Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 17th June, 2019

Encephalitis claims lives of 63 children in Bihar's Muzaffarpur

(Inputs from Dr Vipin M. Vashishtha) Recurrent, seasonal outbreaks of acute brain disease in children with high case-fatality rates have been occurring almost every year in some regions of the country. All outbreaks need not have been due to one specific disease / syndrome. Cases may be occurring sporadically also, but whether sporadic and epidemic cases represent one syndrome needs clarification.

Currently, there seems to be two sets of these outbreaks dominating the entire scenario, first caused by viruses like Japanese encephalitis, Chandipura, influenza, enteroviruses, etc or bacteria such as Orientia tsutsugamushi (e.g. Scrub typhus in Gorakhpur).

Another group of these outbreaks are caused by environmental toxins like cassia occidentalis, toxins in litchi fruits like MCPG & MCPA (hypogycins), etc.

While former group is constituted by a true encephalitic illness, the latter is not true encephalitis but a multisystem disease in which brain is involved secondarily, i.e. the encephalopathy illness. However, often this key difference is not appreciated owing to faulty case definition that leads to unnecessary investigations.

We, a group of four health professionals, investigated a fatal, recurring outbreaks of acute brain illness in many district of western UP, Uttarakhand and Haryana during late 90s' and early 2000, and found it was not an encephalitis but a Reye-like encephalopathy that presented in outbreak form every year during winter months. Later, we found it was caused by consumption of beans of a ubiquitous weed, Cassia occidentalis that lead to the genesis of acute hepatomyoencephalopathy (HME) syndrome.

The anthroquinones present in the beans were responsible for this syndrome. This was a landmark study that presented a new paradigm in outbreak investigations in India and some neighbouring countries. It also brought the role of environmental toxins in the forefront. Later, a mysterious outbreak in Bangladesh was found due consumption of 'Ghaghra Shak' by the natives, Litchi consumption behind Muzaffarpur outbreaks, cassia poisoning in Malkangiri, Orissa outbreaks, etc. When we retrospectively analyzed some of the unexplained outbreaks in the past like the one in Bangalore (Benakappa DG, et al. Indian J Pediatr.1991), another near Haryana, Punjab and Chandigarh (Ghosh D, et al.Indian Pediatr.1999), etc, they were all pointing toward HME syndrome secondary to Cassia consumption.

All these illnesses were confused with encephalitis or with Reye-syndrome. In fact, now we can claim that any Reye-like illness presenting in epidemic form must be investigated for the possibility of some environmental toxin as a putative etiologic agent.

A precise case definition is necessary for any outbreak investigation. Strict case definitions were applied in only a few investigations and in all of them the disease was clinically not encephalitis.

Outbreak investigations in India are lacking on this front right from the days of 'Jamshedpur fever' described by late Dr Najeeb Khan in 1954 (Indian J Med Sci. 1954;8:597-599).

Similarly, the enigma of so called 'Nagpur encephalitis’, which was earlier attributed to JE virus and later to heat hyperpyrexia (Sriramachari S, et al. Indian J Med Res. 1976), still persists.

Coming to the Muzaffarpur illness, these recurrent outbreaks are caused by some toxins involved in either the litchi fruit itself like PCPG or MCPA or some hitherto un-diagnosed compound used in the litchi cultivation. The disease is not a true encephalitis but an encephalopathy that needs further elucidation. Rapid correction of hypoglycemia may prevent death in few cases.

Heart Failure Registry underway to create a data bank

Thiruvananthapuram: A National Heart Failure Registry is being prepared to create a data bank on heart diseases across the country. Funded by Indian Council of Medical Research, the idea is to collate data on 10,000 patients in one year. Already 5,000 patients have been listed in the registry.

The Sree Chitra Tirunal Institute for Medical Sciences and Technology here is among the nodal agencies that is preparing the registry. "The registry work began in January and we intend to study the impact of the heart diseases with this registry. In the first 1,000 cases 'enrolled' in the registry, it has been found that ischemic heart disease is the highest among various forms of heart diseases in the country. Its mortality rate is higher compared to that of cancer,'' said Dr S Harikrishnan, national principal investigator and coordinator of National Heart Failure Registry... (ET Healthworld, June 15, 2019)

No politics with doctors please...

Doctors are and will remain next to God. The medical profession is and will remain a noble profession.

In an All-Dharma Gurus spiritual meeting, gurus from all religions participated, and I too spoke on medical profession as also a religion or dharma.

Whether it is doing your duty with devotion and discipline, unconditional love, compassion, nonviolence, unity in diversity, detached attachment and selfless service, all these components of any religion are also the duties of a doctor. ...read more

Using nicotine to help smokers quit

Peter Hajek

Professor of Clinical Psychology and Director of the Health and Lifestyle Research Unit at the Wolfson Institute of Preventive Medicine

In my presentation on "Using nicotine to help smokers quit" at the 6th Global Forum on Nicotine in Warsaw, Poland, I was comparing the reactions to the launch of nicotine replacement treatments (NRT) in 1980s with the reactions that have been meeting the recent advance of alternative nicotine products.

When nicotine chewing gum first appeared, there were concerns about its safety, its potential to entice children to nicotine use, and doubts about giving smokers the drug they are trying to quit. ...read more

Understanding who we are

The classical description of ‘who we are’ comes from Adi Shankaracharya’s Bhaja Govindam, where he says that even the wife refuses to touch the same physical body after death, and if she touches it, a ritual bath has to be taken. This means physical body is not what we are.If we weigh physical body before and after death there will be no difference. The life force, also called consciousness or atman, has no we. ...read more

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 15 June, 2019 to 0830 hrs IST 16 June, 2019)

Heat Wave:

Yesterday, Heat Wave Conditions were observed at many places over Vidarbha; in some parts over Coastal Andhra Pradesh & Yanam and in isolated pockets over West Madhya Pradesh, Chhattisgarh and Telangana.

Maximum Temperature

Maximum temperatures were markedly above normal (5.1°C or more) at most places over Jharkhand, Chhattisgarh and Telangana; many places over East Uttar Pradesh, Bihar, Marathwada, Vidarbha and Coastal Andhra Pradesh & Yanam; at a few places over Punjab and at isolated places over Odisha and Gangetic West Bengal; appreciably above normal (3.1°C to 5.0°C) at most places over Uttarakhand and Rayalaseema; at many places over West Uttar Pradesh, Karnataka and Tamilnadu, Puducherry & Karaikal;at a few places over Himachal Pradesh, Madhya Pradesh and Kerala & Mahe and at isolated places over Haryana, Chandigarh & Delhi; above normal (1.6°C to 3.0°C) at most places over Lakshadweep; at many places over Madhya Maharashtra and at a few places over Sub-Himalayan West Bengal & Sikkim. . Yesterday, the highest maximum temperature of 46.4°C was recorded at Sultanpur (East Uttar Pradesh).

Temperatures Recorded at 1430 Hours IST of Yesterday, the 16th June, 2019

  • Patna(Bihar) recorded the maximum temperature of 44.4°C

  • Temperatures recorded at 1430 hours IST of Yesterday have risen by 3-5°C. in one or two pockets of Madhya Pradesh, Saurashtra & Kutch, Gangetic West Bengal and Assam & Meghalaya, by 1- 3°C in most Parts over Nagaland, Manipur, Mizoram& Tripura; at some parts over Jammu & Kashmir,Konkan & Goa,Kerala and Madhya Maharashtra and in one or two pockets of Himachal pradesh, East Rajasthan, Madhya Pradesh, North Interior Karnataka and Tamilnadu & Puducherry.

Healthcare News Monitor

Medical Insurance: Act in Good Faith

India Legal

In a recent judgment, the Supreme Court said that failure on the part of a person to reveal his past history of disease is valid ground for repudiation of his insurance policy benefits. A bench of Justices DY Chandrachud and Hemant Gupta in Life Insurance Corporation of India vs Manish Gupta said that a contract of insurance involves “utmost good faith”, and the failure of the insured to disclose his past history of cardiovascular disease is valid ground for repudiation. The LIC policy was taken by Manish Gupta in June 2008 under the category of non-medical general (NMG) insurance for a sum of Rs 1.6 lakh. Under the NMG policy, no medical exam is done and the policy is subject to self-disclosure by the person taking the insurance of the presence or absence of a disease. In the insurance form, Gupta denied having any pre-existing heart disease. The next year, he submitted a claim after undergoing a mitral valve replacement (MVR). The claim was denied by the Life Insurance Corporation of India (LIC) on the ground that he was suffering from a pre-existing illness.

As doctors demand security, Telangana surgeon narrates ordeal of ‘harassment’

The Times of India

Warangal-based orthopaedic surgeon Dr P Sudhir Kumar was left stunned when a woman patient, who had come for a checkup, accused him of misbehaviour and created a scene at a hospital here earlier this week. "A female patient came with the complaint of backache and body pains. I heard the patient's complaint, asked her to turn around and was about to examine her back when she pushed my hand away and started shouting. I was surprised by her reaction," said Dr Kumar while narrating his ordeal. Alleging a conspiracy to defame the hospital, he said, "Even before I could react, one male patient who was in the room and two other from outside came and started shouting and abusing me. After some time, her husband along with others came and abused me. I told them I was only about to examine her and did not do anything wrong." It took the doctor to call the police to tackle the staged incident, as he calls it. He later went to the police station and "lodged a complaint against them for defaming and insulting." "I took out the CCTV footage which clearly shows what I had done. As a senior practitioner working for 16 years in Warangal, if I am facing this kind of harassment how would others tackle situations like these? I have been made scapegoat and defamed in this incident as lots of videos and posts went viral on social media," he said.

200 more doctors quit as logjam continues

The Times of India- Sumati Yengkhon

Doctors continued to resign from their posts on Saturday, with 127 more from city government hospitals and 88 from the districts putting in their papers to back junior doctors, who have been protesting against mob assault and subsequent state apathy to stop the practice. With the West Bengal government still grappling to break the deadlock, the number of resignations may rise further on Monday. In RG Kar Medical College, the epicentre of mass resignation, the list grew longer with 18 doctors deciding to quit on Saturday. On Friday, 107 doctors from the hospital had signed a mass resignation letter. Of the 250 faculty members at Calcutta National Medical College and Hospital, 125 have signed the mass resignation. On Saturday, doctors from other departments tendered their resignation.

AMC doctors' stir against Kolkata hospital violence

The Times of India-Rajib Dutta

Expressing solidarity with their counterparts in West Bengal, doctors at Assam Medical College (AMC) in Dibrugarh have been providing services wearing red-stained bandages and black badges since Friday. Without resorting to complete cessation of services, the doctors' fraternity at AMC, which is the first medical college in the northeast, have been protesting against the assault on fellow doctors in Kolkata on Tuesday. The protests at AMC are being held under the banner of the Junior Doctors' Association, Assam Medical College Students' Association, the Dibrugarh branch of Indian Medical Association and Assam Medical College Teachers' Association.

West Bengal CM must reach out to doctors, and an upgrade of public health care is vital

The Hindu

An attack on doctors at a medical college hospital in Kolkata over the death of a patient has become the focal point of an agitation by medical professionals that is causing distress to tens of thousands. There can be no argument against the doctors’ primary demands — a safe working environment and measures to ensure that unsuccessful treatments do not become a trigger for reprisals. The Indian Medical Association, which seeks to look after doctors’ interests and the well-being of the community, has endorsed the demands and called for a strike on June 17. Whatever the provocation, the violence that severely injured a doctor is indefensible, and the guilty must be brought to book. Yet, the remedy cannot lie solely in new legal provisions for offences that are already covered by special laws in some States, and in the Indian Penal Code. On the other hand, there are clear factors that are deepening the social divide. Chief among these are neglect of the public health sector, unaffordable treatments under a predominantly commercialised care delivery system, State governments’ reluctance to fill vacancies in public hospitals, and the increasingly high cost of medical education in the private sector. Some of these concerns were underscored in a review of violence against doctors by the National Medical Journal of India two years ago.

Andhra Pradesh doctors to suspend services for 24 hours from June 17-18

The New Indian Express

Doctors and staffers of All India Institute of Medical Sciences (AIIMS) Mangalagiri and private hospitals in Vijayawada extended solidarity towards the agitating doctors of Kolkata by wearing black badges on their arms while performing duty on Saturday. Responding to the call given by Indian Medical Association (IMA), all non-emergency services in both private and government hospitals across the State will be suspended for 24 hours from 6 am on Monday to 6 am on Tuesday. “We strongly condemn the attacks on doctors in Kolkata. It is high time we show our strength and condemn such attacks. Outpatient and non-emergency services in all hospitals across the State will be suspended for 24 hours. We want implementation of Prevention of Violence Against Doctors Act, enacted in 2008,” IMA, Vijayawada president Dr TV Ramana Murthy said.