1. Gambia child deaths and cough syrups
Why is the West African nation reporting cases of kidney failure in children mostly below five? Are India-manufactured paracetamol syrups responsible for these deaths? What has the World Health Organization said? Have similar cases been reported elsewhere?
On October 8, Gambia’s Health Minister Ahmadou Lamin Samateh said that the number of child deaths likely linked to contaminated cough syrups made by an Indian manufacturer had risen to 69.
The Gambia’s director of health services Mustapha Bittaye was quoted by Reuters as saying that a number of children began to get sick with kidney problems within three to five days of consuming a paracetamol syrup sold locally.
On October 5, the WHO issued a medical alert about four substandard products “that fail to meet either their quality standards or specifications”. These were four cough syrup variants — Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup, whose manufacturer was listed as Maiden Pharmaceuticals Limited, Haryana, India.
The story so far:
On October 8, Gambia’s Health Minister Ahmadou Lamin Samateh said that the number of child deaths likely linked to contaminated cough syrups made by an Indian manufacturer had risen to 69. This comes a day after Gambian President Adama Barrow said that the surge in acute kidney injuries linked to the paracetamol syrups was under control.
What happened in The Gambia?
In early September, health authorities in the West African nation of The Gambia were investigating if there was a link between dozens of child deaths from acute kidney injuries and the consumption of a paracetamol syrup used for fever, cough, cold, and pain.
The Gambia’s director of health services Mustapha Bittaye was quoted by Reuters as saying that a number of children began to get sick with kidney problems within three to five days of consuming a paracetamol syrup sold locally. The affected children would experience fever, inability to pass urine, and vomiting, followed by kidney failure. According to Gambian Health Ministry figures, 28 children had died by early August, with the fatality rate being 90%. In September, The Gambia started coordinating with the World Health Organization (WHO) about the incidents and reported four locally-sold cough syrups it suspected could be linked to the injuries and deaths.
On October 5, the WHO issued a medical alert about four substandard products “that fail to meet either their quality standards or specifications”. These were four cough syrup variants — Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup, whose manufacturer was listed as Maiden Pharmaceuticals Limited, Haryana, India. The alert added that the products mentioned were unsafe and their use, especially in children, could “result in serious injury or death”. The WHO further specified that its laboratory analysis of samples of each of the four products had confirmed that they contained “unacceptable amounts” of two “contaminants” — diethylene glycol and ethylene glycol. WHO head Tedros Adhanom Ghebreyesus, calling the incidents “beyond heartbreaking”, said that the four syrups in question have been “potentially linked to” the cases of kidney injuries and to the deaths of children in The Gambia.
While The Gambia had started recalling all medicines containing paracetamol syrup in September, it began the recall of the four specific Indian-made syrups only after the WHO’s product alert. Additionally, it said that while these four syrups had been identified in The Gambia, there was a possibility that they may have been informally distributed to other markets.
What are these toxic chemicals?
According to the WHO, diethylene glycol and ethylene glycol are toxic to humans when consumed and can prove to be fatal. The agency’s alert listed the toxic effects of the two chemicals as pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which could lead to death.
Both diethylene glycol and ethylene glycol are illegal adulterants that may be used as solvents in liquid medication. Common solvents such as glycerine (also known as glycerol) and propylene glycol are used in cough syrups to provide a liquid base to non-water-soluble paracetamol or acetaminophen; these solvents also act as preservatives, thickeners, sweeteners, and antimicrobial agents, according to the United States National Center for Biotechnology Information (NCBI).
Medical experts say that in order to cut expenses and due to the solubility of compounds like diethylene glycol and ethylene glycol, manufacturers may sometimes substitute it for non-toxic solvents such as glycerine or propylene glycol or comparatively cheaper commercial grade versions of these solvents which may contain diethylene glycol and ethylene glycol, potentially resulting in contamination.
Instances of contamination and deaths linked to diethylene glycol are not new. Such cases have been reported before in India, the U.S., Bangladesh, Panama, and Nigeria.
Last year, 12 children died in the Udhampur district of Jammu due to a contaminated cough syrup called Coldbest-PC, manufactured by a company in Himachal Pradesh. These deaths were also linked to the presence of high levels of diethylene glycol in the cough syrup. The State’s administration later ordered the withdrawal of the drug from all the other States where it was marketed. This was the fourth case of mass glycol poisoning in India. In 1973, there was a similar incident at the Children’s Hospital, Egmore in Chennai that caused the deaths of 14 children. In 1986, similar poisoning at Mumbai’s J.J. Hospital caused the deaths of 14 patients who were otherwise on the path to recovery. In 1998, 33 children died in two hospitals located in New Delhi due to similar poisoning.
In 2007, the U.S. Food and Drug Administration (FDA) issued a guidance to pharmacy compounders, repackers, and suppliers about a potential public hazard— glycerin(e) contaminated with diethylene glycol (DEG), calling DEG a “poison”. The FDA’s advisory followed reports of fatal DEG poisoning of consumers who ingested medicinal syrups, such as cough syrup or acetaminophen syrup.
How have Indian authorities reacted?
The WHO has initiated a deeper probe in coordination with the Indian authorities. India’s Central Drugs Standard Control Organisation (CDSCO) has also launched an investigation to ascertain the facts and details of the matter in collaboration with the State Drugs Controller of Haryana, the State where the manufacturer Maiden Pharmaceuticals is located.
According to the preliminary inquiry, Maiden Pharmaceutical Limited was licensed by the State drug controller for the products under reference and held manufacturing permission for these products. The company has so far exported these four cough syrups only to The Gambia. Indian authorities are now waiting for the WHO to share the exact “one-to-one causal relation of death” with the four medicines and the details of the product labels so that they can identify the “source of the manufacturing of the products”.
According to the All India Organisation of Chemists and Distributors (AIOCD), none of the four cough syrups mentioned in the WHO’s alert was available for sale in India. “Maiden Pharmaceutical Limited has no presence in the Indian domestic market and they only export their products,’ the organisation said. The CDSCO said that, as a practice, the importing country tests the products for quality before sanctioning their usage.
Meanwhile, Gambian President Mr. Barrow has vowed to boost health and safety measures including better quality control over imported medicines, ordering the creation of “a quality control national laboratory for drugs and food safety”.
2. The illusion of being faster than light: how a star problem was solved
How using the Global Astrometric Interferometer for Astrophysics (GAIA) spacecraft and Hubble Space Telescope instruments as well as other observatories on earth, scientists were able to observe exciting phenomena for the very first time
Mooley, K.P., Anderson, J. & Lu, W. Optical superluminal motion measurement in the neutron-star merger GW170817. Nature 610, 273–276 (2022). https://doi.org/10.1038/s41586-022-05145-7
In 2017, astrophysicists observed an unusual feat among the stars. The Laser Interferometer Gravitational-Wave (LIGO) observatories recorded a signal which indicated that two massive and dense stellar bodies had merged to form a third body, likely a black hole. In the process they gave off vibrations that quite literally shook the universe and its very fabric of space-time. For the very first time, scientists noted that this observation of the LIGO observatories coincided with the measurements made by other telescopes that measured visual and electromagnetic signals. Was this light given off by the merging bodies? Evidence seemed to suggest that it was. From this, scientists, piecing together evidence from complementary measurements, surmised that the event they had observed was of two neutron stars merging and forming a black hole and, in the process, giving off light. An unusual jet of matter was observed that gave an illusion of travelling faster than light. These were all exciting phenomena observed for the very first time by telescopes and observatories.
Crossing the speed of light
Now, using data that had been recorded by the Global Astrometric Interferometer for Astrophysics (GAIA) spacecraft and Hubble Space Telescope instruments, scientists have confirmed that the above picture is correct. They have made it more precise and descriptive.
In a paper published in Nature, they describe measuring the “apparent speed” of the jet to be about seven times the speed of light.
They have also measured more accurately a factor called the Lorenz factor which scales with the actual speed of the particles in the jet. Unlike earlier estimates which placed this factor at about 4, the present paper estimates this factor to be over 40. This is because they measure the speed of the relativistic jet to be close to 0.9997c, where “c” is the speed of light.
This resolves the earlier fuzziness about what the source was and puts the source clearly as massive neutron stars merging to give a black hole and throwing off relativistic jets of particles in the process.
Merging neutron stars
Neutron stars are stellar corpses, left behind after a star has undergone a supernova explosion and reached the end of its lifetime. They are extremely dense, containing more mass than the sun in a sphere that is a few tens of kilometre wide.
The observation of particles moving at seven times the speed of light is an illusion. “This happens in cases where a source moves (towards us) with a velocity that is very close to light’s velocity. This phenomenon is known to astrophysicists earlier,” says Resmi Lekshmi, a scientist with the Department of Earth and Space Sciences, Indian Institute of Space Science and Technology, Thiruvananthapuram, who has worked in this area.
This has been seen in many active galactic nuclei — galaxy centres that harbour black holes — and binary star systems within our galaxy, where one of the stars is a black hole. “Mostly, black holes are responsible for producing such fast-moving material,” she explains.
The present measurements and observations made with GAIA data are extremely challenging. They amount to measuring the position of an object in sky co-ordinates. “These authors measured a change in sky position one millionth the span of the full moon,” says Dr. Lekshmi. Normally, if one were making these measurements from earth-based telescopes, it would require data from radio telescopes spaced apart by intercontinental distances. This technique is called Very Long Baseline Interferometry (VLBI) and was used in the earlier papers. “Here, the authors could beat VLBI in precision because they calibrated Hubble Space Telescope data with GAIA, which is a precision astrometry mission,” she says.
However, the researchers used both their Hubble Space Telescope and GAIA optical position measurement along with the earlier VLBI position measurement to get a better estimate of the speed of the source and angle (viewing angle) with which it is travelling with respect to us on earth. Dr. Lekshmi clarifies that this estimate requires plugging in equations of the special theory of relativity. “So, it is an estimate as opposed to a measurement,” she says.
Impact of the study
The significance of the paper is that now, we have learnt that neutron star mergers can result in material moving with speeds as high as 0.9997c.
Earlier results using Very Long Baseline Interferometry had pegged this value at about 0.938c. And with the new results this lower limit has been improved. Even earlier, with VLBI, it was understood that it was a neutron-star merger that produced such ultra-relativistic material.
Before the VLBI results, there were several models that could replicate the observations. “The observations could be explained both by ultra-relativistic material and non-relativistic material, with some differences in assumptions,” says Dr. Lekshmi. That study indicated that the observed gamma ray bursts were produced along with the ultra-relativistic material.
This paper, in turn, strengthens the hypothesis that such neutron star mergers are responsible for a class of gamma-ray bursts. Gamma-ray bursts are flashes of extreme gamma ray photons that release a huge amount of energy — nearly ten-raised-to-47 joules. They come from different galaxies in the universe and are observed here quite frequently.
3. Giraffes brought to India by British may belong to endangered species
About 150 years ago, British colonialists brought batches of what they thought were a single species of the northern giraffe to India, from their other colonial possessions in Africa. These now comprise a captive population of 29 northern giraffes across the country.
A recent genealogical study of the largest captive herd in India at the Alipore Zoological Garden in Kolkata has confirmed that the giraffes in this facility, at least, are most likely “critically endangered” Nubian giraffes (Giraffa camelopardalis camelopardalis) or the endangered Rothschild giraffe (Giraffa camelopardalis rothschildi).
Speaking to The Hindu, R. Sanil, Associate Professor, Molecular Biology Laboratory, Government Arts College, Udhagamandalam, where dung samples of the 10 giraffes from Kolkata were analysed, said that the Nubian giraffes are believed to be among three sub-species of the northern giraffe, according to a whole genome sequencing study conducted in 2021. He pointed out that there were giraffes in captivity in Mysuru, Chennai, Patna, Guwahati, and Hyderabad, and it was imperative to identify their species too.
A genetic distance analysis of the giraffes in Alipore showed that they were most closely related to Nubian and Rothschild giraffes. “As both the Nubian and Rothschild giraffes are listed as ‘critically endangered’ and ‘endangered’ by the IUCN [respectively], we think it’s imperative that the Central Zoo Authority conducts further studies of giraffes in captivity so that the species are not interbred with each other and the giraffes’ germplasm is preserved,” Mr. Sanil added.
Sulekha J. Backer, research scholar and one of the lead authors of the paper titled ‘Captive giraffes in Alipore Zoological Garden, Kolkata are Nubian!’, said “stud-books” maintained in zoos across India had little to no information on where the giraffes brought from Africa had been captured; so the only way to identify the species would be through a mitochondrial gene study.
4. Editorial-1: The dire need to talk about 1962
“Failure is a great teacher” is a truism. Subsequent discussion on this quote leads one through the ‘enlightenment’ that accrues to those who engage in an honest, open and no-holds-barred conversation on what went wrong; they learn from the misadventure and come out stronger. “Events that have brought joy or an accomplishment that has enriched an individual or a group are readily remembered, celebrated and commemorated publicly. But a synonym for commemoration is ‘observe’. Hence, we as a nation commemorated the golden jubilee of the 1965 India-Pakistan war, while the celebration of the golden jubilee of the 1971 war, that saw the birth of Bangladesh, was commemorated with pan-India seminars, symposia, discussions, television debates and exhibitions. Yet, with just a day before the 60th observance of a dark moment in the history of our young nation, the 1962 India-China war (it began on October 20), there is no indication of its observance in which India lost so many of its brave men — (as in one report) 1,383 soldiers killed, 1,047 wounded, 1,696 missing and over 400 prisoners of war with the Chinese.
The main issues
Let us pause for a moment in tribute to those brave sons; but, thereafter, let us discuss what went so terribly wrong. Did those Indians die in vain? Were there any bright sparks in those 30 days (October 20 – November 20, 1962) which can give us solace? So, let the discourse be about five issues that I can distill from various accounts about the war.
First, is the international standing of the national leadership in world fora any index to the ‘power’ of a nation? Prime Minister Jawaharlal Nehru, the builder of modern India, was a champion too in the eyes of the newly independent countries in Asia and Africa and was feted by the West. But misguided optimism in the ephemeral ‘moral’ superiority and peaceful intentions of the Chinese leadership resulted in an enfeebled Indian Army that was ill-prepared and ill-equipped to face the realities of hard power.
Second, an underestimation of the strength of the Indian Air Force (IAF) resulted in its offensive fleet not being used; all writings indicate that the use of fighter aircraft would have been a game changer especially since the Chinese air force was severely operationally handicapped due the high altitude of the airfields from which its aircraft would have had to operate.
A lop-sided equation
Third, the lop-sided power equation between the political, bureaucratic and military top brass was responsible for many ills as there was micro-management of events from the top — why was it that the Army top brass was not strong enough to stand up to the political interference in affairs that were purely military?
Fourth, what lessons can be drawn from the stellar performance of the Indian jawan on the front? The stories of Major Shaitan Singh and many others are legendary. But what is not talked about is the unheralded, unsung and back-breaking work put in by the transport and helicopter aircrew of the IAF. They flew troops and equipment round the clock, into primitive advanced landing grounds and helipads and brought back casualties with aircraft such as the Mi-4 helicopters and Otter light transporters overloaded beyond one’s wildest imagination. To give the hard-worked pilots some rest, young fighter aircrew flew as co-pilots; they were handed over controls after take-off while the captains got some sleep till just before landing.
And last, while the frontline war fighter lived up to his credo, why did senior military leadership in the field wilt when asked to deliver what was expected of their rank and position?
Begin the review
This article has been written in hindsight. This advantage needs to be channelised into knowledge and wisdom that should be imparted to young field grade and mid-level officers, both civil and military. But there is an appeal. Can the politicians join in too, for it is their leadership that modulates events that follow years and decades later? So, it can start with the Government opening up documents that are still classified, which includes the Henderson Brooks-Bhagat report. The war colleges of the three services, the Defence Services Staff College (Wellington, Tamil Nadu) and the National Defence College (Delhi), need to delve into what transpired during that fateful period. The media too should debate this. This is the least we can do to honour those brave Indians and to observe the 60th year of an event that is a black spot on our collective conscience. And, even as the nation rejoices in India’s victories that came after that dark period, the young in this great nation must know the truth about the 1962 war. It is a part of our history.
5. Editorial-2: Whose pleasure?
The Constitution has no provision for a Governor to sack Ministers
Kerala Governor Arif Mohammed Khan’s indirect threat that he can independently dismiss Ministers is neither in keeping with the dignity of his office nor in line with the Constitution. His claim that “statements of individual ministers that lower the dignity of the Governor’s office can invite action including withdrawal of pleasure” has no basis in the constitutional system. Article 164 of the Constitution, which says the Chief Minister shall be appointed by the Governor and other Ministers shall be appointed by the Governor on the Chief Minister’s advice, adds that “the Ministers shall hold office during the pleasure of the Governor”. There have been instances of Governors dismissing Chief Ministers, but those were related to constitutional situations in which the legislative majority of the incumbent ministry was in doubt. It is also now judicially determined that the question of majority can be answered only on the floor of the legislature through a confidence vote. Nothing in the Article means that the Governor may independently dismiss a Minister. The pleasure doctrine exists only in a constitutional sense, and is exercised by the Governor only on the advice of the Chief Minister. In other words, the term ‘pleasure of the Governor’ is used as a euphemism to refer to the Chief Minister’s power to drop a Minister from the Council of Ministers.
The context for this particular confrontation appears to be the Governor’s reluctance to grant assent to the Kerala University Laws (Amendment) Bill, 2022. Higher Education Minister R. Bindu’s remark that the Governor should return the Bill for reconsideration instead of withholding his approval indefinitely was a possible trigger for his comment. While Governors may differ with the contents of a Bill and may exercise the available constitutional options, they should not use their powers to stall legislation unpalatable to them. In the realm of university laws, Governors, being Chancellors of most universities, the scope for friction is quite high. It should be remembered that the office of Chancellor is created by the statute that establishes a university, and the legislature is equally competent to curtail the Chancellor’s powers or even abolish the system of having the Governor as Chancellor. Even the M.M. Punchhi Commission, which reviewed Centre-State relations, recommended that Governors should not be burdened with the role of Chancellors. It is time to implement this principle. Governors seem to have an exaggerated notion of their own roles under the Constitution. They are expected to defend the Constitution and may use their powers to caution elected regimes against violating the Constitution, but this does not mean that they can use the absence of a time-frame for decision-making and the discretionary space given to them to function as a parallel power centre.