Effect of El Niño Southern Oscillations on the incidence of enteric fever in Ahmedabad, India from 1985 to 2017

To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Niño Southern Oscillations and Indian Ocean Dipole over enteric fever incidence. Method: A total of 29 808 Widal positive enteric fever cases reported by the Ahmedabad Municipal Corporation and local climate data in 1985-2017 from Ahmedabad Meteorology Department were analysed. El Niño, La Niña, neutral and Indian Ocean Dipole years as reported by the National Oceanic and Atmospheric Administration for the same period were compared for the incidence of enteric fever. Results: Population-normalized average monthly enteric fever case rates were the highest for El Niño years (25.5), lower for La Niña years (20.5) and lowest for neutral years (17.6). A repeated measures ANOVA analysis showed no significant difference in case rates during the three yearly El Niño Southern Oscillations categories. However, visual profile plot of estimated marginal monthly means showed two distinct characteristics: an early rise and peaking of cases in the El Niño and La Niña years, and a much more restrained rise without conspicuous peaks in neutral years. Further analysis based on monthly El Niño Southern Oscillations categories was conducted to detect differences in median monthly case rates. Median case rates in strong and moderate El Niño months and strong La Niña months were significantly dissimilar from that during neutral months (P<0.001). Conclusions: El Niño Southern Oscillations events influence the incidence of enteric fever cases in Ahmedabad, and further investigation from more cities and towns is required.

brief review of septic cardiomyopathy and possible preventive strategies

Sepsis induced cardiomyopathy leads to significant morbidity and mortality if not identified early and treated judiciously. A lot is written and discussed about it but till date, the syndrome remains a dilemma. Clinicians have used various modalities like beta- blockers to reduce heart rate, polymyxin B hemofiltration to neutralize the endotoxinemia thereby interfering with the progression of myocardial dysfunction, statins for its anti - inflammatory, antithrombotic and antioxidative properties thereby causing myocardial protection in the same way as it does in coronary artery disease. Ivabradine is a novel drug which is the first If current inhibitor that causes selective heart rate reduction without any antihypertensive effect like beta blockers and doesn't affect hemodynamics. Its still in the trial stage. At present the only effective measure seems to be intensive fluid therapy, aggressive source control and use of broad spectrum antibiotics and maintenance of optimum hemodynamics with vasoactive agents