Recovery After Rabies
An experimental protocol called the Milwaukee protocol
has been used to save three patients with documented rabies.
The first person to survive, Jeanna Giese, developed
rabies after bitten by a rabid bat. She did not receive post exposure
prophylaxis. When she reached the hospital she couldn’t talk, stand or sit
and had fluctuating consiousness. She was ventilated and started on a
ketamine-midazolam induced coma, amantidine and ribavarin. Her medical
coma was withdrawn after a week and she was supplemented with
tertrahydrobiopterin for 6 months. She then received intensive
rehabilitation for a year. Now 4 years later, she has a driving license,
is studying biology in Marian University and is normal except for a slight
limp and slow speech.
The second patient was 8 year old Nelsy Gomez, in
Colombia who developed rabies after the bite of a rabid cat. She recovered
quickly on the Milwaukee protocol but died a month later of pneumonia.
Rabies is usually lethal within a week hence much credit is being given to
The third success for the protocol is from Brazil.
Fifteen year old Menezes, developed rabies after a bite from a rabid bat
though he did receive 4 doses of antirabies vaccine. He received the
medically induced coma for 2 weeks and is now slowly being weaned off the
Willoughby, the father of the Milwaukee protocol, who
is an infectious disease specialist, has studied pterins and monoamine
neurotransmitter metabolites in the CSF of rabies patients. He found they
had low tetrahydrobiopterin, and pathological deficiency of dopamine and
serotonin transmission which may explain some of the neurological
manifestations. Neuronal nitric oxide synthase is also tetrahydrobiopterin
dependant and may cause cerebrovascular insufficiency. If more detailed
study of the role of tertrahydrobiopterin proves its role, we will have a
metabolically specific, readily available, enteral therapy for rabies.
(J Inherit Metab Dis. 2008 Oct 25; Scientific American 21 November 2008).
E-Waste: The New Hazard
Electronic waste comes from broken down electrical and
electronic machines like computers and cell phones. What is disturbing
about it is that many parts are toxic and non-biodegradable. Mumbai city
produces 12,000 tons of e-waste annually according to the Maharashtra
Pollution Control Board. The bigger problem is that other Western
countries regularly export e-waste to India because of our greater ability
to recycle and reuse. Also India’s lackadaisical environmental rules as
well as lesser stringent working conditions are an open invitation for
e-waste. A Carnegie Mellon University study estimated that in 2002, the US
sent about 10 million computer units to Asia for recycling, keeping only
about three million on its own shores.
Toxic substances include lead, mercury and cadmium in
circuit boards and monitors. A typical computer monitor may contain more
than 6% lead by weight, much of which is in the lead glass of the CRT.
Recyclers, many of them women and children, melt computer parts with
acids, releasing a smoky stream of lead, dioxin and other toxins.
Carcinogenic substances in electronic waste include polychlorinated
biphenyls (PCBs). Capacitors, transformers, PVC insulated wires, PVC
coated components that were manufactured before 1977 often contain
dangerous amounts of polychlorinated biphenyls. The garbage handlers who
deal with it on a daily basis are at most risk. Disposal by landfill will
lead to soil and water pollution with long term hazards.
In Mumbai, e-waste collection is mainly by the
unorganized sector. The only e-waste collecting truck in Mumbai is
operated by an organization called Ecoreco. An e-waste recycling plant is
on the anvil in Mumbai, but Bangalore has an electronic waste processing
Technology is a double edged sword which needs
sheathing. (The Economic Times 8 December 2008, Greenercomputing news,
8 December 2008)