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Bats spread the Nipah virus, which causes severe encephalitis and high mortality. Multiple reports have come from Malaysia, Bangladesh, Singapore, and India. Pteropus fruit bats are known to host the virus. The virus has caused four outbreaks in Kerala in the past quinquennium. Scholars believe the virus is indigenous to the state's bat population. Climate change, resource depletion, deforestation, natural terrain changes, farming, and industrialization all contribute to viral disease outbreaks. In this review, we will discuss the epidemiological background of the previous NiV outbreak. We will also examine the transmission method epidemic prevention and control strategies and possible causes of the outbreak. Four Nipah epidemics have occurred in Kerala in the past five years. Expert investigation suggests that the virus may be endemic in the state抯 bat population. Kerala, India, has many bat species. In 2018, research found viral infections in the local fruit bat population. Traditionally, people eat fresh toddy or sap from trees, which can be polluted by bats carrying the Nipah virus. Kerala's healthcare system also closely monitors unexplained fevers for Nipah virus infections. The World Health Organisation and Indian Council of Medical Research found that the entire state is susceptible to Nipah virus infections. The virus is a major cause of encephalitis outbreaks, which have high mortality rates, mostly in Indo-Bangladesh.
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Background: Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory airway disorder often leading to type II respiratory failure (RF). Non-invasive ventilation (NIV) is crucial in COPD management. This study compares T (Timed), ST (Spontaneous-Timed), and iVAPS (Intelligent volume assured pressure support) modes. Method: A prospective, experimental, comparative study spanned two years. One hundred COPD patients with Type 2 RF were randomized into three groups: T mode (n=33), ST mode (n=33), and iVAPS mode (n=34). Outcome assessment included clinical, hematological parameters, and intubation rate. Result: The study revealed varying degrees of success among the three modes of NIV. iVAPS mode demonstrated the highest success rate, with 79.4% of cases achieving positive outcomes. Noteworthy improvements were observed in respiratory rate (RR) and oxygen saturation (SpO2) in the iVAPS group after 12 hours of NIV. Both the ST mode and iVAPS mode showed significant increases in pH levels, with a more pronounced improvement seen in the iVAPS group. Additionally, a substantial reduction in pCO2 levels after BiPAP was noted in the iVAPS group. The intubation rate was lowest in the iVAPS group, though the difference did not reach statistical significance. Conclusions: iVAPS mode demonstrated superior outcomes, including significant improvements in RR, SpO2, pH, and pCO2. While the intubation rate was lowest in the iVAPS group, statistical significance was not achieved. iVAPS emerges as a promising alternative, potentially averting the need for invasive ventilation. Larger, diverse studies are needed to validate these findings.
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Objetivo: Describir la evolución en la Unidad de Cuidados Intensivos Pediátricos (UCIP) de los pacientes con bronquiolitis, tratados inicialmente con cánula nasal de alto flujo de oxígeno (CAFO) en la Unidad Emergencias. Determinar factores predisponentes de ingreso a ventilación no invasiva (VNI) o invasiva con intubación orotraqueal (TET). Métodos: Trabajo descriptivo retrospectivo por revisión de historias clínicas. Se incluyeron todos los pacientes menores de 2 años de edad con diagnóstico de bronquiolitis, sin comorbilidades, que ingresaron a UCIP polivalente luego de haber sido previamente tratados con CAFO en la Unidad de Emergencias entre los meses de Agosto 2017 y Agosto 2019. Resultados: Se evaluaron 145 pacientes. La mediana de edad fue de 4,4 meses (RIC 2-6 meses), con una mediana de tiempo desde el inicio de los síntomas hasta la consulta de 45,4 hs (RIC 24-72). La mediana del score de TAL modificado al ingreso a UCIP 8,4 (RIC 8-9). El 98,6% requirió asistencia respiratoria mecánica (ARM), en el grupo VNI 52,4% (75) y en el grupo TET 47,5% (68). El rescate de germen fue en 60% de los casos virus sincicial respiratorio (VSR). El 5,5% fueron co-infecciones. De los pacientes con rescate positivo para VSR, el 52,9% (46) requirieron VNI y 47,1% (41) TET. Los pacientes estudiados permanecieron en CAFO una mediana de 20 hs previo al ingreso a UCIP (RIC: 6-24). Aquellos que estuvieron en VNI con una mediana de 23,3 hs (RIC 6-24) y los que requirieron TET 17 hs (RIC 6-21). La mortalidad evidenciada en el grupo TET fue de 1,38% correspondiente a 2 pacientes, donde también se encontró un 7,5% de complicaciones. La mediana de días de internación en UCIP fue de 8,6 (5-11) para la totalidad de la población estudiada siendo 5,2 (4-6) para los pacientes en VNI y 12 días (9-14) para los pacientes en TET. Conclusiones: Casi la totalidad de pacientes tratados con CAFO en la Unidad Emergencias que requirieron pasar a UCI necesitaron ARM. Ni el score de TAL ni la cantidad de horas de CAFO previo al ingreso en UCI nos permitieron diferenciar los pacientes del grupo VNI de aquellos del grupo TET (AU)
Objective: To describe outcome of patients who were admitted to the pediatric intensive care unit (PICU) with bronchiolitis initially treated with high-flow oxygen through a nasal cannula (HFNC) at the emergency department and to determine predisposing factors for the need for non-invasive ventilation (NIV) or invasive endotracheal intubation (ETI). Methods: A retrospective descriptive study with a review of the clinical records was conducted. All patients less than 2 years of age with bronchiolitis without comorbidities that were admitted to the general PICU following treatment with HFNC at the emergency department between August 2017 and August 2019 were included in the study. Results: 145 patients were evaluated. Median age was 4.4 months (IQR 2-6 months). Median time from symptom onset to first consultation was 45.4 hours (IQR 24-72). Median modified TAL score on PICU admission was 8.4 (IQR 8-9). Overall 98,6% required mechanical ventilation (MV), 52.4% (75) in the NIV and 47.5% (68) in the ETI group. In 60% of the cases respiratory syncytial virus (RSV) was isolated. Co-infections were found in 5.5%. Of the patients with an RSV-positive isolate, 52.9% (46) required NIV and 47.1% (41) ETI. Patients had remained on HFNC for a median of 20 hours prior to PICU admission (IQR 6-24). Patients were on NIV for a median time of 23.3 hours (IQR 6-24) and on ETI for a median time of 17 hours (IQR 6-21). In the ETI group, mortality rate was 1.38%, corresponding to two patients, while the complication rate was 7.5%. Median length of PICU stay was 8.6 days (5-11) for the entire study population, 5.2 days (4-6) for patients on NIV, and 12 days (9-14) for those on ETI. Conclusions: Almost all patients treated with HFNC at the emergency department who required admission to the PICU needed MV. Neither TAL score nor time on HFNC allowed us to differentiate patients requiring NIV from those who needed ETI (AU)
Subject(s)
Humans , Infant , Respiration, Artificial , Bronchiolitis/therapy , Intensive Care Units, Pediatric , Noninvasive Ventilation/methods , Cannula , Retrospective StudiesABSTRACT
Introduction: The first Nipah Virus (NiV) outbreak occurred in India in the year 2001 at Siliguri. The second outbreak happened at Nadia in 2007. Nipah Virus exhibits neurological and pneumonic tropism with the predominant clinical presentation being encephalitis in humans. Material and Methods: The present study was a record based prospective study on 67 cases admitted with pyrexia of unknown origin in North Bengal Medical College during the period from 18.02.2001 to 30.02.2001 and a parallel study on epidemiological record carried out by PSM department also taken into account. All necessary investigations including autopsy examination, pathological, and microbiological study were done. Results: There was a clustering of cases around Bhaktinagar. There was a strong H/O Medinova Nursing Home Contact among the patients. 18 out of 20 cases were staff of that Nursing Home. Serum samples tested show NiV specific IgM and IgG in 9 out of 17 samples with one sample which was positive for IgG only suggesting past infection. The cases were admitted with predominant neurological symptoms (53.73% cases) but about 80% recovered with no residual neuro deficit. The natural reservoir of NiV is present in Bangladesh and in Northern India. Conclusion: When NiV infection is suspected, infection control practices must be strengthened to avoid an outbreak in a hospital setting. Here the present study is presenting the experience in the first outbreak of the Nipah virus in India at Siliguri for awareness of clinical personnel to control further outbreak at the very beginning.
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Objective To investigate the failure factors of no-invasive ventilation (NIV) as an initial ventilation mode for the treatment of community acquired pneumonia (CAP).Methods Totally 237 cases of CAP patients with NIV as initial ventilation were analyzed retrospectively in the emergency department of Beijing Chaoyang Hospital.According to the failure of NIV,patients were divided into two groups.General clinical data and acute physiological and chronic health score (APACHE Ⅱ),physiological parameters,pulmonary infection and the prognosis of the patients were recorded,and were compared between the two groups.The risk factors of NIV 1 hour and 3 hours later were analyzed by multivariate logistic regression.Results Compared with the NIV failure group,the mortality of the patients in the NIV successful group (17.6 and 35.6,P＜ 0.01) was significantly lower.The risk factors for the NIV1 hour failure of the patients included the APACHE Ⅱ score(OR=l.352,95％CI:l.132-3.015,P=0.035),the hemodynamic support (OR=9.826,95％CI:2.525-86.377,P=0.002) and the severity of the pulmonary infection,and the risk factors for the physiological index of the failure of NIV3 hours included hemodynamic support(OR=6.365,95％CI:2.552-28.316,P=0.004),respiratory frequency and pH value.Conclusions Hemodynamic support is the most important risk factor for the failure of NIV in CAP patients.During the NIV treatment,the patients' respiratory frequency,oH and blood pressure should be closely monitored to ensure the success and safety of the treatment.
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Objective: To observe the clinical effect of clustered non-invasive mechanical ventilation strategy in the treatment for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with hypercapnia encephalopathy(HE) so as to evaluate the safety and effectiveness of the scheme. Methods: According to the inclusion criteria, 164 patients with AECOPD complicated with HE were divided into the observation group(74 cases) and the control group (90 cases) as the random method. The patients of observation group were treated with clustered non-invasive ventilation(NIV), and the patients of control group were treated with invasive mechanical ventilation(IMV). The blood gas indexes of the two groups before and after 2 hours of treatment were observed, and the improved situations of the two groups were evaluated by KPS score. Besides, the hospitalization time and the mechanical ventilation time of the two groups were observed, and the incidence of adverse events and case fatality rate of 1 year in the two groups were counted and analyzed, and the reliability of the clustered NIV scheme was further evaluated. Results: Before treatment, there were no significant differences in pH, oxygenation index(PaO2/FiO2), partial pressure of carbon dioxide in artery (PaCO2) level and KPS score between the two groups(t=1.021, t=1.301, t=0.985, t=1.017, P>0.05). Although these indicators were obviously improved after these patients of two groups were treated, the differences of them between before and after treatment were no significant(t=2.017, t=1.825, t=1.163, t=1.520, P>0.05). On the other hand, the differences of time of mechanical ventilation, the hospitalization time and the times of intubation between the observation group and the control group were significant(t=7.018, t=8.523, t=7.954, P<0.05). In the observation group, there were 12 cases were failure, and 4 patients died in hospital, while the number of died in hospital were 18 cases in control group, and the difference of the number of died in hospital between the two groups was significant(x2=5.631, P<0.05). Besides, the difference of complication between the two groups was significant(x2=7.014, P<0.05). And the difference of case fatality rate of 1 year between the two groups was no significant. Conclusion: It is safe and effective for patients with AECOPD complicated with HE to implement cluster noninvasive mechanical ventilation strategy on the basis of meeting the condition of non-invasive mechanical ventilation. And it has clinical application value.
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Nipah virus (NiV) is a member of the genus Henipavirus of the family Paramyxoviridae, characterized by high pathogenicity and endemic in South Asia. It is classified as a Biosafety Level-4 (BSL-4) agent. The case-fatality varies from 40% to 70% depending on the severity of the disease and on the availability of adequate healthcare facilities. At present no antiviral drugs are available for NiV disease and the treatment is just supportive. Phylogenetic and evolutionary analyses can be used to help in understanding the epidemiology and the temporal origin of this virus. This review provides an overview of evolutionary studies performed on Nipah viruses circulating in different countries. Thirty phylogenetic studies have been published from 2000 to 2015 years, searching on pub-med using the key words ‘Nipah virus AND phylogeny’ and twenty-eight molecular epidemiological studies from 2006 to 2015 have been performed, typing the key words ‘Nipah virus AND molecular epidemiology’. Overall data from the published study demonstrated as phylogenetic and evolutionary analysis represent promising tools to evidence NiV epidemics, to study their origin and evolution and finally to act with effective preventive measure.
ABSTRACT
Nipah virus (NiV) is a member of the genus Henipavirus of the family Paramyxoviridae, characterized by high pathogenicity and endemic in South Asia. It is classified as a Biosafety Level-4 (BSL-4) agent. The case-fatality varies from 40% to 70% depending on the severity of the disease and on the availability of adequate healthcare facilities. At present no antiviral drugs are available for NiV disease and the treatment is just supportive. Phylogenetic and evolutionary analyses can be used to help in understanding the epidemiology and the temporal origin of this virus. This review provides an overview of evolutionary studies performed on Nipah viruses circulating in different countries. Thirty phylogenetic studies have been published from 2000 to 2015 years, searching on pub-med using the key words 'Nipah virus AND phylogeny' and twenty-eight molecular epidemiological studies from 2006 to 2015 have been performed, typing the key words 'Nipah virus AND molecular epidemiology'. Overall data from the published study demonstrated as phylogenetic and evolutionary analysis represent promising tools to evidence NiV epidemics, to study their origin and evolution and finally to act with effective preventive measure.
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Objective To study the effect of BiPAP NIV in treating severe asthma that resists incretion.Method 38 asthma patients that resist incretion were selected with 19 patients given BiPAP NIV and the other 19 patients given oxyen by nasal catheter.We study the changes of blood gas analysis and days of hospitalization.Result After 4 days' treating,two group patients' PO_2 increase obviously and their dyspnea alleviate.In BiPAP NIV group,PO_2 is higher than that of the control group(P