Morning Medtalks with Dr KK Aggarwal

Morning Health Talk:

May 22nd, 2018 :

Nipah Virus (NiV) update in Kozhikode

• NiV has caused recurrent human outbreaks in Bangladesh and West Bengal, India since 2001.
•  Several outbreaks of acute Nipah encephalitis have occurred in various districts in Bangladesh, in the neighbouring district of Siliguri in India, and in the Southern Philippines
•  The natural host is fruit bats of the Pteropus species, four of which have been demonstrated to have serologic evidence of infection with this virus. The virus has also been isolated from foetal tissue and uterine fluids of these bats
•  Nipah virus may be able to spread from human to human.
•  Nipah virus primarily causes an encephalitic syndrome with a high mortality rate. The characteristic MRI abnormalities are multiple, small (less than 5 mm), asymmetric focal lesions in the subcortical and deep white matter without surrounding oedema.
•  The incubation period ranges from 7 to 40 days.
• Treatment options: supportive, ventilation, aspirin and pentoxyfylline, Ribavirin, chloroquine

Abstract

During January and February of 2001, an outbreak of febrile illness with altered sensorium was observed in Siliguri, West Bengal, India.

Siliguri is an important commercial center with a population of ≈500,000. It is near borders with China, Bangladesh, Nepal, and Sikkim.

The outbreak occurred among hospitalized patients, family contacts of the patients, and medical staff of 4 hospitals. Japanese encephalitis, which is endemic in this area, was initially suspected, but the age group affected and the epidemiologic features suggested a different disease.

Nipah virus (NiV), zoonotic paramyxovirus, was implicated as the cause of a highly fatal (case-fatality ratio 38%–75%), febrile human encephalitis in Malaysia and Singapore in 1999 and in Bangladesh during the winters of 2001, 2003, and 2004.

The natural reservoir of NiV is presumed to be fruit bats of the genus Pteropus. Evidence of NiV infection was detected in these bats in Malaysia, Bangladesh, and Cambodia.

In the Malaysian outbreak, NiV was introduced into the pig population, and most of the human cases resulted from exposure to ill pigs.

However, an intermediate animal host was not identified during the Bangladesh outbreaks, which suggests that the virus was transmitted either directly or indirectly from infected bats to humans. Human-to-human transmission of NiV was also documented during the outbreak in Faridpur, Bangladesh.

The clinical manifestations of the cases in Siliguri were like those of NiV cases in Bangladesh and Siliguri is near affected areas in Bangladesh. (Emerg Infect Dis. 2006 Feb; 12(2): 235–240.)

International

Tempabay: As per Taiwan’s health minister they are feeling “very angry” for not being invited to the WHO assembly in Geneva.

Disease knows no border or politics, excluding Taiwan from the WHO could create a “potentially fatal leak in the global health system.”

Chinese official earlier in the day blamed Taiwan’s Democratic Progressive Party for not acknowledging the “One China” principle. China has refused to let Taiwan participate in the WHO assembly since Taiwanese elected a pro-independence president in 2016.

Legal

India has enforced a no-fly list (NFL) for disruptive airline passengers.

Level one covers unruly behaviour like physical gestures. Punishment under this level can be grounding of up to three months.

The second level is for physically abusive behaviour like pushing and sexual harassment, where grounding is up to six months. Under each level, grounding time is doubled for subsequent offences

Level (three) of on-board unruly behaviour that entails grounding from two years to a lifetime. This level covers life-threatening behaviour like damage to aircraft operating systems, serious physical violence and attempted or actual breach of cockpit.

One airline or multiple airlines can execute the decision.

Why can’t the healthcare providers come out with a similar provision. They can come out with no admission list except for giving first aid.

Beware of elderly abuse: A son who ill-treats and assaults his mother cannot claim the right to enter her house, the Bombay high court has observed.

• The Delhi Police is seeking legal opinion in a case in which a new born was allegedly wrongly declared dead by the Max Hospital in Shalimar Bagh, after the Delhi Medical Council gave a clean chit to the hospital and ruled out any medical negligence on its part. DMC said were “procedural lapses and inadequate documentation”, but “no medical negligence can be attributed on the part of doctors”. ( My views: as the case was registered by the police the matter probably will be decided by the court)
• A 48-year-old woman died due to alleged medical negligence by the doctors at Kishtwar hospital, who operated upon the woman a month ago and forgot to remove a medical sponge, used in the operation, from her body. The husband of the deceased, Mohammed Iqbal, along with other protesters, demanded an FIR to be lodged against the doctor. (Views: there can not be an intention to leave the sponge, but can be the element of knowledge that sponge can remain therefore the full procedure must be documented that all efforts were made to prevent this lapse and the consent must include that sepsis is a complication of surgery and that inspite of all efforts rarely sponge can be left during the surgery as a counting error)

Clinical

• Researchers at the John Innes Centre, in Norwich, UK and Brigham and Women’s Hospital in Boston think that by-products of a toxin called microcin B17 may cause inflammation in IBD. Microcin B17 is produced by E Coli.
• A nasal spray containing the calcium-channel blocker etripamil could allow patients to convert acute paroxysmal supraventricular tachycardia phase 2 data from the Intranasal Etripamil for the Conversion of PSVT to Sinus Rhythm (NODE-1) trial suggest.
• There is a high incidence of previously unrecognized, silent atrial fibrillation (AF) in patients at high risk for AF and stroke, according to REVEAL AF study, silent AF as tracked by implanted monitor and lasting 6 minutes or longer occurred in about 30% of high-risk patients over a period of 18 months and 40% of patients at 30 months.
• The US Food and Drug Administration has approved sodium zirconium cyclosilicate, a medication that rapidly restores normal potassium levels, for adults with hyperkalemia.
• Patients with atrial fibrillation (AF) who are receiving anticoagulation after a recent ischemic stroke or transient ischemic attack are at increased risk for symptomatic intracranial haemorrhage when MRI shows cerebral microbleeds as per CROMIS-2 trial published in May 16 in Lancet Neurology
• Large volume paracentesis (LVP) is the first-line therapy in patients with large ascites (grade 3 ascites), which should be completely removed in a single session. LVP should be followed with plasma volume expansion to prevent post-paracentesis circulatory dysfunction (PPCD).
• Non-steroidal anti-inflammatory drugs should not be used in patients with ascites because of the high risk of developing further sodium retention, hyponatremia, and AKI.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI