Snake bites are a neglected public health problem in all tropical countries, and particularly in Malabar region of Kerala, India. Demographic characteristics and clinical parameters vary in this part ...of the world, and studies based on them are scarce. Increased incidence of capillary leak syndrome (CLS) in hemotoxic snake bites and emergence of cases of hump-nosed pit viper (HNPV,
) envenomation are some notable features seen here.
The study was conducted to assess the epidemiological profile and clinical features to identify factors contributing to outcome in patients with venomous snakebites.
An observational cross-sectional study was done among patients with snakebite envenomation, admitted to Government Medical College, Kozhikode, Kerala, from January 2012 to October 2016.
There were 1,500 cases of toxic snake bites, of which 65% of these cases were males. Forty eight percent of them were aged between 21 and 40 years. Hemotoxic snake bites predominated, accounting for 912 cases. Viperine bite was the most commonly observed snakebite, and 70% of this was due to Russell's viper and 25% due to HNPV. Among the neurotoxic bites, common krait bites predominated. Overall mortality was 8.8%. CLS was the major cause of death (80%). The mean dose of antivenom given for neuroparalytic snakebite was 10.25 vials, and 18.5 vials for hemotoxic bites. Albuminuria, neutrophilic leucocytosis, thrombocytopenia, acute kidney injury (AKI), and early onset of symptoms were associated with poor outcome.
This study emphasizes the importance of snakebite as a significant threat to the community in the tropics. CLS in hemotoxic snake bites is the leading cause of mortality and is often refractory to any treatment measures. This study also brings to light the graveness of complications caused by HNPV envenomation. Anti-snake venom with activity against HNPV venom needs to be manufactured. Lack of awareness, delayed presentation to the hospital, and treatment by nonmedical personnel also add to the risk of mortality.
Background: An outbreak of Nipah virus infection was confirmed in Kerala, India in May 2018. Five out of 23 cases including the first laboratory-confirmed case were treated at Baby Memorial Hospital ...(BMH), Kozhikode. The study describes the clinical characteristics and epidemiology of the Nipah virus outbreak at Kozhikode during May 2018. Objective: To study the clinical and epidemiological profile of Nipah virus epidemic that occurred in Kerala in May 2018. Methods: A collaborative team of physicians and epidemiologists from BMH, Medical College Hospital (MCH) Kozhikode and from the Indian Medical Association (IMA) conducted this study. The clinical and exposure history and the data on outbreak response were gathered from hospital medical records and through interviewing patient relatives and health workers using questionnaires. Results: It was identified that out of the 23 patients with Nipah virus infection, 21 (91.3%) expired. Out of the 21 patients, 18 tested positive for Nipah virus by Real Time polymerase chain reaction (RT-PCR). It has been found that only the index case was infected in the community from fruit bats. Rest of the cases were due to transmission of the virus at three public hospitals. Median age was 45 years. 65% of them were males. Median incubation period was 9.5 days. Fever (100%), altered sensorium (84.2%), tachycardia (63.1%), hypertension (36.8%), segmental myoclonus (15.7%), segmental sweating (15.7%) and shortness of breath (73.6%) were common features. Mean duration of illness was 6.4 days. Conclusion: The rapid spread of infection uncovered the miserable state of health care system in implementing infection control measures. The case fatality and the socio-economic burden warrant developing appropriate treatments, vaccines and diagnostics.
We conducted a serosurvey of 155 healthcare workers and 124 household and community members who had close contact with 18 patients who had laboratory-confirmed Nipah virus infections in Kerala, ...India. We detected 3 subclinical infections; 2 persons had IgM and IgG and 1 only IgM against Nipah virus.
Abstract
Background
An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department ...(ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described.
Methods
The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed.
Results
The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing.
Conclusion
The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained.
Twelve cases of Nipah virus disease were treated in the emergency department of a referral hospital in Kozhikode, India, in May 2018. The case fatality ratio was 83.3%. Ten cases each had encephalitis and acute respiratory distress syndrome and 3 had myocarditis. Transmission was mostly nosocomial.
“Snow storm” testis Raveendran, AV; Ismail, Syed Mohammed; Kumar, KG Sajeeth
Bangladesh journal of medical science (Ibn Sina Trust),
01/2021, Letnik:
20, Številka:
1
Journal Article
Odprti dostop
Testicular microlithiasis is an asymptomatic condition associated with calcification within theseminiferous tubule, natural history of which is not clearly known.Association with varioustesticular ...malignancies warrant regular follow up in patients with microlithiasis.
Bangladesh Journal of Medical Science Vol.20(1) 2021 p.194-196
Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, one of the most common infectious diseases in the Asia-Pacific region. It has been reported from northern, eastern, and ...southern India, and its presence has been documented in at least 11 Indian states. However, scrub typhus meningoencephalitis has not been well documented in Kerala. We report two cases of scrub typhus meningoencephalitis from northern Kerala. The diagnosis was made based on the clinical pictures, presence of eschar, and a positive Weil-Felix test with a titer of > 1:320. The first patient succumbed to illness due to respiratory failure and the second patient improved well.
Nipah Virus (NiV) is a highly fatal emerging zoonotic virus and a potential threat to global health security. Here we describe the characteristics of the NiV outbreak that occurred in Kerala, India, ...during May-June 2018.
We used real-time reverse transcription polymerase chain reaction analysis of throat swab, blood, urine, and cerebrospinal fluid specimens to detect NiV. Further, the viral genome was sequenced and subjected to phylogenetic analysis. We conducted an epidemiologic investigation to describe the outbreak and elucidate the dynamics of NiV transmission.
During 2-29 May 2018, 23 cases were identified, including the index case; 18 were laboratory confirmed. The lineage of the NiV responsible for this outbreak was closer to the Bangladesh lineage. The median age of cases was 45 years; the sex of 15 (65%) was male. The median incubation period was 9.5 days (range, 6-14 days). Of the 23 cases, 20 (87%) had respiratory symptoms. The case-fatality rate was 91%; 2 cases survived. Risk factors for infection included close proximity (ie, touching, feeding, or nursing a NiV-infected person), enabling exposure to droplet infection. The public health response included isolation of cases, contact tracing, and enforcement of hospital infection control practices.
This is the first recorded NiV outbreak in South India. Early laboratory confirmation and an immediate public health response contained the outbreak.
Introduction: Intracranial Haemorrhage (ICH) is any bleeding that occurs inside the intracranial vault, which includes the brain parenchyma and the surrounding meningeal spaces. It is a devastating ...illness associated with significant morbidity and mortality. The ICH score was developed in 2001 as a predictive tool for mortality. It is a six point score based on five components i.e, age, ICH volume, Intraventricular Haemorrhage (IVH), site of bleed and Glasgow Coma Scale (GCS). Aim: To study the utility of ICH score for predicting 30 day mortality and morbidity and also to determine if ICH calculated 24 hours after admission is a better indicator of mortality. Materials and Methods: This was a longitudinal observational study conducted among 235 patients, with spontaneous ICH, who were admitted in the Department of General Medicine, Government Medical College, Kozhikode, Kerala, India, from January 2019 to December 2019. Data collected included risk factors, clinical features and Glasgow Coma Scale (GCS), and Computed Tomography (CT) findings. The ICH score was calculated at the time of presentation and after 24 hours. Functional status of the patients were assessed using modified Rankin Scale (mRS) on day 30 of the illness. Chi-square test was used to analyse categorical variables. Odds ratio was calculated. Relation between ICH score and mRS on day 30 was analysed using logistic regression. A p-value <0.05 was taken as statistically significant. Results: The mean age of the study population was 61.52±12.67 years. Overall, 136 (57.9%) patients were males. Prevalence of hypertension, diabetes mellitus, dyslipidemia, and alcohol abuse were 85.5%, 34%, 31.9% and 17%, respectively. There were 60 deaths (25.5%). All components of ICH score i.e, age (OR=5.39), GCS (OR=488.65), ICH volume (OR=5.519), IVH (OR=29.08), and site of ICH (OR=18.32) as well as newer parameters, like, the presence of hydrocephalus (OR=18.32), midline shift (OR=7.49) and anisocoria (OR=12.25) were significant predictors of mortality (p-value <0.05). Hemiplegia (177, 75.3%) was the most common, and seizure (24, 10.2%) was the least common presentation. Mortality rate was higher in those with higher ICH scores (100% for scores 4 and 5, and 79.3% for score 3). Receiver Operating Characteristic (ROC) curve with ICH score of 3 as cut-off predicted outcome with an accuracy of 94.9% (90% sensitivity and 96.6% specificity). Conclusion: Intracranial haemorrhage score is a practical tool in predicting patient outcome in patients with ICH. The ICH score calculated after 24 hours was observed not to be superior to that calculated at the time of admission.
PDF
