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Morning Medtalks with Dr KK Aggarwal 25th May 2018

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Dr KK Aggarwal    25 May 2018

CMAAO

The World Medical Association has echoed the call from the World Health Organisation for a vigorous response to the latest Ebola outbreak in the Congo, which has so far caused more than 20 deaths. Dr. Ardis Hoven, Chair of the WMA, speaking at a meeting in Geneva on the 100th anniversary of the Spanish flu pandemic, questioned whether the world was prepared for another pandemic like Spanish flu. ‘One hundred years ago the deadly Spanish flu pandemic killed between 50 and 100 million people in a matter of months. It affected 500 million people around the world. Today, how certain are we that we can protect ourselves from another global virus outbreak? In today’s globally connected world, have we seriously prepared for the greater risks we would face from a new deadly virus sweeping the world?’

Dr. Hoven said that the deaths from the 2016 Ebola crisis in west Africa were directly caused by Ebola, but also indirectly caused by the collapsed health care system through the pandemic. A weak health care system allowed the virus to spread in the first place. What was needed to combat the latest epidemic, as well as the threat from future epidemics, was an urgent strengthening of health care systems and increased investment around the world.

Nipah

The deaths are mostly concentrated in north Kerala, particularly the districts of Calicut and Mallapuram. Kerala government has claimed that the situation is under control, adding that it was working on quarantining and treating the affected people.

  1. The two patients in Mangaluru are doing very well. The woman had returned from Kozhikode, Kerala, and the other patient had not gone there in the recent past.
  2. Kannur district administration on Wednesday directed hospitals to take necessary arrangements in view of the Nipah virus deaths in Kozhikode.
  3. Nipah virus is a member of the Paramyxoviridae and was initially isolated and identified in 1999 during an outbreak of encephalitis and respiratory illness among pig farmers and people with close contact with pigs in Malaysia and Singapore. Flying foxes of the genus Pteropus were subsequently identified as the reservoir. Since this outbreak, no subsequent cases (in neither swine nor human) have been reported in either Malaysia or Singapore, although outbreaks still occur in neighboring Bangladesh
  4. In a cabinet meeting the Kerala government also remembered Lini – a nurse at EMS Memorial Cooperative hospital at Perambra in Kozhikode - who developed fever after attending to a Nipah patient.  The government decided to give a government job to Linis husband Sajeesh, who works in Bahrain. Linis two children will be given Rs 10 lakh each as compensation.

Transmission to humans

  1. In the Malaysian outbreak, human infection occurred through direct contact with respiratory secretions and urine from infected pigs. Case control studies showed that Nipah infected persons were more likely than controls to have had direct contact with pigs. Other affected patients were those who had occupational contact, including abattoir workers and pork sellers
  2. A nurse in the Malaysian outbreak who had cared for Nipah virus-infected patients was found to be seropositive and have MRI findings typical of Nipah encephalitis, despite the fact that she had no exposure to infected animals
  3. In Bangladesh, there was an initial report of Nipah virus infection in 2001, and since then recurrent outbreaks have occurred almost annually. Unlike the Malaysian outbreaks, no clusters of ill animals have been reported and a case-control study found that there was no increased risk of Nipah virus infection among individuals who had contact with a potential intermediate host (such as a pig). Nipah infection resulted from bat-to-human (eg, direct contact with bats or their secretions, consumption of raw date palm sap contaminated by bat saliva and human-to-human transmission.
  4. Human-to-human transmission was important in the 2004 outbreak, in which 33 of 36 reported cases had a history of close contact with another infected patient prior to the onset of illness. Among patients with Nipah virus infection secondary to exposure from an infected patient, the median incubation period was nine days (range, 6 to 11 days)
  5. In the Philippine outbreak, there was evidence of horse-to-human and human-to-human transmission. Ten of 17 patients (59 percent) had either been involved in slaughtering horses or consuming infected horse meat, while most of the others, including two healthcare workers, helped care for patients

Financial Health

  1. Section 40 A (3) read with Section 43 of Income Tax Act, 1961: any expenditure in respect of which payment in aggregate is made to a person in a single day exceeding Rs. 10,000, otherwise than by an account payee cheque drawn on a bank or account payee bank draft or use of electronic clearing system through a bank account, shall not be allowed as a deduction in the computation of income.

Policy

  1. DCGI has proposed to introduce a unique code on drug packs to ensure the authenticity of the medicine. DTAB has granted its approval to the same. Manufacturers of 300 brands are required to print a 14 digit alphanumeric code on the medicine packs along with a contact number. Consumers can message this code to the designated contact number and they get a prompt response giving details about drug manufacturers’ name, batch number, manufacturing date, the expiry date of the medicine.

Public Health

World Health Assembly delegates today agreed an ambitious new strategic plan for the next five years. It sets three targets: to ensure that by 2023, 1 billion more people benefit from universal health coverage; 1 billion more people are better protected from health emergencies; and 1 billion more people enjoy better health and wellbeing. WHO estimates that achieving this “triple billion” target could save 29 million lives.

Roma Bhattacharya 95 years old and still going strong: https://www.facebook.com/drkkaggarwal/videos/1839466909407937/

Pollution

  1. New data from WHO shows that 9 out of 10 people breathe air containing high levels of pollutants.
  2. WHO estimates that around 7 million people die every year from exposure to polluted air.
  3. Ambient air pollution alone caused some 4.2 million deaths in 2016, while household air pollution from cooking with polluting fuels and technologies caused an estimated 3.8 million deaths in the same period.

IMANDB Experts View

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Weather

Temperatures Recorded at 1430 Hours IST the 24th May, 2018 o Temperatures more than 40.0°C is observed at most parts of Punjab, Haryana, Delhi, Rajasthan, Madhya Pradesh, Vidarbha and Telengana; at many parts of Gujarat region; and at one or two pockets of Uttar Pradesh, Bihar, Jharkhand, Gangetic West Bengal, Saurashtra & Kutch, North Interior Karnataka, Marathwada and Chhattisgarh

Temperature recoded at 1430 hours of today have risen by 3-5°C at many parts of Telengana; at some parts of Gangetic West Bengal, Jharkhand and Odisha and at one or two pockets of Vidarbha; by 1-3°C at some parts of East Madhya Pradesh, Bihar and Andhra Pradesh and at one or two pockets of Jammu & Kashmir, Himachal Pradesh, Haryana, West Rajasthan, Gujarat region, West Madhya Pradesh, Chhattisgarh, Konkan & Goa, South Interior Karnataka, Kerala and Tamilnadu & Puducherry (Annexure 4). Heat Wave Warnings for Next 5 Days (on next page) (For significance of colour code and criteria for Heat Wave.

Heat wave conditions are very likely to persist over parts of Northwest India and Central India during 24th-28th May.

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