Ethical aspects in the use of radiation in medicine: update from ICRP Task Group 109.

Whereas scientific evidence is the basis for recommendations and guidance on radiological protection, professional ethics is critically important and should always guide professional behaviour. The International Commission on Radiological Protection (ICRP) established Task Group 109 to advise medical professionals, patients, families, carers, the public, and authorities about the ethical aspects of radiological protection of patients in the diagnostic and therapeutic use of radiation in medicine. Occupational exposures and research-related exposures are not within the scope of this task group. Task Group 109 will produce a report that will be available to the different interested parties for consultation before publication. Presently, the report is at the stage of a working document that has benefitted from an international workshop organised on the topic by the World Health Organization. It presents the history of ethics in medicine in ICRP, and explains why this subject is important, and the benefits it can bring to the standard biomedical ethics. As risk is an essential part in decision-making and communication, a summary is included on what is known about the dose-effect relationship, with emphasis on the associated uncertainties. Once this theoretical framework has been presented, the report becomes resolutely more practical. First, it proposes an evaluation method to analyse specific situations from an ethical point of view. This method allows stakeholders to review a set of six ethical values and provides hints on how they could be balanced. Next, various situations (e.g. pregnancy, elderly, paediatric, end of life) are considered in two steps: first within a realistic, ethically challenging scenario on which the evaluation method is applied; and second within a more general context. Scenarios are presented and discussed with attention to specific patient circumstances, and on how and which reflections on ethical values can be of help in the decision-making process. Finally, two important related aspects are considered: how should we communicate with patients, family, and other stakeholders; and how should we incorporate ethics into the education and training of medical professionals?

Molecular characterization of CTX-M type Extended Spectrum Beta Lactamase producing E. coli isolated from humans and the environment.

PURPOSE: Escherichia coli is a common pathogen causing community- and hospital-acquired infections. The infections caused by the Extended Spectrum Beta Lactamase (ESBL) enzymes-producing E. coli hinder antibiotic treatment. MATERIALS AND METHODS: Plasmid DNA samples were subjected to PCR specific for TEM, SHV and CTX-M genes obtained from 110 E. coli strains isolated from hospitalized patients, healthy individuals and environment in Vellore, South India . RESULTS: Among the 110 isolates tested, 21.8% were positive for TEM and 2.7% positive for SHV and 91.8% positive for CTX-M. The proportion of CTX-M positive E. coli was not statistically different between the study groups. Nineteen of 20 strains were CTX-M-15 type and the other was CTX-M-14 type. The phylogenetic analysis of 19 strains clustered with the pandemic CTX-M-15-ST131 strain, indicating this as an evolving global problem for antibiotic therapy. The geomapping of samples indicated 'hotspot' areas of healthy individuals, patients and the environmental samples. CONCLUSION: The spatial presentation of GIS mapping allowed identification of clustering among patients and healthy individuals and contaminated environmental points.

Incidence of extended spectrum beta lactamase producing Escherichia coli among patients, healthy individuals and in the environment.

We investigated the faecal carriage of extended spectrum ß-lactamases (ESBL) producing Escherichia coli in different groups of human subjects and in the environment. A total of 363 E. coli strains were isolated from stool samples of patients (n = 77), healthy subjects (n = 170) and from different environmental samples (n = 116). A total of 124 ESBL producing E. coli strains were isolated in this study. The frequency of ESBL producing E. coli was found to be highest (60.3%) among the strains isolated from patients, followed by healthy individuals (38%) and the environment (10.5%). The environment was observed to have a very low number of ESBL producing E. coli.

Neonatal Group B Streptococcal bacteraemia in India: ten years' experience.

Group B Streptococcus (GBS) is an infrequent cause of neonatal septicaemia in many developing countries. In a perinatal centre in India with 60,119 live births between 1988 and 1997, GBS was isolated from blood cultures of 10 babies. Thus the incidence of GBS bacteraemia was 0.17 per 1000 live births. Lethargy, respiratory distress and poor perfusion were the presenting features in eight symptomatic babies. Two babies had meningitis, three required ventilatory support and one died. There were no cases of late onset disease. The low incidence could be due to the low rate of colonisation and high prevalence of protective antibody in the mothers.

Bacteremia due to beta haemolytic streptococci.

The Beta haemloytic streptococci (BHS) are well recognised human pathogens causing a variety of infections, including septicemia. It is important to ensure their isolation from clinical specimens by using optimum media. Moreover, since the different groups have different pathogenic potential, it is equally important to routinely serogroup them; this is emphasized here. Since, BHS are uniformly will greatly decrease morbidity and mortality due to BHS infection.

A leprosy health education project.

Results of a survey of knowledge and attitudes of the general public towards leprosy and knowledge, attitudes and practices of leprosy patients are reported. This survey is the base line for a health education project, based on social psychological theories of behavior, which is described. The results of the survey show that the general public has very little knowledge about leprosy; patients have more knowledge. Attitudes measured with a Likert scale are negative for the general public and only slightly positive for the patients. Allopathic treatment for leprosy is preferred by most, but many do not relate the "patch" to leprosy and therefore do not seek early treatment. In addition, many patients do not complete the treatment. There is much need for health education.