Clinico-epidemiological presentations and management of Nipah virus infection during the outbreak in Kozhikode district, Kerala state, India 2023.

India experienced its sixth Nipah virus (NiV) outbreak in September 2023 in the Kozhikode district of Kerala state. The NiV is primarily transmitted by spillover events from infected bats followed by human-to-human transmission. The clinical specimens were screened using real-time RT-PCR, and positive specimens were further characterized using next-generation sequencing. We describe here an in-depth clinical presentation and management of NiV-confirmed cases and outbreak containment activities. The current outbreak reported a total of six cases with two deaths, with a case fatality ratio of 33.33%. The cases had a mixed presentation of acute respiratory distress syndrome and encephalitis syndrome. Fever was a persistent presentation in all the cases. The Nipah viral RNA was detected in clinical specimens until the post-onset day of illness (POD) 14, with viral load in the range of 1.7-3.3 × 104 viral RNA copies/mL. The genomic analysis showed that the sequences from the current outbreak clustered into the Indian clade similar to the 2018 and 2019 outbreaks. This study highlights the vigilance of the health system to detect and effectively manage the clustering of cases with clinical presentations similar to NiV, which led to early detection and containment activities.

Unveiling the Truth: Diagnosing Bacterial Meningitis Through Repeat Lumbar Punctures.

Bacterial meningitis is a cause of global concern given its associated high rates of mortality and complications. Timely diagnosis and management are crucial in improving outcomes in patients. Lumbar puncture and radiological investigations form the crux of diagnosis. However, the clinical course becomes complicated if lumbar puncture results are unrevealing and equivocal for bacterial meningitis. We present a case of a 60-year-old female who was diagnosed with bacterial meningitis on repeated lumbar puncture. Clinical vigilance and a high degree of suspicion is needed to ensure that patients with bacterial meningitis are diagnosed and managed appropriately, especially in cases with inconclusive lumbar puncture or radiological investigations.

Reversible Systolic Heart Failure in a Patient on Ibrutinib Chemotherapy.

Ibrutinib is an irreversible Bruton tyrosine kinase inhibitor that is approved for the treatment of mantle cell lymphoma, chronic lymphocytic leukemia, small lymphocytic lymphoma, Waldenström macroglobulinemia, marginal zone lymphoma, and mantle cell lymphoma. However, it is associated with significant cardiotoxic effects, with hypertension and atrial fibrillation being the most common. We present the case of a 42-year-old female with a medical history significant for lymphoplasmacytic lymphoma who presented with non-arrhythmic, non-ischemic cardiomyopathy after four months of chemotherapy with ibrutinib. In addition, her left ventricular ejection fraction improved markedly within a few days of stopping ibrutinib. We propose that the use of ibrutinib may be associated with reversible non-ischemic cardiomyopathy even in the absence of cardiac arrhythmias. Therefore, clinicians should be cognizant of the signs and symptoms of cardiomyopathy in patients on ibrutinib chemotherapy.

Social media, vaccine hesitancy and trust deficit in immunization programs: a qualitative enquiry in Malappuram District of Kerala, India.

BACKGROUND: With increased penetration of the internet and social media, there are concerns regarding its negative role in influencing parents' decisions regarding vaccination for their children. It is perceived that a mix of religious reasons and propaganda by anti-vaccination groups on social media are lowering the vaccination coverage in Malappuram district of Kerala. We undertook a qualitative study to understand the factors responsible for generating and perpetuating vaccine hesitancy, the pathways of trust deficit in immunization programs and the interaction between various social media actors. METHODS: In-depth interviews and focus group discussions were conducted among parents/caregivers, physicians, public sector health staff, alternative system medical practitioners, field healthcare workers and teachers in areas with highest and lowest vaccination coverage in the district, as well as with communication experts. RESULTS: The trust deficit between parents/caregivers and healthcare providers is created by multiple factors, such as providers' lack of technical knowledge, existing patriarchal societal norms and critical views of vaccine by naturopaths and homeopaths. Anti-vaccine groups use social media to influence caregivers' perceptions and beliefs. Religion does not appear to play a major role in creating vaccine resistance in this setting. CONCLUSIONS: A long-term, multipronged strategy should be adopted to address the trust deficit. In the short to medium term, the health sector can focus on appropriate and targeted vaccine-related communication strategies, including the use of infographics, soft skills training for healthcare workers, technical competency improvement through a mobile application-based repository of information and creation of a media cell to monitor vaccine-related conversations in social media and to intervene if needed.

Role of Glucagon-Like Peptide-1 Receptor Agonists in the Management of Non-Alcoholic Steatohepatitis: A Clinical Review Article.

Non-alcoholic fatty liver disease (NAFLD) has emerged as one of the lethal causes of chronic liver disease globally. NAFLD can ultimately progress to non-alcoholic steatohepatitis (NASH) given persistent cellular insult. The crux of the problem lies in fat accumulation in the liver, such as increased fatty acid substrates owing to consumption of a high-fat diet, altered gut physiology, and excess adipose tissue. Being the hepatic manifestation of metabolic syndrome, insulin resistance is also among one of the many stimuli. Therefore, drugs, such as glucagon-like peptide-1 receptor agonist (GLP-1 RA) can play a significant role in reducing inflammation, in addition to weight loss and dietary habits. In this review article, we have reviewed the role of exenatide, liraglutide, and semaglutide in the management of NASH. Two of the agents, exenatide and semaglutide, have a predominant role in reducing alanine aminotransferase (ALT) levels, therefore reducing inflammation and promoting weight loss. However, these agents have a lesser impact on the degree of fibrosis. Liraglutide, on the other hand, has been shown to significantly decrease the degree of fibrosis and has been found helpful in reversing mild degrees of steatosis. Therefore, these agents warrant attention to the new perspective that has been presented so that future guidelines may incorporate and streamline individualized therapy.

Quality of Life of End Stage Renal Disease Patients Undergoing Dialysis in Southern Part of Kerala, India: Financial Stability and Inter-dialysis Weight Gain as Key Determinants.

BACKGROUND: Quality of Life (QoL) reflects the quality and outcome of healthcare along with key indicators of performance such as mortality and morbidity. OBJECTIVE: The aim of the study was to measure the QoL among patients with End Stage Renal Disease (ESRD) on maintenance hemodialysis and to understand various correlates of QoL. METHODS: A total of 95 ESRD patients from three dialysis centres in Southern districts of Kerala were interviewed. QoL was measured using vernacular version of World Health Organization Quality Of Life - Brief Version (WHOQOL-BREF) questionnaire. RESULTS: The mean age of the patients was 56.2 ± 13 years and 73.7% were males. Mean converted scores for overall QoL was 42.37 ± 21.3 and Health-related QoL (HRQoL) was 43.3 ± 18.3, indicating poor QoL. Males had significantly higher physical domain scores (p < 0.03). Occupation, income and Socio-economic Status (SES) influenced overall HRQoL while better income and higher SES predicted better scores in psychological and environmental domains. CONCLUSION: Patients with better control over inter-dialysis weight gain (≤1600 g) had significantly higher scores. This study highlights the importance of using QoL tools in assessing the QoL of patients and the factors contributing to it.

Public health implications of Sabarimala mass gathering in India: A multi-dimensional analysis.

INTRODUCTION: Mass gathering for religious and spiritual purposes are common in India. However, mass gathering health and travel medicine is still in its infancy in India. OBJECTIVES: The study explored bio-medical, environmental and psycho-social dimensions of mass gathering in Sabarimala pilgrimage, which is annually attended by 25 million pilgrims. METHODS: In a cross sectional design, the investigators travelled the pilgrim trail and stayed in the shrine area to conduct the interviews (sample = 1259), to observe the practices as well as to assess the environmental conditions including sanitation. We did in-depth interviews of a subset of samples of the pilgrims, laboratory tests for water quality and secondary analysis of health services data. RESULT: 43.4% pilgrims reported at least one health problem. Leg pain, joint/muscle pain, breathlessness, were the common symptoms. Pilgrims expressed concern about drinking water and food safety and majority of them felt the crowd management as unsatisfactory. Untreated sewage and solid waste were found to pollute the water downstream. Average patient presentation rate for 2014-2017 was 4999.6 per 100,000 pilgrims and referral to Hospital Rate was 19 per 100,000 pilgrims. Mortality rate ranged from 18.5 to 21 per 100,000 pilgrims among those who attended the health centers for ailments. Death due to Coronary Artery Heart Disease (CAHD) has slightly decreased over the period of 3 years from 97.6% to 85.1%. CONCLUSION: Data with respect to safety, health and environment at the pilgrim sites need to be continuously assessed to understand changes and trends and to develop an effective mass gathering and safe pilgrimage policy (MGSPP).

IoT-Based Geotechnical Monitoring of Unstable Slopes for Landslide Early Warning in the Darjeeling Himalayas.

In hilly areas across the world, landslides have been an increasing menace, causing loss of lives and properties. The damages instigated by landslides in the recent past call for attention from authorities for disaster risk reduction measures. Development of an effective landslide early warning system (LEWS) is an important risk reduction approach by which the authorities and public in general can be presaged about future landslide events. The Indian Himalayas are among the most landslide-prone areas in the world, and attempts have been made to determine the rainfall thresholds for possible occurrence of landslides in the region. The established thresholds proved to be effective in predicting most of the landslide events and the major drawback observed is the increased number of false alarms. For an LEWS to be successfully operational, it is obligatory to reduce the number of false alarms using physical monitoring. Therefore, to improve the efficiency of the LEWS and to make the thresholds serviceable, the slopes are monitored using a sensor network. In this study, micro-electro-mechanical systems (MEMS)-based tilt sensors and volumetric water content sensors were used to monitor the active slopes in Chibo, in the Darjeeling Himalayas. The Internet of Things (IoT)-based network uses wireless modules for communication between individual sensors to the data logger and from the data logger to an internet database. The slopes are on the banks of mountain rivulets (jhoras) known as the sinking zones of Kalimpong. The locality is highly affected by surface displacements in the monsoon season due to incessant rains and improper drainage. Real-time field monitoring for the study area is being conducted for the first time to evaluate the applicability of tilt sensors in the region. The sensors are embedded within the soil to measure the tilting angles and moisture content at shallow depths. The slopes were monitored continuously during three monsoon seasons (2017-2019), and the data from the sensors were compared with the field observations and rainfall data for the evaluation. The relationship between change in tilt rate, volumetric water content, and rainfall are explored in the study, and the records prove the significance of considering long-term rainfall conditions rather than immediate rainfall events in developing rainfall thresholds for the region.