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.
Rhinosporidiosis James, J; Thulaseedharan, N K
QJM : An International Journal of Medicine,
2017-Jun-01, 2017-06-01, 20170601, Letnik:
110, Številka:
6
Journal Article
Faucial diphtheria James, J; Mathews, S; Thulaseedharan, N K
QJM : An International Journal of Medicine,
01/2018, Letnik:
111, Številka:
1
Journal Article
Background
Albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65), Glasgow-Blatchford bleeding score (GBS) and modified GBS (mGBS) are three ...pre-endoscopy scoring systems used in the risk stratification of upper gastrointestinal bleeding (UGIB). The utility of such scoring systems in a population is estimated by their accuracy and calibration in the population. We aimed at validating and comparing the accuracy of the three scoring systems in predicting clinical outcomes including in-hospital mortality, need for blood transfusion, endoscopic treatment and rebleeding risk.
Method
We conducted a single-center, retrospective cohort study on patients with UGIB at a tertiary care center in India over 12 months. Clinical and laboratory data was collected from all patients admitted with UGIB. All patients were risk stratified using AIMS65, GBS and mGBS. The clinical outcome examined were: in-hospital mortality, requirement of blood transfusion, need for endoscopic treatment and rebleeding during hospital stay. The area under receiver-operating curve (AUROC) was calculated to assess the performance and calibration curves (Hosmer–Lemeshow goodness of fit curve) were plotted to examine how accurately the model describes the data of all three scoring systems.
Results
Total 260 patients were included in the study, of which 236 (90.8%) were males. As many as 144 (55.4%) patients required blood transfusion and 64 (30.8%) required endoscopic treatment. While the incidence of rebleeding was 7.7%, in hospital mortality was 15.4%. Of 208 who underwent endoscopy, the most common causes identified were varices (49%) and gastritis (18.2%), followed by ulcer (11%), Mallory-Weiss tear (8.1%), portal hypertensive gastropathy (6.7%), malignancy (4.8%) and esophageal candidiasis (1.9%). The median AIMS65 score was 1, GBS 7 and mGBS 6. The area under curve (AUROC) for AIMS65, GBS and mGBS was (0.77, 0.73,0.70), (0.75, 0.82,0.83), (0.56, 0.58,0.83), (0.81, 0.94,0.53) for in-hospital mortality, blood transfusion requirement, endoscopic treatment and rebleeding prediction, respectively.
Conclusion
GBS and mGBS are superior to AIMS65 in predicting the requirement of blood transfusion and rebleeding risk, whereas in-hospital mortality was better predicted by AIMS 65. Both scores performed poorly in predicting the need of endoscopic treatment. An AIMS65 of 0,1 and a GBS of ≤ 1 are not associated with significant adverse events. A poor calibration of the scores in our population points to the lack of generalizability of these scoring systems.
Trichuris trichiura Niyas, V K M; Balasubramanian, P; Thulaseedharan, N K
QJM : An International Journal of Medicine,
2019-Jul-01, 2019-07-01, 20190701, Letnik:
112, Številka:
7
Journal Article
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.
PDF
