and prevents disease.
Researchers at Crop Tech in Blackberg, Virginia, are using tobacco to produce a treatment for Gauchers disease, a rare, life-threatening genetic condition affecting about one in 40,000 in the USA and one in 500 of those of eastern European descent. Sufferers have a defective version of the enzymes human glucocerebrosidase, hGC, which prevents them from processing certain fatty substances called complex lipids. These accumulate to toxic levels causing bone deformities, liver and spleen problems and early death.
The two drugs currently available for this condition are extremely expensive around $300,000 a year per patient. A single dose of ceredase is made from about 2,000 human placentas and cerezyme is made from hamster ovaries. A single leaf of tobacco, however, can be genetically engineered to produce an equivalent amount of hGC which can be more easily and cheaply extracted.
Tobacco is well-suited for producing proteins on a large scale as it generates biomass rapidly and it is a prolific producer of sees, facilitating rapid scale-up. But harvesting these precious proteins can be tricky. Researchers have come up with a solution to get to the root of the problem a process called rhizosecretion.
Tobacco plants are grown hydroponically and release large quantities of protein from their roots into the surrounding solution by virtue of special sequences added to the protein which send them to the plants secretory system.
This allows continuous, large-scale production of pure, active therapeutic proteins. Domestic animals such as sheep, cows and rabbits are widely used to produce pharmaceuticals. They can be induced to secrete large amounts of useful proteins such as insulin in their milk, blood or urine by inserting the appropriate gene into their genetic make-up.
Transgenic mice that secrete human growth hormone into their seminal fluid recently hit the headlines. Plants on the other hand are a more favourable, cost-effective and aesthetic alternative to producing pharmaceuticals in transgenic animals.
The golden grains of pharmaceutical-containing corn and vaccine-rich tobacco foliage could change the face of conventional farming as we know it and provide a new niche market for tobacco farmers.
Looking into the future, crops will be pharmed for a wide range of non-food uses, particularly to produce proteins to treat and prevent human disease. Plants are poised to become the biofactories of a new agricultural age.
New millennium's surgeons
FROM the time of Hippocrates, surgery has always been the salvation of inner medicine. In inner medicine, physicians have dwelt too much on dogma, opinion, and speculation. Too often, their errors have passed undiscovered into the grave. The surgeon, for his good, has had sharper training on facts and his errors hit him promptly in the face (Lancet 1922)
The word "docere" has been derived from doctus (Latin), a term, meaning to teach. The ancient Romans used the term for those who delivered lectures on philosophical subjects.
Surgeons, with academic appointments, are teachers. The greatest effect they have on their students is the preceptoral impact delivered via their personal surgical philosophy and the implementation of that philosophy through the concerned, compassionate and pragmatic delivery of patient-care. In this way teachers contribute significantly to the enhancement of the understanding of the practice of clinical surgery for the betterment of the patients.
Surgeons as educator, should examine their roles and obligations. Students should be recognised as adult learners with varying goals and amounts of ability as well as motivation. A teacher has to demonstrate interest in and commitment to education. Trainee surgeons require thoughtful mentors to learn to be intelligent and caring surgeons.
Teaching intelligent, eager and young residents is a stimulating and challenging exercise, nay, absolute pleasure.
Teaching posts should be given only to those who truly love teaching. This assignment should not be given to those members of the faculty who view teaching as a necessity associated with a coveted faculty appointment. It is an occasion of sharing one's learning experience with students.
The students need to be guided through a process that demands answers derived from acquired basic science information and via synthesis and analysis of that allows the student to arrive at a differential diagnosis and formulate a therapeutic approach to the problem.
William Lynn Phelps wrote: "Teaching is not merely a life work, an occupation or a struggle; it is a passion. I love to teach as a painter loves to paint, as a musician loves to play, as a singer loves to sing, as a strong man rejoices to run a race. Teaching is an art an art so great and so difficult to master that a man or a woman can spend a long life at it without realising much more than his or her limitations and mistakes, and his or her distance from the ideal. But the main aim of my existence has been to become a good teacher, just as every architect wishes to be a good architect, and every professional poet strives towards perfection".
The Halstedian-based system of resident education has produced generations of fine technical surgeons and provided quality patient-care. However, the development of new surgical technologies are challenging this system. The hospital inpatient population is changing as a broader range of diseases is treated surgically and the therapies become more complex.
Computer-based surgical simulation, often referred to as virtual reality, holds enormous potential for enhancing surgical training. Residents need to learn not only the operations performed by their predecessors; they also need to learn entirely new and different types of skills and procedures like minimally invasive surgery, robot-assisted operations etc. The acquisition of new sets of different skills may be necessary multiple times during the course of one's career in an era of compounding technology.How many of us believe in this philosophy? Those who believe are lateralised. This is a major factor for "brain drain", and not the monetary considerations as put forward in the lay press.
Academic surgeons are expected to diagnose and treat, most often by operation, and to impart knowledge to residents with the help of a variety of teaching methods.
The most important factor in good mentoring is the physical presence in the learning environment.