Simple measures can help prevent Nipah infection

Health Care, Heart Care Foundation of India, Medicine Comments Off

Avoid getting infected by observing basic hygiene

New Delhi, 28 May 2018: Some simple hygienic practices can help people from contracting the brain-damaging Nipah virus. These include frequent washing of hands and cooking food properly before consuming it. The virus has thus far claimed about 13 lives in Kerala and led to quarantining of at least 40 others. The latest outbreak has affected four districts of Kerala — Kozhikode, and the neighboring districts of Malappuram, Kannur and Wayanad.

The Nipah virus is a zoonotic disease naturally transmitted from vertebrate animals to humans. Human-to-human transmission has also been documented. The condition was first identified among pig farmers in Malaysia, and the disease surfaced in Siliguri, West Bengal in 2001 and again in 2007. It has been affirmed that those outside of Kerala need to be careful only if they are travelling to the affected areas or coming into contact with an infected person.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Clinically, the main presentation of Nipah virus infection is as an encephalitic syndrome characterized by onset of non-specific symptoms – sudden onset of fever, headache, myalgia, nausea and vomiting followed by drowsiness, disorientation and mental confusion. The infected person can become comatose within 24 to 48 hours. The case fatality rate of Nipah encephalitis ranges from 9% to 75%. There is no effective treatment for Nipah virus infection. The mainstay of treatment is supportive care focusing on managing fever and the neurological symptoms. Infection control practices and barrier nursing are important as person-to-person transmission may occur. Severely ill patients need intensive care.”

Ribavirin, a nucleoside analog, can be given empirically as it has a broad spectrum of antiviral activity against both RNA and DNA viruses.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Nipah virus is classified internationally as a biosecurity level (BSL) 4 agent. Biosafety Level 4 is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections and life-threatening disease that is frequently fatal, for which there are no vaccines or treatments, or a related agent with unknown risk of transmission (CDC).”

Some additional tips from HCFI.

Ensure that the food you eat is not contaminated by bats or their feces. Avoid consuming fruits bitten by bats.
Avoid drinking toddy that is brewed in open containers near palm trees.
Prevent contact with anyone who has contracted the disease. Sanitize and wash your hands thoroughly of you happen to visit someone with NiV.
Clothes, utensils and items typically used in the toilet or bathroom, like buckets and mugs, should be cleaned separately and maintained hygienically.
It is important to cover the face while transporting the dead body of anyone who dies after contracting Nipah fever. Refrain from hugging or kissing the dead person and take precautions while bathing the body before cremation or burial.

Triggers and treatment approaches to acute heart failure differ worldwide

Health Care Comments Off

The first analysis of data from the International REPORT-HF show that triggers of acute heart failure and treatment approaches differ in different geographical regions of the world as also the drugs used as treatment.

While, ischemia/acute coronary syndrome (ACS)/infarction constituted 25.6% of cases of HF in the Southeast Asian region, nonadherence to diet and medications (19.2%) were the main cause in North America.

In Southeast Asia, the other factors causing HF (in descending order) were nonadherence to diet and medications (5.4%), uncontrolled hypertension (5.2%), arrhythmia (4.7%) followed by pneumonia/respiratory process/infection (4.5%).
Uncontrolled hypertension (8.2%), arrhythmia (7.6%), ischemia/ACS/infarction (3.5%) and pneumonia/respiratory process/infection (4.1%) were found to be the other triggers for HF in North America.
Treatment approaches also found to vary among the different regions globally.

Inotropes were used more often in Southeast Asia Western Pacific, and Eastern Europe (11.3–13.5%) compared to other regions viz. Western Europe and North America (3.1–4.3%).

The time between contacting medical services and receiving intravenous diuretics was 3.5 hours (average) in North American vs just over one hour in other regions. While, treatment with IV vasodilators within 6 hours of hospital contact was associated with a significantly shorter length of hospitalization across all regions, factors like renal function, systolic BP, signs of congestion on chest X-ray and cause of acute HF also influenced duration of hospital stay.

These results from the REPORT-HF registry were presented at the ongoing Heart Failure 2018 and the World Congress on Acute Heart Failure in Vienna, Austria.

Unlike other registries, the REPORT-HF (REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) is a dedicated HF global registry and collates data collected from patients in different regions of the world. The data compares regional differences in causes of acute heart failure, therapies, time to treatment and treatment outcomes in order to better understand the epidemiology of HF worldwide.

The Registry included 18,805 patients hospitalized with new‐onset (first diagnosis) heart failure (HF) or decompensation of chronic HF from 44 countries across seven regions: 1,622 patients in North America, 2,686 patients in Central and South America, 2,810 patients in Eastern Europe, 3,661 patients in Western Europe, 2,265 in the Eastern Mediterranean and Africa, 2,369 in Southeast Asia and 3,392 in the Western Pacific.

The median age of patients was 67 years, 52% were Caucasian, 31% were Asian, 5% were Black, and 61% were men.

(Source: ESC, May 26, 2018)

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA