More than a hundred deaths in Bihar Muzaffarpur

In the last few weeks over 120 deaths have been reported in children in Muzaffarpur Bihar because of encephalopathy syndrome mostly associated in malnourished children.

Common features

1. Encephalopathy like presentation
2. In most cases virus is not detected
3. Malnourished children
4. Hypoglycemia because of Lichi syndrome a possibility
5. Precipitation by heat disorder a possibility

Answer

Ministry of Health Government of India, Ministry of Ayush Government of India, Ministry of Women and Child Development Government of India along with the Ministry of Rural Development to work together in finding a solution

If the root cause is severe malnutrition that must be addressed on top priority.

The disease should be made notifiable

In unexplained deaths, postmortem should be done

All children must be treated with standard Protocol (treat hypoglycemia, hyperthermia and possible treatable infection like typhus)

Declare it as a State Public Health Emergency so that all focus shifts to the outbreak in reducing further mortality

Airlift patients to AIIMS like institutions to find out the cause and possible future public health interventions

Can one use expired injections?

EpiPens and other autoinjectors filled with epinephrine to treat severe allergic reactions may still be potent enough to work many months past their labeled expiration date, according to a new study in online May 28 in the Journal of Allergy and Clinical Immunology.

The US FDA requires autoinjector expiration dates to ensure that the devices never contain less than 90% of the original dose of epinephrine.

For the study, researchers tested the contents of 46 different autoinjectors to see how much epinephrine remained after the expiration dates on the labels. Half of the devices were tested at least two years after their labeled expiration date. At this point, 80% of the devices still retained 90% or more epinephrine, indicating they were still effective under the FDA rules.

Devices six months past their labeled expiration date in the study still had 100% of the original epinephrine dose. One year after the labeled expiration date, devices still had 95% of the original epinephrine dose. And all of the autoinjectors tested that were up to 30 months beyond their labeled expiration date still had 90% of the dose remaining.

The authors also note that they did not test the expired injectors effectiveness in stopping an anaphylaxis episode.

Right now, the expiration date is 18 months from the time the product is manufactured, a duration that is shorter than the expiration date for most other medications.

Legal implications

Supreme court of India any violation of the manufacturer’s warning and recommendation is not to be done (Balram Prasad vs Kunal Saha & Ors on 24 October 2013).But in life threatening situations in absence of any other available alternative there are exceptions

• 1.Section 52 in The Indian Penal Code: Good faith”.—Nothing is said to be done or believed in “good faith” which is done or believed without due care and attention.

• 2.Section 92: Act done in good faith for benefit of a person without consent “ Nothing is an offence by reason of any harm which it may causes to a person for whose benefit it is done in good faith, even without that person’s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit;

• 3.IPC 88: Act not intended to cause death, done by consent in good faith for person’s benefit.—Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm. Illustration A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z’s death and intending in good faith, Z’s benefit performs that operation on Z, with Z’s consent. A has committed no offence.

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Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 16 June, 2019 to 0830 hrs IST 17 June, 2019)

Heat Wave:

Heat Wave Conditions were observed at some places with severe Heat wave at isolated places over Bihar. Heat Wave Conditions were observed at many places over Vidarbha, Coastal Andhra Pradesh & Yanam and Telangana and in isolated pockets over Gangetic West Bengal, Jharkhand, East Uttar Pradesh, Marathawada, Chhattisgarh and Tamilnadu, Puducherry & Karaikal.

Maximum Temperature

Maximum temperature departures as on 16-06-2019: Maximum temperatures were markedly above normal (5.1°C or more) at most places over Jharkhand; at many places over Bihar, Telangana and Coastal Andhra Pradesh & Yanam; at a few places over Chhattisgarh and at isolated places over East Uttar Pradesh, Gangetic West Bengal, Vidarbha and Tamilnadu, Puducherry & Karaikal; appreciably above normal (3.1°C to 5.0°C) at most places over Marathawada, North Interior Karnataka and Rayalaseema; at many places over Coastal & South Interior Karnataka and Kerala & Mahe; at isolated places over Madhya Maharashtra; above normal (1.6°C to 3.0°C) at most places over Lakshadweep; at many places over Konkan & Goa; at a few places over Madhya Pradesh and Odisha and at isolated places over Sub-Himalayan West Bengal & Sikkim and Nagaland, Manipur, Mizoram & Tripura. Yesterday, the highest maximum temperature of 45.3°C was recorded at Allahabad (East Uttar Pradesh).

Temperatures Recorded at 1430 Hours IST of Yesterday, the 17th June, 2019

• Shanti-Niketan(West Bengal) recorded the maximum temperature of 42.4°C

• Temperatures recorded at 1430 hours IST of Yesterday rose by 3-5°C in many Parts over Punjab and at some parts over Odisha, Chhattisgarh and Uttarakahand; by 1-3°C in many Parts over Gujarat region and in one or two pockets of Jammu & Kashmir, Himachal Pradesh, Rajasthan, Madhya Pradesh, West Uttar Pradesh, Coastal Andhra Pradesh and Tamilnadu & Puducherry.