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   2010| July-September  | Volume 2 | Issue 3  
    Online since August 16, 2010

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Chemical warfare agents
K Ganesan, SK Raza, R Vijayaraghavan
July-September 2010, 2(3):166-178
DOI:10.4103/0975-7406.68498  PMID:21829312
Among the Weapons of Mass Destruction, chemical warfare (CW) is probably one of the most brutal created by mankind in comparison with biological and nuclear warfare. Chemical weapons are inexpensive and are relatively easy to produce, even by small terrorist groups, to create mass casualties with small quantities. The characteristics of various CW agents, general information relevant to current physical as well as medical protection methods, detection equipment available and decontamination techniques are discussed in this review article. A brief note on Chemical Weapons Convention is also provided.
  25,531 1,563 122
Chemical, biological, radiological, and nuclear decontamination: Recent trends and future perspective
Vinod Kumar, Rajeev Goel, Raman Chawla, M Silambarasan, Rakesh Kumar Sharma
July-September 2010, 2(3):220-238
DOI:10.4103/0975-7406.68505  PMID:21829318
Chemical, biological, radiological, and nuclear (CBRN) decontamination is the removal of CBRN material from equipment or humans. The objective of the decontamination is to reduce radiation burden, salvage equipment, and materials, remove loose CBRN contaminants, and fix the remaining in place in preparation for protective storage or permanent disposal work activities. Decontamination may be carried out using chemical, electrochemical, and mechanical means. Like materials, humans may also be contaminated with CBRN contamination. Changes in cellular function can occur at lower radiation doses and exposure to chemicals. At high dose, cell death may take place. Therefore, decontamination of humans at the time of emergency while generating bare minimum waste is an enormous task requiring dedication of large number of personnel and large amount of time. General principles of CBRN decontamination are discussed in this review with emphasis on radiodecontamination.
  16,388 588 25
Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents
Aruna C Ramesh, S Kumar
July-September 2010, 2(3):239-247
DOI:10.4103/0975-7406.68506  PMID:21829319
In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury.
  14,374 402 16
Biological warfare agents
Duraipandian Thavaselvam, Rajagopalan Vijayaraghavan
July-September 2010, 2(3):179-188
DOI:10.4103/0975-7406.68499  PMID:21829313
The recent bioterrorist attacks using anthrax spores have emphasized the need to detect and decontaminate critical facilities in the shortest possible time. There has been a remarkable progress in the detection, protection and decontamination of biological warfare agents as many instrumentation platforms and detection methodologies are developed and commissioned. Even then the threat of biological warfare agents and their use in bioterrorist attacks still remain a leading cause of global concern. Furthermore in the past decade there have been threats due to the emerging new diseases and also the re-emergence of old diseases and development of antimicrobial resistance and spread to new geographical regions. The preparedness against these agents need complete knowledge about the disease, better research and training facilities, diagnostic facilities and improved public health system. This review on the biological warfare agents will provide information on the biological warfare agents, their mode of transmission and spread and also the detection systems available to detect them. In addition the current information on the availability of commercially available and developing technologies against biological warfare agents has also been discussed. The risk that arise due to the use of these agents in warfare or bioterrorism related scenario can be mitigated with the availability of improved detection technologies.
  11,316 549 19
Radiation-induced biomarkers for the detection and assessment of absorbed radiation doses
Sudha Rana, Raj Kumar, Sarwat Sultana, Rakesh Kumar Sharma
July-September 2010, 2(3):189-196
DOI:10.4103/0975-7406.68500  PMID:21829314
Radiation incident involving living organisms is an uncommon but a very serious situation. The first step in medical management including triage is high-throughput assessment of the radiation dose received. Radiation exposure levels can be assessed from viability of cells, cellular organelles such as chromosome and different intermediate metabolites. Oxidative damages by ionizing radiation result in carcinogenesis, lowering of the immune response and, ultimately, damage to the hematopoietic system, gastrointestinal system and central nervous system. Biodosimetry is based on the measurement of the radiation-induced changes, which can correlate them with the absorbed dose. Radiation biomarkers such as chromosome aberration are most widely used. Serum enzymes such as serum amylase and diamine oxidase are the most promising biodosimeters. The level of gene expression and protein are also good biomarkers of radiation.
  10,134 410 25
Chlorine leak on Mumbai port trust's Sewri yard: A case study
Rakesh Kumar Sharma, Raman Chawla, Surendra Kumar
July-September 2010, 2(3):161-165
DOI:10.4103/0975-7406.68496  PMID:21829311
Chemical emergencies involving hazardous chemicals are not uncommon in India. More than 25 incidents have been identified in National Disaster Management Guidelines - Chemical (Industrial) Disaster Management, released in May 2007. In a recent occurrence on the morning of 14 July 2010, nearly at 3:00 a.m., chlorine leak was reported from a gas cylinder referred as turner, weighing about 650 kg, corroding with time at the Haji Bunder hazardous cargo warehouse in Mumbai Port Trust, Sewri, affecting over 120 people in the neighborhood, including students, laborers, port workers and fire fighters, of whom 70 were reported critical. It has been observed to be a blatant case of ignorance and negligence as well as contraventions to the safety and environmental safeguard requirements under existing statues as well as non-maintenance of failsafe conditions at the site requisite for chlorine storage. The analysis revealed significant gaps in the availability of neutralization mechanism and the chlorine stored in open increased the possibility of formation of ingress mixture due to busting of chlorine filled tankers. The Government of India has institutionalized emergency preparedness framework at national, state and district level as envisaged in Disaster Management Act, 2005, to prepare the nation to mitigate such incidences, if all the preventive safety provisions fail. Ministry of Environment and Forests (MoEF) is preparing National Action Plan-Chemical (Industrial) Disaster Management based on National Guidelines to implement all the mechanisms of capacity development across the country.
  7,654 423 2
Group counseling: A silver lining in the psychological management of disaster trauma
Nidhi Maheshwari, Ravinder Yadav, Nirender Pal Singh
July-September 2010, 2(3):267-274
DOI:10.4103/0975-7406.68509  PMID:21829322
Management of disaster effects, physical or psychological, has been the subject of considerable research. Though physical rehabilitation of the victims of any disaster, whether natural or man-made, receives immediate attention, the management of psychological trauma often remains a challenge for the disaster management machinery, in general, and mental health professionals, in particular. The magnitude of population affected, on the one hand, and lack of sufficient mental health professionals, on the other hand, often hinders the psychological rehabilitation of a cross section of the affected population. We attempt to present an overview of the literature to bring home the understanding of correlates of psychological effects in the mass disaster affected population in this article. It dwells on the efficacy of group counseling as the most appropriate paradigm of primary prevention to check the onset of severe psychological disorders. The article also presents an overview of two case studies: tsunami disaster (Nagapatanam, Tamil Nadu, India) and victims of bomb blast (Dhimajee, Assam, India) to highlight the silver lining in the psychological management of disaster traumas. It is proposed that group counseling can prove to be a most important mental rehabilitation program to further strengthen the efficacy of individual therapeutic interventions.
  6,974 179 1
Medical radiation countermeasures for nuclear and radiological emergencies: Current status and future perspectives
Rajesh Arora, Raman Chawla, Rohit Marwah, Vinod Kumar, Rajeev Goel, Preeti Arora, Sarita Jaiswal, Rakesh Kumar Sharma
July-September 2010, 2(3):202-212
DOI:10.4103/0975-7406.68502  PMID:21829316
Nuclear and radiological emergencies (NREs) occurred globally and recent incidences in India are indicating toward the need for comprehensive medical preparedness required both at incident site and hospitals. The enhanced threat attributed toward insurgency is another causative factor of worry. The response capabilities and operational readiness of responders (both health and non-health service providers) in contaminated environment need to be supported by advancement in R & D and technological efforts to develop prophylactics and radiation mitigators. It is essential to develop phase 1 alternatives of such drugs for unseen threats as a part of initial preparedness. At the incident site and hospital level, external decontamination procedures need to be standardized and supported by protective clothing and Shudika kits developed by INMAS. The medical management of exposure requires systematic approach to perform triage, resuscitation and curative care. The internal contamination requires decorporation agents to be administered based on procedural diagnostics. Various key issues pertaining to policy decisions, R & D promotion, community awareness, specialized infrastructure for NREs preparedness has been discussed. The present review is an attempt to provide vital information about the current status of various radiation countermeasures and future perspective(s) ahead.
  6,249 270 13
Chemical, Biological, Radiological, and Nuclear disaster management
JR Bhardwaj
July-September 2010, 2(3):157-158
DOI:10.4103/0975-7406.68492  PMID:21829309
  5,563 396 5
Chemical, biological, radiological and nuclear training issues in India: A fresh perspective
Mudit Sharma
July-September 2010, 2(3):275-280
DOI:10.4103/0975-7406.68510  PMID:21829323
Appropriate training is the key to the right level of preparedness against any disaster, and Chemical, Biological, Radiological and Nuclear (CBRN) disasters are no different. The presence of contamination precludes rescue operations to commence soon after the event and it takes a systematic approach to detect and decontaminate the CBRN hazard. Achieving such interventions poses a critical challenge because humans do not possess any inborn, natural sensors with which to recognize these dangers early enough. This requires special training besides the right tools to achieve the objective. CBRN training in India has evolved over the years as a pure military-related concept to a disaster-level response training involving the first responders. The complex nature of CBRN agents requires a methodical and systematic approach to counter the response successfully, and the training for this necessitates adoption of proven modern principles of education management, like training needs analysis, operational research, etc. Simulation as a training and planning offers repeatability, controllability and the possibility for evaluation and is being successfully used in some advanced countries for training responders in the relatively unknown and mysterious domain of CBRN disaster management training. There is also a perceived need to integrate and standardize the curricula to suit the respective first responder. It is strongly felt that with the able support of apex agencies like National Disaster Management Authority and guidance of the Defence Research and Development Organisation, the training effort in CBRN disaster management will get the right impetus to achieve a stature of a modern, progressive and mature endeavour. This will enable India to develop a strong CBRN defence posture very much in line with the country's emerging status globally as a technological power.
  5,468 351 3
Nutrition in emergencies: Issues involved in ensuring proper nutrition in post-chemical, biological, radiological, and nuclear disaster
Som Nath Singh
July-September 2010, 2(3):248-252
DOI:10.4103/0975-7406.68507  PMID:21829320
Accidental or deliberate exposure to chemical, biological, radiological, and nuclear (CBRN) agents poses considerable threat throughout the world. Under such conditions, ensuring proper nutrition is a difficult task due to contamination of food available in the affected area. Generally, food is not prepared or served in an environment contaminated by CBRN agents. Foods that are properly packed need to be decontaminated from outside before use. These agents get incorporated in to food chain. Therefore, especially the foliage vegetables, milk and meat products from affected area are not fit for consumption. Potassium iodide has protective role, as radioiodine uptake into the thyroid can be blocked by its pharmacological doses. This is most effective when taken before exposure, but still has significant effects up to five to six hours postexposure. The antioxidant vitamins and minerals may be included in therapeutic feeding programs, as they are known to protect against oxidative stress. Minimum requirement of calories and nutrients are similar to other disasters and are discussed in the present review.
  5,375 233 4
Lymphocyte chromosomal aberration assay in radiation biodosimetry
Paban K Agrawala, JS Adhikari, NK Chaudhury
July-September 2010, 2(3):197-201
DOI:10.4103/0975-7406.68501  PMID:21829315
Exposure to ionizing radiations, whether medical, occupational or accidental, leads to deleterious biological consequences like mortality or carcinogenesis. It is considered that no dose of ionizing radiation exposure is safe. However, once the accurate absorbed dose is estimated, one can be given appropriate medical care and the severe consequences can be minimized. Though several accurate physical dose estimation modalities exist, it is essential to estimate the absorbed dose in biological system taking into account the individual variation in radiation response, so as to plan suitable medical care. Over the last several decades, lots of efforts have been taken to design a rapid and easy biological dosimeter requiring minimum invasive procedures. The metaphase chromosomal aberration assay in human lymphocytes, though is labor intensive and requires skilled individuals, still remains the gold standard for radiation biodosimetry. The current review aims at discussing the human lymphocyte metaphase chromosomal aberration assay and recent developments involving the application of molecular cytogenetic approaches and other technological advancements to make the assay more authentic and simple to use even in the events of mass radiation casualties.
  5,122 263 18
Himalayan Bioresource Rhodiola imbricata as a promising radioprotector for nuclear and radiological emergencies
Raman Chawla, Sarita Jaiswal, Raj Kumar, Rajesh Arora, Rakesh Kumar Sharma
July-September 2010, 2(3):213-219
DOI:10.4103/0975-7406.68503  PMID:21829317
In recent years, a lot of interest has been generated world over in the area of radioprotection for first responders going to work in the hot zones at the incident site. A large number of molecular drugs have been screened for radioprotective efficacy, but with little success. The requirement of differential radioprotection necessitates a holistic approach, which can be realized using herbs in view of their multifaceted mode of action. Our earlier studies showed the radioprotective potential of Rhodiola imbricata, a Himalayan high-altitude plant. In this study, our focus has been to compare the pro-oxidant/antioxidant activities of three fractionated extracts of R. imbricata. The aqueous fraction exhibited significant (P < 0.05) pro-oxidant activity (up to 100 mg/ml) under metal ion-induced stress ± flux [transition metal (Fe/Cu) ± 0.25 kGy]. A decrease in the dielectric constant of the solvent system utilized for extraction, exhibited a significant (P < 0.05) negative correlation (−0.955) with mean protection potential of lipid against radiation flux. Such an effect was visualized as a significant shift from pro-oxidant to antioxidant activity in methanolic fraction (dielectric constant = 33), as compared to aqueous fraction (dielectric constant = 80). Aqueous fraction is predominantly pro-oxidant at maximal concentrations, indicating its anticancer potential. The presence of transition metals modulates such a biphasic activity differentially in various fractions, i.e., the conversion of Fe(III) or Cu(II) to Fe(II) or Cu(I), respectively, due to the presence of certain bioactive constituents (electron donation at lower concentrations), favors pro-oxidant activity. On the other hand, certain other active constituents involved in metal ion chelation contributed to the overall antioxidant activity. The methanolic fraction exhibited significant antioxidant activity up to 250 mg/ml, which contributed to its radioprotective efficacy. The aquo-methanolic fraction exhibited (disparate properties), i.e., concentration-dependant cytotoxicity (up to 250 mg/ml) and cytoprotection at 1000 mg/ml. R. imbricata, in general, exhibited a significant solvent-dependant variation in radioprotective efficacy. In conclusion, solvent extraction and dose are crucial in bioactivity modulation and R. imbricata could be developed as a potential prophylactic radiation countermeasure for use in nuclear and radiological emergencies.
  4,950 198 11
Ensuring safe water in post-chemical, biological, radiological and nuclear emergencies
Praveen Kumar Amar
July-September 2010, 2(3):253-266
DOI:10.4103/0975-7406.68508  PMID:21829321
Disaster scenarios are dismal and often result in mass displacement and migration of people. In eventuality of emergency situations, people need to be rehabilitated and provided with an adequate supply of drinking water, the most essential natural resource needed for survival, which is often not easily available even during non-disaster periods. In the aftermath of a natural or human-made disaster affecting mankind and livestock, the prime aim is to ensure supply of safe water to reduce the occurrence and spread of water borne disease due to interrupted, poor and polluted water supply. Chemical, biological, radiological and nuclear (CBRN) emergencies augment the dilemma as an additional risk of "contamination" is added. The associated risks posed to health and life should be reduced to as low as reasonably achievable. Maintaining a high level of preparedness is the crux of quick relief and efficient response to ensure continuous supply of safe water, enabling survival and sustenance. The underlying objective would be to educate and train the persons concerned to lay down the procedures for the detection, cleaning, and treatment, purification including desalination, disinfection, and decontamination of water. The basic information to influence the organization of preparedness and execution of relief measures at all levels while maintaining minimum standards in water management at the place of disaster, are discussed in this article.
  4,919 174 3
Chemical, Biological, Radiological, and Nuclear disasters: Pitfalls and perils
Rakesh Kumar Sharma
July-September 2010, 2(3):155-156
DOI:10.4103/0975-7406.68490  PMID:21829308
  3,588 291 6
Undeclared disaster: Radiation episode in New Delhi - Medical overview and hard lessons to learn!
Vivek Chhabra
July-September 2010, 2(3):159-160
DOI:10.4103/0975-7406.68495  PMID:21829310
  3,043 170 2